Category: Nevin Manimala

J Ren Care. 2025 Mar;51(1):e70002. doi: 10.1111/jorc.70002.

ABSTRACT

BACKGROUND: Many people with kidney failure start and remain on in-centre haemodialysis treatment despite evidence of improved outcomes with home dialysis. To make an informed modality decision patients must receive frequent, high-quality modality education. This education is inconsistent in the in-centre haemodialysis setting, where patients spend the most time with nurses while receiving haemodialysis treatments.

OBJECTIVES: The aim of this study was to examine in-centre haemodialysis nurses’ perceptions around modality education for patients receiving in-centre haemodialysis using the COM-B model of behaviour change.

DESIGN: We used framework analysis as a research method, applying the COM-B model as a theoretical framework to understand nurses’ perceptions of modality education.

PARTICIPANTS: We interviewed 13 in-centre haemodialysis nurses in a single province in Canada.

APPROACH: We completed semi-structured interviews via Zoom, which ranged from 30 to 60 min.

FINDINGS: Participants reported knowledge deficits, lack of experience or exposure to other dialysis modalities, and lack of resources to support modality education practices. In-centre haemodialysis nurses reported some factors that enhanced modality education, including strong nurse-patient therapeutic relationships and previous experience in other dialysis modalities.

CONCLUSIONS: Nurses could have a role in modality education but had different views on what this role should be. Nurses faced barriers in modality education such as knowledge deficits, a lack of experience with home modalities, and limited patient teaching resources. Factors that favoured modality education were strong nurse-patient relationships and previous experience with other modalities.

PMID:39865379 | DOI:10.1111/jorc.70002

Clin Oral Implants Res. 2025 Jan 25. doi: 10.1111/clr.14405. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the treatment of peri-implant mucositis (PM) using a nonsurgical submarginal peri-implant instrumentation (NSPI) with or without chlorhexidine (CHX) solutions.

METHODS: Fifty-six patients (28 per group) were randomly assigned to the test (NSPI + 0.12% mouthwash and subgingival CHX irrigation plus tongue brushing with 1% CHX gel) or the control group (NSPI + placebo mouthwash and subgingival placebo irrigation plus tongue brushing with placebo gel). At baseline, 1, 3, 6 months, bleeding on probing (BOP), probing pocket depth (PPD), modified gingival index (mGI), modified plaque index (mPlI), full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and the proportions of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were recorded. The BOP reduction was set as a primary outcome. Data were analyzed to assess BOP reduction at a 6-month follow-up and to identify significant predictors of implant-site BOP through mixed generalized linear regression.

RESULTS: After 6 months in both groups, a significant reduction of BOP, PD, mPlI, mGI, FMBS, and FMPS was noted (p < 0.05). However, at 6 months, the test group was more effective than the controls in reducing median BOP (∆values control/test: 39.3% [95% CI 37.4-42.3] vs. 48.7 [95% CI 46.5-51.2], p = 0.044), as well as mPlI (p = 0.041) and the proportion of Treponema denticola (p = 0.039). Moreover, the implant-sites BOP reduction was significantly influenced by test treatment (p < 0.001), history of periodontitis (p = 0.003), and a high number of cigarettes/day (p = 0.002), the proportion of Porphyromonas gingivalis (p = 0.021) and Tannerella forsythia (p = 0.032).

CONCLUSIONS: NSPI + CHX showed better results compared to placebo in implant-sites BOP reduction. The high number of cigarettes/day and the proportion of Porphyromonas gingivalis and T. forsythia negatively influenced the BOP reduction in PM-treated patients.

PMID:39865359 | DOI:10.1111/clr.14405

Liver Int. 2025 Feb;45(2):e16240. doi: 10.1111/liv.16240.

ABSTRACT

BACKGROUND AND AIMS: The performance of non-invasive liver tests (NITs) is known to vary across settings and subgroups. We systematically evaluated whether the performance of three NITs in detecting advanced fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) varies with age, sex, body mass index (BMI), type 2 diabetes mellitus (T2DM) status or liver enzymes.

METHODS: Data from 586 adult LITMUS Metacohort participants with histologically characterised MASLD were included. The diagnostic performance of the Fibrosis-4 Index (FIB-4), enhanced liver fibrosis (ELF) and vibration-controlled transient elastography liver stiffness measurement (VCTE LSM) was evaluated. Performance was expressed as the area under the receiver operating characteristics curve (AUC). Thresholds for detecting advanced fibrosis (≥F3) were calculated for each NIT for fixed (high) sensitivity, specificity and predictive values.

RESULTS: Differences in AUC between all subgroups were small and statistically not significant, indicating comparable performance in detecting ≥F3, irrespective of these clinical factors. However, different thresholds were needed to achieve the same level of accuracy with each test. For example, for a fixed sensitivity and specificity, the thresholds for all three NITs were higher in patients with T2DM. Effects for sex, age and liver enzymes were less pronounced.

CONCLUSIONS: Performance of the selected NITs in detecting advanced liver fibrosis does not vary substantially with clinical characteristics. However, different thresholds have to be selected to achieve the same sensitivity, specificity and predictive values in the respective subgroups. Large prospective studies are called for to study NIT accuracy considering multiple patient characteristics.

PMID:39865358 | DOI:10.1111/liv.16240

Head Neck. 2025 Jan 24. doi: 10.1002/hed.28083. Online ahead of print.

ABSTRACT

BACKGROUND: To correlate between immunohistochemical expression of tumor-infiltrating lymphocytes (TILs), tumor-associated macrophages (TAMs), and natural killer (NK) cells with the AJCC 8th edition TNM staging system and other disease-modifying clinico-pathological variables.

METHODS: The representative histology sections of tumor invasive margin (IM) and tumor core (TC) were selected according to the International Immuno-Oncology Biomarker Working Group and were subjected to immunohistochemistry with antibodies for TILs (CD3, CD8, FOXP3), NK Cells (CD57), TAMs (CD68, CD163) and pan-leukocyte marker (CD45). Histo-immuno-density-intensity (HIDI) scoring was calculated as a product of the proportion and intensity of staining. Ordinal-ordinal and continuous-ordinal variables were correlated using Kendall’s tau-b (τb), and binary-ordinal variables were correlated using Rank-Biserial (r_rb) statistics.

RESULTS: A total of 111 patients were included in the study. None of the clinical and pathological parameters showed a strong correlation with any of the immune infiltrates including TNM staging.

CONCLUSION: We hypothesize an independent activity of tumor immunology in the disease prognosis.

TRIAL REGISTRATION: CTRI/2020/07/026335.

PMID:39865357 | DOI:10.1002/hed.28083

Pediatr Blood Cancer. 2025 Jan 25:e31568. doi: 10.1002/pbc.31568. Online ahead of print.

ABSTRACT

PURPOSE: To explore the potential relationship between social media (SoMe) and burnout or overall wellbeing within the field of oncology.

DESIGN: A cross-sectional study of adult and pediatric oncology professionals conducted using an anonymous electronic survey. The survey was disseminated through the Children’s Oncology Group (COG) and the SWOG Cancer Research Network (SWOG) member listservs.

RESULTS: The majority of pediatric and adult oncology professionals are not engaging on, with only 873/3000 (29%) using SoMe professionally. Use of SoMe was associated with statistically significant higher incidence of self-reported burnout and poorer self-reported work‒life integration (WLI). However, both groups reported the same degree of career satisfaction and choosing the same career/job again. SoMe users and non-users reported similar overall psychological distress, although the use of SoMe was associated with less severe psychological distress.

CONCLUSION: While SoMe users reported higher rates of burnout and poorer WLI compared to non-users, it was not accompanied by higher levels of psychological distress. Furthermore, there were no differences in career satisfaction. These misalignments require further study.

PMID:39865348 | DOI:10.1002/pbc.31568

Immunol Cell Biol. 2025 Jan 25. doi: 10.1111/imcb.12848. Online ahead of print.

ABSTRACT

Natural killer (NK) cells are emerging agents for cancer therapy. Several different cytokines are used to generate NK cells for adoptive immunotherapy including interleukin (IL)-2, IL-12, IL-15 and IL-18 in solution, and membrane-bound IL-21. These cytokines drive NK cell activation through the integration of signal transducers and activators of transcription (STAT) and nuclear factor-kappa B (NF-κB) pathways, which overlap and synergize, making it challenging to predict optimal cytokine combinations for both proliferation and cytotoxicity. We integrated functional assays for NK cells cultured in a variety of cytokine combinations with mathematical modeling using feature selection and mechanistic regression models. Our regression model successfully predicts NK cell proliferation for different cytokine combinations and indicates synergy of activated STATs and NF-κB transcription factors between priming and post-priming phases. The use of IL-21 in solution in the priming of NK cell culture resulted in an improved NK cell proliferation, without compromising cytotoxicity potential or interferon gamma secretion against hepatocellular carcinoma cell lines. Our work provides an integrative framework for interrogating NK cell proliferation and activation for cancer immunotherapy.

PMID:39865344 | DOI:10.1111/imcb.12848

J Esthet Restor Dent. 2025 Jan 25. doi: 10.1111/jerd.13420. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the color stability of a one-shade resin-based composite material (RC) and a glass-ionomer cement (GIC) after staining with plaque detectors (PDs) with different formulations and delivery forms.

MATERIALS AND METHODS: Rectangular-shaped specimens (7 × 3 × 2 mm) were produced with RC (Venus Diamond One, Kulzer) and GIC (Fujy IX GP, GC) (n = 30). Further, the following PDs were used on the specimens: (1) tablets (T; Plaq-Search, TePe); (2) mouthwash (M; Plaque Agent, Miradent); and (3) light-curing liquid (L; Plaque test, Ivoclar). The PDs were removed with dedicated toothbrushes (T₁) and the specimens were repolished (T₂). The protocol was repeated after 1 week of storage in artificial saliva (staining-T₃ and repolishing-T₄). Color measurement were performed at baseline (T₀) and all testing times (T₁-T₄) using a recently introduced digital colorimeter (SmartColor, Smart Vision). Color changes (ΔE_ab) compared to T₀ were automatically recorded by the digital instrument. The data were statistically analyzed (p < 0.05).

RESULTS: The type of PD, the polishing procedure and their interactions influenced the color stability of both restorative materials (p < 0.05). Particularly, after the second PDs application, M and L produced the highest color changes (p < 0.05), with GIC showing higher color variability than RC. Although repolishing reduced the color changes of RC (p < 0.05), it could not reestablish the initial color of GIC, irrespective of the PD used (p < 0.05). Except for RC associated with T, all materials exhibited discoloration above the clinical perceptibility (1.77) and acceptability (2.66) thresholds.

CONCLUSIONS: The influence of PDs on the color stability of RC and GIC was material-dependent. GIC showed higher color instability than RC. Repolishing could not reestablish the original color of GIC and only attenuated the color changes of the one-shade RC. The newly introduced digital colorimeter was an important tool to standardize and simplify color measurement evaluations.

CLINICAL SIGNIFICANCE: PDs can pose a potential risk to the color stability of restorative materials. Dental practitioners should be careful when recommending the frequency of at-home application of PDs, taking into consideration the material properties and the position of the restorations of each patient.

PMID:39865343 | DOI:10.1111/jerd.13420

Cancer. 2025 Feb 1;131(3):e35723. doi: 10.1002/cncr.35723.

ABSTRACT

BACKGROUND: There is much concern that opioids administered as intravenous (iv) bolus for pain relief may inadvertently increase their risk for abuse. However, there is insufficient data to support this. The authors compared the abuse liability potential, analgesic efficacy, and adverse effect profile of fast (iv push) versus slow (iv piggyback) administration of iv hydromorphone among hospitalized patients requiring iv opioids for pain.

METHODS: In this double-blind, double dummy, randomized, 2 × 2 crossover trial, patients with ≥4 cancer-related pain were randomly assigned to receive either iv hydromorphone 1 mg administered over 2 minutes (fast iv push) or 15 minutes (slow iv piggyback) during the first treatment period. Participants crossed over to receive the alternate treatments during the second period after a 6-hour washout period.

RESULTS: Eighty-three eligible patients were allocated to slow-fast (42, 51%) or fast-slow (41, 49%). Both treatments produced low abuse potential scores with no difference between them (mean peak Drug Effect Questionnaire “drug liking” subscale of fast [24.00] vs. slow [24.34], p = .82). A total of 92% and 94% of slow and fast iv hydromorphone recipients, respectively, had similar improvements in pain scores over 120 minutes (odds ratio, 0.67; 95% confidence interval, 0.06-5.82, p = .65). Drowsiness was more frequent with the fast than the slow rate (50% vs. 29% at 15 minutes [p = .03] and 52% vs. 31% at 60 minutes [p = .03]).

CONCLUSIONS: Slow iv hydromorphone infusion resulted in similar abuse liability potential and pain improvement but less sedation than fast injection. These findings, taken together, suggest that the slow infusion may be considered as a first-line modality for iv opioid administration in hospitalized patients requiring intermittent opioids for pain.

PMID:39865340 | DOI:10.1002/cncr.35723

Infect Dis (Lond). 2025 Jan 26:1-7. doi: 10.1080/23744235.2025.2456902. Online ahead of print.

ABSTRACT

BACKGROUND: Whether a detected virus or bacteria is a pathogen that may require treatment, or is merely a commensal ‘passenger’, remains confusing for many infections. This confusion is likely to increase with the wider use of multi-pathogen PCR.

OBJECTIVES: To propose a new statistical procedure to analyse and present data from case-control studies clarifying the probability of causality.

METHODS: We conducted a case-control study in US outpatient settings that enrolled patients aged 18 to 75 years with acute lower respiratory tract infection and controls without respiratory symptoms. Patients underwent multi-pathogen PCR testing. The positive etiologic predictive value was calculated to estimate the probability that each potential pathogen was the cause of symptoms. The outcome was illustrated using a modified forest plot and by classifying pathogens into five categories clarifying the probability for causality.

RESULTS: We enrolled 618 adult cases and 497 asymptomatic controls. The modified forest plot and the classification of risk for causality aimed to facilitate understanding. Pathogens likely to be causative when present included influenza A and B, SARS-CoV-2, rhinovirus, and parainfluenza viruses, while Staphylococcus aureus is almost always commensal. Broad confidence intervals for the positive etiologic predictive value made it difficult to draw conclusions for potential pathogens with low prevalence.

CONCLUSION: This pilot study shows that the proposed statistical approach is likely to be practical for analysing larger case-control studies or for a meta-analysis of multiple studies. This method may help when interpreting the results from multi-pathogen PCR.

PMID:39864052 | DOI:10.1080/23744235.2025.2456902

J Ultrasound. 2025 Jan 26. doi: 10.1007/s40477-025-00986-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Post-stroke cognitive impairment (PSCI) and dementia affect short- and long-term outcome after stroke and can persist even after recover from a physical handicap. The process underlying PSCI is not yet fully understood. Transcranial Doppler ultrasound (TCD) is a feasible method to investigate cerebrovascular aging or dementia, through the pulsatility index (PI), the cerebrovascular reactivity (e.g. the Breath-Holding Index (BHI)) and the functional Transcranial Doppler sonography (fTCD). Aim of the study was to assess the usefulness of PI, BHI, Resistance Index (RI) and fTCD in evaluating the risk of cognitive impairment evolution in patients with minor stroke (MS), compared to patients with transient ischemic attack (TIA) and to healthy controls (HC).

MATERIAL AND METHODS: PI, RI, BHI and fTCD were evaluated in the middle cerebral artery (MCA) of MS patients, TIA and HC. Patients with MS and TIA were enrolled within six days from the cerebrovascular event (acute phase) and the tests were repeated after 180±15 days from t0 (control phase). During the TCD recording, particular sections of MoCA test and FAB test were performed.

RESULTS: 43 subjects were enrolled: 13 MS, 16 TIA and 14 HC. MFV analysis in the acute phase demonstrated no difference between MFVs at rest vs MFVs during MoCA/FAB tests in TIA and MS (acute phase), a significant increase of MFVs during MoCA/FAB tests vs MFVs at rest in HC (p<0.01), a statistically significant difference in the PI of MS vs HC at rest (p=0.048) and in BHI between HC vs MS (p<0.001) and HC vs TIA (p<0.01). In the control phase the absence of a statistically significant difference in MFVs was observed only in MS patients (MFVs at rest vs MFVs during MoCA) and PI and BHI values were in the normal range both in MS and TIA. No correlation was observed between MoCA test results and MFV, PI or RI, in any of the three groups.

CONCLUSION: A different cerebral vasoreactivity, in terms of no increase in MFV, was found when performing cognitive tasks in patients with MS and TIA compared to HC in the acute phase. TCD is a fundamental tool to study cerebral vasoreactivity.

PMID:39864049 | DOI:10.1007/s40477-025-00986-0