Nevin Manimala

Work. 2025 Aug 25:10519815251370711. doi: 10.1177/10519815251370711. Online ahead of print.

ABSTRACT

BackgroundThe burnout syndrome has been described mainly among the working population. However, it is observed that students experience burnout syndrome as well, and that physician burnout may already start during the studies od medicine. Findings also show increased problem of alcohol consumption among medical students.ObjectiveDetermine the risk of burnout in the sample of medical students, and to evaluate their alcohol consumption, as well as to determine whether there is any association between these two entities.MethodsParticipants were 290 students of Faculty of Medicine, from all six study years. Maslach Burnout Inventory – Student Survey (MBI-SS) was used to evaluate the degree of burnout. Alcohol Use Disorder Identification Test (AUDIT) was used to evaluate alcohol consumption.ResultsIn the MBI-SS subcategory of Emotional Exhaustion, 81% reported high burnout risk. Results of low burnout risk in the subcategory of Cynicism, gradually decreased during the course of studies. The highest medium burnout risk was reported in the subcategory of Academic Efficacy, at 45.20%. The number of students belonging to the minimum risk level, Zone 1, on the AUDIT test, gradually decreased as the years of study increased. There is a slightly statistically significant, positive correlation between Emotional Exhaustion and alcohol use (p ≤ 0.05), as well as between Cynicism and alcohol use (p ≤ 0.05).ConclusionHigh burnout levels and their association with alcohol use in medical students imply a further investigation of these complex and harmful issues, and raise concern for the mental well-being of the future medical practitioners.

PMID:40853638 | DOI:10.1177/10519815251370711

World J Pediatr Congenit Heart Surg. 2025 Aug 25:21501351251360692. doi: 10.1177/21501351251360692. Online ahead of print.

ABSTRACT

Background: The World Database for Pediatric and Congenital Heart Surgery (WDPCHS) was utilized to define the incidence of one-year mortality and identify associated risk factors following surgery for congenital heart disease. Methods: The WDPCHS was queried from January 2017 to September 2022 for all tier 1 surgeries submitted to the database. Out-of-hospital death was defined as a death between 30 days postoperatively and up to one year. Preoperative risk factors and other demographics were evaluated. Chi-square test was used to evaluate associations, a multivariable logistic regression model was performed and the P value for statistical significance was set at <.05. Results: Among 9764 patients alive at hospital discharge (or 30 days), overall, one-year mortality was 1.47% (n = 144). Mortality was highest in STAT 5, 22.88% (27/118) (P < .0001). Risk factors with a higher incidence of one-year mortality included: non-Trisomy 21 genetic syndromes 6.38% (18/282), more than three preoperative risk factors 12.12% (16/132), more than three postoperative complications 9.81% (37/377) all P < .0001. Highest mortality by procedure was seen with the Norwood procedure 22.88% (27/118) and truncus arteriosus repair 8.97% (7/78), both P < .0001. By multivariable analysis, the risk of one-year mortality remained significantly higher with more than three preoperative risk factors (OR 5.85, 95% CI 3.12-10.96), non-Trisomy 21 chromosomal abnormalities (OR 3.04, 95% CI 1.75-5.29), and STAT 5 cases (OR 28.4, 95% CI 15.02-53.71). Conclusions: Based on these findings, there are certain risk factors (multiple preoperative risk factors, chromosomal abnormalities, STAT 5 category) that warrant targeted increased surveillance to improve one-year outcomes.

PMID:40853632 | DOI:10.1177/21501351251360692

Work. 2025 Aug 25:10519815251370596. doi: 10.1177/10519815251370596. Online ahead of print.

ABSTRACT

BackgroundEffective workload management in education is crucial for student well-being with nature-based Virtual Reality (VR) interventions presenting a viable solution. Most publications primarily examined high-end VR devices with immersive Head-Mounted Displays (HMDs), leading to a study gap in areas with restricted access to advanced VR technology.ObjectivesThis study explores the impact of a low-cost non-immersive VR environment on students’ workload and cognitive performance in an educational context.MethodsThe participants were divided into two groups: a control group using traditional screen-based tasks and an intervention group using low-cost VR tools. Subjective workload was assessed using NASA-TLX and the participants were further categorized based on their perceived workload levels. Objective physiological data, including heart rate variability (HRV) and galvanic skin response (GSR), were recorded, and cognitive performance was measured using the Pauli Test.ResultsThe results showed no significant differences in physiological, psychological, or performance outcomes between the control and intervention groups, implying that non-immersive VR did not significantly affect stress levels. Due to the limited sensory engagement, non-immersive VR did not activate the body or engage cognition effectively.ConclusionThese findings suggest that the non-immersive VR intervention not sufficient to produce measurable cognitive impact. Future research is encouraged to investigate the potential of immersive VR environments, which might provide a greater sensory experience. In addition, longer exposure durations should be examined to enhance understanding of the effects on cognitive load, relaxation, and overall well-being in nature-based VR applications. Even though differences were not statistically significant, non-immersive VR still reduced stress and enhanced engagement.

PMID:40853605 | DOI:10.1177/10519815251370596

Eur Radiol. 2025 Aug 25. doi: 10.1007/s00330-025-11945-y. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate whether quantitative DWI and qualitative T2WI parameters can predict lymph node involvement in clinical early rectal cancer.

MATERIALS AND METHODS: This retrospective study included consecutive patients who had rectal MRI from January 1, 2010, to March 31, 2021, showing T1-T2 rectal cancer before undergoing total mesorectal excision without neoadjuvant therapy. Visible mesorectal lymph nodes on DWI were segmented by a junior reader, and ADC values were extracted. Additionally, the junior reader and a senior reader independently recorded qualitative T2WI parameters of the most suspicious lymph node per patient. Histopathology was the reference standard for malignant (pN+) and benign (pN-) lymph node status.

RESULTS: Of 69 patients (37 men and 32 women) (median age, 55 years; IQR: 48-66), 23 (33%) had pN+ status; 46 (67%) had pN- status. ADC_mean (in × 10^-3 mm²/s) of the most suspicious lymph node was not different between the two patient groups (junior reader: 1087 vs. 926, p = 0.31; senior reader: 1178 vs. 1086, p = 0.89). The Dutch criteria, based on the combination of T2WI size and morphologic parameters, showed better diagnostic performance for the senior vs. junior reader: accuracy, sensitivity, specificity, PPV, and NPV of 79.7% (95% CI: 68.3-88.4%), 56.5% (95% CI: 34.5-76.8%), 91.3% (95% CI: 79.2-97.6%), 76.5% (95% CI: 50.1-93.2%), and 80.8% (95% CI: 67.5-90.4%), vs. 69.6% (95% CI: 57.3-80.1%), 26.1% (95% CI: 12.2-48.4%), 91.3% (95% CI: 79.2-97.6%), 60% (95% CI: 26.2-97.8%), and 71.2% (95% CI: 57.9-82.2%).

CONCLUSIONS: Additional research on alternative and more objective methods for lymph node characterization is needed.

KEY POINTS: Question The performance of MRI for nodal staging in clinical early rectal cancer in particular is a knowledge gap in the literature. Findings The Dutch criteria, based on T2WI size and morphologic parameters, performed better in differentiating metastatic from benign lymph nodes than the quantitative DWI ADC parameter. Clinical relevance Accurate nodal staging in early rectal cancer is crucial for treatment decision-making. Our study highlights the need for additional research on alternative and more objective methods for lymph node characterization.

PMID:40853592 | DOI:10.1007/s00330-025-11945-y

Intern Emerg Med. 2025 Aug 25. doi: 10.1007/s11739-025-04089-w. Online ahead of print.

ABSTRACT

Intermediate-risk pulmonary embolism (IRPE) is a critical clinical entity with significant mortality risk due to normotensive shock, a condition marked by low cardiac index despite maintained blood pressure. Accurate and timely detection of hemodynamic compromise in IRPE remains a challenge. Velocity Time Integral (VTI), a Doppler echocardiographic parameter, has emerged as a potential non-invasive tool for predicting hospital outcomes, but the evidence remains fragmented. This systematic review and meta-analysis aim to evaluate the diagnostic accuracy of VTI in this context. A systematic literature search encompassing PubMed, EMBASE, and SCOPUS Databases was conducted from inception till December 2024. Studies assessing VTI’s diagnostic accuracy for predicting hospital outcomes in IRPE were included. A bivariate random-effects model was used to pool sensitivity and specificity, with heterogeneity analyzed via I² statistics and meta-regression. Literature search yielded 9 studies with 2038 patients. Pooled sensitivity and specificity of VTI for predicting hospital outcomes in IRPE were 79% (95% CI 69-86%) and 81% (95% CI 70-88%), respectively. Diagnostic odds ratio was 15.58 (95% CI: 7.42-32.69). Heterogeneity was moderate to high (I² = 66.59%), with specificity showing greater variability. Meta-regression identified study-level characteristics, including risk of bias and VTI measurement site (LVOT vs. RVOT), as sources of variability. VTI demonstrates moderate sensitivity and specificity in predicting hospital outcomes such as mortality, in-hospital mortality, resuscitated cardiac arrest, hemodynamic instability or the need for reperfusion therapy. VTI, offers a non-invasive, real-time diagnostic option. However, study heterogeneity and methodological limitations highlight the need for further research.

PMID:40853590 | DOI:10.1007/s11739-025-04089-w

Saudi Pharm J. 2025 Aug 25;33(5):30. doi: 10.1007/s44446-025-00035-1.

ABSTRACT

BACKGROUND: Limited research has explored the genetic variability of CYP3A4 and CYP3A5 in the Saudi population, particularly concerning tacrolimus (Tac) therapy among Saudi kidney transplant patients (SKTP).

OBJECTIVES: To investigate specific CYP3A4 and CYP3A5 polymorphisms in SKTP and evaluate their influence on Tac dose requirements and trough levels.

METHODS: A total of 251 Saudi participants were recruited, comprising 129 kidney transplant patients and 122 healthy volunteers. Genomic DNA was extracted, and polymorphisms in CYP3A4 (*1B, *6, *18, *22) and CYP3A5 (*2, *3, *4) were analyzed using real-time PCR and allele-specific sequencing. Genotype frequencies and minor allele frequencies (MAF) were calculated, and the impact of CYP3A variants on Tac dosing and trough levels (C0) was assessed in SKTP.

RESULTS: The CYP3A41B polymorphism was absent, with all participants being homozygous wild type (G/G). For CYP3A5*3, 98.4% of participants carried the mutant genotype (*3/*3), while 1.6% carried the wild-type genotype (*1/*1). Patients with the wild-type allele (*1/*1) required significantly higher Tac doses and exhibited lower trough concentrations (C0) compared to those with the mutant genotype (*3/3). Other polymorphisms, such as CYP3A4*22, were rare, with approximately 90% of participants carrying the wild-type allele.

CONCLUSION: This study highlights the high prevalence of the CYP3A5*3/*3 genotype and wild-type CYP3A4 alleles in the Saudi population. The genetic variability significantly affects Tac trough levels and dosing requirements necessary to achieve therapeutic targets. These findings underscore the importance of pharmacogeneticguided Tac dosing to optimize therapeutic outcomes in SKTP.

PMID:40853585 | DOI:10.1007/s44446-025-00035-1

J Epidemiol Glob Health. 2025 Aug 25;15(1):110. doi: 10.1007/s44197-025-00450-6.

ABSTRACT

OBJECTIVE: This study aims to analyze the epidemiological characteristics, spatial and temporal distribution patterns, and trends in the evolution of scrub typhus (ST) in Jiangsu Province from 2006 to 2023. Scrub typhus was chosen for this study due to its increasing incidence in Jiangsu Province, its substantial health burden on rural populations, and its relevance as a vector-borne disease influenced by environmental and seasonal factors.

METHODS: Data on ST cases in Jiangsu Province from 2006 to 2023 were obtained from the China Disease Control and Prevention Information System. Descriptive statistics were used to summarize the overall epidemiological trends. Spatial autocorrelation analysis (Global and Local Moran’s I) assessed the overall and local distribution patterns of ST cases. while spatial-temporal hotspot analysis identified regions with significant clustering of cases over time, providing insights into potential high-risk areas.

RESULTS: A total of 16,998 ST cases were reported in Jiangsu Province, with an average annual incidence rate of 1.13 per 100,000. The gender distribution showed a male-to-female ratio of 1:1.20. The ages of affected individuals ranged from 3 months to 97 years, with a mean age of 60 years. Farmers represented the largest occupational group, accounting for 84.68% of the cases. The incidence rate showed a significant upward trend (χ²trend = 8484.517, p < 0.001). Peak incidence occurred primarily between October and November. The global Moran’s I index ranged from 0.071 to 0.345. Local autocorrelation analysis revealed that Yancheng and Nantong cities were high-high clustering areas. Spatial-temporal hotspot analysis revealed that hotspots were predominantly located in the northern and central regions of Jiangsu, while the southern region was identified as a cold spot. These hotspots displayed oscillating patterns, with new hotspots emerging in specific areas. Standard deviation ellipse analysis indicated that the epidemic spread continued to expand along the north-south axis, while the east-west axis showed relative stability. Spatial-temporal scanning analysis identified four high-incidence spatial-temporal clustering zones.

CONCLUSION: The incidence of ST in Jiangsu Province exhibited a significant upward trend, with distinct seasonal peaks between October and November. The epidemic demonstrated a pronounced transmission along the north-south axis, spatial-temporal clustering, and a shifting center of gravity. It is recommended to strengthen surveillance in high-risk areas and implement targeted prevention and control measures during high-risk seasons, particularly for vulnerable populations, to effectively curb the spread of the epidemic.

PMID:40853578 | DOI:10.1007/s44197-025-00450-6

Int Ophthalmol. 2025 Aug 25;45(1):351. doi: 10.1007/s10792-025-03715-y.

ABSTRACT

BACKGROUND/OBJECTIVES: To determine the proportion of eyes with optical coherence tomography (OCT) features of polypoidal choroidal vasculopathy (PCV) among patients diagnosed as neovascular age-related macular degeneration (nAMD) based on Asia-Pacific Ocular Imaging Society (APOIS) Diagnostic Criteria.

METHODS: This study was a retrospective cross-sectional review of OCT images. Medical records of treatment-naïve nAMD patients between January 2018 and June 2023 were reviewed. Clinical and demographic profile at presentation was collected. OCT scans were reviewed for presence of APOIS Diagnostic Criteria. Eyes were classified as having PCV features (PCV) based on the presence of ≥ 2 major OCT APOIS diagnostic criteria and then compared with eyes not having these features (non-PCV).

RESULTS: OCT scans of 45 eyes of 38 patients diagnosed with nAMD were analyzed. Mean age was 69.4 years old (range 53-83), 71.1% of patients were female, and 81.6% had unilateral disease. There was no statistically significant difference among clinical and demographic characteristics between PCV and non-PCV groups. Twenty-four eyes (53.3%) had ≥ 2 major APOIS criteria for PCV. Among PCV eyes, sub-RPE ring-like lesion and double-layer sign were the most common major (87.5%) and minor OCT criteria (100%), respectively. Sharp-peaked PED (p < 0.001), sub-RPE ring-like lesion (p < 0.001), en face OCT complex RPE elevation (p = 0.005) and double-layer sign criteria (p = 0.007) were more frequent in the PCV than in the non-PCV group.

CONCLUSION: More than half of Filipino eyes diagnosed with nAMD fulfill the OCT criteria for PCV. The APOIS PCV Workgroup Criteria helps identify patients who will benefit from additional confirmatory and treatment options.

PMID:40853572 | DOI:10.1007/s10792-025-03715-y

Urolithiasis. 2025 Aug 25;53(1):163. doi: 10.1007/s00240-025-01831-z.

ABSTRACT

Infections are common postoperative complications associated with the use of medical implants such as ureteric double-J stents. However, bacterial resistance to antibiotics poses serious risks to human health. These complications highlight the need for novel antibacterial agents. This study aimed to synthesize ionic liquids (ILs) with antibacterial potential, namely, 1-benzyl-3-(2-nitrobenzoyl)-1 H-imidazol-3-ium chloride (OM-1) and 4-(dimethyl amino)-1-(4-nitrobenzoyl) pyridin-1-ium chloride (OM-2), for use as biocompatible coating materials on double-J stents. The chemical structures of the synthesized ILs were confirmed by Nuclear Magnetic Resonance (NMR) and Fourier Transform Infrared (FTIR) spectroscopy. The antibacterial properties were evaluated using the Kirby-Bauer Disk Diffusion method on Klebsiella pneumoniae and Escherichia coli. Cytotoxicity was evaluated in a human skin fibroblast cell line (HFF-1) using a 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2 H tetrazolium (MTS) assay. Molecular docking and ADMETox analyses were also performed to calculate binding affinities and pharmacokinetic properties. At 50 µg/mL, OM-1 and OM-2 exhibited significant activity against Klebsiella pneumoniae (p = 0.04), with OM-1 differing significantly from Gentamicin (p = 0.017). In Escherichia coli, both ILs exhibited significant differences compared to piperacillin/tazobactam (p < 0.001 and p = 0.002, respectively). At 100 µg/mL, both ILs demonstrated statistically significant differences compared to Ceftazidime and Piperacillin/Tazobactam. The IC₅₀ values for OM-1 and OM-2 in HFF-1 cells were calculated as 260.90 µg/mL and 216.35 µg/mL, respectively. Docking studies performed on OM-1 revealed stronger binding affinity as antifungal and antioxidant, while OM-2 was a stronger candidate for antibacterial applications due to its ADMETox profile. These findings, supported by both experimental and computational studies, confirm the biocoating potential of OM-1 and OM-2 for double-J stents.

PMID:40853571 | DOI:10.1007/s00240-025-01831-z

JAMA. 2025 Aug 25. doi: 10.1001/jama.2025.13074. Online ahead of print.

ABSTRACT

IMPORTANCE: Melanoma, the fifth most common cancer in the US, has increased from 8.8 per 100 000 in 1975 to 28.42 per 100 000 in 2022. Cutaneous melanoma comprises 94% of cases, with 104 960 US cases projected for 2025.

OBSERVATIONS: Cutaneous melanoma presents as a new, changing, or irregularly pigmented skin lesion. Cutaneous melanoma subtypes include superficial spreading (≈70%), lentigo maligna (≈15%), nodular (≈5%), desmoplastic (≈4%), amelanotic (2%-8%), spitzoid (<2%), and acral (≈1%). Risk factors for cutaneous melanoma include UV radiation exposure, skin type (eg, skin that always burns, never tans), presence of benign and atypical nevi, and personal or family history of melanoma. Primary prevention consists of avoiding direct sunlight and indoor tanning, and photoprotection (sunscreen and sun-protective clothing). Based on United States Cancer Statistics data from 1999 to 2021, 77% of patients with cutaneous melanoma had localized disease (involving only the primary site), 9.5% had regional (nodal) disease, 4.7% had distant metastasis, and 8.8% were unstaged. Melanoma staging, which includes tumor thickness and ulceration and presence of lymph node or distant metastasis, ranges from stage 0 (melanoma in situ) to stage IV (distant metastasis). Localized melanoma (stage IA-IIA) is surgically excised, with margins of 0.5 cm to 2 cm based on depth of invasion. Sentinel lymph node biopsy is recommended for cutaneous melanoma that is ulcerated or 0.8 mm or more thick. Following surgery, patients with stage IIB-C melanoma have improved recurrence-free survival with adjuvant anti-PD-1 immunotherapy compared with placebo (hazard ratio [HR] for recurrence or death, 0.62 [95% CI, 0.49-0.79] for pembrolizumab and 0.42 [95% CI, 0.30-0.59] for nivolumab). For stage III disease, recurrence risk is decreased with nivolumab (HR, 0.72 [95% CI, 0.60-0.86]), pembrolizumab (HR, 0.61 [95% CI, 0.51-0.72]), or BRAF + MEK inhibitor therapy (dabrafenib + trametinib) (HR, 0.52 [95% CI, 0.43-0.63]). First-line treatment for distant metastatic or unresectable melanoma is dual checkpoint blockade with ipilimumab (anti-CTLA-4) and nivolumab. In 2017, 10-year melanoma-specific survival rates were 98% to 94% for stage IA-B, 88% to 75% for stage IIA-C, 88% for stage IIIA, 77% to 60% for stage IIIB-C, and 24% for stage IIID. In 2024, patients with distant metastatic or unresectable melanoma treated with ipilimumab and nivolumab had a 10-year overall survival rate of 43%.

CONCLUSIONS AND RELEVANCE: Melanoma is a common cancer in the US. Treatment for stage IA-IIA melanoma is surgical resection. Anti-PD-1 immunotherapy after surgical excision improves recurrence-free survival in stages IIB-C melanoma. For stage III melanoma, anti-PD-1 immunotherapy or BRAF + MEK inhibitor therapy decreases risk of melanoma recurrence. First-line therapy for metastatic melanoma is dual checkpoint blockade with ipilimumab and nivolumab.

PMID:40853557 | DOI:10.1001/jama.2025.13074