Nevin Manimala

Aust Vet J. 2025 Jun 12. doi: 10.1111/avj.13456. Online ahead of print.

ABSTRACT

OBJECTIVE: To quantify the intensity of sound associated with breathing in brachycephalic dogs and determine detectability on a mobile phone application (app). In addition, analyse differences in sound volume before and after sedation, and 2 weeks post-surgical treatment of brachycephalic obstructive airway syndrome (BOAS).

STUDY DESIGN: Clinical prospective pilot study.

ANIMALS: 28 brachycephalic dogs.

METHODS: A mobile phone app was used to measure and record the sound of breathing in decibels (dB) in a quiet room before and after sedation, as well as 10-14 days following corrective surgery. Statistical analysis was performed to determine if there was an improvement in breathing volume between each time point.

RESULTS: Prior to sedation, the mean sound intensity was 30.8 dB. After sedation of 5 minutes, it decreased significantly to 25.8 dB (p = 0.0013). At the post-operative consultation (10-14 days later), the mean intensity had further declined to 22.9 dB, significantly lower than both pre-sedation and post-sedation values (P < 0.001).

CONCLUSION: The intensity of a brachycephalic patient’s breathing is detectable by a mobile phone app and significantly reduces following surgical treatment involving palatoplasty, sacculectomy and alarplasty.

CLINICAL SIGNIFICANCE: With further research, the loudness of breathing may prove to be a useful, readily available, objective measurement tool to add to the current BOAS grading systems, allowing communication between veterinarians regarding the severity of BOAS. Future prospective studies may also involve the correlation of measurements with the risk of complications.

PMID:40506753 | DOI:10.1111/avj.13456

Addict Sci Clin Pract. 2025 Jun 12;20(1):49. doi: 10.1186/s13722-025-00578-7.

ABSTRACT

BACKGROUND: Substance use disorder (SUD) is a growing public health concern in Sweden. Various treatments for SUD exist, with motivational treatment, cognitive behavioral therapy, and relapse prevention being the nationally recommended approaches. Attachment theory and the salutogenic theory with its core concept, sense of coherence (SOC) provides valuable insights into individuals’ available personal resources and their potential for adherence to treatment. The aims of the present study were to examine attachment styles (secure, insecure-avoidant, and insecure-anxious) and SOC (overall and dimensional – comprehensibility, manageability, and meaningfulness- scores) in individuals with SUD; to explore potential correlations between these constructs ; and to assess their predictive value for treatment completion.

METHODS: Clinical data were collected between 2014 and 2023 from 164 clients at a Swedish outpatient clinic for addiction who initiated the intensive, integrated treatment program. The sample comprised 109 men and 55 women, aged 18 to 72 years (M = 40.71). Data were gathered using validated self-report instruments (the Attachment Style Questionnaire and the Sense of Coherence Questionnaire). Statistical analyses included descriptive statistics, correlation analysis, and logistic regression.

RESULTS: Individuals with SUD predominantly exhibited an insecure-avoidant attachment style. The four dimensions reflecting insecure attachment (discomfort with relationships, relationships as secondary, need for approval, and preoccupation with relationships) were negatively correlated with overall SOC and its three components. In contrast the secure attachment dimension (confidence in self and others) showed positive association with SOC. The strongest associations were found between the manageability component of SOC and all attachment dimensions. The insecure-anxious attachment style showed the strongest association with early dropout from treatment, while higher manageability was significantly associated with an increased likelihood of treatment completion.

CONCLUSION: The predominance of an insecure-avoidant attachment style among clients undergoing intensive, integrated treatment for SUD underscores the importance of reinforcing a secure attachment and strengthening SOC to facilitate treatment completion. These findings highlight the need for comprehensive, integrated social and psychiatric care for individuals with SUD.

PMID:40506751 | DOI:10.1186/s13722-025-00578-7

J Med Case Rep. 2025 Jun 12;19(1):272. doi: 10.1186/s13256-025-05343-7.

ABSTRACT

BACKGROUND: Renal tubular acidosis is a rare disorder affecting acid-base balance, and its coexistence with endocrine abnormalities such as hyperparathyroidism and pheochromocytoma is exceptionally uncommon. This combination presents unique diagnostic and therapeutic challenges requiring a multidisciplinary approach.

CASE PRESENTATION: A 25-year-old Iranian woman presented with recurrent flank pain, episodic palpitations, headaches, and intermittent hypertension. Imaging revealed bilateral nephrolithiasis, leading to ureteroscopic lithotripsy. Biochemical evaluation confirmed distal renal tubular acidosis (type 1), hyperparathyroidism, and pheochromocytoma, a rare and complex association. Metabolic acidosis, hypokalemia, and elevated catecholamine metabolites were noted. Potassium citrate was prescribed for stone prevention, and the patient remains asymptomatic after a year of follow-up.

CONCLUSION: This case underscores the need for heightened clinical suspicion when nephrolithiasis is accompanied by systemic symptoms. The rare coexistence of renal tubular acidosis, hyperparathyroidism, and pheochromocytoma highlights the importance of early recognition and a multidisciplinary approach to prevent complications and optimize patient outcomes.

PMID:40506745 | DOI:10.1186/s13256-025-05343-7

Mov Ecol. 2025 Jun 12;13(1):41. doi: 10.1186/s40462-025-00567-0.

ABSTRACT

BACKGROUND: Animal movement is influenced by both the physical environment and social environment. The effects of both environments are not independent from each other and identifying whether the resulting movement trajectories are shaped by interactions between individuals or whether they are the result of their physical environment, is important for understanding animal movement decisions.

METHODS: Here, we assessed whether the commonly used methods for inferring interactions between moving individuals could discern the effects of environment and other moving individuals on the movement of the focal individual. We used three statistical methods: dynamic interaction index, and two methods based on step selection functions. We created five scenarios in which the animals’ movements were influenced either by their physical environment alone or by inter-individual interactions. The physical environment is constructed such that it leads to a correlation between the movement trajectories of two individuals.

RESULTS: We found that neglecting the effects of physical environmental features when analysing interactions between moving animals leads to biased inference, i.e. inter-individual interactions spuriously inferred as affecting the movement of the focal individual. We suggest that landscape data should always be included when analysing animal interactions from movement data. In the absence of landscape data, the inference of inter-individual interactions is improved by applying ‘Spatial+’, a recently introduced method that reduces the bias of unmeasured spatial factors.

CONCLUSIONS: This study contributes to improved inference of biotic and abiotic effects on individual movement obtained by telemetry data. Step selection functions are flexible tools that offer the possibility to include multiple factors of interest as well as combine it with Spatial+.

PMID:40506736 | DOI:10.1186/s40462-025-00567-0

Crit Care. 2025 Jun 12;29(1):239. doi: 10.1186/s13054-025-05469-6.

ABSTRACT

BACKGROUND: Invasive group A streptococcus (iGAS) infection incidence is rising. These infections have been studied as a whole but can be associated with critical illness in a population with a wide array of underlying conditions, sites of infection and clinical presentations. Using an unsupervised clustering approach, we aimed to identify specific clinical phenotypes regarding presentation, management and outcome.

METHODS: This was a retrospective multicentric study including all patients admitted to one of 9 ICUs of Paris University Hospitals for an iGAS infection between 01/03/2018 and 01/08/2023. iGAS infection was defined as GAS growth in any microbiological sample from a sterile site. Patients were grouped according to a clustering algorithm (k-prototypes) using a comprehensive set of clinical and biological variables available upon ICU admission. Clusters were described and clinical presentation, management and outcome were compared.

RESULTS: 148 patients were included. According to the Silhouette criterion, patients were grouped in 3 clusters, and 7 patients remained unclassified. Cluster 1 (n = 73) comprised a greater proportion of less severely-ill female patients with painful skin and soft tissue infections, a quarter of whom had taken non-steroidal anti-inflammatory drugs. Cluster 2 (n = 42) was characterized by a high rate of respiratory infections with frequent viral co-infections. Cluster 3 (n = 26) included mostly socially deprived patients with high rates of chronic alcohol consumption and psychiatric illness, with severe organ dysfunction related to otherwise pauci-symptomatic skin and soft tissue infections. There was no significant difference in time to source control across clusters (0 [0-0] vs 0 [0-0] vs 0 [0-1] days, p = 0.12). Patients included in cluster 2 less frequently received antitoxin antibiotics than patients from clusters 1 and 3 (79% vs 45% vs 69%, p < 0.001) and tended to more frequently require ECMO support (3% vs 12% vs 0%, p = 0.07), while those from cluster 1 were less likely to receive invasive mechanical ventilation (48% vs 74% vs 77%, p = 0.005). There was no difference in ICU-mortality between clusters (19% vs 29% vs 31%, p = 0.32).

CONCLUSIONS: Based on simple and readily available clinical admission characteristics of critically ill patients with iGAS, unsupervised clustering analysis identified three specific patient populations that differed regarding ICU management. Whether tailoring management would affect outcome warrants further research.

PMID:40506732 | DOI:10.1186/s13054-025-05469-6

Harm Reduct J. 2025 Jun 12;22(1):106. doi: 10.1186/s12954-025-01246-4.

ABSTRACT

BACKGROUND: Drug consumption rooms (DCRs) are harm reduction facilities providing safer and hygienic setting for supervised administration of drugs aimed at decreasing negative health and social consequences of drug use. The first DCR in Czechia was opened in September 2023 in city of Brno in a mobile form operating in a socially excluded area (SEA). A research project informed the implementation of the DCR.

METHODS: A mixed methods design was applied in the following phases: desk review, research before and after the launch of the mobile DCR, and routine monitoring of programme performance. Two cross-sectional questionnaire surveys among PWUDs (n = 131 and 135), ethnographic observation, focus group (n = 19), interviews with PWUDs (n = 26 and 19), with personnel of addiction services and local officials (n = 16 and 12), and residents (n = 7 and 6) were performed prior to and after the launch of the DCR. Thematic analysis of qualitative data, descriptive and regression analyses of quantitative data were performed.

RESULTS: There was a need and high willingness to use the DCR among potential clients. The significant predictors were opioid use (adjusted odds ratio, AOR = 3.4 in survey 1 and 3.9 in survey 2), drug injection in the last 30 days (AOR 4.3 in survey 1), being in the probationary period during the previous 30 days (AOR 10.0 in survey 1), witnessing an overdose in the past 30 days (AOR 8.5 in survey 2), HCV positivity ever in life (AOR 2.9 in survey 2), living in SEA (AOR 2.7 in survey 2) and Roma ethnicity (AOR 2.8 in survey 2). The beginnings of the DCR were relatively slow with low initial number of clients and drug administrations. However, with time, and programme adjustments following research results, the attendance at the facility has grown.

CONCLUSIONS: Research was instrumental in shaping the DCR in Brno before and during its implementation. The DCR showed a potential to attract the most vulnerable PWUDs from SEA. Despite a slow start, the DCR has become an integral part of low-threshold services for PWUDs in Brno and has proven its feasibility in the Czech settings.

PMID:40506711 | DOI:10.1186/s12954-025-01246-4

Malar J. 2025 Jun 12;24(1):189. doi: 10.1186/s12936-025-05444-0.

ABSTRACT

BACKGROUND: Global malaria control programmes such as approaches to community engagements to deliver malaria control interventions have been successful in controlling malaria. Strategies aimed at accelerating patients’ adherence to prescribed artemisinin-based combination therapy (ACT) are needed in the fight to control and eradicate malaria. Previous studies have shown the power of health education in improving patients’ adherence to ACT. The objective of this study was to establish the impact of a community health education intervention on the patients’ adherence to malaria ACT in Kamuli District, Uganda.

METHODS: A pre-post-test intervention study without a control group was used to understand the impact of community health education training in improving patients’ adherence to ACT. Quantitatively, equal number of 1266 patients were enrolled and assigned into any of the three arms equally (422)-no follow up, follow-up on day 2 and day 4 arm at pre-test and post-test phases. Qualitatively, 24 key informants were enrolled purposively. Mann-Whitney U test was used to establish the impact of the community health education on patients’ adherence to ACT. Statistical significance was established at p < 0.05. Qualitative data was analysed using the thematic analysis technique.

RESULTS: A total of 1688 patients were analysed. At pre-test, the median age was 20 years with majority (64.3%) being females while patients’ adherence was reported to be 588/844 (69.7%). At post-test, the median age was 21 years, majority (62.6%) females, and patients’ adherence 700/844 (82.9%). A Mann-Whitney U test showed a statistically significant difference in the patients’ adherence to ACT of pre-test and post-test after the intervention (U = 308,904, Z = – 6.409, p < 0.0001), with higher adherence at post-test (median = 900.5) than pre-test (median = 788.5) and small effect (0.156). Qualitatively, not all health workers explain clearly how to use the ACT medicines prescribed.

CONCLUSION: Community health education as an intervention was effective in improving patient’s adherence to ACT. Therefore, there is need to avail medical supplies and patient education with adherence support to ensure adequate patients’ adherence to ACT.

PMID:40506709 | DOI:10.1186/s12936-025-05444-0

Ann Surg Oncol. 2025 Jun 12. doi: 10.1245/s10434-025-17640-y. Online ahead of print.

ABSTRACT

BACKGROUND: Neoadjuvant chemotherapy (NAC) has emerged as a potential alternative to upfront surgery (US) followed by adjuvant chemotherapy in locally advanced colon cancer (LACC), offering benefits such as early micrometastases eradication and improved surgical outcomes. However, its efficacy and safety remain uncertain owing to conflicting evidence.

PATIENTS AND METHODS: A systematic review and meta-analysis was conducted evaluating randomized controlled trials (RCTs) comparing NAC with US with adjuvant chemotherapy for LACC. Primary outcomes were 5-year overall survival (OS) and disease-free survival (DFS). Secondary outcomes included positive surgical margin rates and anastomotic leak/abscess. Statistical analyses employed random-effects models, with trial sequential analysis (TSA) assessing the robustness of results.

RESULTS: Eight RCTs with low risk of bias involving 3038 patients were included. NAC improved 5-year OS (81.4% versus 77.8%, hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.64-0.91, p = 0.0028) and DFS (79.2% versus 73.7%, HR 0.80, 95% CI 0.68-0.93, p = 0.0033), with low heterogeneity (I² ≤ 4.4%). NAC significantly reduced positive margin rates (4.1% versus 6.3%, HR 0.49, p = 0.0011) without increasing anastomotic leak/abscess (p = 0.09). The leave-one-out and the TSA analyses confirmed the robustness of OS and DFS findings, with the cumulative Z-curve crossing both the conventional and trial sequential monitoring boundaries for benefit. The GRADE assessments indicated high quality of evidence for the primary outcomes.

CONCLUSIONS: NAC offers superior OS, DFS, and surgical margin outcomes in LACC without heightened surgical risks, supporting its inclusion as a viable and safe treatment option.

PMID:40506679 | DOI:10.1245/s10434-025-17640-y

J Oral Rehabil. 2025 Jun 12. doi: 10.1111/joor.14009. Online ahead of print.

ABSTRACT

INTRODUCTION: Dental implant surgery has become a prevalent treatment option for patients with single tooth defects. However, the success of this surgery relies heavily on precise planning and execution. This study investigates the application of artificial intelligence (AI) in assisting the planning process of dental implant surgery for single tooth defects. Single tooth defects in the oral cavity pose a significant challenge in restorative dentistry. Dental implant restoration has emerged as an effective solution for rehabilitating such defects. However, the complexity of the procedure and the need for accurate treatment planning necessitate the integration of advanced technologies. In this study, we propose the utilisation of AI to enhance the precision and efficiency of implant surgery planning for single tooth defects.

MATERIALS AND METHODS: A total of twenty patients with single tooth loss were enrolled. Cone-beam computed tomography (CBCT) and intra-oral scans were obtained and imported into the AI-dentist software for 3D reconstruction. AI assisted in implant selection, tooth position identification, and crown fabrication. Evaluation included subjective verification and objective assessments. A paired samples t-test was used to compare planning times (dentist vs. AI), with a significance level of p < 0.05.

RESULTS: Twenty patients (9 male, 11 female; mean age 59.5 ± 11.86 years) with single missing teeth participated in this study. Implant margins were carefully positioned: 3.05 ± 1.44 mm from adjacent roots, 2.52 ± 0.65 mm from bone plate edges, 3.05 ± 1.44 mm from sinus/canal, and 3.85 ± 1.23 mm from gingival height. Manual planning (21.50 ± 4.87 min) was statistically significantly slower than AI (11.84 ± 3.22 min, p < 0.01). Implant planning met 100% buccolingual/proximal/distal bone volume criteria and 90% sinus/canal distance criteria. Two patients required sinus lifting and bone grafting due to insufficient bone volume.

CONCLUSION: This study highlights the promising role of AI in enhancing the precision and efficiency of dental implant surgery planning for single tooth defects. Further studies are necessary to validate the effectiveness and safety of AI-assisted planning in a larger patient population.

PMID:40506671 | DOI:10.1111/joor.14009

J Relig Health. 2025 Jun 12. doi: 10.1007/s10943-025-02356-w. Online ahead of print.

ABSTRACT

In illnesses such as cancer, which require prolonged and intensive treatment, patients’ spiritual well-being plays a critical role in enhancing their sense of life meaning and may positively influence treatment outcomes. This descriptive study evaluated the spiritual well-being of patients with cancer. The sample consisted of 300 cancer patients receiving care in the medical oncology service and outpatient chemotherapy unit of a training and research hospital in Ankara between February and May 2024. Data were collected using an introductory information form and the Spiritual Well-Being Scale. A statistically significant relationship was found between the subscale scores and patients’ gender, education level, income level, diagnostic status, and time since diagnosis (p < 0.05). In conclusion, the study showed that cancer patients demonstrated moderate levels of meaning and peace and high levels of belief. These findings indicate a potential need for interventions that address the spiritual and religious care needs of cancer patients following diagnosis.

PMID:40506662 | DOI:10.1007/s10943-025-02356-w