Nevin Manimala

BMC Med Educ. 2025 Feb 12;25(1):227. doi: 10.1186/s12909-025-06832-5.

ABSTRACT

BACKGROUND: Retaining anatomical knowledge is crucial for safe and effective medical practice, yet many medical graduates struggle to apply this knowledge in clinical settings over time. This study aimed to evaluate and compare the retention of gross anatomy and clinical anatomy knowledge among medical graduates in Sudan.

METHODS: A cross-sectional study was conducted in a sample of 385 medical graduates from various Sudanese universities, estimated using the Cochrane formula. The participants completed a self-administered questionnaire assessing their knowledge of gross and clinical anatomy, as well as demographic and educational factors. The data were analyzed via descriptive statistics, paired t-tests, and ANOVA.

RESULTS: Clinical anatomy knowledge was significantly better retained (mean score: 68.39%) than gross anatomy knowledge was (mean score: 45.35%). The retention of gross anatomy is influenced by academic background, with integrated and hybrid learning approaches showing better outcomes than traditional methods do. In contrast, clinical anatomy retention was more consistent across demographic factors but varied by speciality, with emergency medicine, general practice, surgery and radiology showing the highest retention levels.

CONCLUSION: Clinical anatomy is retained more effectively due to its frequent application in practice, whereas gross anatomy requires greater integration with clinical relevance to enhance retention. The study recommends medical curricula that merge gross and clinical anatomy through active learning strategies and continuous education to improve long-term retention and clinical competency.

PMID:39939944 | DOI:10.1186/s12909-025-06832-5

BMC Cardiovasc Disord. 2025 Feb 12;25(1):95. doi: 10.1186/s12872-025-04498-x.

ABSTRACT

BACKGROUND: This study explores the relationship between angiotensin-converting enzyme (ACE) gene polymorphisms and early diastolic dysfunction in patients with hypertension utilizing four-dimensional echocardiography and assesses the prognosis.

METHODS: This study consecutively selected 470 patients with hypertension who visited the Fourth Affiliated Hospital of Soochow University between September 2021 and August 2022, with 274 meeting the inclusion criteria. Hypertension gene testing was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) techniques, and the Hardy-Weinberg equilibrium test was used to confirm genetic equilibrium. Patients were categorized into the D allele group (n = 163) and the non-D allele group (n = 111). Diastolic function was assessed using four-dimensional echocardiography, which included averaging the E/e’ ratio over three cardiac cycles, measuring the left atrial (LA) maximum volume index (LA volume), tricuspid regurgitation velocity (TR velocity), LA strain, and left ventricular isovolumic relaxation time (IVRT). Patients were subsequently classified into the diastolic dysfunction group (n = 133) and the normal diastolic function group (n = 141). Chi-square tests were used to analyze differences in diastolic function indicators between the groups, Logistic regression was applied to control for potential confounding factors, and receiver operating characteristic (ROC) curves were plotted to assess the predictive value of different ACE alleles for diastolic dysfunction in patients with hypertension.

RESULTS: The genotype distribution in both the D allele group and the non-D allele group was consistent with Hardy-Weinberg equilibrium (P > 0.05). Compared to the non-D allele group, echocardiographic indicators in the D allele group showed a decline in diastolic function: the average E/e’ ratio over three cardiac cycles (14.67 [13.82, 15.80] vs. 9.30 [8.12, 12.00]), LA volume (32.76 [29.34, 34.61] vs. 25.61 [22.63, 29.64] ml/m²), TR velocity (2.90 [2.40, 2.90] vs. 1.40 [1.10, 2.40] cm/s), LA strain (18.00 [14.00, 25.00] vs. 37.00 [24.00, 40.00] %), and IVRT (104.25 [95.87, 106.25] vs. 88.09 [80.99, 96.56] ms). Differences between each group were statistically significant (all P < 0.05). The number of patients with diastolic dysfunction was higher in the D allele group (n = 102; 62.6%) compared to the non-D allele group (n = 31; 27.9%). In the logistic regression model, the D allele was associated with an increased risk of early diastolic dysfunction in hypertension (OR = 4.32, 95% CI = 2.56-7.27, P < 0.01). In the adjusted model, the D allele remained associated with an elevated risk of early diastolic dysfunction in hypertension (OR = 3.83, 95% CI = 2.24-6.54, P < 0.01). ROC curve analysis indicated that the D allele has predictive value for early diastolic dysfunction in patients with hypertension (area under the curve [AUC], 0.667; 95% confidence interval [CI], 0.608-0.723; sensitivity, 76.7%; and specificity, 56.7%; P < 0.05).

CONCLUSIONS: The ACE-D allele is associated with early diastolic dysfunction in hypertension. ACE gene testing can enhance the predictive value for diastolic dysfunction in patients with hypertension.

PMID:39939942 | DOI:10.1186/s12872-025-04498-x

Eur J Cancer. 2025 Feb 7;218:115292. doi: 10.1016/j.ejca.2025.115292. Online ahead of print.

ABSTRACT

BACKGROUND: The use of surrogate endpoints may expedite the reporting of study outcomes of clinical trials. The validity of disease-free survival (DFS) as a surrogate for overall survival (OS) in the neoadjuvant treatment of esophageal (E) or gastroesophageal junctional (GEJ) carcinomas remains uncertain.

OBJECTIVE: To evaluate DFS as a surrogate end-point for OS in E/GEJ using the meta-analytical approach DESIGN, SETTING, AND PARTICIPANTS: individual patient data from an international meta-analysis on operable locally advanced E/GEJ, which including randomized trials comparing at least two of the neo-adjuvant treatment strategies: upfront surgery (S), chemotherapy followed by surgery (CS), and/or chemoradiotherapy followed by surgery (CRS).

MAIN OUTCOMES AND MEASURES: Individual (Kendall’s tau) and trial-level (R2) correlations between DFS and OS were estimated using a Clayton copula.

RESULTS: DFS and OS data were available for a total of 4518 pts: 2222 pts included in CS vs S, 1908 pts in CRS vs S, and 388 in CS vs CRS comparisons. 3440 patients had a DFS event and 3303 patients died. Kendall’s tau was 0.73 [95 % CI 0.71 – 0.75] and R2 trial-level correlation was 0.95 [0.84 – 0.99] for CS vs S, Kendall’s tau was 0.76 [0.74 – 0.77] and R2 was 0.96 [0.87 – 0.99] for CRS vs S, Kendall’s tau was 0.87 [0.78 – 0.92] and R2 was 0.93 [0.43 – 1] for CRS vs CS. In a multistate model, the median time in the recurrence state was shorter in older vs more recent trials: mean time of 10.8 [10.2 – 11.4] vs 16.5 months [15.4-17.6].

CONCLUSIONS AND RELEVANCE: DFS is a validated surrogate endpoint for OS in trials evaluating neoadjuvant chemotherapy or chemoradiotherapy in E/GEJ. DFS may be more useful as an endpoint when delays between recurrences and death become larger.

PMID:39938127 | DOI:10.1016/j.ejca.2025.115292

JMIR Form Res. 2025 Feb 12;9:e65206. doi: 10.2196/65206.

ABSTRACT

BACKGROUND: Decreasing aggression through stress reduction is an important part of forensic psychiatric treatment. DEEP is an experience-based virtual reality intervention that uses biofeedback to train diaphragmatic breathing and increase relaxation. Although DEEP has shown promising results in reducing stress and anxiety in students and adolescents in special education, it has not been examined in forensic psychiatric populations.

OBJECTIVE: This study aimed to evaluate DEEP’s potential to reduce stress, emotional tension, and anger in forensic psychiatric inpatients.

METHODS: A mixed methods, alternating treatment, single-case experimental design was conducted with 6 Dutch forensic inpatients. For 20 days, participants engaged in 4 DEEP sessions. Experience sampling was used for continuous monitoring of stress, emotional tension, and anger twice daily. A repeated linear mixed model was used as a primary statistical approach for analyzing the experience sampling data as well as visual analyses. Finally, semistructured interviews were conducted with participants and health care professionals to compare quantitative with qualitative results.

RESULTS: Of the 6 participants, 3 (50%) completed all 4 DEEP sessions, while the other 3 (50%) missed one session due to technical difficulties or absence from the inpatient clinic. P1 showed a significant reduction of stress after session 2 (β=-.865; P=.005). No significant changes over time were found, although an experienced effect was reported during the interviews. P2 showed no significant results. They reported the sessions as being repetitive, with no experienced effect. P3 showed a momentary increase of emotional tension after the first session (β=-.053; P=.002), but no changes were observed over time. No experienced effects were reported in the interview. P4 did not show significant results over time, and was hesitant to report clear experienced effects. P5 showed a significant decline of emotional tension (β=-.012; P=.006), stress (β=-.014; P=.007), and anger (β=-.007; P=.02) over time. They also reported short-term experienced effects in the interview. P6 showed a significant decline of stress over time (β=-.029; P<.001) and reported experiencing substantial effects. Finally, health care professionals reported a relaxing effect of DEEP in their patients but did not expect many long-term effects because no clear behavioral changes were observed.

CONCLUSIONS: DEEP shows promise in teaching deep breathing techniques to forensic psychiatric inpatients, potentially decreasing stress, emotional tension, and anger in some patients. However, DEEP is not a one-size-fits-all intervention that supports every patient because the effectiveness on the outcome measures varied among participants. To increase effectiveness, emphasis should be put on supporting patients to transfer deep breathing skills into their daily lives. This highlights the importance for the structural integration of DEEP into current treatment protocols.

PMID:39938081 | DOI:10.2196/65206

J Mother Child. 2025 Feb 11;28(1):113-128. doi: 10.34763/jmotherandchild.20242801.d-24-00038. eCollection 2024 Feb 1.

ABSTRACT

BACKGROUND: Women with sensory disabilities, including deafness and blindness, face significant barriers to equitable healthcare in pregnancy, childbirth, and postnatal care. Representing over 5% of the global population-a number expected to rise-these women often encounter discrimination, limited information access, and inadequate childbirth support, increasing pregnancy-related risks.

MATERIALS AND METHODS: This systematic review examines childbirth methods for women with sensory disabilities and the healthcare barriers they face during prenatal, perinatal, and postnatal periods. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 methodology, searches were performed in PubMed, Scopus, BioMed Central, and Cochrane Library databases. From 270 relevant studies, 10 met the inclusion criteria, comprising 8 quantitative and 2 qualitative studies. All studies were critically appraised using the Caldwell framework.

RESULTS: The review identified that women with sensory disabilities, particularly those who are deaf or blind, experience higher rates of caesarean sections compared to women without disabilities. However, a significant proportion of women in this demographic group successfully deliver vaginally. The review also highlighted substantial healthcare barriers, including inadequate communication between patients and healthcare providers, limited information regarding childbirth options, and insufficient postnatal care. Discrimination and obstetric violence were reported in several studies, further exacerbating the healthcare experiences of these women.

CONCLUSIONS: This study highlights the urgent need for healthcare systems to enhance communication, accessibility, and support for women with sensory disabilities. An equity and inclusion framework in maternal care should ensure that these women receive adequate and respectful healthcare. Addressing these gaps will improve outcomes for mothers and newborns and reduce discrimination and inequitable treatment.

PMID:39938073 | DOI:10.34763/jmotherandchild.20242801.d-24-00038

Am J Phys Med Rehabil. 2025 Feb 12. doi: 10.1097/PHM.0000000000002715. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the effects of neuromuscular electrical stimulation combined with lumbar stabilization exercises on lumbar multifidus muscle thickness, disability, pain, depression, anxiety, and fear-avoidance beliefs in patients with chronic low back pain; and to examine the correlation between ultrasound and magnetic resonance imaging of the lumbar multifidus.

DESIGN: Forty patients aged 18-65 years were randomized into two groups: Group 1: exercise and Group 2: exercise + neuromuscular electrical stimulation. The participants underwent 15-session electrical stimulation and/or exercise (3 days/week). All outcome measures assessed at baseline, post-treatment, and 3 months after. Multifidus cross-sectional area on magnetic resonance imaging was measured only at baseline.

RESULTS: Multifidus thickness increased, and pain decreased significantly in both groups, more prominent in Group 2. Disability, depression, and fear-avoidance beliefs scores significantly decreased in both groups, while anxiety decreased only in Group 1. Both magnetic resonance and ultrasound measurements demonstrated excellent inter-rater reliability and statistically significant correlations.

CONCLUSION: Both groups improved in terms of pain, disability, psychological status and muscle thickness. Neuromuscular electrical stimulation adjunct to lumbar stabilization exercises demonstrated enhanced effectiveness in increasing lumbar multifidus thickness.

PMID:39938065 | DOI:10.1097/PHM.0000000000002715

Clin Exp Dermatol. 2025 Feb 12:llaf065. doi: 10.1093/ced/llaf065. Online ahead of print.

ABSTRACT

BACKGROUND: Psoriasis is a common autoimmune inflammatory disease. Vitamin B6 is crucial for the body’s inflammatory response, yet the relationship between pyridoxal 5′-phosphate (PLP), 4-pyridoxic acid (4-PA), and vitamin B6 turnover (4-PA/PLP) in psoriasis remains unexplored.

OBJECTIVE: To investigate the relationship of PLP, 4-PA and vitamin B6 catabolism with the risk of psoriasis.

METHODS: This cross-sectional study analyzed 7,540 participants from the National Health and Nutrition Examination Survey. Vitamin B6 catabolism was assessed via the serum 4-PA to PLP ratio (4-PA/PLP). The primary outcome was psoriasis, evaluated using weighted univariate and multivariate logistic regression to determine odds ratios (OR) and 95% confidence intervals (CI). Subgroup analyses were performed by age, gender, body mass index (BMI), hypertension, dyslipidemia, and cardiovascular disease (CVD).

RESULTS: Out of the participants, 208 had psoriasis. After adjusting for confounders, 4-PA levels in cutoff above group were positively associated with psoriasis (OR=1.51, 95% CI: 1.03-2.20). Additionally, 4-PA/PLP correlated with increased psoriasis risk (OR=1.82, 95% CI: 1.02-3.26). However, PLP levels did not show a significant association. The positive link between 4-PA/PLP and psoriasis was consistent in individuals with BMI ≥25 kg/m², hypertension, and those without dyslipidemia.

CONCLUSION: The results revealed significant association of 4-PA and 4-PA/PLP level with the presence of psoriasis. However, further extensive prospective studies are necessary to establish causality.

PMID:39938060 | DOI:10.1093/ced/llaf065

Am J Public Health. 2025 Mar;115(3):414-424. doi: 10.2105/AJPH.2024.307921.

ABSTRACT

Objectives. To identify factors associated with persistent COVID-19 vaccine refusal among Nebraska residents 6 months after an initial COVID-19 diagnosis. Methods. Using case investigation surveillance data and vaccination records from the Nebraska Department of Health and Human Services, a cohort of 16 344 unvaccinated, COVID-19‒confirmed individuals (May 2021‒February 2023) were asked for their reason for nonvaccination (RNV), then followed for 6 months to assess subsequent vaccination status. We used a modified Poisson regression to estimate risk of unvaccinated status at follow-up against predictors, including RNV, demographic characteristics, adherence to mitigation measures, hospitalization, and rurality. Results. Compared with those whose RNV was missed opportunity/lack of convenience, individuals who cited religious exemption (adjusted incidence risk ratio [AIRR = 1.36; 95% confidence interval [CI] = 1.31, 1.41), philosophical objection (AIRR = 1.28; 95% CI = 1.24, 1.34), or institutional confidence/complacency concerns (AIRR = 1.26; 95% CI = 1.19, 1.33) showed greatest risk of nonvaccination. Older age, nonadherence to mitigation measures, and higher rurality are positively associated with nonvaccination. Minority status and hospitalization were correlated with vaccination. Conclusions. Ideology-centered objections held significant weight among previously infected individuals who displayed sustained reluctance toward COVID-19 vaccination. Distinguishing sources of misinformation among ideologically similar communities could instigate reconsideration for vaccination. (Am J Public Health. 2025;115(3):414-424. https://doi.org/10.2105/AJPH.2024.307921).

PMID:39938043 | DOI:10.2105/AJPH.2024.307921

Am J Public Health. 2025 Mar;115(3):397-402. doi: 10.2105/AJPH.2024.307918.

ABSTRACT

Objectives. To measure the effect of the ROE Act on abortion timing for adolescents aged 16 to 17 years in Massachusetts. Methods. The primary outcome was gestational duration at abortion for individuals aged 16 to 19 years at Planned Parenthood League of Massachusetts from 2017 to 2022. Our control group included individuals aged 18 to 19 years undergoing abortions. In our primary analysis, we used a comparative interrupted time series with a linear model to capture temporal trends, seasonality, whether an abortion was undergone during the acute phase of the COVID-19 pandemic, previous abortion, and race/ethnicity categories. Results. Minors aged 16 to 17 years underwent 749 abortions during the study. Individuals aged 18 to 19 years underwent 2773 abortions. The ROE Act resulted in a 5.46-day decrease in gestational duration at abortion among minors (95% confidence interval = -11.82, 0.91). Conclusions. Removal of the parental involvement requirement for adolescents aged 16 to 17 years in Massachusetts led to minors undergoing abortions at earlier gestational durations, highlighting the importance of potential impacts of similar legislation to decrease barriers to abortion access for minors. (Am J Public Health. 2025;115(3):397-402. https://doi.org/10.2105/AJPH.2024.307918).

PMID:39938038 | DOI:10.2105/AJPH.2024.307918

Am J Public Health. 2025 Mar;115(3):387-396. doi: 10.2105/AJPH.2024.307917.

ABSTRACT

Objectives. To assess contraceptive service changes during the Family Planning Elevated (FPE) Contraceptive Access Program in Utah clinics from 2018 to 2023. Methods. We assessed de-identified electronic health record data on female clients aged 18 to 50 years from intervention and matched control sites. We used comparative interrupted time series analyses comparing total number of contraceptive services and their proportion relative to visits between intervention and control sites before, during, and after FPE. Results. Intervention sites provided on average 1.76 (95% confidence interval [CI] = 1.17, 2.66) times as many contraceptive services per month as controls during the 24-month intervention period, with no significant decreases in services noted in the postintervention period. The proportions of total visits related to family planning decreased by a factor of 0.70 (95% CI = 0.52, 0.94) during the intervention period. However, this effect was mitigated at intervention sites where proportions of contraceptive services were 1.44 (95% CI = 0.97, 2.14) times greater than control sites and did not significantly decrease after the intervention. Conclusions. Contraceptive access initiatives have capacity to make meaningful change in communities where they are employed, even after they end. (Am J Public Health. 2025;115(3):387-396. https://doi.org/10.2105/AJPH.2024.307917).

PMID:39938037 | DOI:10.2105/AJPH.2024.307917