Nevin Manimala

Int J Mol Sci. 2025 Apr 21;26(8):3904. doi: 10.3390/ijms26083904.

ABSTRACT

Severe immune effector cell-associated neurotoxicity syndrome (ICANS) occurs in about 30% of all patients with large B-cell lymphoma (LBCL) who are treated with axicabtagene ciloleucel (axi-cel). There are currently limited treatment strategies other than the standard corticosteroids, and it is essential to find additional therapies to manage severe ICANS. We conducted a retrospective study of neurologic outcomes among patients who received axi-cel for LBCL from May 2015 to February 2019. We identified patients who developed severe ICANS and were treated with glucocorticoids followed by intravenous immunoglobulin (IVIG) (n = 9) or glucocorticoids alone (n = 10). There was no statistically significant difference in the time to resolution (TTR) of severe ICANS between groups; however, patients in the IVIG had more severe grades of ICANS with a lower performance status at baseline. The cumulative steroid days were 11.2 in the IVIG arm and 13.5 in the glucocorticoids-only arm. The use of IVIG for severe ICANS after axi-cel therapy was tolerable and safe and is generally recommended in the CAR-T setting in patients with hypogammaglobinemia. The use of IVIG as a potential therapeutic agent for severe ICANS can be further explored in future prospective studies.

PMID:40332772 | DOI:10.3390/ijms26083904

J Forensic Odontostomatol. 2025 Apr 30;43(1):19-32. doi: 10.5281/zenodo.15044914.

ABSTRACT

Sexual dimorphism is an important biological factor for sex estimation from skeletal remains in medicolegal identification. This study aimed to determine using a discriminant function analysis, whether specific maxillary linear and angular measurements performed in cone-beam computed tomography (CBCT) images may be useful to determine the sex in a Colombian population. The sample consisted of 212 CBCT scans acquired from 86 males and 126 females. The protocol included the assessment of 23 parameters, of which 16 were bilateral and seven were non-bilateral. An intra-observer variability test was performed to ensure data reliability and unpaired t tests were applied to determine between-group differences. Significant predictor variables were subjected to univariate and multivariate discriminant function analyses. A total of five non-bilateral and 14 bilateral measures were statistically significant. Univariate discriminant analyses produced a mean percentage of correct prediction after cross-validation ranging from 55.20% to 72.60% for non-bilateral and from 58.70% to 73.10% for bilateral maxillary variables. The association of variables in the multivariate models increased the percentages of correct sex prediction even after cross-validation up to 77.80% for non-bilateral and up to 77.40% for bilateral maxillary measurements. It was concluded that CBCT measurement of maxillary bone parameters may be applied as a complementary technique to discriminate the sex from human remains through discriminant function analysis methods in the Colombian population.

PMID:40332765 | DOI:10.5281/zenodo.15044914

J Forensic Odontostomatol. 2025 Apr 30;43(1):11-18. doi: 10.5281/zenodo.15031141.

ABSTRACT

BACKGROUND: Despite the surging crime rates and diverse operating methods, identifying the perpetrators and suspects is challenging. Incorporating forensic odontology has expanded the scope of forensics. Over the years, saliva has become the hallmark of forensics. This study aimed to develop a scale for assessing the knowledge and awareness about the role of saliva in forensic odontology. The scale was developed sequentially according to the qualitative research methodology: formation of a conceptual framework, systematic development of an item pool and refinement of an item pool (focus group discussion, cognitive interviewing and pretesting). Then, the validity and reliability of the scale were tested.

RESULTS: A conceptual framework was developed based on five constructs, which included forensic sciences, forensic odontology, crime investigations, salivary analysis and forensic genetics. A pool of 28 items was designed based on existing literature and refined through a focus group discussion involving the target audience and expert panellists. After validation by cognitive interview and pretesting, the scale was condensed into a pool of 23 items. Statistical analysis revealed a Cronbach’s alpha of 0.8 (good reliability) and kappa value of 0.79, indicating a strong level of agreement.

CONCLUSION: The Salivary Analysis for Forensic Evidence scale is a valid and reliable tool that consolidates all possible constructs involved in assessing the role of saliva in forensic odontology.

PMID:40332764 | DOI:10.5281/zenodo.15031141

J Forensic Odontostomatol. 2025 Apr 30;43(1):2-10. doi: 10.5281/zenodo.15046145.

ABSTRACT

In forensics, dental age estimation is crucial, and literature has many methods for estimating dental age. London Atlas of Human Tooth Development and eruption method was developed on British and Bangladeshi populations in 2010, and there are likely to be differences between other populations. Malaysian children have not yet been extensively tested for the method’s applicability despite its universal acceptance and reliability. This research aimed to test the applicability of The London Atlas of human tooth development and eruption in children of the Malaysian population aged 4 to 16.99 years old. The study sample included 523 panoramic radiographs of healthy patients who had attended the Dental Paediatrics Department Hospital Tunku Azizah, Malaysia, between May 2019 and December 2019. The intra- and inter-observer errors were analysed by taking 53 radiographs and evaluating them over 14 days using the interclass correlation and Cohen’s Kappa index. A paired t-test was used to compare chronological and estimated age ANOVA F-tests were used to establish if the difference is statistically significant between chronological and estimated age. The range of age estimation fell within a year due to the mean absolute difference of 0.60 years. The mean age for estimated age was 9.31±3.18 for the overall sample, 9.06±3.09 for males, and 9.60±3.27 for females. Paired t-test analysis showed the mean difference between chronological and estimated age of -0.0365 and was not statistically significant (p=0.240). The result also showed no statistically significant difference between the sexes. The difference between the chronological and estimated age was underestimated within minimal range, 0.002 years in males and 0.08 years in females. The London Atlas of human tooth development and eruption showed high accuracy in Malaysian children.

PMID:40332763 | DOI:10.5281/zenodo.15046145

Obes Surg. 2025 May 7. doi: 10.1007/s11695-025-07886-6. Online ahead of print.

ABSTRACT

BACKGROUND: Conversional bariatric surgeries (CBS) are performed using laparoscopic and robotic techniques, but comprehensive data comparing these approaches remains scarce.

OBJECTIVE: To compare the indications and outcomes of laparoscopic versus robotic CBS.

METHODS: The MBSAQIP database was retrospectively analyzed from 2020 to 2022, comparing laparoscopic and robotic CBS. Primary outcomes were 30-day serious complications and mortality.

RESULTS: Of 72,189 CBS procedures, 75.4% were laparoscopic and 24.6% robotic. Mean age and BMI were similar between groups. The most common indications for both approaches were reflux, weight regain, and inadequate weight loss, with reflux being more prevalent in robotic CBS (38.3% vs 33.2%). Sleeve-to-bypass was the most common procedure in both groups (35.8% laparoscopic, 44.2% robotic). Robotic CBS had longer mean operative times (165.4 vs 121.7 min, p < 0.001) and slightly longer hospital stays (1.7 vs 1.6 days, p < 0.001). The rate of serious complications was slightly higher for robotic CBS, though not statistically significant (6.5% vs 6.1%, p = 0.08). Robotic CBS had higher rates of leak (0.9% vs 0.7%, p = 0.071), reoperation (2.8% vs 2.6%, p = 0.138), and readmission (6.7% vs 5.4%, p < 0.001). Mortality rates were similar (0.1% for both, p = 0.942).

CONCLUSIONS: Both laparoscopic and robotic CBS show similar safety profiles with comparable mortality rates. However, robotic CBS was associated with longer operative times, slightly longer hospital stays, and higher readmission rates. These findings suggest that the choice between approaches should consider individual patient factors and institutional expertise.

PMID:40332741 | DOI:10.1007/s11695-025-07886-6

Curr Med Sci. 2025 May 7. doi: 10.1007/s11596-025-00056-w. Online ahead of print.

ABSTRACT

OBJECTIVE: The geriatric nutritional risk index (GNRI) is widely used for nutritional assessment. Poor nutritional status is associated with complications and poor survival in cirrhotic patients. We aimed to investigate the value of the GNRI in predicting outcomes in cirrhotic patients.

METHODS: This retrospective study included 420 cirrhotic patients from three centers between 2013 and 2017. Patients were divided into the high GNRI group (≥ 92) and low GNRI group (< 92). Overall survival (OS) in the two groups was evaluated via the Kaplan‒Meier method. Cox proportional hazards model was used to estimate the value of the GNRI in predicting outcomes. Restricted cubic spline model was used to intuitively display the dose‒response associations between the GNRI and OS. A nomogram was constructed to predict OS.

RESULTS: During the 2-year follow-up period, 58 (13.81%) patients died, and 262 (62.38%) patients experienced episodes of complications. Compared with patients in the low GNRI group, those in the high GNRI group had lower mortality rates (18.73% vs. 5.23%, P < 0.001). The GNRI was an independent predictor of OS (hazard ratio [HR] = 0.958, 95% confidence interval [CI] 0.929-0.988, P = 0.007). The GNRI was associated with the cumulative incidence of ascites (HR = 0. 954, 95% CI 0.940-0.969, P < 0.001), spontaneous bacterial peritonitis (HR = 0.928, 95% CI 0.891-0.966, P < 0.001), hepatic encephalopathy (HE; HR = 0.944, 95% CI 0.920-0.968, P < 0.001), and hepatorenal syndrome (HRS) (HR = 0.916, 95% CI 0.861-0.974, P = 0.005). Furthermore, 6 independent factors were included to construct the nomogram for OS prediction, including GNRI, age, total bilirubin, serum sodium, history of HE and HRS. The C statistics of our model were 0.83 (95% CI 0.75-0.90) and 0.80 (95% CI 0.73-0.86) at 1 and 2 years, respectively. Patients whose GNRI score decreased within 3 and 6 months had poorer outcomes (P < 0.001).

CONCLUSIONS: The lower GNRI score was associated with the higher cumulative incidence of complications and poorer OS of cirrhotic patients. The GNRI could be a helpful tool for assessing nutritional status and prognosis of these patients.

PMID:40332738 | DOI:10.1007/s11596-025-00056-w

Curr Med Sci. 2025 May 7. doi: 10.1007/s11596-025-00043-1. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the neuroprotective effects of cholecalciferol cholesterol emulsion (CCE), a vitamin D (VD) precursor, in a murine model of acute cerebral infarction (ACI) and to elucidate the role of the Nrf2 signaling pathway in mediating these effects.

METHODS: Forty C57BL/6J mice (male and female) were divided into five groups (n = 10 per group): control, control + CCE, ACI, ACI + CCE, and ACI + CCE + ML385 (an Nrf2 inhibitor). ACI was induced by middle cerebral artery occlusion (MCAO). CCE was administered for three weeks prior to ACI induction, and ML385 was administered intravenously to inhibit Nrf2. Neurological function, brain edema, and infarct size, as well as inflammatory and apoptotic marker levels, were assessed post-ACI. Statistical analyses were conducted via one-way ANOVA and Student’s t test, with P < 0.05 considered significant.

RESULTS: Compared to ACI group, CCE significantly reduced neurological deficits, brain edema, and infarct size (P < 0.01). The ACI + CCE group presented improved short-term memory retention, as evidenced by shorter avoidance latency in shuttle avoidance tests (P < 0.01). CCE administration attenuated the expression of inflammatory markers (IL-6, MIF, Lp-PLA2) while increasing IL-10 levels (P < 0.001). Furthermore, CCE increased Nrf2 and HO-1 expression and reduced apoptosis by decreasing the Bax/Bcl-2 ratio in brain tissue (P < 0.001). ML385 abolished these neuroprotective effects, confirming the role of the Nrf2 pathway in mediating the benefits of VD.

CONCLUSION: VD, via VD receptor-mediated activation of the Nrf2/HO-1 pathway, reduces inflammation, apoptosis, and neurological damage following ACI. These findings support the therapeutic potential of VD in the treatment of ischemic stroke and highlight the importance of Nrf2 in mediating these effects.

PMID:40332737 | DOI:10.1007/s11596-025-00043-1

J Med Humanit. 2025 May 7. doi: 10.1007/s10912-025-09952-7. Online ahead of print.

ABSTRACT

The 1889 Russian (also called ‘Asiatic’) Flu epidemic can be described as one of the first modern pandemics. The development of extensive railroad and shipping networks during and prior to this period facilitated the previously unprecedented movement of goods and people around the world. It additionally propagated the process of shrinking the barriers between the countryside and major metropolises. While the COVID-19 pandemic resulted in lockdown measures nearly worldwide and prompted widespread social, economic, and cultural disruptions, the Russian Flu was not accompanied by such drastic changes. In this article, it is argued that the blunted historical consciousness of this epidemic were a result of a combination of factors, including the nascent state of scientific research and understanding of infectious diseases, the circumscribed reach of media, implicit comparisons to other contemporary epidemics, temporal closeness to the Spanish Flu and suppression of memory, and most substantially the lack of an organized public health apparatus to act upon the epidemic. As a result, the 1889 Russian pandemic, though significant in terms of its mortality and economic impact, was quickly forgotten from the collective consciousness and has long been a hidden lesson from history.

PMID:40332729 | DOI:10.1007/s10912-025-09952-7

J Patient Rep Outcomes. 2025 May 7;9(1):50. doi: 10.1186/s41687-025-00875-4.

ABSTRACT

BACKGROUND: Vasomotor symptoms (VMS; hot flashes) associated with menopause have significant impacts on health-related quality of life and are a leading cause for women seeking medical attention. Patient-reported outcome (PRO) instruments are commonly used to assess treatment benefit in VMS clinical trials and must demonstrate supportive evidence of measurement properties within the context of use. This study evaluated the measurement properties of scores from the Hot Flash Daily Diary (HFDD), PROMIS Sleep Disturbance Short Form 8b (PROMIS SD SF 8b) and Menopause-Specific Quality of Life (MENQOL) for measuring treatment efficacy in VMS clinical trials.

METHODS: Measurement properties of the HFDD, PROMIS SD SF 8b, and MENQOL scores were assessed using data (n = 400 participants) from a randomized, placebo-controlled, phase 3 study evaluating the efficacy and safety of elinzanetant for the treatment of VMS in postmenopausal women (OASIS 2). Analyses assessed distributional properties, reliability, validity, responsiveness, and thresholds for meaningful change.

RESULTS: Minimal floor and ceiling effects were found across the instruments at baseline. Inter-item correlations, and confirmatory factor analysis or item-response theory supported dimensionality and scoring for the MENQOL and PROMIS SD SF 8b, respectively. Test-retest reliability between Weeks 8 and 12 was good to excellent for HFDD Frequency and Severity of moderate-to-severe hot flashes scores, PROMIS SD SF 8b T-score and MENQOL Total score (intra-class correlation coefficients 0.835-0.971). Convergent and divergent correlations with instruments assessing similar or distinct constructs were consistent with pre-specified hypotheses. Known-groups validity was supported by significant differences (p < 0.0001) between subgroups hypothesized a priori as being clinically distinct. Responsiveness was indicated by consistent and statistically significant differences (p < 0.0001) in mean changes from baseline to Week 4 and 12 between groups of participants classified as ‘improved’, ‘stable’ and ‘worsened’ (effect sizes for improvement 0.81-4.62). Triangulation of estimates from multiple anchor-based analyses derived meaningful within-individual change thresholds for the HFDD, PROMIS SD SF 8b and MENQOL scores that were likely to exceed measurement error.

CONCLUSIONS: Findings provide evidence that HFDD, PROMIS SD SF 8b, and MENQOL scores are valid, reliable and responsive to change, supporting their use for assessing key efficacy endpoints in VMS clinical trials.

PMID:40332718 | DOI:10.1186/s41687-025-00875-4

Minerva Dent Oral Sci. 2025 May 7. doi: 10.23736/S2724-6329.25.05199-X. Online ahead of print.

ABSTRACT

BACKGROUND: Oral health is crucial for overall well-being, as conditions like periodontitis are increasingly associated with systemic diseases, including type 2 diabetes, cardiovascular diseases, and neurological disorders. Research in the UK and globally has revealed limited awareness among medical students about these connections, emphasizing the need for curriculum enhancements. This study assessed the awareness of year 3 and 4 medical students about oral-systemic disease connections.

METHODS: Following approval from the University of Central Lancashire School of Medicine and Dentistry Ethics Committee, a cross-sectional questionnaire-based survey was conducted. The survey, consisting of multiple-choice questions with multiple answer options, was delivered anonymously via an internal Teams channel to a representative cohort of year 3 and 4 medical students. The questionnaire covered general awareness of oral-systemic health, specific oral disease knowledge, and a focused evaluation of the periodontitis-diabetes relationship. Statistics included descriptive analysis and chi-square tests to assess associations between responses. Measures of association, such as Phi and Cramér’s V, were also calculated.

RESULTS: A total of 122 students participated (65.67% year 3, 34.33% year 4). Most (91.04%) acknowledged the link between oral and general health. While 80.6% identified periodontitis as gum disease, 8.96% associated it with tooth decay, and 10.45% were unaware. Awareness of the bidirectional relationship with diabetes was limited; 60% recognized that diabetes increases periodontitis risk, but only 29.9% understood the reverse.

CONCLUSIONS: This study highlights gaps in medical students’ knowledge of oral-systemic health, emphasizing the need for better integration of oral health education in the medical curriculum. Aligning with WHO strategies and European Federation of Periodontology initiatives, improved interprofessional education can enhance patient care through collaboration between medical and dental professionals.

PMID:40331335 | DOI:10.23736/S2724-6329.25.05199-X