Category: Nevin Manimala

BMC Cancer. 2025 Nov 3;25(1):1687. doi: 10.1186/s12885-025-15140-6.

ABSTRACT

BACKGROUND: The clinical heterogeneity observed in chronic lymphocytic leukemia (CLL) is largely attributed to diverse underlying genomic alterations. Fluorescence in situ hybridization (FISH) remains the standard cytogenetic technique but is limited to predefined loci. As a genome-wide approach, optical genome mapping (OGM) facilitates the identification of structural variants (SVs), such as copy number variations (CNVs), offering a broader genomic perspective. This study was designed to compare the findings of FISH and OGM in a cohort of CLL patients. By integrating these two cytogenetic approaches, we sought to evaluate the potential of OGM in detecting additional or cryptic genomic alterations that may impact prognosis and therapeutic decision-making.

METHODS: Twenty newly diagnosed or treatment-naive CLL patients were analyzed using both FISH and OGM. SVs, CNVs, and chromosomal abnormalities were compared across methods. Concordance and discordance were evaluated, and OGM-specific alterations were examined for clinical relevance. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0. Given the limited sample size (n=20), only descriptive statistics were applied. Frequencies and percentages were used to summarize categorical variables, while continuous variables were expressed as median and range.

RESULTS: The cohort had a median age of 61.5 years (range: 44-83), with 60% male. No abnormalities were detected by either method in 2 patients. Among the remaining 18 patients OGM revealed 22 SVs, 32 CNVs, and 8 aneuploidies. In 3 patients, FISH results were negative, whereas OGM identified various abnormalities.

CONCLUSIONS: According to our results OGM identified additional chromosomal abnormalities not covered by the FISH panel in three of our patient cohort out of the five patients in whom FISH analysis had not detected any abnormalities, highlighting the potential to reshape prognostic algorithms in CLL. Our data emphasize the utility of OGM as a valuable adjunct to standard cytogenetic assessment.

PMID:41184797 | DOI:10.1186/s12885-025-15140-6

BMC Infect Dis. 2025 Nov 3;25(1):1486. doi: 10.1186/s12879-025-11834-1.

ABSTRACT

BACKGROUND: Interferon-gamma release assays (IGRAs) are widely used for detecting latent tuberculosis infection (LTBI). However, these tests can yield indeterminate results, posing challenges for clinical management. The management of these indeterminate outcomes varies, creating uncertainty in clinical practice. This study systematically evaluates the effectiveness of repeat IGRA testing versus additional tuberculin skin testing (TST) in resolving indeterminate IGRA results during LTBI screening.

METHODS: We conducted a systematic review and meta-analysis, searching PubMed, Embase, Web of Science, and the Cochrane Library databases on May 18, 2024, without start date or language restrictions. Studies were included if they screened for LTBI in healthy or high-risk populations using IGRA, reported indeterminate results, and managed these results with repeat IGRA testing and/or additional TST. A random-effects model was used to calculate pooled results.

RESULTS: A total of 59 studies were included in this analysis. Among these, 40 studies assessed the use of additional TST in individuals with indeterminate IGRA results, yielding a pooled confirmation rate of 98.6% (95% CI: 96.2-99.8%). Additionally, 27 studies examined repeat IGRA testing, which resulted in a pooled confirmation rate of 68.9% (95% CI: 57.0-79.6%). Furthermore, eight studies evaluated both TST and repeat IGRA testing, with the pooled confirmation rate for the TST being 93.7% (95% CI: 78.7-99.9%), higher than the pooled confirmation rate for repeat testing at 76.5% (95% CI: 44.6-97.1%). However, there was no statistically significant difference in the confirmation rates between the two testing methods (OR = 2.13, 95% CI: 0.47-9.76).

CONCLUSIONS: In managing indeterminate IGRA results during LTBI screening, head-to-head studies show no significant difference in confirmation rates between additional TST and repeat IGRA. Across nearly 60 studies, additional TST tends to have a slightly higher confirmation rate, though the difference is not statistically significant. Clinically, for patients with an initial indeterminate IGRA who are immunocompetent, with convenient sample collection or a need for rapid results, additional TST may help achieve more reliable outcomes. Selection of follow-up testing should consider the cause of indeterminate results, feasibility, and risk of patient loss to follow-up.

PMID:41184792 | DOI:10.1186/s12879-025-11834-1

BMC Musculoskelet Disord. 2025 Nov 3;26(1):1022. doi: 10.1186/s12891-025-09227-1.

ABSTRACT

PURPOSE: Artificial intelligence (AI) has become incredibly popular over the past several years, with large language models (LLMs) offering the possibility of revolutionizing the way healthcare information is shared with patients. However, to prevent the spread of misinformation, analyzing the accuracy of answers from these LLMs is essential. This study will aim to assess the accuracy of five freely accessible chatbots by specifically evaluating their responses to questions about patellofemoral instability (PFI). The secondary objective will be to compare the different chatbots, to distinguish which LLM offers the most accurate set of responses.

METHODS: Ten questions were selected from a previously published international Delphi Consensus study pertaining to patellar instability, and posed to ChatGPT4o, Perplexity AI, Bing CoPilot, Claude2, and Google Gemini. Responses were assessed for accuracy using the validated Mika score by eight Orthopedic surgeons who have completed fellowship training in sports-medicine. Median responses amongst the eight reviewers for each question were compared using the Kruskal-Wallis and Dunn’s post-hoc tests. Percentages of each Mika score distribution were compared using Pearson’s chi-square test. P-values less than or equal to 0.05 were considered significant. The Gwet’s AC2 coefficient was calculated to assess for inter-rater agreement, corrected for chance and employing quadratic weights.

RESULTS: ChatGPT4o and Claude2 had the highest percentage of reviews (38/80, 47.5%) considered to be an “excellent response not requiring classification”, or a Mika score of 1. Google Gemini had the highest percentage of reviews (17/80, 21.3%) considered to be “unsatisfactory requiring substantial clarification”, or a Mika score of 4 (p < 0.001). The median ± interquartile range (IQR) Mika scores was 2 (1) for ChatGPT4o and Perplexity AI, 2 (2) for Bing CoPilot and Claude2, and 3 (2) for Google Gemini. Median responses were not significantly different between ChatGPT4o, Perplexity AI, Bing CoPilot, and Claude2, however all four statistically outperformed Google Gemini (p < 0.05). Inter-rater agreement was classified as moderate (0.40 > AC2 ≥ 0.60) for ChatGPT, Perplexity AI, Bing CoPilot, and Claude2, while there was no agreement for Google Gemini (AC2 < 0).

CONCLUSION: Current free access LLMs (ChatGPT4o, Perplexity AI, Bing CoPilot, and Claude2) predominantly provide satisfactory responses requiring minimal clarification to standardized questions relating to patellar instability. Google Gemini statistically underperformed in accuracy relative to the other four LLMs, with most answers requiring moderate clarification. Furthermore, inter-rater agreement was moderate for all LLMs apart from Google Gemini, which had no agreement. These findings advocate for the utility of existing LLMs in serving as an adjunct to physicians and surgeons in providing patients information pertaining to patellar instability.

LEVEL OF EVIDENCE: V.

PMID:41184787 | DOI:10.1186/s12891-025-09227-1

BMC Med Imaging. 2025 Nov 3;25(1):440. doi: 10.1186/s12880-025-01982-w.

ABSTRACT

BACKGROUND: Precise benign and malignant breast tumors classification is essential for effective treatment planning and outcome prognostication. Medical imaging’s capability to classify breast tumors has been greatly improved by the accelerated advancement of artificial intelligence (AI). This research presents a comprehensive evaluation of the efficiency of AI-assisted ultrasound elastography (UE) specifically applied to classify benign and malignant breast tumors for the first time.

METHODS: We conducted extensive literature search in PubMed, Embase, IEEE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database, and China Biology Medicine disc (CBM) to identify relevant studies that applied or developed AI algorithms for classifying benign and malignant breast masses employing UE. We used bivariate mixed-effects model for statistical analysis, obtaining binary diagnostic accuracy data to generate pooled estimates (e.g., sensitivity and specificity). The Quality Assessment of Diagnostic Accuracy Studies-AI (QUADAS-AI) tool was applied to assess the methodological quality of the included research. Sensitivity analysis was conducted to verify the robustness of the findings, and Deeks’ funnel plot was employed to examine potential publication bias. Meta-regression analysis was used to investigate the sources of heterogeneity. Clinical applicability was evaluated by Fagan nomogram.

RESULTS: The meta-analysis comprised sixteen relevant studies. Summary estimates indicated high diagnostic accuracy: the pooled sensitivity was 0.90 (95% CI: 0.85-0.94), the pooled specificity was 0.88 (0.81-0.93), the positive likelihood ratio (PLR) was 7.5 (4.7-11.9), and the negative likelihood ratio (NLR) was 0.11 (0.07-0.18). The diagnostic odds ratio (DOR) was 67 (33-137), and the area under the summary receiver operating characteristic curve (AUC) was 0.95 (0.93-0.97).

CONCLUSION: AI-assisted UE demonstrates outstanding performance in benign and malignant breast tumors classification. This study was registered with PROSPERO (CRD42024590031).

PMID:41184781 | DOI:10.1186/s12880-025-01982-w

BMC Pregnancy Childbirth. 2025 Nov 3;25(1):1155. doi: 10.1186/s12884-025-08295-4.

ABSTRACT

BACKGROUND: Iron folic acid supplementation is one of the most global public health interventions to alleviate iron deficiency anemia during pregnancy. Both folic acid and iron deficiencies constitute the major micronutrient deficiencies in Ethiopian women. Non-adherence to folic acid supplementation is a factor for iron deficiency anemia among pregnant women including at selected study area, OBJECTIVE: To identify determinants of non-adherence to iron-folic acid intake among pregnant women who attended antenatal care in Bishoftu town public health facilities, Ethiopia 2022.

METHODS: Facility-based unmatched case-control study was conducted from April 1 to May 30, 2022. A total of 105 cases and 211 controls of pregnant women participated in the study by using systematic random sampling methods for control and consecutive sampling was used for the case. Cases were pregnant women who started ANC service and take iron/folate supplements one month before data collection and who received IFA tablets less than 4 days per week. Controls were pregnant women who started ANC service and take iron/folate supplements one month before data collection and who take IFA tablets greater or equal to 4 days per week. Data were collected by trained health workers using interviewer administered structured questionnaires, entered into Epi-data version 4.6, and exported to Statistical Package for Social Sciences version 25 for analysis. Logistic regression was used to identify determinants of the non-adherence to iron-folic acid supplementation, and the variables with p-value < 0.25 were recruited for multivariable analysis, and an adjusted odds ratio with a 95% confidence interval and a p-value of ≤ 0.05 was used to declare the statistical significance of the variables.

RESULTS: Of the identified determinants of non-adherence to iron-folic acid supplementation:- women aged 15-24 years and 25-34 years [AOR = 5.0, 95% CI (3.04, 12.80), AOR = 11.8, 95% CI (8.01, 12.60)], women who started first ANC > 16 weeks (AOR = 2.41, 95% CI:1.11, 5.25), women who received ANC visit two and three [AOR = 5.17, 95% CI (2.50, 13.02), AOR = 2.95 95% CI (1.26, 6.80)], women with inadequate knowledge (AOR = 3.5,95% CI:1.70,7.20), women who received 30 and below tablets (AOR = 7.80, 95% CI:4.01, 18.02) were the determinants of non-adherence to iron-folic acid supplementation.

CONCLUSIONS: Women’s age, pregnancy weeks during first ANC, frequency of ANC follow-up, knowledge of women on iron-folic acid supplementation, women who received 30 and below tablets were significant predictors for non-adherence to folic acid supplementation. Thus, the town health office should work on non-adherence to folic acid supplementation during pregnancy to improve knowledge of all age groups of women during ANC visits with concerned stakeholders.

PMID:41184769 | DOI:10.1186/s12884-025-08295-4

BMC Prim Care. 2025 Nov 3;26(1):338. doi: 10.1186/s12875-025-03025-3.

ABSTRACT

BACKGROUND: In Dutch general practice, urinary tract infections (UTIs) are the most common indication for prescribing antibiotics. General practice assistants (GPAs) are the first point of contact for patients with UTI-associated symptoms and sometimes even manage these cases without consulting a general practitioner. Nevertheless, literature on how GPAs provide and experience UTI-care is limited.

METHODS: To investigate the knowledge, attitude, and practice of Dutch GPAs regarding UTIs in general practice, we constructed a cross-sectional online survey. The survey assessed actively working Dutch GPAs’ knowledge, practice, and attitude in UTI-care. Participants were recruited through social media platforms in May and June 2024. Descriptive statistics were used to perform primary data-analysis. Secondary analysis was performed using univariate and multivariate logistic regression models.

RESULTS: 478 of the 643 obtained responses were eligible for analysis. Results showed 95.8% of the GPAs think their UTI knowledge is sufficient. However, only one-fourth of respondents selected all correct groups at higher risk of developing a complicated UTI. Additionally, almost 70% of the respondents would perform urinalysis as a precaution if a patient hands in urine, even when UTI-associated symptoms are absent. Nine out of ten GPAs would never disregard urinalysis results. Furthermore, while GPAs indicated to apply shared decision-making often, wait-and-see policies are not regularly advised.

CONCLUSIONS: GPAs seem to be unaware of their limitations regarding UTI-care, especially overvaluing the urine dipstick as a diagnostic tool. GPAs should adjust their preconceived notions of patient preferences, since patients’ willingness to try non-antibiotic treatments is higher than they think.

PMID:41184746 | DOI:10.1186/s12875-025-03025-3

Chin Med J (Engl). 2025 Nov 3. doi: 10.1097/CM9.0000000000003858. Online ahead of print.

NO ABSTRACT

PMID:41184719 | DOI:10.1097/CM9.0000000000003858

Radiol Med. 2025 Nov 3. doi: 10.1007/s11547-025-02142-4. Online ahead of print.

ABSTRACT

PURPOSE: Serous cystadenomas (SCAs), solid pseudopapillary neoplasms (SPNs), neuroendocrine neoplasms (NENs), and mucinous cystic neoplasms (MCNs) are pancreatic tumors that frequently develop calcifications. Identifying the presence and pattern of calcifications on unenhanced CT scans can significantly aid radiologists in differential diagnosis.

METHODS: Patients were included if they had a confirmed diagnosis through pathology or endoscopic ultrasound and MRI follow-up for at least one year. Exclusion criteria were the absence of CT imaging and multiple pancreatic lesions. Two radiologists independently reviewed unenhanced CT scans to assess lesion location, size, presence of calcifications, and calcification patterns, categorized as Type 1 (punctate), Type 2 (curvilinear/elongated), and Type 3 (coarse). Statistical analysis was performed using Fisher’s test for categorical variables, Kruskal-Wallis and Mann-Whitney tests for numerical variables, and logistic regression models to assess the impact of calcification patterns on diagnosis. Sensitivity, specificity, accuracy, and AUC-ROC were calculated for predictive models.

RESULTS: 311 patients (mean age 61 ± 14 years; 56.9% female) were included. Calcifications were present in 27.7% of cases. Calcified NENs and SPNs were more frequently in the body/tail (p = 0.003), and calcified NENs were larger than non-calcified ones (p < 0.001). Punctate calcifications were most common in NENs, while coarse calcifications predominated in SCAs, decreasing the likelihood of a NEN diagnosis and increasing the probability of SCA. The AUC-ROC values were 0.891 for NENs and 0.986 for SCAs.

CONCLUSIONS: Approximately 30% of pancreatic tumors exhibit calcifications. Punctate intratumoral calcifications are more indicative of NENs, whereas coarse calcifications strongly suggest SCAs, influencing the differential diagnosis.

PMID:41184716 | DOI:10.1007/s11547-025-02142-4

Geroscience. 2025 Nov 4. doi: 10.1007/s11357-025-01957-3. Online ahead of print.

ABSTRACT

Nearly half of patients with dementia have comorbid hypertension. However, evidence on the clinical outcomes of antihypertensive medications (AHMs) in these patients remains inconsistent. This review synthesises evidence on cognitive, functional and behavioural outcomes, cardiovascular events, hospitalisation, mortality and adverse drug events related to the use of AHMs in patients with dementia. The review was registered with PROSPERO (CRD42024619054) and is reported following the PRISMA guidelines. We searched MEDLINE, Embase, CENTRAL, PsycINFO, CINAHL and Google Scholar. Random-effects meta-analyses were conducted. We included 36 studies (10 randomised controlled trials (RCTs) and 26 observational follow-up studies) involving 276,793 patients. Meta-analysis showed a small but statistically significant cognitive benefit with AHM use versus non-use in observational studies (standardised mean difference (SMD) 0.23; 95% CI 0.20 to 0.27; p < 0.001), but not in RCTs (SMD – 0.01; 95% CI – 0.16 to 0.14; p = 0.92). Associations with functional outcomes (SMD 0.45; 95% CI – 0.52 to 1.42; p = 0.36), behavioural outcomes (SMD – 0.11; 95% CI – 0.79 to 0.57; p = 0.75) and mortality (hazard ratio 1.32; 95% CI 0.41 to 4.27; p = 0.64) were not significant. Regimens containing renin-angiotensin system blockers (RASBs) showed less cognitive decline compared to other AHMs. Data on the cardiovascular outcomes of AHM use were limited. In summary, AHM use was associated with slower cognitive decline in observational studies (not in RCTs), but no significant relationships with functional, behavioural, or mortality outcomes. The slowed cognitive decline was most pronounced with RASBs. More research, especially RCTs, examining the clinical benefits of AHM use in people with dementia is required.

PMID:41184695 | DOI:10.1007/s11357-025-01957-3

Surg Endosc. 2025 Nov 3. doi: 10.1007/s00464-025-12321-z. Online ahead of print.

ABSTRACT

BACKGROUND: Robotic surgery demands specialized training to ensure proficiency and patient safety. Deliberate practice using Virtual Reality (VR) robotic simulation platforms provides a safe method for skill acquisition. The first part of our Initial curriculum (IC) consisted of 33 VR drills on the SimNow Simulator, which was refined in 2021 to 19 VR drills using a Simulation-Based Mastery Learning (SBML) approach. This study evaluates the feasibility and effectiveness of our refined curriculum (RC).

METHODS: A total of 87 general surgery residents were included. IC was completed by 41 residents, while 46 residents completed the RC. Metrics such as console time, pre- and post-test VR drill scores, and inanimate drill performance were assessed. Statistical analyses included independent or paired t-tests and Mann-Whitney U, or Wilcoxon Signed Rank tests for non-parametric data.

RESULTS: In the IC, 83% of participants achieved mastery versus 100% in the RC. Mean console training time was significantly reduced from 7 h 6 m (95% CI: 6.20-7.92) in the IC to 5 h 42 m (95% CI: 4.74-6.10) in the RC (p = 0.005), demonstrating enhanced efficiency. For VR drills, the IC median score improved from 62 (126-28) to 353 (366-317) (p < 0.001), with a median time reduction of 847 s (1169-565) (p < 0.001). In the RC, the median test score improved from 65.5 (138.75-37.75) to 344.5 (365.5-291.25) (p < 0.001), with a median time reduction of 999 s (1449.5-548.25) (p < 0.001). Inanimate drill times also improved: the IC median time decreased from 928.5 s (1066-853.5) to 741.5 s (859-613.5) (p < 0.001), while the RC median time decreased from 909.5 s (1037.7-744.7) to 464.5 s (518-413.7) (p < 0.001).

CONCLUSION: Reducing VR drills from 33 to 19 content-aligned drills with new proficiency benchmarks maintained effectiveness while significantly decreasing VR console training time. These findings support the feasibility of implementing this streamlined robotic training curriculum in general surgery residency programs without compromising skill acquisition.

PMID:41184674 | DOI:10.1007/s00464-025-12321-z