Nevin Manimala

Otol Neurotol. 2025 Jan 22. doi: 10.1097/MAO.0000000000004415. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify the incidence of positive autoimmune laboratory markers in idiopathic sudden sensorineural hearing loss (iSSNHL) and its impact on hearing prognosis.

STUDY DESIGN: Retrospective cohort database study.

SETTING: A collaborative national database (TriNetX) sourced from 79 large healthcare organizations in the United States.

PATIENTS: Adults (≥18 years old) diagnosed with iSSNHL (ICD-10 H91.2) treated with systemic steroids.

INTERVENTIONS: Autoimmune laboratory markers and salvage intratympanic (IT) steroids for SSNHL (CPT 69801).

MAIN OUTCOME MEASURES: 1) Positivity of autoimmune laboratory markers-rheumatoid factor (RF), ANCA, DNA double strand antibody (Ab), Sjogren syndrome A and B Abs, SCL-70 Ab, cardiolipin IgG Ab, Jo-1 Ab, ANA, mitochondria Ab. 2) Percent of patients that underwent salvage IT steroids, cochlear implantation, or hearing aid evaluation-all utilized as a proxy for hearing outcomes.

RESULTS: Subjects with iSSNHL who had autoimmune testing (n = 17,413) were marginally more likely to be positive for at least one autoimmune laboratory marker compared to subjects without iSSNHL (n = 17,413; 23.0% vs. 21.4%, p = 0.0006). Statistical significance was lost after removing nonspecific autoimmune markers, however. Of those with iSSNHL who received systemic steroid treatment, subjects with positive autoimmune markers (n = 5,153) versus negative autoimmune markers (n = 5,153) underwent similar rates of salvage IT steroids (7.1% vs. 7.8%, p = 0.154), hearing aid evaluation (2.76% vs 2.47%, p = 0.354), and cochlear implantation (1.65% vs. 1.69%, p = 0.878).

CONCLUSIONS: Patients with iSSNHL have a marginally higher incidence of nonspecific positive autoimmune laboratory markers compared to those without iSSNHL; however, the presence of these markers does not predict treatment response or prognosis. Specifically, autoimmune markers did not predict the need for salvage IT steroids, nor CI and hearing aid use in iSSNHL. Autoimmune laboratory testing may be useful in iSSNHL patients with additional symptoms suspicious for an autoimmune disorder; however, a generalized screening is not recommended as it is unlikely to alter management or prognosis.

PMID:39965237 | DOI:10.1097/MAO.0000000000004415

Otol Neurotol. 2025 Feb 4. doi: 10.1097/MAO.0000000000004410. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the quality of information provided by artificial intelligence platforms ChatGPT-4 and Claude 2 surrounding the management of vestibular schwannomas.

STUDY DESIGN: Cross-sectional.

SETTING: Skull base surgeons were involved from different centers and countries.

INTERVENTION: Thirty-six questions regarding vestibular schwannoma management were tested. Artificial intelligence responses were subsequently evaluated by 19 lateral skull base surgeons using the Quality Assessment of Medical Artificial Intelligence (QAMAI) questionnaire, assessing “Accuracy,” “Clarity,” “Relevance,” “Completeness,” “Sources,” and “Usefulness.”

MAIN OUTCOME MEASURE: The scores of the answers from both chatbots were collected and analyzed using the Student t test. Analysis of responses grouped by stakeholders was performed with McNemar test. Stuart-Maxwell test was used to compare reading level among chatbots. Intraclass correlation coefficient was calculated.

RESULTS: ChatGPT-4 demonstrated significantly improved quality over Claude 2 in 14 of 36 (38.9%) questions, whereas higher-quality scores for Claude 2 were only observed in 2 (5.6%) answers. Chatbots exhibited variation across the dimensions of “Accuracy,” “Clarity,” “Completeness,” “Relevance,” and “Usefulness,” with ChatGPT-4 demonstrating a statistically significant superior performance. However, no statistically significant difference was found in the assessment of “Sources.” Additionally, ChatGPT-4 provided information at a significant lower reading grade level.

CONCLUSIONS: Artificial intelligence platforms failed to consistently provide accurate information surrounding the management of vestibular schwannoma, although ChatGPT-4 achieved significantly higher scores in most analyzed parameters. These findings demonstrate the potential for significant misinformation for patients seeking information through these platforms.

PMID:39965220 | DOI:10.1097/MAO.0000000000004410

Rev Neurosci. 2025 Feb 20. doi: 10.1515/revneuro-2024-0149. Online ahead of print.

ABSTRACT

This review explores the correlation of non-alcoholic fatty liver disease (NAFLD) with cognitive function and brain changes. A comprehensive search of relevant studies in the PubMed database up to June 2024 was conducted, including various study designs such as cross-sectional, longitudinal, case-control, and cohort studies. Data were extracted from 24 studies, focusing on study design, sample size, NAFLD diagnosis, control of confounders, key findings, and limitations. Neuropsychological tests utilized within each study were grouped into relevant cognitive domains. Statistical analyses and comparisons were also performed on the observed changes in brain parameters across the studies. The meta-analysis on the domain of general cognition was conducted. Results indicated that NAFLD was significantly associated with general cognition, executive function, attention, and memory. NAFLD impacts the total brain volume, the volumes of specific brain regions and certain high-intensity brain regions, the cerebral blood flow and perfusion, the integrity of nerve fiber bundles, and the brain abnormalities or lesions such as cerebral hemorrhage, cerebral microbleeds, and white matter lesions. NAFLD also affects the thickness and surface area of certain cortical regions and the resting-state brain function MRI indicators in specific brain areas. Despite these findings, the included studies varied in design, population characteristics, and outcome measures, which introduced heterogeneity that might influence the generalizability of the results. Overall, NAFLD is associated with a decline in cognitive function and alterations in certain brain parameters. Furthermore, NAFLD may exert its influence on cognition by impacting brain structure.

PMID:39965194 | DOI:10.1515/revneuro-2024-0149

JMIR Form Res. 2025 Feb 18;9:e57826. doi: 10.2196/57826.

ABSTRACT

BACKGROUND: Spinal pain, one of the most common musculoskeletal disorders (MSDs), significantly impacts the quality of life due to chronic pain and disability. Physical activity has shown promise in managing spinal pain, although optimizing adherence to exercise remains a challenge. The digital development of artificial intelligence (AI)-driven applications offers a possibility for guiding and supporting patients with MSDs in their daily lives.

OBJECTIVE: The trial aimed to investigate the effect of an 8-week AI-composed exercise program on pain intensity and well-being in patients with spinal pain. It also examined the relationship between exercise frequency, pain intensity, and well-being. In addition, app usage frequency was examined as a proxy for app engagement.

METHODS: Data from users who met the inclusion criteria were collected retrospectively from the medicalmotion app between January 1, 2020, and June 30, 2023. The intervention involved the use of the medicalmotion app, which provides 3-5 personalized exercises for each session based on individual user data. The primary outcomes assessed pain intensity and well-being using the numeric rating scale (NRS) and the Likert scale. Data were collected at baseline (t0), 4 weeks (t1), and 8 weeks (t2). The correlation between exercise frequency, pain intensity, and well-being was analyzed as a secondary outcome. In addition, average session length and frequency were measured to determine app engagement. Statistical analysis included ANOVA and Spearman correlation analysis.

RESULTS: The study included 379 participants with a mean age of 50.96 (SD 12.22) years. At t2, there was a significant reduction of 1.78 points on the NRS (P<.001). The score on the Likert scale for well-being improved by 3.11 points after 8 weeks. Pain intensity showed a negative correlation with the number of daily exercises performed at t1 and t2. Well-being had a small negative correlation with the average number of exercises performed per day. The average number of exercises performed per day was 3.58. The average session length was approximately 10 minutes, and the average interaction with the app was 49.2% (n=27.6 days) of the 56 available days.

CONCLUSIONS: Overall, the study demonstrates that an app-based intervention program can substantially reduce pain intensity and increase well-being in patients with spinal pain. This retrospective study showed that an app that digitizes multidisciplinary rehabilitation for the self-management of spinal pain significantly reduced user-reported pain intensity in a preselected population of app users.

PMID:39965189 | DOI:10.2196/57826

Neurology. 2025 Mar 25;104(6):e213423. doi: 10.1212/WNL.0000000000213423. Epub 2025 Feb 18.

ABSTRACT

OBJECTIVES: Increasing numbers of older adults are reentering community following incarceration (i.e., reentry), yet risk of incident neurodegenerative disorders associated with reentry is unknown. Our objective was to determine association between reentry status (reentry vs never-incarcerated) and mild cognitive impairment (MCI) and/or dementia.

METHODS: This nationwide, longitudinal cohort study used linked Centers for Medicare & Medicaid Services and Veterans Health Administration data. Participants were aged 65 years or older who experienced reentry between October 1, 2012, and December 31, 2018, with no preincarceration MCI/dementia, compared with age-matched/sex-matched never-incarcerated veterans. MCI/dementia was defined by diagnostic codes. Fine-Gray proportional hazards models were used to examine association.

RESULTS: This study included 35,520 veterans, mean age of 70 years, and approximately 1% women. The reentry group (N = 5,920) had higher incidence of MCI/dementia compared with the never-incarcerated group (N = 29,600; 10.2% vs 7.2%; fully adjusted hazard ratio [aHR] 1.12; 95% CI 1.00-1.25). On further investigation, reentry was associated with increased risk of dementia with or without prior MCI diagnosis (aHR 1.21; 95% CI 1.06-1.39) but not MCI only.

DISCUSSION: Transition from incarceration to community increased risk of neurocognitive diagnosis. Findings indicate health/social services to identify and address significant cognitive deficits on late-life reentry. Limitations include generalizability to nonveterans.

PMID:39965180 | DOI:10.1212/WNL.0000000000213423

JCO Clin Cancer Inform. 2025 Feb;9:e2400177. doi: 10.1200/CCI-24-00177. Epub 2025 Feb 18.

ABSTRACT

PURPOSE: Treatment deintensification for human papillomavirus-positive (HPV+)-associated oropharyngeal cancer (OPC) has been the catalyst of experts worldwide. In situ hybridization is optimal to identify HPV+ OPC, but immunohistochemistry for its surrogate p16INK4a (p16) is standard-of-care given its availability and sensitivity. HPV testing is not required for clinical management, so treatments are often administered on the basis of p16 status alone. However, the prognosis of p16/HPV discordant tumors is uncertain.

MATERIALS AND METHODS: This cohort study included 727 consecutive patients with OPC with digitized unstructured pathology reports receiving curative radiation therapy at an academic cancer center. Natural language processing (NLP) methods were used to classify biomarker status and compared against manually derived classification. Patients were excluded if either p16 or HPV testing was not performed or equivocal. Primary end points were progression-free survival (PFS), cancer-specific survival (CSS), and overall survival.

RESULTS: NLP classified p16 and HPV status from a majority (91%) of reports. Accuracy, positive predictive value, sensitivity, and F-score for NLP-derived p16/HPV were 84%/82%, 91%/87%, 90%/89%, and 90%/88%, respectively. Four groups were identified: p16-positive (p16+)/HPV+ (75%), p16+/HPV-negative (HPV-; 13%), p16-negative (p16-)/HPV- (10%), and p16-/HPV+ (2%). There was no statistically significant difference in outcomes between p16+/HPV- and p16-/HPV- patients (5-year PFS 76.1% v 68.9%; P = .12; 5-year CSS 81.5% v 84.9%; P = .22). Number needed to harm calculations estimated one excess cancer-related death for every 10 p16+/HPV- patients, compared with that expected with p16+/HPV+ patients.

CONCLUSION: NLP classified head and neck cancer pathology reports with high concordance with gold-standard categorization, but a conspicuous portion of reports could not be interpreted. p16/HPV discordant OPC constitutes a noteworthy minority of patients. The inferior prognosis of p16+/HPV- suggests that p16 alone for prognostication is insufficient-especially when considering treatment de-escalation.

PMID:39965177 | DOI:10.1200/CCI-24-00177

J Trop Pediatr. 2025 Feb 5;71(2):fmaf007. doi: 10.1093/tropej/fmaf007.

ABSTRACT

To estimate the seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection among hospitalized children aged between 1 and 12 years. A cross-sectional study was conducted to determine the seroprevalence of SARS-CoV-2 antibodies among hospitalized children at a tertiary care hospital in the North-East region of India for a period of 13 months (October 2022-November 2023). The presence of SARS-CoV-2 antibodies was estimated using enzyme-linked immunosorbent assay method. Sociodemographic characteristics and clinical profile of the participants were analyzed. The seroprevalence of SARS-CoV-2 infection among hospitalized children aged between 1 and 12 years was estimated to be 98.4%. This was comparable for children between the age groups 1-5 years (97.9%) and 6-12 years (99.1%) (P-value = .478). The most commonly reported symptoms among the seropositive children were fever (76.8%), nasal stuffiness (69.5%), cough (67.8%), diarrhea (23.6%), and nausea/vomiting (23.2%). None of the study participants had a prior history of laboratory confirmed coronavirus disease (COVID-19) infection in the past and none were vaccinated against COVID-19. Results of the univariate analysis showed that there was no significant difference between the seropositive and seronegative children in the distribution of sociodemographic characteristics, clinical profile, and laboratory findings. Our study observed a remarkably high anti-SARS-CoV-2 seropositivity rate of 98.4%, suggesting a significant under-recognized burden of COVID-19 in the pediatric population. The findings highlight the need for continued preventive measures and the development of age-appropriate vaccination strategies, particularly in tropical settings.

PMID:39965169 | DOI:10.1093/tropej/fmaf007

J Speech Lang Hear Res. 2025 Feb 18:1-14. doi: 10.1044/2024_JSLHR-24-00419. Online ahead of print.

ABSTRACT

PURPOSE: This study uses a voice production model to estimate muscle activation levels and subglottal pressure (P_S) in patients with phonotraumatic vocal hyperfunction (PVH), based on ambulatory measurements of sound pressure level (SPL) and spectral tilt (H₁-H₂). In addition, variations in these physiological parameters are evaluated with respect to different values of the Daily Phonotrauma Index (DPI).

METHOD: The study obtained ambulatory voice data from patients diagnosed with PVH and a matched control group. To infer physiological parameters, ambulatory data were mapped onto synthetic data generated by a physiologically relevant voice production model. Inverse mapping strategies involved selecting model simulations that represented ambulatory distributions using stochastic (random) sampling weighted by probability with which different vowels occur in English. A categorical approach assessed the relationship between different values of DPI and changes in estimated physiological parameters.

RESULTS: Results showed significant differences between the PVH and control groups in key parameters, including statistical moments of H₁-H₂, SPL, P_S, and muscle activity of lateral cricoarytenoid (LCA) and cricothyroid (CT) muscles. Higher DPI values, reflecting more severe PVH, were associated with increased mean LCA activation and decreased LCA variability, along with decreased mean CT activation and increased median P_S. These findings highlight the relationship between muscle activation patterns, P_S, and the severity of vocal pathology as indicated by the DPI. It is hypothesized that a major driver of muscle activation and P_S changes is the variation in maladaptive adjustments (vocal effort) when compensating for the presence of vocal pathology.

CONCLUSIONS: This study demonstrated that noninvasive ambulatory voice data could be used to drive a voice production modeling process, providing valuable insights into underlying physiological parameters associated with PVH. Future research will focus on refining the predictive power of the modeling process and exploring the implications of these findings in further delineating the etiology and pathophysiology of PVH, with the ultimate goal to develop improved methods for the prevention, diagnosis, and treatment of PVH.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.28352720.

PMID:39965156 | DOI:10.1044/2024_JSLHR-24-00419

J Speech Lang Hear Res. 2025 Feb 18:1-24. doi: 10.1044/2024_JSLHR-24-00203. Online ahead of print.

ABSTRACT

PURPOSE: Transgender and gender-diverse (TGD) people and their communication wishes are diverse and heterogeneous, so it is important to understand the situation and goals of each person individually when they arrive for professional interventions. This article describes the development and content validation of the Voice and Communication Situation Questionnaire developed with and for TGD people presumed female at birth (VCSQ^PFAB).

METHOD: Phase 1 included a transdisciplinary literature review and an initial draft of a questionnaire designed to collect self-reports of sociocultural positioning, voice and communication function, and well-being of TGD people presumed female at birth (PFAB). Phase 2 involved collection of information and feedback on the draft questionnaire via focus groups of 31 members of the PFAB community in Germany, Sweden, and the United States.

RESULTS: Revisions were based on the feedback from all focus groups and consensus within the research team. Feedback highlighted the need to develop a clear approach to introducing the questionnaire to respondents and to provide support during its completion so that self-ratings and descriptions capture the client perspective regarding categories built into the questionnaire.

CONCLUSIONS: The final draft of the VCSQ^PFAB provides an adequate framework for a person-centered and culturally responsive approach to working with TGD people PFAB. The tool is now ready to be piloted in clinical settings and statistically analyzed for further psychometric properties.

PMID:39965155 | DOI:10.1044/2024_JSLHR-24-00203

Ann Am Thorac Soc. 2025 Feb 18. doi: 10.1513/AnnalsATS.202406-603OC. Online ahead of print.

ABSTRACT

RATIONALE: Continuity of nursing care is highly valued in the intensive care unit (ICU), but its impact on patient outcomes remains unclear.

OBJECTIVES: To investigate the relationship between nurse continuity and mortality among ICU patients.

METHODS: We performed a retrospective cohort study using electronic health records from 38 ICUs across eighteen hospitals between 2018 and 2020. Cumulative nurse continuity was defined at the shift level as the proportion of 12-hour shifts in which the patient received care from a nurse that had previously provided care to them, up to and including the present shift. Employing a landmark analysis framework, we used logistic regression to assess the relationship between in-hospital mortality and cumulative nurse continuity at each shift, adjusting for potential confounders.

MEASUREMENTS AND MAIN RESULTS: The study included 47,564 ICU patients. In-hospital mortality was 10.4%. Average cumulative nurse continuity increased from 10.2% at shift three to 34.2% at shift 14. In the regression models, increasing cumulative nurse continuity was associated with a modest but statistically significant increase in mortality in some but not all shifts. The results were robust to sensitivity analyses including limiting the cohort to patients receiving mechanical ventilation, excluding patients admitted during the COVID-19 pandemic, using different measures of continuity, and treating continuity as a time-varying covariate using proportional hazards regression.

CONCLUSIONS: Nurse continuity was not associated with lower mortality and may lead to increased mortality in some settings. Further research is needed to understand the mechanisms underlying the association between nurse continuity and ICU outcomes.

PMID:39965150 | DOI:10.1513/AnnalsATS.202406-603OC