Category: Nevin Manimala

J Gambl Stud. 2025 Dec 10. doi: 10.1007/s10899-025-10464-1. Online ahead of print.

ABSTRACT

Gambling has become a significant social issue in Kenya, particularly among men in peri-urban areas, driven by economic hardships and the proliferation of digital betting platforms. This study aims to explore the reasons for gambling among men in Matasia Location, Ngong Sub-County, Kajiado County, a semi-arid region with notable socio-economic challenges. A descriptive mixed-methods approach was used, surveying 150 men aged 18-65 identified at gambling hotspots (betting shops, bars, and eateries), with 145 completing questionnaires (96.7% response rate). Data were collected in July 2025 and analysed using SPSS 25 for descriptive statistics and chi-square tests, complemented by thematic analysis of interviews. Key motivations, frequency, types, and spending habits of gambling were assessed to identify driving factors. The primary reason for gambling was the desire for wealth, as participants indicated 48.3% were motivated by this factor, followed by financial pressures, with survey data revealing 25.5% cited this reason. Daily gambling was reported, with individuals reporting 54.5% engaged in it regularly, and 57.2% spent KES 1,000-5,000 monthly. Sports betting and casino games were the most common types, with interviewees noted 58.6% preferred sports betting and 51.7% chose casino games. The Key Informant Interview (Member of County Assembly) for Matasia Location, highlighted idleness and unemployment as key drivers. Economic desperation and digital accessibility fuel gambling in Matasia, and interventions such as vocational training, financial literacy programs, and policy restrictions on online platforms are recommended, aligning with Kenya’s National Substance Abuse Prevention Strategy (2021) and Sustainable Development Goal 3.

PMID:41370025 | DOI:10.1007/s10899-025-10464-1

Ann Indian Acad Neurol. 2025 Dec 10. doi: 10.4103/aian.aian_508_25. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: This study aimed to assess the frequency, characteristics, and clinical associations of mirror movements in individuals with Parkinson’s disease, considering factors such as age, side of symptom onset, disease severity, and motor asymmetry.

METHODS: This cross-sectional observational study included 87 individuals with Parkinson’s disease, diagnosed according to Movement Disorder Society criteria. Exclusion criteria included atypical Parkinsonism, dementia, and refusal to consent. Mirror movements were assessed using video-recorded standardized tasks and scored with the Woods Teuber scale. Clinical parameters, including the Unified Parkinson’s Disease Rating Scale (UPDRS-III), Hoehn and Yahr scale (H and Y staging), and lateralized motor severity, were analyzed. Statistical correlations were performed using SPSS version 26.

RESULTS: Mirror movements were observed in 65.5% of participants, predominantly affecting the upper limbs (98% in fingers). The frequency of mirror movements increased with age (84.6% in those aged 70-90 years, P = 0.04) and was significantly higher in individuals with left-sided symptom onset (74.1% vs. 51.5%, P = 0.03). The severity of mirroring correlated with the side of disease onset and greater lateral differences in UPDRS motor scores (>30, P = 0.015). A rare subtype of discordant mirror movements (non-homologous movements) was identified in 8.2% of individuals.

CONCLUSIONS: Mirror movements are a frequent and underrecognized feature in individuals with Parkinson’s disease. Their clinical associations indicate a greater frequency in older individuals, those with left-sided onset, and those with more asymmetric motor involvement. These findings highlight the potential utility of mirror movements as a clinical biomarker for disease lateralization and progression. Further research, including functional imaging studies, is warranted to elucidate the underlying mechanisms.

PMID:41370014 | DOI:10.4103/aian.aian_508_25

Inflamm Bowel Dis. 2025 Dec 10:izaf290. doi: 10.1093/ibd/izaf290. Online ahead of print.

ABSTRACT

INTRODUCTION: Post-traumatic stress disorder (PTSD) is diagnosed when a person experiences chronic psychological distress following a traumatic event that involves a real or perceived threat to life or bodily harm. Up to one-third of inflammatory bowel disease (IBD) patients report some PTSD symptoms due to their disease (IBD-PTS); however, most data are collected in Caucasian populations. IBD-PTS is associated with poorer outcomes. To our knowledge, this is the first study to evaluate IBD-PTS in Black and Latino/a patients.

METHODS: Adult IBD patients of Black and/or Latino/a race were recruited at 2 IBD clinics. Those meeting eligibility requirements completed these assessment tools online: PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5), Adverse Childhood Experience (ACE) Questionnaire, Inflammatory Bowel Disease Questionnaire (IBDQ), and Demographic and Clinical Information. White, non-Hispanic IBD patients from a previously published dataset from IBD Partners were used for age- and sex-matched controls (2:1).

RESULTS: In total, the study included 180 matched controls and 90 participants, including 57.8% of Black and Latino/a patients who had experienced extreme fear or threats to life/bodily harm related to IBD; 33.3% who scored ≥31 on the PCL-5 (minimum criteria for IBD-PTS) vs 12.8% of matched controls. Black and Latino/a patients also reported more severe IBD-PTS symptoms. Those with higher PCL-5 scores had more adverse childhood experiences and were more likely to have been hospitalized, had surgery, or used the emergency room for IBD. More severe IBD-PTS was associated with poorer HRQoL.

CONCLUSIONS: Black and Latino/a IBD patients may have rates of IBD-PTS 2.5 times higher than White peers, with more severe PTSD symptoms. Prior nonmedical adverse life events may be risk factors for the development of IBD-PTS. Additional research is warranted.

PMID:41370008 | DOI:10.1093/ibd/izaf290

Ann Indian Acad Neurol. 2025 Dec 10. doi: 10.4103/aian.aian_176_25. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: This study aims to determine the effect of nonpharmacological treatments, such as vibration, electric stimulation, acupressure, massage therapy, cryotherapy, and exercise, on the restless legs syndrome (RLS) severity score.

METHODS: Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed for selecting studies to be included in the meta-analysis. The International Prospective Register of Systematic Reviews (PROSPERO) registered this study. Many databases, including Google Scholar, Embase, PubMed, and Scopus, were utilized to locate randomized controlled trials (RCTs). The analysis employed Cochrane’s risk of bias tool 2.0 to evaluate the quality of the incorporated RCTs. Standardized mean difference (SMD) figures were employed for all outcomes to assess the impact of every nonpharmacological intervention. The aggregate effect of each was expressed using forest plots. A random-effects model was used for pooling. The heterogeneity of the included studies was evaluated using I2 values. All relevant statistical calculations were carried out using R Studi version 4.3.0.

RESULTS: A total of 17 studies were selected for meta-analysis. There was a significant reduction in RLS severity after vibration/stimulation (SMD -1.09, 95% CI -2.45 to -0.27, P = 0.014), and a non-significant trend for acupressure (SMD -0.87, 95% CI -2.21 to 0.47, P = 0.203), massage therapy (SMD -3.49, 95% CI -10.81 to 3.83, P = 0.350), cryotherapy (SMD -1.27, 95% CI -3.72 to 1.18, P = 0.309), and exercise (SMD -2.05, 95% CI -23.95 to 19.84, P = 0.856). There was an improvement in sleep quality measured using the pooled Pittsburgh Sleep Quality Index after the nonpharmacological intervention (SMD: -0.51, 95% CI: -0.73 to -0.28). However, this improvement was not found to be significant (P = 0.73).

CONCLUSIONS: The study demonstrated significant reductions in RLS severity with nonpharmacological interventions, offering viable alternatives to medication. However, the improvement in sleep quality was not statistically significant. Further research is needed to optimize these treatments.

PMID:41370003 | DOI:10.4103/aian.aian_176_25

Pharm Stat. 2026 Jan-Feb;25(1):e70048. doi: 10.1002/pst.70048.

ABSTRACT

In cell therapy product development, cell expansion is highly correlated with response and safety. Significant heterogeneity in patient and product characteristics contributes to variability in cell expansion, persistence and response. Integrating exposure assessments enables us to use comprehensive information to make informed dose selection decisions, aligning with the expectations outlined in FDA’s Project OPTIMUS. We propose a seamless phase I/II design that integrates data from toxicity, efficacy, cellular kinetics (CK), and baseline patient/product characteristics for optimal dose selection. Utilizing random forest (RF) with all available data, we guide dose escalation and subsequently narrow down the dose options. Additional patients are then randomly assigned to promising doses for further investigation. Throughout this process, interim analyses based on RF estimations are conducted to discontinue doses that are deemed futile or toxic. The optimal dose (OD) is ultimately chosen based on its safety profile and highest efficacy rate. The proposed RF-based seamless phase I/II design, incorporating exposure data, is entirely data-driven for dose determination. Simulation studies show that the proposed design has desirable operating characteristics, including high accuracy in selecting the optimal dose and effectively allocating patients to potentially therapeutic doses while minimizing exposure to toxic doses. On average, the RF-based algorithm selects 0-3 doses for further exploration.

PMID:41369984 | DOI:10.1002/pst.70048

Pain Ther. 2025 Dec 10. doi: 10.1007/s40122-025-00802-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Axial pain is a common complication following expansive unilateral open-door laminoplasty (ELAP); however, traditional statistical methods are unable to effectively predict this complication. This study developed machine learning (ML) models to predict post-ELAP axial pain and identify key predictors.

METHODS: This retrospective study enrolled 851 cervical spondylotic myelopathy (CSM) patients undergoing ELAP, split into training (n = 714) and temporal validation sets (n = 137). Demographic, imaging, clinical, and surgical data were collected. Predictive features were selected by the least absolute shrinkage and selection operator (Lasso) regression, followed by ML model development with grid search optimizing hyperparameters. The top-performing model underwent temporal validation, and SHapley Additive exPlanations (SHAP) analyzed predictor contributions.

RESULTS: The training set included 218 axial pain cases; the test set had 47. Key predictors (C7 laminoplasty, cervical kyphosis, etc.) were identified to develop ML model. Post-optimization, extreme gradient boosting (XGBoost) achieved superior performance (internal validation area under the receiver [AUC] = 0.948; 95% confidence interval [CI] 0.918-0.978), maintained in temporal validation (AUC = 0.906; 95% CI 0.858-0.954). Through SHAP analysis, the predictors were ranked in descending order of importance as follows: C7 laminoplasty, quantity-based surgical segment classification, cervical kyphosis, angle of lamina open-door, cervical lordosis, and occupying rate of cervical spinal canal.

CONCLUSIONS: ML models coupled with SHAP analysis effectively predict post-ELAP axial pain, identifying the key predictors. Performing segment-selective ELAP, avoiding unnecessary C7 laminoplasty, and maintaining optimal open-door angle are critical factors in avoiding the occurrence of axial pain following ELAP.

PMID:41369971 | DOI:10.1007/s40122-025-00802-x

EJNMMI Res. 2025 Dec 10. doi: 10.1186/s13550-025-01351-2. Online ahead of print.

ABSTRACT

BACKGROUND: Isotopic renography is pivotal for assessing upper urinary tract obstruction and provides renal functional parameters. New 3D-CZT cameras offer enhanced sensitivity and innovative full SPECT protocols that need to be validated on phantoms. Current renal phantoms are often complex and suitable for 2D imaging. Using a new printed 3D renal phantom, we compared planar and full SPECT dynamic imaging.

METHODS: A 3D-printed renal phantom mimicking pediatric/adult kidneys was designed. Each kidney subunit, connected to a bladder-bag, was programmably infused with 7.5 MBq of [^99mTc]-Pertechnetate to simulate normal nephrograms. An asymmetry of renal activity was simulated using different activity ratios. Each acquisition was conducted on both conventional NaI(Tl) and 3D-CZT cameras.

RESULTS: The 3D printed phantom enabled the acquisition of consistent and reproducible nephrograms. T_max, T_1/2, and A_{20 – min/max} ratios showed no statistically significant differences between planar and SPECT. Simulated asymmetric renal function demonstrated a strong linear correlation between activity and AUC with r = 0.9455 and 0.9471 (p < 0.0001), respectively for conventional and 3D cameras.

CONCLUSION: This innovative 3D phantom allowed the acquisition of reproducible nephrograms with parameters comparable to those of clinical examinations. At low activity, 3D-CZT camera acquisitions provided equivalent values to conventional cameras, supporting their use for qualitative imaging and follow-up.

PMID:41369969 | DOI:10.1186/s13550-025-01351-2

AIDS Behav. 2025 Dec 10. doi: 10.1007/s10461-025-04975-6. Online ahead of print.

ABSTRACT

Severe adverse drug reactions (ADRs) associated with antiretroviral therapy (ART) present a major public health challenge, particularly in resource-limited settings like Ethiopia where pharmacovigilance systems are often constrained. Despite the widespread rollout of ART, contemporary evidence on the incidence and predictors of these severe events in the Ethiopian context remains limited. This study aimed to determine the time to development of severe ADRs and identify their significant predictors among adults receiving ART in Northwest Ethiopia. A retrospective follow-up study was conducted, enrolling 634 HIV-positive adults who initiated ART between April 1, 2018, and March 31, 2023. Participants were selected using a stratified random sampling technique. Data were extracted meticulously from patient medical records and analyzed using STATA version 17. Survival analysis was performed using Kaplan-Meier curves and log-rank tests, while bi-variable and multivariable Cox proportional hazards regression models were carried out to identify independent predictors. Over a total follow-up period of 16,315 person-months, 29 patients developed severe ADRs, with the majority of incidents occurring within the first 9 to 21 months of treatment initiation. The overall incidence density was calculated at 18 per 10,000 person-months (95% CI: 12, 26). Multivariable analysis identified advanced baseline WHO clinical stage (III & IV) (Adjusted Hazard Ratio [AHR] = 9.86, 95% CI: 5.21, 13.24) and a low baseline CD4 count below 350 cells/μL (AHR = 3.21, 95% CI: 1.01, 5.43) as statistically significant predictors for a shorter time to severe ADR. The findings indicate that the risk is highest in the initial months of therapy and is strongly correlated with advanced disease stage and immunosuppression at baseline. This underscores the critical need for intensified clinical monitoring and counseling for high-risk patients, especially during the first year of ART, and highlights the urgency of strengthening national pharmacovigilance systems to improve patient safety outcomes.

PMID:41369962 | DOI:10.1007/s10461-025-04975-6

J Imaging Inform Med. 2025 Dec 10. doi: 10.1007/s10278-025-01752-8. Online ahead of print.

ABSTRACT

To reduce the amount of required labeled data for lung disease severity classification from chest X-rays (CXRs) under class imbalance, this study applied deep active learning with a Bayesian Neural Network (BNN) approximation and weighted loss function. This retrospective study collected 2319 CXRs from 963 patients (mean age, 59.2 ± 16.6 years; 481 females) at Emory Healthcare affiliated hospitals between January and November 2020. All patients had clinically confirmed COVID-19. Each CXR was independently labeled by 3 to 6 board-certified radiologists as normal, moderate, or severe. A deep neural network with Monte Carlo Dropout was trained using active learning to classify disease severity. Various acquisition functions were used to iteratively select the most informative samples from an unlabeled pool. Performance was evaluated using accuracy, area under the receiver operating characteristic curve (AU-ROC), and area under the precision-recall curve (AU-PRC). Training time and acquisition time were recorded. Statistical analysis included descriptive metrics and performance comparisons across acquisition strategies. Least Confidence achieved 92.8% accuracy (AU-ROC, 0.95) in binary classification (normal vs. diseased) using 9.24% of the training data. In the multi-class setting, Mean STD achieved 70.5% accuracy (AU-ROC, 0.85) using 21.87% of the labeled data. These methods outperformed more complex and computationally expensive acquisition functions and significantly reduced labeling needs. Deep active learning with BNN approximation and weighted loss effectively reduces labeled data requirements while addressing class imbalance, maintaining or exceeding diagnostic performance.

PMID:41369959 | DOI:10.1007/s10278-025-01752-8

JAMA Dermatol. 2025 Dec 10. doi: 10.1001/jamadermatol.2025.4929. Online ahead of print.

ABSTRACT

IMPORTANCE: Acute digital ischemia, digital ulcers, and gangrene are debilitating complications of systemic sclerosis and other vasculopathies and are often refractory to standard vasodilator and immunosuppressive therapies. Botulinum toxin (BTX) has emerged as a potential rescue therapy, but its clinical effectiveness and safety remain unclear.

OBJECTIVE: To evaluate the effectiveness and safety of BTX injections for ischemic digital complications and identify predictors of treatment response using individual participant data (IPD).

DATA SOURCES: MEDLINE (PubMed), Embase (Ovid), and Scopus were searched from inception through April 20, 2024.

STUDY SELECTION: Eligible studies included patients who presented with acute digital ischemia, ischemic digital ulcers, or gangrene. Studies were limited to Raynaud disease without digital ulcers or gangrene were excluded. Two reviewers independently screened articles using Covidence, with discrepancies resolved by consensus with the senior author. Of 116 studies screened, 31 (27%) met inclusion criteria.

DATA EXTRACTION AND SYNTHESIS: Data were extracted in duplicate and study quality was assessed using the Joanna Briggs Institute checklist. Descriptive statistics were used to summarize baseline characteristics, treatment regimens, and outcomes.

MAIN OUTCOMES AND MEASURES: The primary outcome was complete response (CR), which was defined as resolution of ischemia or ulcer healing. Secondary outcomes included adverse events and time to response. Cox regression was used to identify factors associated with CR.

RESULTS: This systematic review and IPD meta-analysis included 119 patients (72 female individuals [75.0%]; mean [SD] age, 49.0 [15.1] years). BTX was associated with high CR rates for ischemia (93.1%), ulcers (90.1%), and gangrene (87.5%). Adverse events were infrequent, with transient muscle weakness (7.6%) and injection site pain (5.9%) being most common. No associated factors reached statistical significance in multivariable models, but autoimmune etiology and younger age were associated with faster response in Kaplan-Meier analyses.

CONCLUSIONS AND RELEVANCE: The results of this systematic review and IPD meta-analysis suggest that BTX injections appear to be a safe and effective adjunct for refractory digital ischemia in systemic sclerosis. Prospective trials are needed to confirm long-term effectiveness and standardize administration protocols.

PMID:41369954 | DOI:10.1001/jamadermatol.2025.4929