Nevin Manimala

Folia Med Cracov. 2025 Jul 31;65(2):142-152. doi: 10.24425/fmc.2025.156131.

ABSTRACT

There is a lack of research that methodically clarifies baseline muscle tone values and demonstrates their activation during balance tests using selected parts of the 4-Stage Balance Test. The study involved 41 men and 34 women (mean age approximately 22 years (X = 21.83 y, SD 1.5 y)). Data were collected using a questionnaire containing socio-demographic and anthropometric data. Range of motion was measured using a goniometer (SFTR Goniometer Baseline 360 degrees), limb length and circumference were measured using a ADE MZ10021 tape measure and static balance was assessed using two tests from the 4-Stage Balance Test. Eight muscles (Rectus Femoris (RF), Vastus Lateralis (VL), Vastus Medialis (VM), Semitendinosus (S), Biceps Femoris (BF), Tibialis Anterior (TA), Gastrocnemius Medialis (GM), Gastrocnemius Lateralis (GL)) bioelectrical activity data were obtained using a Noraxon MR 400 sEMG device and MyoTrace software. Statistical analysis was performed using SPSS Statistics v25. In parallel foot position the highest EMG activity was observed in the VM (99.18 mV), S (55.27 mV) and RF (33.06 mV) muscles. In semi-tandem foot position the highest activity was observed in S (120.8 mV), GM (59.03 mV), and TA (47.84 mV) muscles, with the lowest in BF (6.58 mV) muscle. 1. Lowered base of support increases the activity of the semitendinosus and medial gastrocnemius muscles. 2. Maintaining the feet-together stance depends on the synergy between the semitendinosus and medial gastrocnemius muscles. 3. Maintaining semi-tandem positioned halfway in front of the other foot depends on the synergy between the vastus lateralis and tibialis anterior muscles.

PMID:41329980 | DOI:10.24425/fmc.2025.156131

Folia Med Cracov. 2025 Jul 31;65(2):101-111. doi: 10.24425/fmc.2025.156128.

ABSTRACT

OBJECTIVES: The study examined the natural progression of squamous intraepithelial lesions (SIL) and human papilloma virus (HPV) infection during pregnancy, comparing initial and postpartum results. It also assessed delivery mode’s impact on outcomes and strategies to improve follow-up care for women with abnormal cervical cancer screening results.

METHODS: This retrospective study analyzed data from 59 pregnant women with SIL/positive HPV, assessing variables such as cytology, HPV status, and delivery mode. Statistical tests included Wilcoxon rank-sum and Fisher’s exact tests.

RESULTS: The average age of patients was 29 years. Over 50% were primigravidas. A significant reduction in abnormal cytology was observed postpartum (89.83% vs. 62.50%, p = 0.009), with an increase in normal results (10.17% vs. 37.50%). No significant differences were found in HPV status (88.89% vs. 81.25%, p =0.655). Colposcopy findings were stable for 76.32% of patients between Visits 1 and 2, with 50% stability between Visits 2 and 3. Postpartum, 30.43% showed regression, while 8.70% showed progression (p = 0.017, padj < 0.050). Higher regression rates were observed after vaginal birth compared to the cesarean section (45.45% vs. 15.38%, p = 0.182) but no significant differences were found (p = 1.000). Almost 60% of patients were lost to postpartum follow-up.

CONCLUSION: Further studies with a larger population of Polish patients are needed. Cervical cancer screening should be optimized and integrated into a national registry. Pregnant patients with abnormal screening results should be managed by experts, and strategies to enhance patient compliance must be implemented.

PMID:41329977 | DOI:10.24425/fmc.2025.156128

Folia Med Cracov. 2025 Jul 31;65(2):93-99. doi: 10.24425/fmc.2025.156127.

ABSTRACT

The gold standard for assessing liver fibrosis is core needle biopsy. Its invasive nature, however, limits its wide use. Hence the need for non-invasive methods in patients with hepar venostaticum due to right ventricular [RV] failure: one of them is the FIB4 index. Another method, Fibroscan, is based on an ultrasound technique from elastography.

OBJECTIVE: to assess the correlation and determination indices between the FIB4 index and the assessment of liver stiffness by Fibroscan (E) on one hand and echocardiographic parameters describing RV function on the other hand. The study group: 33 patients (74 ± 13 years) with heart failure due to pulmonary hypertension, arterial hypertension, valvular diseases, myocardial infarction or cardiomyopathy.

RESULTS: echocardiography – RV dimension 38 ± 8 mm, systolic pressure in pulmonary artery (SPAP) 53 ± 24 mmHg, tricuspid annular plane systolic excursion (TAPSE) 17 ± 4mm, acceleration time of flow through the pulmonary valve (ACT) 79 ± 23 ms, the degree of tricuspid valve regurgitation 2 ± 1; the FIB4 result in this group – 2.54 ± 1.19, and the stiffness index E: 13.79 ± 12.55 kPa. Only RV dimension and the degree of tricuspid valve regurgitation showed moderately strong positive correlation with the stiffness index E: the correlation index – 0.327 and 0.382, respectively, with the determination index 27.9% and 43.4%, respectively.

CONCLUSION: The results emphasize the relationship between the morphological remodeling of the RV and the degree of secondary tricuspid regurgitation and the advancement of fibrotic changes in the liver and encourage the continuation of studies on larger groups of patients with a homogeneous etiology of RV failure, using a wider spectrum of echocardiographic parameters.

PMID:41329976 | DOI:10.24425/fmc.2025.156127

Eur Heart J Acute Cardiovasc Care. 2025 Dec 2:zuaf158. doi: 10.1093/ehjacc/zuaf158. Online ahead of print.

ABSTRACT

BACKGROUND: Contemporary guidelines support the use of a pharmaco-invasive (PI) strategy with immediate transfer to a percutaneous coronary intervention (PCI)-capable hospital for ST-elevation myocardial infarction (STEMI) when timely primary PCI (pPCI) is unattainable. However, when reperfusion with fibrinolysis fails to occur, rescue PCI is recommended.

METHODS: In a pre-specified analysis from STREAM-2, we explored patients randomized to PI treatment and compared those receiving half-dose tenecteplase who required rescue intervention to those with successful fibrinolysis undergoing scheduled angiography. To provide context for those randomized pPCI, we also explored the relationship between site of randomization, i.e., community hospital (CH) versus ambulance on clinical outcomes. Resolution of ST-elevation following angiography and the composite of 30-day all-cause death, shock, heart failure and reinfarction, as well as safety, reflected by stroke and non-intracranial bleeding, were measured.

RESULTS: Of the 583 patients in the current study, 168 patients required rescue intervention [43.5%], 218 patients had successful fibrinolysis scheduled for angiography and 197 were randomized to pPCI. Rescue PCI patients, compared to those undergoing scheduled angiography, had less ST resolution ≥50% (76.3% versus 92.5%, P<0.001) and worse clinical composite outcomes at 30 days (16.7% versus 6.0%, P<0.001) with a higher risk of intracranial hemorrhage (2.4% versus 0.5%). Intermediate outcomes were observed for patients undergoing pPCI (ST resolution ≥50%: 78.7%; 30-day composite outcome: 12.2%). Rescue intervention deployed in CH patients required 10 minutes longer compared to ambulance patients: however, there was similar ST resolution ≥50% (72.2% versus 80.5%, P=0.219) and comparable 30-day composite outcome (17.6% versus 15.7%, relative risk [RR] 0.97, 95% confidence interval [CI] 0.50 – 1.87), irrespective of location. pPCI required 48 minutes longer in CH patients, but resulted in similar outcomes to ambulance patients (ST resolution ≥50%: 77.0% versus 80.2%, P=0.595; 30-day composite outcome: 9.3% versus 15.6%, RR 1.57, 95% CI 0.72-3.41, respectively).

CONCLUSION: Contemporary PI with half-dose tenecteplase in older patients requiring rescue intervention led to less ST resolution and worse 30-day outcomes compared to those with successful fibrinolysis receiving scheduled angiography. Notably, delays to deploying rescue PCI in CH patients were shortened over those previously achieved thereby resulting in similar outcomes to those randomized in the ambulance. Our results reinforce the benefits of functional hub and spoke models with rapid transfer to a PCI-capable facility.

PMID:41329963 | DOI:10.1093/ehjacc/zuaf158

JMIR Res Protoc. 2025 Dec 2;14:e71680. doi: 10.2196/71680.

ABSTRACT

BACKGROUND: Suboptimal diet quality and physical inactivity are key risk factors for chronic disease and disability in Canada. However, the lack of high-quality population-level data hinders the development of evidence-based strategies to support improvements in diet quality, movement behaviors (physical inactivity, activity, and sleep), and health. The lack of data is also a barrier to developing capacity in diet and physical activity assessment and epidemiology in Canada.

OBJECTIVE: This protocol describes the development of the largest known repository of dietary intake and movement behavior data in Canada by drawing upon an existing longitudinal cohort study, the Canadian Partnership for Tomorrow’s Health (CanPath). In the short-term, the data will be used to examine associations between system factors (eg, retail food environments) and dietary intake. In the longer-term, data will be available to pursue a range of research questions, including longitudinal associations between diet, movement behavior, and health outcomes.

METHODS: Participants in CanPath (>330,000 adults) who can complete online questionnaires are eligible and will be asked to complete a baseline web-based questionnaire including questions on demographic characteristics and screeners capturing dietary intake and movement behaviors. Subsequently, participants will be invited to complete an online 24-hour dietary recall using the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24-Canada-2018) and an online 24-hour activity recall using Activities Completed Over Time in 24 Hours (ACT24). Repeat recalls will be administered 1-2 weeks later. A subset of participants will be invited to complete 2 additional ASA24-Canada-2018 and Activities Completed Over Time in 24 Hours recalls 6 months later. One year after baseline, participants will be invited to complete past-year diet and movement behavior questionnaires. In Québec, dietary intake and movement behavior data are from 3000 CanPath participants enrolled in the NutriQuébec study. Participant addresses will be linked to geospatial data on the food, built, and social environment.

RESULTS: Data collection began in 2025. As of manuscript acceptance (November 4, 2025), 3171 participants had been recruited. Data processing and cleaning will be completed in 2027, and analyses will occur in 2028. It is anticipated that dietary intake and movement behavior data will be available for up to 100,000 adults.

CONCLUSIONS: This protocol outlines the collection of detailed data on dietary intake and movement behavior in a large cohort spanning all provinces in Canada. In addition to allowing examination of a range of research questions related to diet, movement behavior, and health, the combination of assessment tools will support methodological research, including expanding analytical strategies to mitigate the effects of error in dietary and movement behavior data. This effort will also build capacity in the collection, processing, and harmonization of dietary and movement behavior data among cohorts and provide a training ground for emerging researchers.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/71680.

PMID:41329954 | DOI:10.2196/71680

JMIR Mhealth Uhealth. 2025 Dec 2;13:e80094. doi: 10.2196/80094.

ABSTRACT

BACKGROUND: Keystroke dynamics on smartphones have emerged as a promising form of passive digital biomarker. While previous studies have explored their utility in several diseases and disorders, relatively few have examined how these dynamics change systematically with chronological age in the general population.

OBJECTIVE: This study aimed to investigate age-related patterns in mobile keystroke dynamics, with a particular focus on temporal variations throughout the day. By identifying behavioral signatures associated with different age groups, we further assess whether artificial intelligence-based models can accurately estimate chronological age using passively collected keystroke data.

METHODS: We conducted a field study involving 177 healthy adults in the Republic of Korea, collecting free-living smartphone typing logs over multiple weeks through a custom Android keyboard app (CodeRed Corp). For each keystroke, the app recorded press and release timestamps and key type, from which 43 behavioral features were extracted across categories of speed, frequency, and temporal variability. Weekly feature vectors were constructed at 3 temporal resolutions (6-hour intervals, daily, and weekly). In total, 8 artificial intelligence models, including random forest, TabNet, transformer, and long short-term memory, were trained with participant-wise 10-fold cross-validation. A custom loss function was introduced to reduce intraparticipant prediction variability. Descriptive statistics and ablation studies were conducted to assess behavioral trends and feature contributions.

RESULTS: The study included 177 participants (female: n=115; male: n=62) with a mean age of 28.8 (SD 11.1) years, all residing in the Republic of Korea. On average, data were collected for 25 weeks per participant, resulting in a dataset of more than 2.5 million typing sessions. Descriptive analysis revealed clear age-related differences. Younger participants typed faster and more frequently, while older participants showed slower and more variable typing. The long short-term memory model using the 6-hour interval median features achieved the best age estimation performance (mean absolute error 3.69 years, R²=0.71). When the customized loss function was applied, the model’s performance further improved to a mean absolute error of 3.60, with a reduction in intraparticipant variability in estimated ages by 7.8%. Notably, feature importance analysis suggested that the early morning (midnight to 6 AM) and late evening (6 PM to midnight) periods may carry more age-discriminative keystroke patterns.

CONCLUSIONS: Our findings demonstrated that smartphone keystroke dynamics reflect age-sensitive behavioral patterns, particularly when analyzed with fine-grained temporal resolution. While the primary goal was not age estimation per se, the ability to model these patterns highlights the potential of keystroke dynamics as a passive, unobtrusive behavioral marker for age-related functional characteristics. These insights may inform future applications in digital health, such as age-sensitive personalization or early detection of age-related decline without requiring any active user input.

PMID:41329951 | DOI:10.2196/80094

JMIR Res Protoc. 2025 Dec 2;14:e63663. doi: 10.2196/63663.

ABSTRACT

BACKGROUND: Maternal mental health concerns either during pregnancy or the postpartum period are a public health challenge. Depression, anxiety, and stress can lead to poorer outcomes in the antenatal and postpartum periods. There is evidence that the effect of stress, anxiety, and depression during pregnancy negatively affects fetal neurodevelopment and children’s developmental outcomes. Early diagnosis can improve treatment outcomes and prevent negative impacts on the mother and baby. Identifying risk factors, such as age, socioeconomic status, mental health history, and family dysfunction, and clinical manifestations are important for public health programs.

OBJECTIVE: This study aims to determine the prevalence of depression and associated risk factors among antenatal and postnatal women attending government health clinics in Selangor.

METHODS: A multicenter cross-sectional study will be conducted among antenatal and postnatal women attending government health clinics (Klinik Kesihatan) in Selangor, Malaysia, from August 1, 2024, to December 31, 2026. We will perform a simple random sampling in all 9 districts in Selangor to select 1 government health clinic in each district. The inclusion criteria for this study are women aged 18 years and older who are either pregnant or delivered a newborn or stillborn child within the preceding 6 weeks. We will use a published screening tool (Edinburgh Postnatal Depression Scale) to determine the level of depression among antenatal and postnatal women. We will also collect data on sociodemographic characteristics, obstetric factors, and psychosocial support.

RESULTS: We will obtain ethics approval from the relevant ethics boards prior to data collection. Data will be analyzed using SPSS version 26.0 (IBM Corporation) and we will conduct a descriptive analysis to determine the prevalence of depression. We will calculate the level of depression among antenatal and postnatal women and score it based on a previous study conducted in Malaysia, with a score of ≥12 indicating the presence of depression. The association between depression and risk factors will be determined by multiple logistic regression analysis. P values less than .05 will be considered statistically significant.

CONCLUSIONS: Depression is one of the mental health complications that may arise following childbirth. Therefore, the findings of this study on the prevalence and associated risk factors of depression among antenatal and postnatal women in Selangor may help women address this challenge and improve maternal mental health during pregnancy and after birth.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/63663.

PMID:41329948 | DOI:10.2196/63663

Psychol Health Med. 2025 Dec 2:1-22. doi: 10.1080/13548506.2025.2594173. Online ahead of print.

ABSTRACT

In the evolving global landscape, developing innovative abilities has become the new goal of higher education in the world. Within this framework, universities face a significant task of developing training models that cultivate top innovative minds, so that these individuals acquire the skills needed to face complex challenges in modern times. This study employed a cross-sectional analysis involving sample size of 340 randomly selected students majoring in the Humanities field in Guangxi province, China. Here, data is collected using validated instruments measuring key constructs, including Course Design and Teaching Methods, Educational Philosophy, Educational Resources and Environment, and Faculty Development on Teaching Effectiveness. Confirmatory factor analysis (CFA) indicated good model fit with indices of CFI = 0.971, RMSEA = 0.035, SRMR = 0.037, and GFI = 0.905. Structural Equation Modeling (SEM) revealed that Course Design and Teaching methods significantly mediated the relationship between educational environment factors and talent quality with standardized path coefficients of ${\chi }^2$ = 549.686, p < 0.261, and ${\chi }^2/\mathrm{df}$ = 1.409. These findings support the hypothesis framework highlighting the critical role of teaching effectiveness in enhancing talent development within the New Humanities educational context. Implications for educational practice and policy in Guangxi universities are discussed. Results of mediation analysis confirmed that the connection amongst the training factors and Teaching Effectiveness is fully mediated by Critical Factors in Training Models. Descriptive statistics show high internal consistency and good convergent validity. The study finds that well-designed teaching methods are more critical for enhancing Teaching Effectiveness, while other factors, although relevant, are less important.

PMID:41329928 | DOI:10.1080/13548506.2025.2594173

J Cataract Refract Surg. 2025 Nov 26. doi: 10.1097/j.jcrs.0000000000001845. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate clobetasol propionate ophthalmic suspension (CPN) as treatment for inflammation and pain after cataract surgery.

SETTING: Nine outpatient surgery centers in the USA.

DESIGN: A randomized, double-masked, placebo-controlled, dose-selection, two-part study.

METHODS: After uncomplicated cataract surgery, participants were randomized to CPN 0.05% or placebo (1:1) twice daily (BID) for 21 days (Part A), or CPN 0.05%, CPN 0.1%, or their corresponding placebos (1:1:1:1) BID for 3 days, then once daily (QD) for 11 days (Part B). Primary efficacy endpoints were anterior chamber cell (ACC) count and ocular pain grade; secondary endpoints included visual acuity, anterior chamber flare (ACF) grade and number of participants rescued. Safety assessments included adverse events, ophthalmoscopy assessments and intraocular pressure (IOP).

RESULTS: In Part A, 45 participants were randomized (mean age 67.7 years; 71.1% female). In Part B, 87 participants were randomized (mean age 68.0 years; 63.2% female). CPN 0.05% BID for 21 days (Part A) produced statistically significant reductions of ACC count and ACF grade compared to placebo, with similar results after only 14 days of dosing. The CPN BID/QD regimens (Part B) were less efficacious than 0.05% BID. No participants on CPN were rescued. CPN was well tolerated, with an adverse event profile similar to placebo, including no meaningful IOP increases during up to 21 days of dosing.

CONCLUSIONS: CPN 0.05% BID for 3 weeks was safe and reduced ocular inflammation after cataract surgery.

TRANSLATIONAL RELEVANCE: CPN 0.05% administered twice a day has the potential to be a safe and effective treatment for inflammation after cataract surgery.

PMID:41329923 | DOI:10.1097/j.jcrs.0000000000001845

J Pers Disord. 2025 Nov;39(6):461-485. doi: 10.1521/pedi.2025.39.6.461.

ABSTRACT

Identity impairment is central to personality pathology generally, but less is known about how identity impairment appears differently across personality pathology. The AMPD lists a criterion for disorder-specific identity impairment for each personality disorder (PD), but these criteria have not been adequately empirically examined. N = 305 university students completed self-report measures of personality pathology (traditional DSM-5 and AMPD conceptualizations) and identity impairment (identity diffusion). We explored which identity diffusion items associated most strongly with each PD scale. Results were mixed. Predictions were partially supported in that at least one expected identity diffusion item emerged as most strongly associated with antisocial, avoidant, and borderline PDs. For narcissistic, obsessive-compulsive, and schizotypal PDs, predictions were not supported. Results were somewhat consistent between DSM Section II and AMPD scales for most PDs, except avoidant and obsessive-compulsive PD. We emphasize the need for further empirical study on disorder-specific identity impairment across personality pathology.

PMID:41329921 | DOI:10.1521/pedi.2025.39.6.461