Category: Nevin Manimala

J Esthet Restor Dent. 2025 Oct 11. doi: 10.1111/jerd.70045. Online ahead of print.

ABSTRACT

BACKGROUND: The integration of thermal imaging with artificial intelligence (AI) offers a novel, non-invasive approach for assessing gingival inflammation. While thermal imaging has been widely applied in other medical fields, its use in evaluating gingival health remains largely unexplored. This study is the first to utilize AI-supported analysis of thermal gingival images in patients with mouth breathing habits, aiming to detect and classify gingival inflammation severity. This research establishes specific thermal thresholds for gingival health and disease in this unique population.

METHODS: Forty participants were included, stratified according to periodontal status and clinically confirmed breathing pattern (mouth or nasal breathing), under standardized imaging conditions. From these participants, 160 images were annotated, producing 1734 labeled data points categorized according to bleeding on probing (BoP) for diagnosis, with Gingival Index (GI) applied only for secondary stratification of inflammation severity. Preprocessing included image resizing, outlier removal, and calculation of mean RGB values. The XGBoost algorithm was used for classification, with hyperparameters optimized via grid search and 5-fold cross-validation to ensure robust model performance.

RESULTS: The XGBoost Achieved Outstanding Classification Results, With an Accuracy of 92.74%, Precision of 92.95%, Sensitivity of 92.74%, and an F1 Score of 92.78%. Cross-Validation Confirmed the Model’s Reliability, With Mean-Test and Validation-Scores of 88.28% and 89.43%, Respectively.

CONCLUSIONS: This study represents the first application of AI-supported thermal imaging for evaluating gingival inflammation in mouth breathers, marking a significant step forward in periodontal diagnostics. By establishing specific thermal thresholds in this unique population, it highlights the potential of this innovative approach as a non-invasive, real-time, and scalable diagnostic tool. Future research should focus on refining AI algorithms and expanding datasets to enhance clinical applicability, paving the way for advanced diagnostics and personalized care in periodontology.

PMID:41074551 | DOI:10.1111/jerd.70045

Ann Med. 2025 Dec;57(1):2564286. doi: 10.1080/07853890.2025.2564286. Epub 2025 Oct 11.

ABSTRACT

BACKGROUND: Doravirine (DOR) has demonstrated good efficacy for the treatment of people with HIV (PWH); however, there is limited real-world research in developing countries.

METHODS: We retrospectively assessed the efficacy and safety of DOR/lamivudine (3TC)/tenofovir disoproxil fumarate (TDF) at 24 and 48 weeks in treatment-naïve and treatment-experienced PWH.

RESULTS: A total of 83 PWH were included from January 1, 2022, to December 31, 2023. The median age was 40 years (32-54). Twenty-seven patients (32.5%) were treatment-naïve PWH, and 56 patients (67.5%) were treatment-experienced PWH, the most common switch was from integrase inhibitors (37/56) to DOR, followed by efavirenz (18/56) and nevirapine (1/56). In treatment-naïve PWH, the median CD4+ T-cell count was 222.9 ± 144.2 cells/mL at baseline, which increased to 337.8 ± 189.6 cells/μL at week 24 (p < 0.001) and to 431.6 ± 259.9 cells/μL at week 48 (p < 0.001). The overall VS rate was 76.9% (20/26) at week 24 and 93.3% (14/15) at week 48. Creatinine (Cr) significantly increased from baseline to week 48 (p = 0.013) but remained normal. There were no significant differences observed in BMI, glucose, estimated glomerular filtration rate (eGFR), liver enzymes, or plasma lipid levels between the baseline and follow-up data. In treatment-experienced PWH, there were no significant changes in the VS rate, CD4+ T-cell count, Cr, eGFR or liver enzymes between the baseline and follow-up data. However, compared to baseline, statistically significant reductions in plasma lipids were observed at week 24 and at week 48. There was also a significant decrease observed in BMI at week 48 compared with baseline. In addition, anxiety, depression and sleep disorders improved in those patients who switched regimens from efavirenz to DOR.

CONCLUSIONS: We provide a short-term observational report of the efficacy and safety of DOR/3TC/TDF in routine clinical practice, further supporting its use in PWH.

PMID:41074542 | DOI:10.1080/07853890.2025.2564286

Microsc Res Tech. 2025 Oct 11. doi: 10.1002/jemt.70079. Online ahead of print.

ABSTRACT

Light (LM) and specular microscopies (SM) are standard techniques used by eye banks during corneal endothelial cell density (ECD) and morphology evaluation. This study aimed to develop a novel Hybrid method (HY) that integrates the benefits of both SM and LM while minimizing their drawbacks. A total of 283 endothelial images from LM and SM were analyzed from 31 corneas. For HY analysis, LM images were processed using SM-dedicated software to semi-automatically determine ECD, CV% (coefficient of variation), and HEX% (hexagonality). Agreements between LM, SM, and HY, as well as inter-operator bias, were assessed using the Bland-Altman analysis. Evaluability of corneas with LM, SM, and HY was recorded during 311 examinations on 70 corneas. HY agreed with SM in ECD determination, while LM differed from HY (bias: 134 cells/mm²) and SM (bias: 115 cells/mm²). HY showed agreement with SM in HEX% determination, while a bias of 3.4% was observed in CV%. Inter-operator variability analysis showed significant differences in LM evaluations (ECD, EC morphology score). For HY, no significant inter-operator bias was obtained in ECD and HEX%, whereas CV% displayed a significant bias (3.1%). Corneal evaluability was significantly higher in LM and HY (both 96.5%) than in SM (72.7%). HY enabled quantitative ECD and morphology investigation of corneal endothelia using LM-obtained images. HY, SM, and LM techniques statistically agreed in ECD and morphology examinations, or showed clinically acceptable bias. The HY method demonstrated lower inter-operator variability than LM and higher evaluability than SM.

PMID:41074540 | DOI:10.1002/jemt.70079

J Inherit Metab Dis. 2025 Nov;48(6):e70099. doi: 10.1002/jimd.70099.

ABSTRACT

Urea cycle disorders (UCDs) are rare inherited metabolic diseases characterized by defective detoxification of nitrogen, leading to hyperammonemia and neurological complications. While pediatric UCDs have been extensively studied in Japan, data on adult patients remain limited. This study aims to evaluate the current status of Japanese adult UCD patients, hereby comparing long-term outcomes after neonatal/infantile or late onset in a new nationwide study investigating clinical manifestations and management. In total, we collected data of 116 adult UCD patients diagnosed and/or treated at various institutions, combining this new cohort (34 UCD patients between January 2010 and December 2022) with data from a previous nationwide study (82 UCD patients between January 2000 and March 2018). Among 116 adult UCD patients, ornithine transcarbamylase deficiency was the most common subtype (N = 69). Hyperammonemia occurred in 91.4% of patients, and intellectual disability was present in 50.0%. Patients generally showed reduced final height and BMI compared to Japanese controls, particularly among females and those with infantile-onset UCDs. Peak ammonia levels ≥ 360 μmol/L were significantly associated with intellectual disability. Liver transplantation (LT) was performed in 20 patients, and although it helped to avoid hyperammonemia, it did not statistically improve neurocognitive outcomes in patients with peak ammonia < 360 μmol/L. This study provides the first comprehensive overview of adult UCD patients in Japan, highlighting frequent growth impairment and variable cognitive outcomes. LT improves metabolic control but cannot prevent intellectual disability in all patients. These findings underscore the need for early diagnosis, individualized treatment strategies, and long-term follow-up into adulthood.

PMID:41074536 | DOI:10.1002/jimd.70099

BMC Infect Dis. 2025 Oct 10;25(1):1268. doi: 10.1186/s12879-025-11728-2.

ABSTRACT

BACKGROUND: TB is a chronic infectious disease caused by the rod-shaped bacillus Mycobacterium tuberculosis. Ethiopia is ranked 12th among the 30 countries with a high TB burden. The aim of this study was to assess the prevalence and associated risk factors for pulmonary tuberculosis (PTB) among suspected patients in Sawla General Hospital, Gofa Zone, Southern Ethiopia.

METHODS: A hospital-based cross-sectional study was carried out on 253 suspected tuberculosis (TB) patients who visited Sawla General Hospital between September 21 and October 24, 2023. The data were collected using a structured questionnaire. Sputum samples were examined using the GeneXpert MTB/RIF assay. The data were analyzed using SPSS version 27. Descriptive statistics are presented as frequencies and percentages. Logistic regression was used to identify the factors associated with tuberculosis. A p value < 0.05 indicated statistical significance.

RESULTS: The age range of the study participants was 18 to 89 years, with a mean age of 38.9 years and a standard deviation of 12.0 years. Among 253 suspected TB patients, 27 (10.7%) were identified as having PTB. A relatively higher proportion of PTB cases 18.4% (7/38) was observed among individuals aged 45-54 years, 11.8% (13/110) of females, 16.2% (11/68) of urban residents, 33.3% (2/6) of widowed individuals, and 22.2% (2/9) of students. According to the current study, smoking status and khat chewing status were significantly associated with PTB, with AORs of 3.547 (1.084, 11.605; 95% CI) and 2.852 (1.029, 7.904; 95% CI), respectively.

CONCLUSION: Cigarette smoking and khat chewing were found to be associated with PTB. These findings suggest that targeted health education and behavioral interventions may be beneficial.

PMID:41073914 | DOI:10.1186/s12879-025-11728-2

BMC Emerg Med. 2025 Oct 10;25(1):204. doi: 10.1186/s12873-025-01364-z.

ABSTRACT

BACKGROUND: The Saitama Tone Health and Medical Care Region Medical Collaboration Promotion Council has established a regional medical network system (Patient-Centered Digital Health Records, Tonetto) that shares medical information among healthcare facilities and provides medical services to Tonetto users. This system has facilitated the sharing of medical information between core hospitals, general hospitals, and clinics, thereby contributing to improved medical care. Furthermore, Tonetto has facilitated the availability of patient information for emergency transport. This study aimed to evaluate the impact of Tonetto on emergency transportation times for older patients.

METHODS: The study population consisted of 1,820 older patients (aged 65 and over) among 2,542 emergency patients transported to East Saitama General Hospital between January and December 2023. Based on their registration status in the Tonetto system, the patients were divided into two groups: a Tonetto-registered group (n = 319) and a Tonetto-nonregistered group (n = 1,501). Statistical analysis was performed using a general linear model that included main effects and interaction terms for the three categories of transport distance (< 5, 5-10, and ≥ 10 km) and two categories of Tonetto registration status. The difference in transport time was estimated based on Tonetto registration status for each transport distance category. To control for confounding variables, the model included severity, age, sex, and transport distance as covariates.

RESULTS: The difference in transport time (minutes) between the Tonetto-nonregistered group and the Tonetto-registered group (95% confidence interval) was – 0.3 (- 3.0, 2.4), – 3.5 (- 8.9, 1.9), – 24.3 (- 38.3, – 10.2), respectively. A reduction of 24 min in transport time was observed in the Tonetto-registered group for distances of 10 km or more (p = 0.001).

CONCLUSIONS: Tonetto registration was associated with a substantial reduction in emergency transport time for older patients over long distances. These findings demonstrate the potential of regional medical information networks to improve the efficiency of emergency care and support the development of a nationwide emergency medical information system in Japan.

PMID:41073895 | DOI:10.1186/s12873-025-01364-z

BMC Cardiovasc Disord. 2025 Oct 10;25(1):734. doi: 10.1186/s12872-025-05133-5.

ABSTRACT

BACKGROUND: The appropriate periprocedural management of oral anticoagulation in transcatheter aortic valve implantation (TAVI) patients who require long-term anticoagulation remains controversial.

PURPOSE: This systematic review and meta-analysis compare the efficacy and safety of periprocedural continuation versus interruption of anticoagulation in patients undergoing TAVI with an indication for long-term anticoagulation.

METHODS: We searched PubMed, Embase, and Cochrane Central databases to identify relevant articles. We included both observational and randomized controlled trials. Data were analysed using random-effects model to calculate the odds ratio (OR) with 95% confidence intervals (CIs). A p < .05 was considered statistically significant.

RESULTS: Four studies comprising 3,144 patients, with anticoagulation continued in 1,500 (47.7%) patients were included. There were no difference between periprocedural continuation and interruption of anticoagulation in the incidence of composite outcomes (OR: 0.84; 95% CI: 0.64-1.10; p = .19), major bleeding (OR: 0.98; 95% CI: 0.57-1.68; p = .95), major vascular complications (OR: 0.93; 95% CI: 0.72-1.20; p = .60), and myocardial infarction (MI) (OR: 0.60; 95% CI: 0.20-1.77; p = .36). However, the incidence of stroke was significantly lower in the continuation group (OR: 0.61; 95% CI: 0.39-0.94; p = .03). The incidence of blood transfusion was not significantly different between the continuation and interruption groups (OR: 0.86; 95% CI: 0.42-1.77; p = .68).

CONCLUSIONS: In this meta-analysis comparing periprocedural continuation of anticoagulation to interruption of therapy in patients undergoing TAVI with concomitant indications for long-term anticoagulation, continuation of anticoagulation was associated with a lower incidence of stroke without increasing the risk of bleeding. These findings suggest a potentially favourable safety profile in favour of continuation of anticoagulant therapy, they should be interpreted with caution and validated in larger and well-designed randomised trials. The review protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number (CRD42024607149).

PMID:41073885 | DOI:10.1186/s12872-025-05133-5

J Appl Clin Med Phys. 2025 Oct;26(10):e70279. doi: 10.1002/acm2.70279.

ABSTRACT

PURPOSE: Improved accuracy in 4DCT imaging and precise targeting of tumors contribute to more effective and targeted radiation therapy. This study focuses on evaluating the accuracy of utilizing the GateCT (VisionRT Ltd, London, United Kingdom) in comparison with a pressure sensor system (ANZAI Medical Co., Ltd., Shinagawa, Tokyo) to provide 4DCT with respiratory information.

METHODS: A dynamic breathing phantom enclosing three spheres (A, P, and R) of different densities was enrolled to produce breathing patterns tracked by the two systems. Image sets for three breathing phases obtained based on GateCT and ANZAI systems were analyzed using deformable registration by deforming the three-phase image sets with the static image sets. Our deformable registration approach revealed how far different phase image sets were from the quantified by various metrics, such as dice similarity coefficient (DSC), mean surface distance (MSD), absolute volume estimation, mean Jacobian, and Warp.

RESULTS: Results indicated DSC values greater than 0.90 across all phases and spheres for both respiratory systems, with mean DSC values for spheres A, P, and R of 0.980 versus 0.977, 0.977 versus 0.976, and 0.977 versus 0.976 for GateCT and ANZAI systems, respectively. MSDs for both systems were consistently less than 2 mm across all spheres and phases. Furthermore, the mean volume estimation error for both systems, relative to the static, exhibited statistical insignificance (p > 0.05). Friedman test revealed significant differences in median Jacobian, and median Warping between the two systems (p < 0.05).

CONCLUSIONS: In addition to the effectiveness of deformable image registration in the quantification of respiratory system performance, both systems exhibited comparable performance in providing 4DCT with respiratory information.

PMID:41073878 | DOI:10.1002/acm2.70279

J Appl Clin Med Phys. 2025 Oct;26(10):e70306. doi: 10.1002/acm2.70306.

ABSTRACT

PURPOSE: Lattice radiotherapy (LRT), a form of spatially fractionated radiation therapy (SFRT), has emerged as a promising approach for treating massive tumors. By delivering high-dose regions within the tumor while sparing surrounding healthy tissue, LRT offers distinct advantages over conventional radiotherapy. Recent advancements in treatment planning systems (TPS), particularly the integration of intelligent optimization engines (IOEs) with automated planning capabilities, have the potential to further refine and expand the clinical utility of LRT. This study aimed to comparatively evaluate the planning quality and clinical feasibility of lattice SFRT treatment plans generated using the Ethos planning system, equipped with an IOE and O-ring linear accelerator, versus the Eclipse planning system paired with a conventional C-arm TrueBeam linac, in patients with stage III non-small cell lung cancer (NSCLC).

METHODS: Twenty retrospective stage III NSCLC cases (GTV > 200 cc) with available PET-CT imaging were selected. A total of 40 plans (20 Eclipse, 20 Ethos) were compared, incorporating lattice spheres (1 cm diameter, 2 cm spacing between spheres) placed in the tumor, FDG-PET/CT-informed intratumoral heterogeneity, prioritizing viable perinecrotic subregions while avoiding critical OARs. Plans aimed to deliver 15 Gy to lattice spheres, limit Valley (PTV minus spheres) doses to 2 Gy, and restrict doses to organs at risk (OARs) to ≤ 3 Gy. Dose conformity, OAR sparing, dose gradient parameters (PEDR, PVDR), planning time, and deliverability, which was evaluated using ArcCheck, EPID gamma analysis, and MLC log-file verification.

RESULTS: Ethos demonstrated statistically significant improvements compared to Eclipse in lattice sphere mean dose (17.2 Gy vs. 15.83 Gy, p < 0.001), V15 Gy coverage (98.2 % vs. 91.74 %, p < 0.001), and dose gradient metrics (PEDR: 6.42 vs. 5.80; PVDR: 3.70 vs. 3.29; both p < 0.001, and VPDR: 0.131 vs. 0.135; PVDR_DVH: 7.62 vs. 7.41). For the valley target, Ethos plans demonstrated a lower mean dose (Dmean: 4.72 Gy vs. 4.91 Gy, p = 0.064), although not statistically significant, and achieved significantly improved dose gradient at V7.5 Gy (14.5% vs. 16.35%, p = 0.019), V5Gy (30.77% vs. 34.84%, p = 0.006), and V2Gy (99.77% vs. 97.79%, p < 0.001) compared to Eclipse. Ethos achieved significantly better OAR sparing, particularly for the bronchial tree, heart, spinal cord, esophagus, and great vessels (all p < 0.01). Furthermore, Ethos substantially reduced planning time (36.55 vs. 95.96 min, p < 0.001). Both planning systems achieved high gamma passing rates (> 95%), confirming the accuracy and deliverability of the treatment plans.

CONCLUSION: The Ethos automated treatment planning demonstrated superior lattice dose conformity, enhanced OAR sparing, and significantly faster optimization compared to Eclipse. This automated optimization capability highlights the potential of Ethos for efficient and effective lattice radiotherapy in managing massive NSCLC tumors.

PMID:41073872 | DOI:10.1002/acm2.70306

Eur J Orthop Surg Traumatol. 2025 Oct 10;35(1):430. doi: 10.1007/s00590-025-04558-0.

ABSTRACT

PURPOSE: Tibial plateau fractures can result in significant morbidity, and complications following surgical fixation may negatively impact recovery. We aimed to evaluate whether such complications influence patient-reported outcomes at 6 months postoperatively.

METHODS: We conducted a retrospective cohort study at a single level I trauma center from 2022 to 2024. Adult patients who sustained a tibial plateau fracture (AO/OTA 41) treated with open reduction internal fixation (ORIF) were eligible for inclusion if they had completed Patient-Reported Outcomes Measurement Information System (PROMIS) surveys at 6 months postoperatively and had clinical follow-up confirming radiographic healing. Patients were excluded if they were under 18 years of age, lacked adequate medical record documentation, were managed non-operatively or with closed reduction percutaneous fixation, or did not complete PROMIS surveys at the 6-month time point. The primary outcomes were PROMIS scores assessing physical function (PF), pain interference (PI), global physical health (GPH), global mental health (GMH), anxiety, and depression. Secondary outcomes included percent of normal function and Brief Resilience Scale (BRS) scores. These outcomes were compared between patients who experienced complications and those who did not.

RESULTS: A total of 106 patients were included (mean age 50.4 years; mean follow-up 261.5 days). Complications occurred in 25.5% of patients, including fracture-related infection (FRI, 10.4%), DVT/PE (7.5%), and reoperation within 6 months (11.3%). Patients with FRI had significantly lower PROMIS-PF scores at 6 months compared to those without FRI (31.5 vs. 37.4, p = 0.015), exceeding the MCID. Other PROMIS domains were not significantly different. Patients undergoing early reoperation prior to 6 months, or reoperation to promote bone healing at any timepoint, demonstrated lower PF scores, though these differences were not statistically significant.

CONCLUSION: In this cohort of patients with tibial plateau fractures, FRI was associated with significantly worse physical function at 6-months as measured by the PROMIS-PF score. This difference was also clinically significant, exceeding the MCID.

PMID:41073836 | DOI:10.1007/s00590-025-04558-0