Nevin Manimala

Indian J Tuberc. 2025 Oct;72(4):513-516. doi: 10.1016/j.ijtb.2024.12.002. Epub 2024 Dec 24.

ABSTRACT

BACKGROUND: The diagnosis of Extrapulmonary TB(EPTB) has always been a challenge for health care providers as it generally requires resource and greater clinical expertise. Timely detection and proper treatment of TB are the key elements of an effective TB control program. Our aim in this study is to determine the diagnostic delay and the factors associated with delay, to estimate the out of pocket expenditure, and the treatment outcome in Extrapulmonary TB Patients.

METHODS: A mixed method study was carried out in Five TB Units of Bangalore Urban District on the newly diagnosed Extrapulmonary TB Patients of the last quarter of 2021. Data from registers and telephonic interviews were used to collect information for the quantitative data and the qualitative assessment was done through In-depth interviews.

RESULTS: Out of 174 patients, 44.2% had a diagnostic delay of more than 1 month. The average expenditure among the subjects for diagnosis and treatment was estimated to be ₹ 56,681. 63% of the patients incurred an expenditure of above ₹ 10,000 before diagnosis and 18.9% had incurred an expenditure above ₹ 10,000 during treatment. 16.7% were lost to follow up, 0.6% were declared cured and 82.2% as treatment completed. In-depth interviews of 30 randomly selected patients with diagnostic delay was done to explore the reasons for delay, which were manually coded to generate the following codes-lack of awareness of symptoms and delayed referral, neglected symptoms and self medication, atypical presentation, misdiagnosis, wrong choice of diagnostic procedure, co-morbidities with overlapping symptoms, incidental finding, ignorance about Government facilities and free TB treatment, and absent or mild symptoms/slow progression of symptoms.

CONCLUSION: Guidelines for diagnosis and treatment of EPTB to health care workers and public awareness about EPTB and provisions of Government facilities needs further emphasis. This will help reduce diagnostic delay of EPTB and its financial burden on the patients thereby ensuring better treatment completion and cure rate aiding in TB elimination.

PMID:40975583 | DOI:10.1016/j.ijtb.2024.12.002

Indian J Tuberc. 2025 Oct;72(4):465-470. doi: 10.1016/j.ijtb.2025.02.016. Epub 2025 Feb 25.

ABSTRACT

BACKGROUND: TB Preventive Treatment (TPT) is considered as an effective intervention to reduce TB incidence by reducing the pool of TB infection in the community. This study was aimed to assess TPT outcome and its associations in West Bengal.

METHOD: ology: A retrospective cohort study conducted using the data from Ni-kshay, the web-based TB information management portal of India. All TPT beneficiaries who have initiated with TPT in the year 2022 were included in the study. To find out the independent risk factor associated with unsuccessful outcome, risk ratio (RR) and adjusted risk ratio (aRR) has been calculated using regression models.

RESULTS: Median age and BMI of the participants were 32 years, & 20.9 kg/m2 respectively. Median delay to TPT initiation from diagnosis of the index TB patients was 23 days. 90.5% (90.2-90.7) outcomes were successful while 9.5% (9.3-9.8) outcomes were unfavourable. 0-9yrs (aRR = 1.31), 10-19yrs (aRR = 1.16) & 20-39yrs (aRR = 1.10) age-groups were more likely to be associated with unsuccessful TPT outcomes. Overweight (aRR = 1.10) & Obese (aRR = 1.19) were associated with unsuccessful outcomes. Participants belong to urban areas (aRR = 1.37) & attending Private Health Facility (aRR = 1.17) were more likely to be associated with an unsuccessful outcome. TPT initiation delay of 8-30 days (aRR = 2.03) and >30 days (aRR = 2.90) was associated with unsuccessful TPT outcomes.

CONCLUSION: There are few gaps as well as few opportunities in the TPT programs in West Bengal. Gaps are both in policy level as well as implementation level. Identified gaps should be addressed for a better TB preventive strategy in West Bengal.

PMID:40975575 | DOI:10.1016/j.ijtb.2025.02.016

Indian J Tuberc. 2025 Oct;72(4):460-464. doi: 10.1016/j.ijtb.2024.11.004. Epub 2024 Nov 19.

ABSTRACT

INTRODUCTION: India has the highest burden of Tuberculosis (TB) in the world. Delay in diagnosis and treatment is one of the main reasons for high burden of TB in India. Proper knowledge, attitude and practice regarding Tuberculosis among health care workers is essential to improve case finding and treatment in TB. Nursing students are the prospective healthcare providers in the fight against tuberculosis.

AIM: To assess the knowledge, attitude, and practice regarding tuberculosis among nursing students.

METHODS: This was a Cross-sectional, analytical type of study done on 313 nursing students after taking Institutional Ethical committee clearance. It was done using a pre-tested, semi-structured questionnaire, on selected nursing colleges in Mangalore city of Karnataka state. Analysis of data was done using the software “IBM SPSS Statistics”. Chi-square test was used to test association. P value less than 0.05 was considered statistically significant.

RESULTS: Only 24.9% of the respondents had good knowledge and 58.8% had moderate knowledge about tuberculosis. Students studying B.Sc. nursing knew more about tuberculosis than those studying General Nursing. 67.4% of students had good attitude towards tuberculosis. Practice towards various aspects of tuberculosis was not satisfactory in more than 50% of the students.

CONCLUSION: Most of the nursing students have moderate knowledge about tuberculosis, but their attitude and practice towards TB is not at satisfactory level. Hence specific training measures should be included in their curriculum to improve their knowledge, attitude, and practice regarding tuberculosis. This will help in early diagnosis and proper treatment of TB.

PMID:40975574 | DOI:10.1016/j.ijtb.2024.11.004

Indian J Tuberc. 2025 Oct;72(4):455-459. doi: 10.1016/j.ijtb.2025.09.001. Epub 2025 Sep 2.

ABSTRACT

BACKGROUND: Tuberculosis (TB) remains a major public health challenge, especially in low- and middle-income countries. Operational Research (OR), supported by robust statistical methods, plays a critical role in optimizing TB control strategies.

OBJECTIVE: This review highlights the statistical tools applied in TB Operational Research, their applications, and the emerging role of Artificial Intelligence (AI) in strengthening data-driven decision-making.

METHODS: We examine classical statistical approaches alongside predictive modeling, cost-effectiveness analysis, and AI-based frameworks. Case examples from diverse settings illustrate their practical impact.

FINDINGS: Statistical methods underpin surveillance, diagnosis, treatment evaluation, and policy modeling in TB programs. AI-driven techniques, such as machine learning and deep learning, are expanding the analytical landscape by enhancing prediction, identifying high-risk populations, and enabling real-time program monitoring.

CONCLUSION: Statistical tools from traditional inference to AI-modeling are essential for advancing TB control. Strengthening methodological rigor, reporting standards and interdisciplinary collaboration will be pivotal in harnessing data for effective TB elimination strategies.

PMID:40975573 | DOI:10.1016/j.ijtb.2025.09.001

Radiologia (Engl Ed). 2025 Sep-Oct;67(5):101576. doi: 10.1016/j.rxeng.2025.101576. Epub 2025 Aug 5.

ABSTRACT

INTRODUCTION: Scientific journals are a fundamental tool for the dissemination of evidence-based medicine. The scientific quality of a journal is related to the level of evidence of its publications. The aim of our study is to analyse and quantify changes in the levels of evidence assigned to articles published in the Radiología journal over the last six years.

MATERIAL AND METHODS: We evaluated articles published in Radiología from 2018 to 2023. A critical reading of the selected articles was carried out and a level of evidence was assigned using two scales that are specific to the field of radiology (Insights into Imaging and the 2011 Oxford Center Evidence Based Medicine). Pearson residuals were used to establish differences in the level of evidence over the years, with a p-value < 0.05 being considered statistically significant. The level of agreement between the two scales for assessing levels of evidence was also compared using the Kappa coefficient.

RESULTS: Of the total 404 publications in Radiología from 2018 to 2023, 275 articles were included for analysis. There was evidence of a progressive increase in the level of evidence for the publications, with a peak in 2023, consistently on both scales (p = 0.043). A Kappa coefficient of 0.92 was obtained in the analysis of agreement between scales (almost perfect agreement).

CONCLUSION: The level of evidence for publications in the Radiología journal has significantly increased in 2023.

PMID:40975552 | DOI:10.1016/j.rxeng.2025.101576

Cardiovasc Pathol. 2025 Sep 18:107782. doi: 10.1016/j.carpath.2025.107782. Online ahead of print.

ABSTRACT

Aortic valve (AV) malformation and AV malfunction have been linked to aortic wall degeneration. Studies concomitantly assessing AV morphology, AV function, age, ascending aortic dilatation, and aortic biomechanical properties are lacking. This exploratory study aims to close this gap. Surgical samples of the ascending aorta (n=102) were histologically assessed. Based on echocardiographic studies, the elastic modulus (slope stress-strain curve) was calculated. Patient characteristics were collected from the patient charts. Samples obtained during autopsy (n=10) served as reference for the microscopic analysis. The patient characteristics, structural aortic wall changes, and biomechanical wall properties were statistically explored using comparative analyses and a Spearman correlation matrix. Marked medial degeneration was found significantly earlier in life for unicuspid AV morphology compared to bicuspid and tricuspid AV. Significantly fewer lamellar units and thinner aortic walls were found in surgical samples compared to the reference group regardless of AV morphology, AV function, age, and aortic dilatation. Adventitial structural impairment was associated with stiffer aortic walls. Hints were found that AV morphology (rather than AV function, age, and presence/absence of aortic dilatation) affects structural and functional ascending aortic wall properties. Additionally, the observations suggest more advanced aortic degeneration in association with unicuspid AV, underpin the need for non-surgical control samples in surgical pathological studies, and highlight the importance of the adventitial layer for aortic biomechanics.

PMID:40975478 | DOI:10.1016/j.carpath.2025.107782

Comput Assist Surg (Abingdon). 2025 Dec;30(1):2562871. doi: 10.1080/24699322.2025.2562871. Epub 2025 Sep 20.

ABSTRACT

High-quality intraoperative video documentation is increasingly valued in surgery for its role in surgical evaluation, procedural archiving, and education. However, the comparative advantages of different recording methods have not been thoroughly examined. In this prospective, double-blinded study, 44 experienced orthopedic surgeons evaluated posterior total hip arthroplasty videos recorded using three techniques: a head-mounted camera, a light-handle-mounted camera, and an externally operated camera. All videos were captured by the same surgeon using standardized hardware and settings. Participants assessed video quality and educational value using a structured questionnaire. Data were analyzed using ANOVA and chi-square testing. The light-handle-mounted camera received the highest mean scores across all five evaluation domains, including visual clarity, image stability, and overall quality (mean scores ranging from 6.91 to 7.98). Repeated measures ANOVA confirmed statistically significant differences among the three camera techniques for all five questions (p = 0.022-0.043). Post hoc analysis revealed that the light-handle-mounted camera significantly outperformed the head-mounted system (p < 0.05 for all comparisons), while the external camera also demonstrated superiority over the head-mounted method. Chi-square testing showed a significant difference in educational suitability ratings (Question 6), with the light-handle-mounted system receiving the highest percentage of affirmative responses (79.5%) compared to the head-mounted (50.0%) and external cameras (31.8%) (p < 0.001). The light-handle-mounted system offered the most balanced solution, providing stable, high-quality recordings without disrupting sterility or workflow. While head-mounted and external methods have niche applications, their practical limitations reduce their suitability for routine documentation in procedures.

PMID:40974608 | DOI:10.1080/24699322.2025.2562871

J Clin Ultrasound. 2025 Sep 20. doi: 10.1002/jcu.70086. Online ahead of print.

ABSTRACT

PURPOSE: To study the diagnostic performance of ultrasound (US) in mild hip osteoarthritis (HOA) compared to conventional radiography (CR) and magnetic resonance imaging (MRI).

METHODS: Fifty-eight patients referred to CR for suspected HOA with at least unilateral Kellgren-Lawrence (KL) 2 change in the CRs were recruited. Bilateral hip US and MRI (n = 116) were performed, and patients filled the Visual Analog Scale (VAS) bilaterally. A sum US score was formed, and its correlation to KL grades and VAS scores was tested. Descriptive statistics, Chi square and McNemar’s test, Spearman correlation, and linear regression analysis were applied as statistical techniques.

RESULTS: US and CR showed similar moderate diagnostic performance compared to MRI with moderate correlation (r = 0.449) between US sum score and KL grades. With pain associations, US sum score showed an OR = 1.725 (CI 1.169-2.546) and KL grades an OR = 2.058 (CI 1.038-4.082).

CONCLUSION: US and CR demonstrated similar moderate diagnostic capability in detecting mild HOA compared to MRI, and both the US sum score and KL grades were associated with increased hip pain. With US and CR demonstrating different aspects of HOA, our findings support the complementary role of US in evaluating patients with suspected HOA.

PMID:40974584 | DOI:10.1002/jcu.70086

Epilepsia Open. 2025 Sep 20. doi: 10.1002/epi4.70150. Online ahead of print.

ABSTRACT

OBJECTIVE: Alterations to brain structures and networks involved in central autonomic and respiratory control are possible biomarkers of SUDEP, but were mainly demonstrated in people at high risk. Postictal generalized EEG suppression (PGES) has been recorded in every case of near or confirmed SUDEP. The structural alterations underpinning PGES are not known.

METHODS: This retrospective study included the brain MRIs of 100 patients with focal and generalized epilepsy who had experienced at least one generalized tonic-clonic seizure (GTCS) documented through long-term video-EEG monitoring, with PGES defined as postictal EEG activity below 10 microvolts lasting at least 20 s. Brain MRIs were parcellated into cortical and subcortical volumes, with further parcellation of thalamic subfields, and univariate and multivariate logistic regression models were applied to identify brain regions associated with PGES.

RESULTS: PGES was observed in 52 of 100 patients. Patients with PGES were older and had a slower heart rate before and after seizures compared to those without PGES. The tonic phase of GTCS was longer in patients with PGES. Univariate logistic regression analysis identified significant associations between PGES and six brain regions: the left and right lateral occipital cortices, left and right precuneus, and left and right thalamus. Multivariate analysis revealed that the right thalamus and both precuneus were independent predictors of PGES. Further analysis of thalamic subfields showed an increased volume of the ventral anterior nucleus of the right thalamus in patients with PGES.

SIGNIFICANCE: Structural alterations in the right thalamus and precuneus are significantly associated with the presence of PGES in epilepsy patients.

PLAIN LANGUAGE SUMMARY: Some people with epilepsy show a period of very low brain activity after a seizure, called PGES, which may be linked to a higher risk of sudden death. We analyzed brain scans from 100 people with epilepsy and found that two brain regions-the right thalamus and the precuneus-were different in those with PGES. These findings may help doctors understand which patients are more at risk after seizures and how to better protect them.

PMID:40974544 | DOI:10.1002/epi4.70150

J Autism Dev Disord. 2025 Sep 20. doi: 10.1007/s10803-025-07040-2. Online ahead of print.

ABSTRACT

PURPOSE: Extended reality (XR) technology has emerged as a promising tool for vocational training by providing controlled, customizable learning environments. This study aimed to evaluate the effectiveness of XR-based interventions in improving vocational skills for individuals with autism spectrum disorder (ASD) and intellectual disability (ID).

METHOD: A meta-analysis was conducted on 26 eligible studies (N = 642) employing pre-post experimental or controlled experimental designs, selected from an initial pool of 3,52 articles. Moderators included: (1) participants’ characteristics (disorder type, age, intelligence quotient, and co-occurring conditions), (2) technical characteristics (level of immersion and human-computer interaction), (3) intervention characteristics (assistance from human interventionist, intervention form, intervention intensity, including frequency, single-session duration, intervention period, total sessions, total duration), (4) target skills, and (5) measurement characteristics (evaluation methods and measurement tools).

RESULTS: We found: (1) XR-based interventions demonstrated a medium overall effect size (SMD = 0.73, 95% CI [0.59, 0.87]) for vocational skills training among individuals with ASD and ID. (2) Based on the results of statistical power analysis, subgroup analyses were conducted for target skill types. We found interventions targeting employment outcomes showed significantly lower effect sizes than those targeting job hard skills, job soft skills, and adaptive psychological traits. Additionally, interventions targeting maladaptive psychological traits were significantly less effective than those targeting job soft skills. (3) Based on results of statistical power analysis, meta-regression was conducted for single-session duration and revealed no significant moderating effect.

CONCLUSION: XR-based interventions show promise for improving vocational skills among individuals with ASD and ID, with effectiveness moderated by target skills. This meta-analysis highlights that improving employment for individuals with ASD and ID requires a multi-layered approach. We need to integrate technology optimization with inclusive policies and employment support.

PMID:40974514 | DOI:10.1007/s10803-025-07040-2