Nevin Manimala

J Neurosurg. 2025 Dec 5:1-11. doi: 10.3171/2025.8.JNS251211. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the long-term visual outcomes following optic nerve decompression in patients with CSF flow disturbances and to propose a mechanistic framework for surgical qualification based on infusion testing and orbital MRI, independent of idiopathic intracranial hypertension (IIH) diagnostic criteria.

METHODS: This retrospective study analyzed 30 eyes in 26 patients with progressive visual impairment and evidence of CSF flow abnormalities. All patients underwent standardized lumbar infusion testing to quantify CSF outflow resistance, pressure-volume index, and opening pressure. Orbital MRI was used to assess perioptic CSF collections or optic canal narrowing. On the basis of these data, patients underwent either optic nerve sheath fenestration (ONSF) or endoscopic optic nerve sheath decompression (EONSD). Visual function was evaluated using mean deviation of the visual field, visual evoked potentials, and optical coherence tomography of the retinal nerve fiber layer (RNFL) thickness at baseline and 6 and 24 months.

RESULTS: Mean deviation of the visual field improved by a median of +1.89 dB (p < 0.05), and P100 latency (i.e., the time between a visual stimulus and the visual cortex’s response) decreased by -5 msec at 24 months. Papilledema resolved in 87.5% of affected eyes. RNFL thickness remained stable or modestly increased across the cohort, with a trend toward greater thickening following EONSD (+9 µm at both 6 and 24 months) compared with ONSF (minimal change at 6 months [+1 µm] and slight thinning at 24 months [-2 µm]), although the differences were not statistically significant. No significant differences in functional outcomes were observed between the procedures. Patients were stratified into 3 CSF pathophysiological subgroups: 1) IIH with elevated intracranial pressure (ICP), 2) abnormal hydrodynamics without raised ICP, and 3) normal ICP and hydrodynamics with MRI-confirmed perioptic CSF collection. Visual improvement occurred across all subgroups, including groups 2 and 3.

CONCLUSIONS: The authors found that optic nerve decompression guided by CSF infusion testing and orbital MRI effectively stabilizes or improves visual function in patients with CSF-related optic neuropathy, including those without elevated ICP. A mechanism-based classification into three surgical phenotypes enables individualized treatment beyond syndromic definitions. This approach may redefine surgical eligibility and expand access to vision-preserving interventions in CSF-mediated optic nerve dysfunction.

PMID:41349016 | DOI:10.3171/2025.8.JNS251211

Neurology. 2026 Jan 13;106(1):e214449. doi: 10.1212/WNL.0000000000214449. Epub 2025 Dec 5.

ABSTRACT

BACKGROUND AND OBJECTIVES: Growing evidence suggests that the APOE ε4 allele, a genetic risk factor for Alzheimer disease (AD), influences the clinical-pathologic features of Parkinson disease (PD). APOE ε4 promotes brain amyloid accumulation, indicating a PD subtype more susceptible to late copathology. However, the early correlates of APOE ε4 carriers in PD are not known. In this study, we used a multimodal approach to define the clinical, neurochemical, and neurophysiologic profiles of APOE ε4 carriers in PD at onset.

METHODS: We conducted a single-center, cross-sectional study at Tor Vergata Hospital (Rome, Italy), enrolling newly diagnosed, drug-naïve PD participants and age-matched/sex-matched healthy controls (HCs). Patients with PD were stratified by APOE genotype into ε4 and non-ε4 carriers and evaluated through a comprehensive clinical assessment and the measurement of CSF amyloid peptides and tau protein levels. Group differences in high-density EEG-based functional connectivity (FC) were analyzed using network-based statistics to identify APOE ε4-modulated patterns. Clinical and biomarker associations with network metrics were tested using analysis of covariance and correlation analyses.

RESULTS: The study included 66 PD participants (mean age 63.2 [10.1] years, 35% female, 52 ε4 noncarriers, 14 ε4 carriers) and 55 HCs (mean age 62.0 [15.2] years, 42% female). PD ε4, compared with PD non-ε4, demonstrated higher motor impairment, especially in bradykinesia (16.4 [7.6] vs 11.0 [5.6], p = 0.02) and gait disturbances (3.46 [2.23] vs 1.94 [1.46], p = 0.003) Movement Disorder Society-sponsored Unified Parkinson’s Disease Rating Scale part III scores, and reduced CSF amyloid-β42 (Aβ42)/amyloid-β40 (Aβ40) ratio (0.09 [0.03] vs 0.13 [0.03], p < 0.001). Network analyses identified ε4-related FC alterations: decreased α-band connectivity (F = 3.9, p = 0.034) and increased β-band connectivity (F = 9.8, p < 0.001). In ε4 carriers, α-FC correlated inversely with gait disturbances (r = -0.62, p = 0.02) and positively with Montreal Cognitive Assessment (r = 0.57, p = 0.03) and CSF Aβ42/Aβ40 (r = 0.54, p = 0.04). β-FC correlated with bradykinesia in both groups, with stronger associations in ε4 carriers (r = 0.54, p = 0.04) than in non-ε4 (r = 0.28, p = 0.04).

DISCUSSION: APOE ε4 defines a PD subtype characterized by greater motor impairment, reduced CSF Aβ42/Aβ40, and distinct FC abnormalities since the onset. An early amyloid-mediated network disruption thus emerges as the potential biological signature of ε4 carriers. Although limited by single-center and cross-sectional design, this study supports APOE ε4 as a stratification marker for early diagnostic and therapeutic strategies in PD.

PMID:41348997 | DOI:10.1212/WNL.0000000000214449

Int Health. 2025 Dec 5:ihaf138. doi: 10.1093/inthealth/ihaf138. Online ahead of print.

ABSTRACT

BACKGROUND: From a public health standpoint, there is merit in determining the levels of Escherichia coli in drinking water, but surveillance datasets often report censored values that may hinder traditional statistical analysis. This study aims to identify sociodemographic factors associated with the presence of E. coli in household drinking water in Bangladesh using Bayesian models for censored data, utilizing data from 6069 households in the Multiple Indicator Cluster Survey 2019.

METHODS: In terms of censoring, we considered two different Bayesian regression strategies: Bayesian Tobit Poisson regression and Bayesian Censored Generalized Poisson regression.

RESULTS: The Bayesian Censored Generalized Poisson regression model was identified as the optimal model for analyzing household fecal contamination. Regression analysis revealed significant associations between household E. coli levels and various factors including division, livestock ownership, location of water sources, treatment of drinking water, household head education, wealth index, source of drinking water, place of handwashing and toilet facility. Households using tube wells had lower E. coli levels than those using other sources. Furthermore, households using pit latrines had 1.03 times higher contamination levels than those using flush latrines.

CONCLUSIONS: Levels of fecal contamination in household water in Bangladesh were alarming. Our findings underscore the need for targeted policy interventions in specific population segments to address household fecal contamination, highlighting the link between sociodemographic and environmental factors with E. coli levels in drinking water.

PMID:41348992 | DOI:10.1093/inthealth/ihaf138

JCO Precis Oncol. 2025 Dec;9:e2500279. doi: 10.1200/PO-25-00279. Epub 2025 Dec 5.

ABSTRACT

PURPOSE: There is growing interest in multicancer detection (MCD) blood tests for diagnosing patients with cancer-related symptoms. However, recent studies suggest that MCD testing may not be sensitive enough to rule out cancer in the symptomatic population without retraining the underlying classifiers. On the basis of clinical guidelines for suspected cancer referral, here we cast these data into a formal diagnostic decision-making perspective to assess clinical utility.

METHODS: Data were extracted from the SYMPLIFY study (ISRCTN10226380), which evaluated the performance of the Galleri test (GRAIL, LLC). The decision threshold for suspected cancer referral was extracted from the National Institute for Health and Care Excellence Guideline 12. Clinical utility was estimated using Bayesian decision curve analysis.

RESULTS: For the guideline-derived decision threshold of 3%, the Galleri MCD test avoided 18,005 unnecessary suspected cancer referrals per 100,000 symptomatic patients, with a 99.4% posterior probability of clinical utility. High probabilities of clinical utility were observed for gynecologic, lower GI, and upper GI referral pathways, avoiding between 25,414 and 62,501 unnecessary referrals per 100,000 symptomatic patients. The rapid diagnostic center and lung referral pathways showed negligible probabilities of clinical utility. The minimum diagnostic performance required for clinical utility varied significantly across referral pathways. The gynecologic pathway showed the lowest sensitivity requirement (under 30% for a highly specific test) and the lung pathway the highest (over 90% for any specificity level).

CONCLUSION: Clinical utility of MCD testing for symptomatic patients in the United Kingdom varies substantially across referral pathways but is favorable for gynecologic and GI cancers. Future pathway-specific optimization of MCD tests must consider clinical utility explicitly and does not require retraining the underlying machine learning classifiers.

PMID:41348983 | DOI:10.1200/PO-25-00279

Health Informatics J. 2025 Oct-Dec;31(4):14604582251401402. doi: 10.1177/14604582251401402. Epub 2025 Dec 5.

ABSTRACT

Introduction: Pediatric restraint orders require frequent renewal to ensure patient safety. Previously, providers depended on nurses paging them upon order expiration, leading to lapses. Methods: In April 2023, we implemented an alerting system in our 38-bed pediatric intensive care unit (PICU) that sent automated text messages to providers upon order expiration. Pediatric wards and adult ICU served as controls. We analyzed 2 years of restraint order data. An unpaired t-test compared pre- and post-intervention. Results: A total of 1394 orders were included (133 PICU, 628 pediatric wards, 633 adult ICU). In the PICU, time without an active order decreased by 39% (2 h 23 min to 1 h 27 min, p = .24) though this result did not reach statistical significance. Conclusion: Despite not reaching statistical significance, this exploratory case study demonstrated that automated EHR alerts may reduce time without an active restraint order. This pilot led the institution’s informatics team to system-wide adoption. While promising, such systems must be balanced against risks like provider alarm fatigue.

PMID:41348972 | DOI:10.1177/14604582251401402

JMIR Public Health Surveill. 2025 Dec 5;11:e83323. doi: 10.2196/83323.

ABSTRACT

BACKGROUND: Long COVID affects millions worldwide, straining health systems and workforce stability. This first nationwide survey among French civil servants combines epidemiological assessment with a Knowledge, Attitudes, and Behaviors approach. Long COVID remains a diagnostic and epidemiological challenge with evolving symptoms and uncertain categorization, particularly among self-suspected cases. Beyond prevalence and risk factors, understanding behavioral dimensions is essential to developing prevention strategies and maintaining workforce resilience.

OBJECTIVE: This study aimed to (1) assess the prevalence of long COVID among French civil servants; (2) identify associated sociodemographic, occupational, and health-related factors; (3) assess disease-related knowledge of long COVID and (4) examine attitudes and behaviors regarding COVID-19 vaccination.

METHODS: This cross-sectional survey was conducted in 2024 among active or retired civil servants in France. A Knowledge, Attitudes, and Behaviors-validated questionnaire, based on World Health Organization guidelines, was used. Responses were compared across 4 COVID-19 status groups (no COVID, COVID-19 without long COVID, diagnosed long COVID, and suspected long COVID). Statistical analyses included univariate tests and multivariable logistic regressions to identify factors associated with diagnosed or suspected long COVID.

RESULTS: Among 3962 eligible respondents, 61 (1.54%; 95% CI 1.20-1.97) reported a formal diagnosis of long COVID and 241 (6.08%; 95% CI 5.38-6.87) without diagnosis. Diagnosed long COVID was significantly associated with long-term sick leave (odds ratio [OR] 1.15, 95% CI 1.03-6.28; P=.04) and long-term illness coverage (OR 0.72, 95% CI 0.27-0.92; P=.03). Suspected long COVID was associated with being in a relationship (OR 1.65, 95% CI 1.08-2.52; P=.02), widowed (OR 2.25, 95% CI 1.18-4.31; P=.01), and uncertain (OR 1.90, 95% CI 1.32-2.74; P<.001) or incomplete COVID-19 vaccination status (OR 1.67, 95% CI 1.16-2.42; P=.01). Knowledge scores differed significantly across groups (ANOVA F3,3476=24.31, P<.001; χ²6=54.92, P<.001), with diagnosed cases showing the highest proportion of high knowledge (13/61, 21%) compared to 12.4% in the non-COVID group. Among 61 diagnosed cases, 36 (59%; 95% CI 46.4-70.5) were vaccinated, 13 (21%; 95% CI 12.9-33.2) intended to get vaccinated, and 12 (20%; 95% CI 11.6-31.3) remained unvaccinated; among suspected cases, these proportions were 173 (71.8%; 95% CI 65.9-77.1), 30 (12.4%; 95% CI 8.8-17.3), and 38 (15.8%; 95% CI 11.6-21.0), respectively.

CONCLUSIONS: Unlike previous studies that examined the clinical or behavioral factors separately, this nationwide analysis linked epidemiological data with knowledge and vaccination behaviors. Among French civil servants, long COVID remains underdiagnosed, where absenteeism and sick leave threaten essential services. The study highlights disparities in disease-related knowledge, vaccination attitudes, and behaviors, underlining the importance of workplace health education and systematic screening. Vaccination is associated with lower odds of long COVID, reinforcing its preventive value. Thus, findings reveal organizational implications and support workplace-based prevention strategies integrating vaccination promotion, early detection, and health literacy to sustain the resilience of public services.

PMID:41348962 | DOI:10.2196/83323

Diagn Interv Radiol. 2025 Dec 5. doi: 10.4274/dir.2025.253574. Online ahead of print.

ABSTRACT

PURPOSE: Skull base osteomyelitis (SBO) and nasopharyngeal carcinoma (NPca) are challenging to differentiate due to overlapping clinical and radiological features. This study aimed to develop and validate a multi-parametric magnetic resonance imaging (MRI)-based radiomics model with high sensitivity, enabling reliable diagnosis of SBO in adult patients presenting with equivocal imaging findings.

METHODS: This was a retrospective, multicenter study using institutional data. The training cohort, comprising 63 adult patients from two classes (31 SBO, 32 NPca) with MRI data, was used for model development and optimization. An external test set (n = 30; 12 SBO, 18 NPca) obtained from two different clinical centers was used for model performance analysis and generalizability. Lesion segmentation was performed using a manual volumetric technique on three axial MRI sequences (pre-contrast T1-weighted, fat-suppressed T2-weighted, and post-contrast fat-suppressed T1-weighted). Hand-crafted radiomic features (n = 2,553) were extracted using the Pyradiomics library. A multi-step process was used to select the final features, including reproducibility analysis using an interclass correlation coefficient threshold of 0.9, pairwise Spearman correlation analysis with a threshold of 0.8 to reduce redundancy, and least absolute shrinkage and selection operator regression. The final set of five features were used to train six machine learning models. The models were internally validated using 5-fold cross-validation, and performance was confirmed using the unseen external test set. Traditional statistical tests, including the Mann-Whitney U test and chi-squared test, were used to compare baseline characteristics, with a P value of <0.05 considered significant.

RESULTS: Among the evaluated classifiers, the random forest model demonstrated the best diagnostic performance, yielding the highest area under the curve (AUC) value in the 5-fold cross-validation analysis. In the external test set, the semantic model demonstrated the best diagnostic performance, achieving an AUC of 0.940 [95% confidence interval (CI): 0.857-1.00], followed by the radiomics model (AUC: 0.903, 95% CI: 0.784-1). The apparent diffusion coefficient (ADC)-based model demonstrated limited discriminative ability (AUC: 0.694, 95% CI: 0.497-0.892). The difference between the semantic and radiomics models did not reach statistical significance (P = 0.644), whereas both significantly outperformed the ADC model (P < 0.05).

CONCLUSION: Radiomics achieved high and consistent performance in distinguishing SBO from advanced NPca. Although expert-based semantic assessment performed slightly better, radiomics provides an objective alternative. ADC-based methods showed limited generalizability due to inter-center variability.

CLINICAL SIGNIFICANCE: Our study confirms the importance of expert radiologist assessment while demonstrating that radiomics offers a comparably effective and objective decision-support tool. Its ability to provide a consistent, quantitative output is particularly valuable for standardizing the diagnostic approach and empowering less experienced radiologists to make more confident assessments.

PMID:41347386 | DOI:10.4274/dir.2025.253574

Clin Nephrol. 2025 Dec 5. doi: 10.5414/CN111841. Online ahead of print.

ABSTRACT

OBJECTIVE: The association between the atherogenic index of plasma (AIP) and chronic kidney disease (CKD) among individuals with different metabolic syndromes remains inadequately characterized. The aim of this study is to assess the correlations between AIP and the risk of CKD among individuals diagnosed with hypertension (HTN), diabetes mellitus (DM), and hyperuricemia (HUA).

MATERIALS AND METHODS: Data from the National Health and Nutrition Examination Survey, collected between 2009 and March 2020, were used to categorize eligible participants into HTN, DM, and HUA groups. Weighted logistic regression models and restricted cubic splines were employed to examine the correlations between AIP and CKD. The incremental predictive value of AIP, compared with conventional CKD risk factors, was assessed using the area under the curve, net reclassification improvement index, and integrated discrimination improvement.

RESULTS: Among individuals in the HTN and DM groups, an increase of one unit in AIP was associated with a 17% increase in the risk of CKD (odds ratio (OR): 1.17, 95% confidence interval (CI): 1.10 – 1.25) and a 29% increase (OR: 1.29, 95% CI: 1.18 – 1.40), respectively. Conversely, within the HUA group, neither persistent AIP nor any of the three AIP levels demonstrated a statistically significant correlation with CKD.

CONCLUSION: The findings demonstrated a significant association between AIP and CKD in individuals with HTN and DM, indicating a potential link between dyslipidemia and CKD risk within these populations. In contrast, AIP did not exhibit a significant association with CKD among individuals with HUA.

PMID:41347374 | DOI:10.5414/CN111841

Int J Gynaecol Obstet. 2025 Dec 5. doi: 10.1002/ijgo.70719. Online ahead of print.

ABSTRACT

BACKGROUND: Subglottic stenosis (SS) is a type of laryngotracheal stenosis defined by a location of less than 1.5 cm below the glottis or the vocal cords. Approximately 20% of cases are idiopathic.

OBJECTIVE: We performed a systematic literature review of idiopathic subglottic stenosis (ISS) complicating pregnancy.

SEARCH STRATEGY: PubMed, Scopus, and clinicaltrials.gov databases were queried from inception through August 10, 2023 with the following terms: idiopathic subglottic tracheal stenosis, subglottic stenosis, subglottic stenoses, tracheal stenosis, tracheal stenoses, and pregnancy. This systematic review was conducted according to the methods described in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines for reporting systematic reviews.

SELECTION CRITERIA: Studies detailing cases of ISS affecting pregnancy were included and studies reporting SS in pregnancy from a known etiology were excluded.

DATA COLLECTION AND ANALYSIS: Our search identified 31 peer-reviewed published cases of ISS complicating pregnancy that met the inclusion criteria. We also included two additional cases from our institution. Publication bias was checked by the Joanna Briggs Institute critical appraisal tools. Descriptive statistical analyses were performed using Excel.

MAIN RESULTS: A majority of patients (26/33, 79%) were diagnosed with ISS during the reported pregnancy. Prior to pregnancy, 20/33 (61%) patients had a working diagnosis or reported symptoms of airway obstruction. Of these patients, 9/20 (45%) carried a diagnosis of asthma, and 6/20 (30%) carried a diagnosis of ISS. Specific symptoms prior to pregnancy were reported in 10/33 (30%) patients. The most common symptoms in these patients were dyspnea (10/10, 100%) and stridor (4/10, 40%). During pregnancy, all patients experienced worsening respiratory symptoms, with dyspnea (31/33, 94%), stridor (18/33, 55%), cough (13/33, 39%), hoarseness (7/33, 21%), and wheeze (5/33, 15%) being the most common symptoms. A total of 22/33 (67%) patients required medical and/or surgical management with dilation and/or excision during pregnancy. Postpartum outcomes were reported in 27/33 (82%) patients, and 1/27 (3.7%) required a tracheostomy immediately postpartum. The majority (18/27, 67%) of these patients required intervention postpartum, while 9/27 (33.3%) were asymptomatic.

CONCLUSION: ISS should be considered in pregnant patients with worsening respiratory symptoms despite medical management of asthma. If high clinical suspicion for upper airway obstruction exists, an otolaryngology referral for evaluation with bronchoscopy is recommended.

PMID:41347323 | DOI:10.1002/ijgo.70719

Swiss Dent J. 2025 Dec 5;135(4):1-15. doi: 10.61872/sdj-2025-04-01.

ABSTRACT

Post-endodontic treatment preferences can be influenced by educational, healthcare, financial, and historical factors. This study aimed to compare the post-endodontic treatment choices – particularly post and single-crown placement – of dentists in Germany and Switzerland. From August to November 2023, a questionnaire was distributed amongst 334 Swiss and 570 German dentists. A total of 50 Swiss dentists (response rate: 15.0%) and 60 German dentists (response rate: 10.5%) completed the survey. Descriptive analyses were conducted, and data presented as percentages. German dentists reported placing posts in 5–20% of endodontically treated teeth, whereas most Swiss dentists did so in less than 5%. Swiss dentists (58%) tended to place posts in teeth with 0–40% remaining tooth structure, while German dentists (60%) began at 40–70%. Regarding post-endodontic restorations, the majority of German dentists (67%) preferred single crowns, whereas most Swiss dentists (68%) favored composite-resin fillings and maintained even teeth with severely reduced coronal hard tissue. These trends were further supported by responses to various clinical case scenarios.

PMID:41347313 | DOI:10.61872/sdj-2025-04-01