Nevin Manimala

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

Br J Clin Pharmacol. 2025 May 7. doi: 10.1002/bcp.70087. Online ahead of print.

ABSTRACT

AIMS: This study aimed to identify patterns of direct oral anticoagulant (DOAC) and vitamin K antagonist (VKA) use in hospitalized patients and to examine their association with in-hospital haemorrhagic complications and mortality.

METHODS: An observational cross-sectional study was conducted among hospitalized patients ≥18 years from 2018 to 2022. Data on hospital discharges were obtained from the minimum data set and were matched with pharmacy records to identify patients treated with DOACs or VKAs. In-hospital haemorrhagic complications and mortality rates were calculated for study groups. Multivariate logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (95%CIs), adjusting for age, sex and comorbidities. Analyses were stratified by medical and surgical profiles. Statistical significance was set at .05.

RESULTS: The study included 74 190 patients, with 4774 receiving DOACs and 1768 VKAs. During the study period, DOAC use increased by 45.11%. DOAC-treated patients had lower complication rates than those treated with VKAs (1.9 vs. 2.8%, respectively; P = .032). DOAC use was linked to a lower risk of haemorrhagic complications in surgical patients (OR = 0.65; 95%CI: 0.35-0.91), while in medical patients, the reduction in risk was not statistically significant (OR = 0.59; 95%CI: 0.33-1.10). No effect on mortality risk was observed among medical and surgical patients.

CONCLUSIONS: The increased use of DOACs among hospitalized patients showed a protective effect against haemorrhagic complications in surgical patients, supporting their increasing use in hospital settings.

PMID:40331313 | DOI:10.1002/bcp.70087

Acta Anaesthesiol Scand. 2025 Jul;69(6):e70047. doi: 10.1111/aas.70047.

ABSTRACT

BACKGROUND: Pain management is an important part of prehospital care. Pain assessment and recognition are inseparable in adequate pain treatment. However, relatively scarce literature is available from Nordic and European countries. We investigated the current practices of pain assessment and management in the Emergency Medical Service (EMS) of one Finnish hospital area.

METHODS: The cohort data were originally collected prospectively to assess various quality processes in EMS. This study was designed as a descriptive, retrospective, register-based cohort study, analysing data from 7245 patients encountered by EMS over a one-month period in the Tampere University Hospital area of Finland in 2021. Pain levels were primarily assessed using the numeric rating scale (NRS). Records were combined with auxiliary data from the National Emergency Response Centre Agency. We grouped patients into six age groups and recorded dispatch categories in seven groups to clarify the impact of age and dispatch category on pain assessment and intensity. We used crosstabulation and Pearson’s chi-square test for statistical analyses; we also applied a linear mixed model to analyse the effect of pain medication on pain intensity.

RESULTS: Pain was assessed once in 2586 (36%) patients and then reassessed a second time for 707 (27%) of those patients. Age and dispatch category affected pain intensity (p < 0.001): Patients under 66 reported higher pain intensity than patients over 66 years. In dispatch categories, “oxygen deficiency” and “non-mechanical accident or exposure,” reported pain intensity was minimal compared to other categories. Of the patients with a pain assessment, 611 (24%) experienced pain equal to or greater than 4 on the NRS scale. We found that assessment with a high NRS level was associated with a higher likelihood of administering potent pain medication.

CONCLUSION: The prevalence of pain assessment is relatively low. The diverse nature of EMS interventions must be considered when improving pain management strategies.

PMID:40331303 | DOI:10.1111/aas.70047

Ecology. 2025 May;106(5):e70086. doi: 10.1002/ecy.70086.

ABSTRACT

Occupancy models estimate a species’ occupancy probability while accounting for imperfect detection, but often overlook the issue of false-positive detections. This problem of false positives has gained attention recently with the rapid advancement of automated species detection tools using artificial intelligence (AI), which generate continuous confidence scores for each species detection. Novel occupancy models have been introduced that integrate these confidence scores to identify false positives, but these models require thorough assessments of diagnosis and validation. Here, we propose a new occupancy model based solely on AI-detected species data. We conducted simulations to examine the inferential and predictive accuracies with known true parameters and analyzed AI-detected species data to test the practical usefulness through goodness-of-fit tests and evaluation with external data. Our proposed model mostly outperformed alternative models that ignore imperfect detection or false-positive error probabilities in terms of accuracy in simulation analyses and goodness-of-fit tests in the case study, but not in terms of discrimination metrics based on external data. The proposed occupancy model aids in understanding species-habitat relationships and developing automated biodiversity monitoring workflows by accounting for both false-negative and false-positive errors.

PMID:40331299 | DOI:10.1002/ecy.70086

Ren Fail. 2025 Dec;47(1):2462443. doi: 10.1080/0886022X.2025.2462443. Epub 2025 Feb 6.

ABSTRACT

BACKGROUND: The correlations between the intra-renal resistive index (RRI) and renal histopathology characteristics, especially in those with infected allografts, have not been sufficiently investigated in renal transplant recipients. We aimed to examine the correlation between RRI and renal allograft infection in these subjects.

METHODS: One hundred nine renal allograft recipients were recruited, and RRI was evaluated for correlation with renal allograft infection. Based on laboratory and histopathological findings, 64 renal-allograft recipients were recruited for the infected group, and 45 were recruited for the non-infected group.

RESULTS: The causes of allograft infection were Cytomegalovirus (CMV) infection (30.3%), urinary tract infections (UTI) (18.3%), and polyomavirus 1 (BK virus) infections (10.1%). There was a statistically significant difference in RRI in those with allograft infections, with the ROC curve for detection of infection utilizing RRI demonstrated an Area Under Curve 0.634 (p-value 0.015; cutoff value: 0.765; CI:0.527-0.742), with a specificity of 64.4% and a sensitivity of 68.8%.

CONCLUSION: Normal renal graft arterial resistivity index values, despite a renal allograft dysfunction, may be indicative of allograft infection, guiding clinicians’ decisions regarding kidney biopsy and facilitating further biopsy interpretations.

PMID:40331298 | DOI:10.1080/0886022X.2025.2462443

HIV Med. 2025 May 7. doi: 10.1111/hiv.70039. Online ahead of print.

ABSTRACT

INTRODUCTION: Stigma and discrimination against people living with human immunodeficiency virus (PLHIV) within healthcare settings remain significant barriers to effective care. Stigmatizing attitudes persist among healthcare professionals, potentially undermining care quality. This study aimed to assess HIV-related knowledge and attitudes among healthcare professionals in Portugal, focusing on identifying factors associated with stigma.

METHODS: This study was part of a European survey by the European Centre for Disease Prevention and Control (ECDC) and the European AIDS Clinical Society (EACS). Data were collected via an online self-administered questionnaire between September and December 2023, targeting healthcare professionals in Portugal. Descriptive statistics, chi-square tests and multivariate logistic regression were used to assess associations between sociodemographic characteristics, HIV knowledge and stigma.

RESULTS: A total of 807 healthcare professionals participated in the study, with a majority being women (78%), and a mean age of 43.5 years. Most respondents were nurses (38%) and doctors (28%), worked in hospitals (54%) or primary healthcare centres (31%). The analysis showed that healthcare professionals working in HIV-dedicated departments, hospitals or community centres exhibited significantly higher levels of HIV-related knowledge. In contrast, female professionals, those over 40 years old and non-doctor professionals were less likely to demonstrate high HIV-related knowledge. Regarding stigma, professionals with limited HIV training and lower HIV knowledge were more likely to display higher levels of stigma.

CONCLUSIONS: These findings highlight the need for targeted educational interventions to reduce stigma. Strengthening HIV-specific training, especially in stigma reduction, is crucial for improving care for PLHIV and fostering an inclusive healthcare environment.

PMID:40331284 | DOI:10.1111/hiv.70039

Colorectal Dis. 2025 May;27(5):e70114. doi: 10.1111/codi.70114.

ABSTRACT

AIM: Rectopexy with concomitant sacrocolpopexy (sacrocolporectopexy) is the favoured technique for treating combined pelvic organ prolapse and internal or external rectal prolapse, despite limited functional improvement. Previous studies have assessed anatomical change after standalone rectopexy or sacrocolpopexy, based on supine MRI defaecography. Since a supine position can underestimate the extent of pelvic organ prolapse, it might also incorrectly assess the anatomical effect of sacrocolporectopexy. The aim of this study was to assess the effect of sacrocolporectopexy on the pelvic anatomy in an upright position.

METHOD: Twenty one female patients undergoing sacrocolporectopexy from December 2022 to June 2024 were included. All patients underwent physical examination and MRI defaecography preoperatively and postoperatively. The descent of the bladder, vaginal vault and anorectal junction and the size of the rectocele and enterocele were assessed on the MRI defaecography images during maximum straining. Significance was tested using a paired t-test and an improvement of ≥10 mm was considered clinically relevant. The results were compared with previous studies, which used supine assessment.

RESULTS: Postoperative improvement was found for the bladder, vaginal vault, anorectal junction, rectocele and enterocele with 14, 44, 5, 16 and 54 mm respectively. The bladder, vaginal vault, rectocele and enterocele showed clinically relevant improvement. Compared with supine results, upright assessments revealed a larger organ lift for the vaginal vault as well as a higher, overall, position of the anorectal junction.

CONCLUSION: Upright assessment of sacrocolporectopexy differs from supine assessment, with statistical and clinically relevant lift for the pelvic organs.

PMID:40331245 | DOI:10.1111/codi.70114