Category: Nevin Manimala

JMIR Aging. 2025 Feb 26;8:e64148. doi: 10.2196/64148.

ABSTRACT

BACKGROUND: The atherosclerotic cardiovascular disease (ASCVD) is associated with dementia. However, the risk factors of dementia in patients with ASCVD remain unclear, necessitating the development of accurate prediction models.

OBJECTIVE: The aim of the study is to develop a machine learning model for use in patients with ASCVD to predict dementia risk using available clinical and sociodemographic data.

METHODS: This prognostic study included patients with ASCVD between 2006 and 2010, with registration of follow-up data ending on April 2023 based on the UK Biobank. We implemented a data-driven strategy, identifying predictors from 316 variables and developing a machine learning model to predict the risk of incident dementia, Alzheimer disease, and vascular dementia within 5, 10, and longer-term follow-up in patients with ASCVD.

RESULTS: A total of 29,561 patients with ASCVD were included, and 1334 (4.51%) developed dementia during a median follow-up time of 10.3 (IQR 7.6-12.4) years. The best prediction model (UK Biobank ASCVD risk prediction model) was light gradient boosting machine, comprising 10 predictors including age, time to complete pairs matching tasks, mean time to correctly identify matches, mean sphered cell volume, glucose levels, forced expiratory volume in 1 second z score, C-reactive protein, forced vital capacity, time engaging in activities, and age first had sexual intercourse. This model achieved the following performance metrics for all incident dementia: area under the receiver operating characteristic curve: mean 0.866 (SD 0.027), accuracy: mean 0.883 (SD 0.010), sensitivity: mean 0.637 (SD 0.084), specificity: mean 0.914 (SD 0.012), precision: mean 0.479 (SD 0.031), and F₁-score: mean 0.546 (SD 0.043). Meanwhile, this model was well-calibrated (Kolmogorov-Smirnov test showed goodness-of-fit P value>.99) and maintained robust performance across different temporal cohorts. Besides, the model had a beneficial potential in clinical practice with a decision curve analysis.

CONCLUSIONS: The findings of this study suggest that predictive modeling could inform patients and clinicians about ASCVD at risk for dementia.

PMID:40009844 | DOI:10.2196/64148

Interact J Med Res. 2025 Feb 26;14:e66286. doi: 10.2196/66286.

ABSTRACT

BACKGROUND: Ferroptosis, as a novel modality of cell death, holds significant potential in elucidating the pathogenesis and advancing therapeutic strategies for breast cancer.

OBJECTIVE: This study aims to comprehensively analyze current ferroptosis research and future trends, guiding breast cancer research advancements and innovative treatment strategies.

METHODS: This research used the R package Bibliometrix (Department of Economic and Statistical Sciences at the University of Naples Federico II), VOSviewer (Centre for Science and Technology Studies at Leiden University), and CiteSpace (Drexel University’s College of Information Science and Technology), to conduct a bibliometric analysis of 387 papers on breast cancer and ferroptosis from the Web of Science Core Collection. The analysis covers authors, institutions, journals, countries or regions, publication volumes, citations, and keywords.

RESULTS: The number of publications related to this field has surged annually, with China and the United States collaborating closely and leading in output. Sun Yat-sen University stands out among the institutions, while the journal Frontiers in Oncology and the author Efferth T contribute significantly to the field. Highly cited papers within the domain primarily focus on the induction of ferroptosis, protein regulation, and comparisons with other modes of cell death, providing a foundation for breast cancer treatment. Keyword analysis highlights the maturity of glutathione peroxidase 4-related research, with breast cancer subtypes emerging as motor themes and the tumor microenvironment, immunotherapy, and prognostic models identified as basic themes. Furthermore, the application of nanoparticles serves as an additional complement to the basic themes.

CONCLUSIONS: The current research status in the field of ferroptosis and breast cancer primarily focuses on the exploration of relevant theoretical mechanisms, whereas future trends and mechanisms emphasize the investigation of therapeutic strategies, particularly the clinical application of immunotherapy related to the tumor microenvironment. Nanotherapy has demonstrated significant clinical potential in this domain. Future research directions should deepen the exploration in this field and accelerate the clinical translation of research findings to provide new insights and directions for the innovation and development of breast cancer treatment strategies.

PMID:40009842 | DOI:10.2196/66286

J Med Internet Res. 2025 Feb 26;27:e55492. doi: 10.2196/55492.

ABSTRACT

BACKGROUND: Sepsis is an organ dysfunction caused by a dysregulated host response to infection. Early detection is fundamental to improving the patient outcome. Laboratory medicine can play a crucial role by providing biomarkers whose alteration can be detected before the onset of clinical signs and symptoms. In particular, the relevance of monocyte distribution width (MDW) as a sepsis biomarker has emerged in the previous decade. However, despite encouraging results, MDW has poor sensitivity and positive predictive value when compared to other biomarkers.

OBJECTIVE: This study aims to investigate the use of machine learning (ML) to overcome the limitations mentioned earlier by combining different parameters and therefore improving sepsis detection. However, making ML models function in clinical practice may be problematic, as their performance may suffer when deployed in contexts other than the research environment. In fact, even widely used commercially available models have been demonstrated to generalize poorly in out-of-distribution scenarios.

METHODS: In this multicentric study, we developed ML models whose intended use is the early detection of sepsis on the basis of MDW and complete blood count parameters. In total, data from 6 patient cohorts (encompassing 5344 patients) collected at 5 different Italian hospitals were used to train and externally validate ML models. The models were trained on a patient cohort encompassing patients enrolled at the emergency department, and it was externally validated on 5 different cohorts encompassing patients enrolled at both the emergency department and the intensive care unit. The cohorts were selected to exhibit a variety of data distribution shifts compared to the training set, including label, covariate, and missing data shifts, enabling a conservative validation of the developed models. To improve generalizability and robustness to different types of distribution shifts, the developed ML models combine traditional methodologies with advanced techniques inspired by controllable artificial intelligence (AI), namely cautious classification, which gives the ML models the ability to abstain from making predictions, and explainable AI, which provides health operators with useful information about the models’ functioning.

RESULTS: The developed models achieved good performance on the internal validation (area under the receiver operating characteristic curve between 0.91 and 0.98), as well as consistent generalization performance across the external validation datasets (area under the receiver operating characteristic curve between 0.75 and 0.95), outperforming baseline biomarkers and state-of-the-art ML models for sepsis detection. Controllable AI techniques were further able to improve performance and were used to derive an interpretable set of diagnostic rules.

CONCLUSIONS: Our findings demonstrate how controllable AI approaches based on complete blood count and MDW may be used for the early detection of sepsis while also demonstrating how the proposed methodology can be used to develop ML models that are more resistant to different types of data distribution shifts.

PMID:40009841 | DOI:10.2196/55492

JMIR Hum Factors. 2025 Feb 26;12:e58362. doi: 10.2196/58362.

ABSTRACT

BACKGROUND: Telehealth is an increasingly important component of health care services. Telehealth services may present an opportunity to increase the equity, accessibility, and effectiveness of health care. As such, it is critical that telehealth design focuses on reducing the barriers to access and usability that may impair some telehealth users.

OBJECTIVE: Our goal was to identify different demographic characteristics, behaviors, or opinions that may predict groups who are likely to face a barrier to using telehealth services.

METHODS: We used data from the National Health Interview Survey and multiple logit regression models focused on different aspects of telehealth to examine three different avenues of telehealth service: looking up health information using the internet, scheduling an appointment using the internet, and communicating with a care provider through email using the internet in order to consider the ways in which different telehealth services may face different barriers.

RESULTS: Our results suggest that middle-aged (36-55 years old) and older adult (56-85 years old) respondents were significantly less likely to look up health information using the internet or schedule an appointment using the internet versus younger individuals (18-35 years old). Specifically, our analysis found that middle-aged adults were found to have a higher odds ratio than older adults (0.83 vs 0.65) for looking up health information using the internet. We also found that there were differences in age groups for using technology to perform health care-related tasks. In terms of searching for health information using the internet and scheduling appointments using the internet, we found differences between men and women, with women being significantly more likely than men to look up health information using the internet, schedule an appointment using the internet, and communicate with a care provider through email using the internet. Across all the investigated variables, we found that the rates of using the internet for looking up health information, scheduling an appointment, and communicating with a care provider over email increased substantially across the study period. The impact of costs was inconsistent across the different models in our analysis. We also found that there is a strong correlation between respondents’ collaboration in their personal health and the likelihood that they would use telehealth services to meet these needs.

CONCLUSIONS: This analysis provides an exploratory look at the data to highlight barriers that may impact a user’s ability to access telehealth services in the context of other potential predictor variables to account for the real-world variability that these may present. Future work should examine the complex relationships of those variables and understand how these interactions are correlated with the respondents’ use of telehealth.

PMID:40009837 | DOI:10.2196/58362

J Med Internet Res. 2025 Feb 26;27:e65092. doi: 10.2196/65092.

ABSTRACT

BACKGROUND: China has changed its COVID-19 prevention and control status since 2023. However, what role telemedicine will play post-COVID-19 is still uncertain.

OBJECTIVE: We aimed to determine the frequency change in health care providers offering telemedicine services before, during, and after COVID-19, as well as the correlation between the frequency change and telemedicine visit time.

METHODS: The Telemedicine Informationization Professional Committee of China (TIPC) carried out a nationwide questionnaire survey. We adopted data from part of the questionnaires that answered questions regarding the frequency of offering telemedicine services before, during, and after the COVID-19 explosion. Chi-square tests were applied to compare general differences in the between-group telemedicine frequency. Regression models were performed to analyze correlations between the frequency change and the time spent in online versus in-person visits.

RESULTS: Questionnaires from 428 providers were included. As reported, 39 (9.11%) providers often and 159 (37.15%) always offered telemedicine services before COVID-19 exploded. The component ratio increased to 12.38% (n=53) of providers often and 45.79% (n=196) always offering telemedicine during COVID-19 explosion and 12.62% (n=54) often and 50% (n=214) always offering telemedicine after pandemic control was relaxed. The increase in frequency shown as a difference between the before and during groups (χ2=17.21, P.002) and between the before and after groups (χ2=30.17, P<.001) was significant, while it was insignificant between the during and after groups (χ2=2.89, P.57). Senior professional titles (odds ratio [OR] 4.38, 95% CI 1.72-11.6) and longer (OR 3.87, 95% CI 1.95-7.89) and shorter (OR 2.04, 95% CI 1.11-3.87) online visits were correlated with the increase in frequency during versus before COVID-19. In addition, senior professional titles (OR 3.47, 95% CI 1.46-8.49), longer (OR 3.14, 95% CI 1.64-6.11) and shorter (OR=2.27, 95% CI 1.31-4.07) online visits, and using third-party telemedicine platforms (OR 0.51, 95% CI 0.29-0.86) were correlated with the increase in frequency after versus before COVID-19. No factor was significantly correlated with the frequency change after versus during COVID-19. In stratified analysis, longer online visits were correlated with both during versus before (OR 3.84, 95% CI 1.73-8.83) and after versus before (OR 3.40, 95% CI 1.61-7.34) groups for providers using hospital-run platforms, while shorter online visits were correlated with both during versus before (OR 8.16, 95% CI 1.39-68.3) and after versus before (OR 5.70, 95% CI 1.22-33.6) groups for providers using third-party platforms.

CONCLUSIONS: The frequency of telemedicine has increased since the COVID-19 pandemic exploded and is correlated with the time spent in online versus in-person visits. The correlation is different for providers using hospital-run and third party platforms. On a hospital-run platform, providers with longer online visits have a higher frequency of offering telemedicine, while on a third-party platform, providers with shorter online visits are more likely to offer telemedicine.

PMID:40009835 | DOI:10.2196/65092

West Afr J Med. 2024 Oct 30;41(10):1028-1033.

ABSTRACT

BACKGROUND: Colonoscopy remains the gold standard for examining and detecting lesions of the colon and can be used as a therapeutic procedure.

AIM: To report our colonoscopy experience in a private hospital in Nigeria.

PATIENTS AND METHODS: This was a retrospective review of all consecutive patients who underwent colonoscopy from September 2020 to January 2022 (17 months) at Saint Nicholas hospital, a private hospital in Lagos, Nigeria. Informed consents for colonoscopy were obtained from all the patients recruited. Ethical approval for the publication of this manuscript was obtained from the Hospital authority. Each patient had a 3-day bowel preparation before the procedure. Statistical analysis was carried out using IBM SPSS version 26.

RESULTS: A total of one hundred and one patients were recruited into the study with no exclusion. There were 68 males and 33 females with a male to female ratio of 2:1. The mean age of the patients was 52.2± 1.4 years with age range of 23-93 years. The most common indication for colonoscopy was bleeding per rectum. Caecal intubation was achieved in 97% of the patients. Normal findings were recorded in 71% of the patients.

CONCLUSION: The most common indication for colonoscopy was bleeding per rectum. Caecal intubation was achieved in the majority of the patients with the colon noted to be normal in over two-thirds of the patients.

PMID:40009832

West Afr J Med. 2024 Oct 30;41(10):1023-1027.

ABSTRACT

AIM: To report the relationship between average keratometric (AK) readings and axial length (AL) measurements in left eyes of patients attending a cataract surgery camp in sub-Saharan Africa.

METHODS: A prospective evaluation of 648 left eyes of consecutive patients who presented for a cataract surgery camp. The KOWA Autorefractor and Alcon ocuscan were used for measurements. Left eyes alone were evaluated to reduce duplication of data. The data obtained were statistically analyzed using Statistical Package for Social Sciences, version 20.0 (SPSS v20).

RESULTS: A total of 648 eyes of 648 patients were analyzed. There were 306 (47.2%) males and 342 (52.8%) females with age range from 11 to 95 years, mean ± SD age of 65.70 ± 14.28 years. AL range was from 18.00 mm to 30.39 mm, mean ± SD of 23.21± 1.19. AK ranged from 38.50 D to 48.50 D with mean ± SD of 43.41±1.68. AK reading of patients’ left eye increased as the patients age increased (p=0.007). AK readings also increased with a reduction in AL (p=<0.001). Hence smaller eyes had steeper corneas. AL of left eye and AK readings were linearly related by: AL = 33.29 – 0.232AK.

CONCLUSION: Average keratometric readings in left eyes of our cohort of patients increased with age (p=0.007) and reducing axial length (p=<0.001). Axial length of left eye and Average-K readings are linearly related by: AL = 33.29 – 0.232AK. This formula can be utilized during cataract camps to estimate either value, used in intraocular lens calculations.

PMID:40009825

West Afr J Med. 2024 Oct 30;41(10):1015-1022.

ABSTRACT

BACKGROUND: Magnesium has been shown to attenuate succinylcholine-induced fasciculation (SIF) and postoperative muscle pain (POMP); however, the optimal dose remains undetermined. This study explores the effects of varying low doses in a Nigerian population.

METHODS: Ninety patients, aged 18 and 65 years, ASA I and II, who had succinylcholine-assisted airway management, under general anaesthesia, (with propofol-midazolam co-induction, isoflurane and pancuronium maintenance), were randomised into three groups. All patients received magnesium pretreatment before induction; group A received 7.5mg/kg, group B received 10 mg/kg, while group C received 20 mg/kg.

RESULTS: Socio-demographic characteristics were comparable in all groups, p-value > 0.05. The overall incidence of SIF was similar between groups A (24, 80.0%) and B (22, 73.3%), and significantly higher than group C (12, 40.0%) (p = 0.001). Incidence of mild SIF were similar between groups A, (13, 43.3%) and B, (16, 53.3%), and statistically lesser than C, (12, 40.0%), p-value 0.001. The overall POMP incidence was similar between group A, (15, 50.0%) and B, (14, 46.7%), and statistically higher than C, (6, 20.0%), p-value 0.021.

CONCLUSION: This study demonstrates that a 20 mg/kg magnesium pretreatment attenuates SIF and POMP more effectively than 7.5 mg/kg and 10 mg/kg doses in patients undergoing succinylcholine-assisted airway management for general anesthesia.

PMID:40009802

JCO Clin Cancer Inform. 2025 Feb;9:e2400156. doi: 10.1200/CCI-24-00156. Epub 2025 Feb 26.

ABSTRACT

PURPOSE: Complex cancers require discussion at multidisciplinary cancer conferences (MCCs) to determine the best management. This study assessed the impact of a tumor board (TB)-specific information technology platform on the quality of information presented, case discussions, and care plans at thoracic MCCs.

METHODS: Between September 2020 and February 2022, using a before-after study design, we prospectively collected data through direct observation of thoracic MCCs at an academic cancer center. In addition, we reviewed medical records to assess the rate of change in care plans, compliance of all care plans with national guidelines, concordance of treatment received with MCC recommendations, and time from MCC presentation to treatment. Observational data were collected using a validated tool, Metric for the Observation of Decision-Making. We used SAS version 9.4 (SAS Institute Inc, Cary, NC) for statistical analyses.

RESULTS: We identified 151 and 166 thoracic cancer cases before and after implementation of the information technology platform, respectively. The overall quality of case presentation and discussion, represented by a mean composite score (summation of individual variables scored on a 1-5 scale, poor to excellent), increased from 56.8 to 82.0 (P < .001). This improvement was also observed across multiple subcomponents of the composite score all with P < .001. There was no statistically significant difference between the two cohorts in rate of change in care plans by the MCC, care plan compliance with national guidelines, and concordance of treatment received with MCC recommendations.

CONCLUSION: Technology improves the quality of information and discussion at TBs. However, this study did not demonstrate an impact on compliance with practice guidelines. Practitioners should explore the available TB technology platforms to optimize the conduct of MCCs in their respective institutions.

PMID:40009786 | DOI:10.1200/CCI-24-00156

West Afr J Med. 2024 Oct 30;41(10):1007-1014.

ABSTRACT

BACKGROUND: Access to affordable and quality care is critical to reducing suffering and mortality from diabetes given the huge economic challenge it poses. Health insurance aims to, among other things, improve the quality of health care services provided to patients.

OBJECTIVES: To assess and compare client satisfaction with quality of care among health-insured and non-insured diabetic patients in Kaduna State.

METHODS: A comparative cross-sectional study was conducted using a two-stage sampling technique and 500 respondents, comprising 250 (50%) insured and 250 (50%) uninsured patients. Data was collected with a pretested, semi-structured, interviewer-administered questionnaire. Data was analysed using IBM SPSS version 25. A p-value < 0.05 was considered statistically significant, and results were presented using tables.

RESULTS: The mean satisfaction scores of the health-insured and noninsured patients were found to be 106.6 and 109.5 respectively. The noninsured patients were more satisfied with the Health workers’ interpersonal approach (p = 0.022) and communication (p = 0.026), while the health-insured patients were more satisfied with the financial aspect of care (p = 0.040). However, there is no statistically significant difference in the composite satisfaction between the health-insured and non-insured patients. Religion, duration of diabetes and educational status were found to be predictors of client satisfaction.

CONCLUSIONS: The study found that although there was no significant difference in total satisfaction with the quality of care, the noninsured patients were more satisfied with the Health workers’ interpersonal approach and communication. It was recommended that the NHIA through accredited health facilities should improve interpersonal relationships and communication with health-insured diabetic patients.

PMID:40009780