Category: Nevin Manimala

Diagnosis (Berl). 2025 Oct 7. doi: 10.1515/dx-2025-0089. Online ahead of print.

ABSTRACT

OBJECTIVES: Clinical reasoning skills are required for safe care, yet they are not consistently taught to advanced practice providers (APPs). In hospital medicine, where APPs work semi-independently, gaps in clinical reasoning can increase the likelihood of error. To address this, we developed a module that uses diagnostic root cause analysis (RCA) to teach clinical reasoning skills to hospital medicine APP fellows.

METHODS: The curriculum was delivered from July 2021 to March 2025. Fellows selected real-world diagnostic errors encountered during clinical rotations, created cognitive fishbone diagrams, and presented their analysis in small-group.

RESULTS: Twenty-seven fellows completed the module and pre-post assessment surveys. Statistically significant improvements were observed across all six domains of knowledge and confidence related to identifying error contributors, analyzing cases, and setting goals. Free-text responses highlighted the module’s emotional safety, peer learning value, and normalization of diagnostic reflection. Two learners published their projects as academic posters, and one graduate now co-facilitates the sessions.

CONCLUSIONS: This module offers a scalable, time-efficient approach to clinical reasoning education that is adaptable across learner levels and specialties. Its peer-led design fosters psychological safety, reflective practice, and creates a natural pathway for APPs to engage in microscholarship – addressing a critical gap in both education and academic inclusion.

PMID:41047825 | DOI:10.1515/dx-2025-0089

Ann Saudi Med. 2025 Sep-Oct;45(5):295-303. doi: 10.5144/0256-4947.2025.295. Epub 2025 Oct 2.

ABSTRACT

BACKGROUND: Recurrent laryngeal nerve injury (RLNI) is a wellknown complication of thyroidectomy that can lead to vocal cord palsy (VCP). Identifying risk factors and reducing the incidence of RLNI are essential for improving surgical outcomes.

OBJECTIVES: To assess the incidence of permanent VCP after thyroidectomy and evaluate its possible associated risk factors.

DESIGN: A retrospective cohort study.

SETTING: A multicenter study conducted in Makkah, Saudi Arabia.

METHODS: The study assessed incidence of permanent RLNI and its associated risk factors in 314 patients who underwent thyroidectomy at our centers in Makkah, Saudi Arabia, between December 2014 and December 2024. The data were gathered on general characteristics, clinical findings, and surgical details. Statistical analyses were performed to identify significant risk factors.

MAIN OUTCOMES MEASURES: Incidence of permanent RLNI and the associated risk factors.

SAMPLE SIZE: 314 patients.

RESULTS: Overall incidence of permanent VCP was 9 (2.9%). The left vocal cord was affected in 3 (1%) of cases, while the right vocal cord was affected in 6 (1.9%). Significant risk factors included age over 45 years (P=.043), male patients (P=.04), prior thyroid surgery (P=.006), and high cumulative doses of radioactive iodine (P=.008). However, no significant associations with factors such as family history of thyroid disease, carcinoma, or incidental disease onset.

CONCLUSION: Post-thyroidectomy VCP is influenced by several factors, including age, gender, previous thyroid surgery, and radioactive iodine dose. These findings highlight the importance of careful pre-operative risk assessment and the use of preventive measures, such as Intra-Operative Nerve monitoring, use of optical magnification and pre-operative predicting of thyroidectomy difficulty to reduce RLNI risk.

LIMITATIONS: Possibility of selection bias due to the retrospective design. In addition to lack of use of certain analytical tests and detailed subgroup analysis due to the moderate sample size.

PMID:41047809 | DOI:10.5144/0256-4947.2025.295

J Dtsch Dermatol Ges. 2025 Oct 5. doi: 10.1111/ddg.15911. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Social media is increasingly establishing itself as an important source of information for skin health. Although demand among users is high, very few dermatologists outside the Anglo-American region use these platforms to provide patient information, and the majority of content is provided by non-medical sources. This study investigated the influence of social media on skincare and preventive behavior among young adults, and the relevance of medically qualified content.

METHODS: An anonymized 34-item online questionnaire was distributed to 454 students at the University of Innsbruck, assessing social media usage, skincare routines, prevention behavior, and perception of dermatological content. Descriptive and inferential statistics (chi-square tests, p < 0.05) were applied.

RESULTS: A significant association was found between time spent on social media and perceived impact on personal skin health (p = 0.014). Participants exposed to dermatologist-created content were significantly more likely to follow a skincare routine (p < 0.001). The majority expressed a desire for more professionally qualified information.

CONCLUSIONS: Social media offers significant potential for providing information about skin conditions and educating patients. A more comprehensive presence of content reviewed by medical professionals may help minimize the spread of misinformation and promote health education, especially among young users.

PMID:41047803 | DOI:10.1111/ddg.15911

Acta Med Indones. 2025 Jul;57(3):341-345.

ABSTRACT

BACKGROUND: Identifying liver fibrosis is crucial for initiating antiviral therapy for hepatitis B infection. Liver biopsy is the gold standard for assessing the degree of fibrosis. However, a liver biopsy is an invasive procedure that carries some risks. This study aimed to evaluate the diagnostic capabilities of the red cell distribution width-to-platelet ratio (RPR) and compare its efficacy for determining the degree of fibrosis in patients with chronic hepatitis B infection with that of the aspartate aminotransferase-to-platelet ratio index (APRI) and the Fibrosis-4 index (FIB-4).

METHODS: This was a retrospective study conducted on patients with chronic hepatitis B infection who had transient elastography results at the Gastroenterology Hepatology Clinic, Dr. Hasan Sadikin General Hospital, Bandung, between January and December 2024. Statistical analysis was performed using receiver operating characteristic curves to determine the diagnostic values and cutoff points of the RPR, APRI, and FIB-4 to detect liver fibrosis based on Transient Elastography in patients with Chronic Hepatitis B infection.

RESULTS: A total of 114 patients with chronic hepatitis B infection were included in this study (42 with significant fibrosis and 72 with nonsignificant fibrosis). The area under the curve (AUC) of the RPR was 0.873 (p < 0.001) with a cutoff point of >0.0538, whereas the AUCs of the APRI and FIB-4 were 0.833 (p < 0.001) and 0.746 (p < 0.001), respectively.

CONCLUSION: The RPR has a higher diagnostic performance than the APRI and is superior to the FIB-4 in assessing the degree of fibrosis in patients with chronic hepatitis B infection. The RPR is a simple and cost-effective test and has the potential to be a screening tool for patients with hepatitis B infection.

PMID:41047800

J Dent Educ. 2025 Oct 5. doi: 10.1002/jdd.70061. Online ahead of print.

ABSTRACT

PURPOSE: The proposed guidelines for implant dentistry education in Australian undergraduate dental programs from the 2010 Australian Consensus Workshop (ACW) have presented notable difficulties in their implementation. This study aims to explore the views of dental students regarding implant dentistry education and recommend improvements.

METHODS: A survey was distributed to final year dental students (n = 73) in one of the Australian dental schools. The 18-question survey was structured into four sections, covering participants experience in implant dentistry, their confidence in applying knowledge acquired from the implant curricula, satisfaction with the implant curricula in terms of quality, quantity, and timing of delivery, and considerations for possible improvements. Multilinear regression analysis was exclusively conducted for Satisfaction Likert data sets.

RESULTS: The response rate was 71.2% (n = 52). Most students reported low confidence in applying implant knowledge clinically (65.4%-80.7%), with a notable increase in confident responses in understanding theory following a practical workshop (from 7.7%-32.6%). Students unanimously agreed on the need for improvements, particularly emphasizing a greater focus on clinical observations (78.8%) and preclinical training (76.9%). The regression model was statistically significant for theory amount (F (1,45) = 4.2, p < 0.05) and Sim-Lab quality (F (1,45) = 5.7, p < 0.02).

CONCLUSIONS: Students expressed a lack of confidence in selecting and treating patients requiring implant dentistry. The quantity of theoretical content and the quality of Sim-Lab experiences were the factors that notably enhanced the satisfaction of students. Some of the obstacles identified by ACW 14 years ago persist in undergraduate dental education.

PMID:41047492 | DOI:10.1002/jdd.70061

Odontology. 2025 Oct 5. doi: 10.1007/s10266-025-01223-0. Online ahead of print.

ABSTRACT

The aim of this study was to evaluate the effect of chitosan (Cht), gelatin (Gel) and silver nanoparticles (AgNPs) at different concentrations as a medicament for the release of basic fibroblast growth factor (bFGF) from infected dentin. Fifty-two single-rooted premolar teeth were standardized to 12 ± 1 mm in length and prepared up to size #100 with K-hand files. The root segments were infected with Enterococcus faecalis for 21 days. Two root segments were used to confirm the mature biofilm formation by scanning electron microscope. After irrigation with 1.5% NaOCl (20 mL/5 min), the samples were randomly divided into five groups (n = 10) based on the intracanal medicament: control group (non-dressed), calcium hydroxide (Ca(OH)₂), Cht/Gel/AgNPs1 (0.18 g Cht/54 μg /mL AgNPs), Cht/Gel/AgNPs2 (0.16 g Cht/108 μg/mL AgNPs), and Cht/Gel/AgNPs3 (0.14 g Cht/162 μg/mL AgNPs). The samples were incubated for two weeks and then irrigated with 17% EDTA (20 mL/5 min). They were then placed in sterile Eppendorf tubes with 1 mL Hank’s balanced salt solution at 37°C, and bFGF levels were measured using an enzyme-linked immunosorbent assay at 24 hours. Each root canal volume was assessed using cone-beam computerized tomography to calculate the final bFGF concentration. Statistical analysis was performed using Shapiro-Wilk, one-way ANOVA, and Tukey tests (p < 0.05). A significant difference was found between the control and the other medicament groups (p < 0.01). The Ca(OH)₂ group showed significantly lower bFGF release levels among all Cht/Gel/AgNPs groups (p < 0.05). A statistically significant difference was observed between the Cht/Gel/AgNPs2 and Cht/Gel/AgNPs1 groups (p = 0.019), as well as between the Cht/Gel/AgNPs2 and Cht/Gel/AgNPs3 groups (p = 0.007). Cht/Gel-containing AgNP medicaments may represent promising agents for revascularization protocols.

PMID:41047431 | DOI:10.1007/s10266-025-01223-0

Eur J Orthop Surg Traumatol. 2025 Oct 5;35(1):417. doi: 10.1007/s00590-025-04542-8.

ABSTRACT

PURPOSE: Distal femur fractures are challenging to manage and fixation with intramedullary nails or plates alone can fail. Linked nail plate constructs (NPC) are increasingly used for complex cases. This five-year review from a UK major trauma centre reports indications and patient outcomes.

METHODS: Patients treated for a distal femoral fracture with a NPC between 1st January 2020 and 1st January 2025 were identified. Patient demographics, mechanism of injury, fracture classification, procedural characteristics, postoperative weight-bearing status, union rates, complications and mortality were recorded.

RESULTS: Thirty-two patients were identified with a mean age of 70 years (20 to 98). Twenty-four (75%) patients were female with a median ASA of 3. There were five (16%) open fractures and ten (31%) peri-prosthetic fractures. Eight (25%) NPCs were revision operations following failure of primary fixation. All operations were performed by at least one consultant. In total, 31 (97%) patients were permitted unrestricted weight bearing postoperatively. Clinical union was achieved in 25 (96%) of 26 patients available for follow-up. There were no significant complications. Mortality rate at 30 days, 3 months and 12 months was 6%, 6% and 16%, respectively.

CONCLUSIONS: This study supports the use of nail plate construct (NPC) in the management of both primary and revision surgery for complex distal femoral fractures. Among 32 patients with a mean age of 70 years, NPC permitted immediate unrestricted weight bearing (97%) with a high rate of union (96%) and a low complication and mortality rates. These findings highlight NPC as an effective option for managing complex distal femur fractures.

PMID:41047422 | DOI:10.1007/s00590-025-04542-8

Signal Transduct Target Ther. 2025 Oct 6;10(1):328. doi: 10.1038/s41392-025-02427-0.

ABSTRACT

Transarterial chemoembolization (TACE) is the standard treatment for intermediate-stage hepatocellular carcinoma (HCC), yet its efficacy as a standalone therapy remains suboptimal. This phase 2 trial (ChiCTR2100049829) evaluated the feasibility and safety of TACE combined with atezolizumab and bevacizumab in patients with intermediate-stage HCC. Participants received TACE followed by atezolizumab and bevacizumab until disease progression, unacceptable toxicity, or death. The primary endpoint was objective response rate (ORR) assessed per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. Secondary endpoints included progression-free survival (PFS), overall survival (OS), ORR by modified RECIST (mRECIST), disease control rate (DCR), time to response (TTR), duration of response (DOR), and adverse events (AEs). Between August 21, 2021 and April 10, 2023, 45 patients were enrolled. As of the data cutoff on September 30, 2024, the median follow-up was 26.7 months. The ORR was 47% per RECIST v1.1 and 67% per mRECIST. Median PFS was 17.9 months, and median OS was 33.0 months. The DCR was 87% (RECIST v1.1) and 91% (mRECIST). Median TTR was 11.9 weeks (RECIST v1.1) and 4.9 weeks (mRECIST), with median DOR of 36.6 weeks (RECIST v1.1) and 44.4 weeks (mRECIST). Of the 45 patients, 44 experienced AEs of any grade, with 20 reporting grade 3-4 AEs; no grade 5 AEs were observed. TACE combined with atezolizumab and bevacizumab appears safe and feasible for intermediate-stage HCC, supporting further investigation in larger studies.

PMID:41047409 | DOI:10.1038/s41392-025-02427-0

Eur Spine J. 2025 Oct 6. doi: 10.1007/s00586-025-09400-z. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to assess the clinical efficacy of posterior endoscopic surgery using a bone tunnel approach in treating cervical spondylotic radiculopathy (CSR) secondary to uncovertebral osteophytes.

METHODS: From January 2022 to July 2023, 68 patients diagnosed with cervical osseous foraminal stenosis due to uncovertebral osteophytes and treated with posterior endoscopic surgery through the bone tunnel approach were retrospectively enrolled in this study, with a minimum follow-up period of 1 year. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) for neck and arm pain, Neck Disability Index (NDI), and success rate according to Odom’s criteria. Radiological outcomes were assessed by measuring the C2-7 sagittal Cobb angle (SCA), segmental angle (SA), and cervical curvature angle (CA) on the lateral, hyperflexion and hyperextension radiographs.

RESULTS: All the patients successfully underwent the procedure without severe complications. The mean operative duration was 84.1 ± 24.6 min, with an average hospital stay of 4.4 ± 2.2 days and a mean follow-up time of 14.7 ± 3.1 months. Significant improvements in the NDI and VAS scores were observed postoperatively (p < 0.05). At the final follow-up, the clinical success rate, defined as excellent or good outcomes, was 100% (43 excellent and 25 good outcomes). On lateral radiographs, no statistically significant differences were detected in SCA, CA, and SA measurements at various time points. On hyperextension radiographs, all measurements at the final follow-up were significantly larger than those taken pre- and postoperatively (p < 0.05). On hyperflexion radiographs, all postoperative measurements were significantly smaller than those taken preoperatively and at the final follow-up (p < 0.05).

CONCLUSION: Posterior endoscopic surgery through the bone tunnel approach is a safe and effective route for achieving direct neuroventral bony decompression, demonstrating favorable clinical and radiological outcomes in the treatment of CSR with uncovertebral osteophytes.

PMID:41047404 | DOI:10.1007/s00586-025-09400-z

Sci Rep. 2025 Oct 5;15(1):34652. doi: 10.1038/s41598-025-20839-4.

ABSTRACT

This paper presents a complete nonclassical symmetry analysis of the nonlinear integrable model known as the (4 + 1)-dimensional Boiti-Leon-Manna-Pempinelli (4D-BLMP) equation. The analysis is divided into two parts. The first part involves constructing systems of nonlinear partial differential equations for the determining equations based on the dimensions of the model. Five distinct cases of these systems are examined and solutions to these systems are found, leading to the creation of various new nonclassical symmetries. The second part focuses on classifying the developed unknown functions using the constructed nonclassical symmetries and their invariant formulations. These classified functions are then applied to obtain a range of new explicit exact solutions to the model. The paper also includes a graphical analysis of the dynamical behavior of these solutions, taking into account special parameter values. The results highlight the existence of various wave structures in the 4D-BLMP equation, setting it apart from other models that lack non-singular complexiton solutions. The analysis of higher-dimensional nonlinear integrable equations is essential because such models capture complex wave phenomena arising in mathematical physics, fluid dynamics, and optical systems. In particular, understanding their exact and nonclassical solutions provides deeper insight into the underlying dynamics and supports the development of effective analytical and numerical techniques.

PMID:41047386 | DOI:10.1038/s41598-025-20839-4