Nevin Manimala

Disaster Med Public Health Prep. 2025 Oct 6;19:e276. doi: 10.1017/dmp.2025.10206.

ABSTRACT

OBJECTIVES: To compare the effectiveness of tabletop exercises (TTX) and high-fidelity in-person simulations (IPS) in improving knowledge, confidence, and perceived preparedness in disaster medicine among emergency medicine residents.

METHODS: A prospective, randomized educational intervention was conducted across 2 urban emergency medicine residency programs. Sixty-three residents were randomized to TTX or IPS groups. Each group completed a preintervention knowledge and confidence assessment, participated in their assigned exercise based on a simulated mass casualty incident (MCI), and underwent a structured debrief. Postintervention surveys assessed change in knowledge and self-reported comfort levels. A paired 2-tailed Student’s t-test was utilized to compare results. Statistical significance was defined as P < 0.01.

RESULTS: Both groups demonstrated increased self-reported confidence and knowledge regarding management of MCIs. TTX participants showed higher median post-test scores (77.4%, N = 38) compared to IPS participants (67.4%, N = 25). Results were not statistically significant (P = 0.079).

CONCLUSIONS: TTX is an effective modality for disaster medicine education, with outcomes comparable to IPS. While TTX may better align with knowledge-based assessments, IPS remains essential for practicing real-time decision-making under stress. Combining these 2 modalities may provide both the knowledge base and psychological duress required for robust disaster scenario training.

PMID:41047872 | DOI:10.1017/dmp.2025.10206

J Fish Biol. 2025 Oct 6. doi: 10.1111/jfb.70245. Online ahead of print.

ABSTRACT

The John Dory Zeus faber is a commercially exploited demersal fish species with a known distribution ranging from the Northeast Atlantic to parts of the Indian and Pacific oceans. A previous genetic survey using cytochrome c oxidase subunit I (COI) DNA barcodes suggested the presence of two geographically segregated taxonomic units within Z. faber. We revisit this hypothesis by expanding the number and geographic coverage of DNA barcodes, addressing a major data gap along parts of the Atlantic coast of Africa and conducting a comprehensive phylogeographic analysis. Our findings consolidated the existence of two highly divergent mitochondrial clades, Clade A and Clade B (mean K2P distance: 7.4%), with the transition zone between them located along the Atlantic coast of Morocco. Clade A exhibited no phylogeographic structure, with haplotypes shared between Northeast Atlantic and Mediterranean populations. Conversely, four geographically structured subclades (mean K2P distance: 0.9%) were detected within Clade B, extending south and eastward from Morocco to Japan and New Zealand. Historical demographic events driving allopatric divergence, along with oceanographic and environmental factors, likely shaped the current geographic distribution of the two clades. These findings not only prompt the need to re-evaluate the taxonomic status of Z. faber but also highlight the probable existence of multiple evolutionarily significant units (ESUs) that must be considered in the scope of stock assessment, fisheries management and conservation purposes.

PMID:41047867 | DOI:10.1111/jfb.70245

Health Promot Pract. 2025 Oct 6:15248399251368310. doi: 10.1177/15248399251368310. Online ahead of print.

ABSTRACT

Adolescence is a critical period for young people’s sexual and reproductive health (SRH), emphasizing the need for support with regards to the prevention of unintended pregnancy or sexually transmitted infections. Multi-level, community-wide initiatives are a widely promoted approach to support young peoples’ SRH, yet research evaluating their impact is scarce, limiting the opportunity for these initiatives to be incorporated into evidence-based practice. This study responds to this evidence gap by estimating the early effects of a city-wide youth sexual health initiative on population-level youth sexual health indicators (condom use, birth control use, combined method use, abstinence, early sex (<15 years), number of sexual partners). A quasi-experimental, difference-in-differences design with propensity weighting was employed using a nearby city as a comparison group and Youth Risk Behavior survey data from from 6,978 high school students. Estimates were generated using logistic regression. Overall, no statistically significant effects on youth sexual health indicators were detected, although the direction of non-significant findings was promising. Effect heterogeneity was detected by grade and race, suggesting that younger and Black/African American youth experienced more favorable impacts of the initiative. This study contributes to the small but growing evaluation research on multi-level, community-wide youth sexual health initiatives and provides a blueprint approach to evaluate similar initiatives using a publicly available data source. Findings highlight the potential for community-wide sexual health initiatives to address disparities in adolescent SRH, support continued effect estimation over longer time periods, and emphasize the value of culturally responsive sexual health programming.

PMID:41047855 | DOI:10.1177/15248399251368310

Ophthalmic Res. 2025 Oct 4:1-12. doi: 10.1159/000548751. Online ahead of print.

ABSTRACT

PURPOSE: Previous studies have demonstrated the efficacy of Faricimab where the intervention in treatment-resistant neovascular age-related macular degeneration (nAMD) had been switched from Aflibercept to Faricimab. This exploratory study aimed to assess the clinical anatomical and functional outcomes of a single intravitreal Faricimab (IVF) injection in those with treatment-resistant nAMD who switched from Aflibercept, in a single tertiary ophthalmology centre.

METHODS: This retrospective, observational real-world study assessed 20 patients (21 eyes) with treatment-resistant nAMD who were switched from intravitreal Aflibercept (IVA) to Faricimab due to persistent subretinal fluid (SRF) despite frequent Aflibercept injections. Patients were switched to a regimen of Faricimab consisting of three loading doses administered at 4-weekly injections. Anatomical and functional measures were assessed at two time points: immediately before the initial Faricimab injection and approximately 4 weeks later, before the second Faricimab injection. The outcome measures were: visual acuity, central macular thickness (CMT), macular volume, and the presence of SRF were evaluated pre- and post-switch.

RESULTS: Twenty-one eyes from 20 patients were analyzed. Statistically significant reductions in CMT (from 570.2 to 482.7 μm; p < 0.01) and macular volume (from 8.57 to 7.87 mm³; p = 0.02) were observed post-switch, while the change in visual acuity did not reach statistical significance (p = 0.051). The number of eyes with SRF decreased from 21 pre-switch to 9 post-switch.

CONCLUSION: The findings from this exploratory study suggests that switching from Aflibercept to Faricimab demonstrated significant physiological improvements among patients with treatment-resistant nAMD. Faricimab may serve as an effective and safe option in this patient population. The exploratory study also identifies changes in CMT and macular volume as outcome measure candidates for future large-scale investigations.

PMID:41047829 | DOI:10.1159/000548751

Diagnosis (Berl). 2025 Oct 7. doi: 10.1515/dx-2025-0089. Online ahead of print.

ABSTRACT

OBJECTIVES: Clinical reasoning skills are required for safe care, yet they are not consistently taught to advanced practice providers (APPs). In hospital medicine, where APPs work semi-independently, gaps in clinical reasoning can increase the likelihood of error. To address this, we developed a module that uses diagnostic root cause analysis (RCA) to teach clinical reasoning skills to hospital medicine APP fellows.

METHODS: The curriculum was delivered from July 2021 to March 2025. Fellows selected real-world diagnostic errors encountered during clinical rotations, created cognitive fishbone diagrams, and presented their analysis in small-group.

RESULTS: Twenty-seven fellows completed the module and pre-post assessment surveys. Statistically significant improvements were observed across all six domains of knowledge and confidence related to identifying error contributors, analyzing cases, and setting goals. Free-text responses highlighted the module’s emotional safety, peer learning value, and normalization of diagnostic reflection. Two learners published their projects as academic posters, and one graduate now co-facilitates the sessions.

CONCLUSIONS: This module offers a scalable, time-efficient approach to clinical reasoning education that is adaptable across learner levels and specialties. Its peer-led design fosters psychological safety, reflective practice, and creates a natural pathway for APPs to engage in microscholarship – addressing a critical gap in both education and academic inclusion.

PMID:41047825 | DOI:10.1515/dx-2025-0089

Ann Saudi Med. 2025 Sep-Oct;45(5):295-303. doi: 10.5144/0256-4947.2025.295. Epub 2025 Oct 2.

ABSTRACT

BACKGROUND: Recurrent laryngeal nerve injury (RLNI) is a wellknown complication of thyroidectomy that can lead to vocal cord palsy (VCP). Identifying risk factors and reducing the incidence of RLNI are essential for improving surgical outcomes.

OBJECTIVES: To assess the incidence of permanent VCP after thyroidectomy and evaluate its possible associated risk factors.

DESIGN: A retrospective cohort study.

SETTING: A multicenter study conducted in Makkah, Saudi Arabia.

METHODS: The study assessed incidence of permanent RLNI and its associated risk factors in 314 patients who underwent thyroidectomy at our centers in Makkah, Saudi Arabia, between December 2014 and December 2024. The data were gathered on general characteristics, clinical findings, and surgical details. Statistical analyses were performed to identify significant risk factors.

MAIN OUTCOMES MEASURES: Incidence of permanent RLNI and the associated risk factors.

SAMPLE SIZE: 314 patients.

RESULTS: Overall incidence of permanent VCP was 9 (2.9%). The left vocal cord was affected in 3 (1%) of cases, while the right vocal cord was affected in 6 (1.9%). Significant risk factors included age over 45 years (P=.043), male patients (P=.04), prior thyroid surgery (P=.006), and high cumulative doses of radioactive iodine (P=.008). However, no significant associations with factors such as family history of thyroid disease, carcinoma, or incidental disease onset.

CONCLUSION: Post-thyroidectomy VCP is influenced by several factors, including age, gender, previous thyroid surgery, and radioactive iodine dose. These findings highlight the importance of careful pre-operative risk assessment and the use of preventive measures, such as Intra-Operative Nerve monitoring, use of optical magnification and pre-operative predicting of thyroidectomy difficulty to reduce RLNI risk.

LIMITATIONS: Possibility of selection bias due to the retrospective design. In addition to lack of use of certain analytical tests and detailed subgroup analysis due to the moderate sample size.

PMID:41047809 | DOI:10.5144/0256-4947.2025.295

J Dtsch Dermatol Ges. 2025 Oct 5. doi: 10.1111/ddg.15911. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Social media is increasingly establishing itself as an important source of information for skin health. Although demand among users is high, very few dermatologists outside the Anglo-American region use these platforms to provide patient information, and the majority of content is provided by non-medical sources. This study investigated the influence of social media on skincare and preventive behavior among young adults, and the relevance of medically qualified content.

METHODS: An anonymized 34-item online questionnaire was distributed to 454 students at the University of Innsbruck, assessing social media usage, skincare routines, prevention behavior, and perception of dermatological content. Descriptive and inferential statistics (chi-square tests, p < 0.05) were applied.

RESULTS: A significant association was found between time spent on social media and perceived impact on personal skin health (p = 0.014). Participants exposed to dermatologist-created content were significantly more likely to follow a skincare routine (p < 0.001). The majority expressed a desire for more professionally qualified information.

CONCLUSIONS: Social media offers significant potential for providing information about skin conditions and educating patients. A more comprehensive presence of content reviewed by medical professionals may help minimize the spread of misinformation and promote health education, especially among young users.

PMID:41047803 | DOI:10.1111/ddg.15911

Acta Med Indones. 2025 Jul;57(3):341-345.

ABSTRACT

BACKGROUND: Identifying liver fibrosis is crucial for initiating antiviral therapy for hepatitis B infection. Liver biopsy is the gold standard for assessing the degree of fibrosis. However, a liver biopsy is an invasive procedure that carries some risks. This study aimed to evaluate the diagnostic capabilities of the red cell distribution width-to-platelet ratio (RPR) and compare its efficacy for determining the degree of fibrosis in patients with chronic hepatitis B infection with that of the aspartate aminotransferase-to-platelet ratio index (APRI) and the Fibrosis-4 index (FIB-4).

METHODS: This was a retrospective study conducted on patients with chronic hepatitis B infection who had transient elastography results at the Gastroenterology Hepatology Clinic, Dr. Hasan Sadikin General Hospital, Bandung, between January and December 2024. Statistical analysis was performed using receiver operating characteristic curves to determine the diagnostic values and cutoff points of the RPR, APRI, and FIB-4 to detect liver fibrosis based on Transient Elastography in patients with Chronic Hepatitis B infection.

RESULTS: A total of 114 patients with chronic hepatitis B infection were included in this study (42 with significant fibrosis and 72 with nonsignificant fibrosis). The area under the curve (AUC) of the RPR was 0.873 (p < 0.001) with a cutoff point of >0.0538, whereas the AUCs of the APRI and FIB-4 were 0.833 (p < 0.001) and 0.746 (p < 0.001), respectively.

CONCLUSION: The RPR has a higher diagnostic performance than the APRI and is superior to the FIB-4 in assessing the degree of fibrosis in patients with chronic hepatitis B infection. The RPR is a simple and cost-effective test and has the potential to be a screening tool for patients with hepatitis B infection.

PMID:41047800

J Dent Educ. 2025 Oct 5. doi: 10.1002/jdd.70061. Online ahead of print.

ABSTRACT

PURPOSE: The proposed guidelines for implant dentistry education in Australian undergraduate dental programs from the 2010 Australian Consensus Workshop (ACW) have presented notable difficulties in their implementation. This study aims to explore the views of dental students regarding implant dentistry education and recommend improvements.

METHODS: A survey was distributed to final year dental students (n = 73) in one of the Australian dental schools. The 18-question survey was structured into four sections, covering participants experience in implant dentistry, their confidence in applying knowledge acquired from the implant curricula, satisfaction with the implant curricula in terms of quality, quantity, and timing of delivery, and considerations for possible improvements. Multilinear regression analysis was exclusively conducted for Satisfaction Likert data sets.

RESULTS: The response rate was 71.2% (n = 52). Most students reported low confidence in applying implant knowledge clinically (65.4%-80.7%), with a notable increase in confident responses in understanding theory following a practical workshop (from 7.7%-32.6%). Students unanimously agreed on the need for improvements, particularly emphasizing a greater focus on clinical observations (78.8%) and preclinical training (76.9%). The regression model was statistically significant for theory amount (F (1,45) = 4.2, p < 0.05) and Sim-Lab quality (F (1,45) = 5.7, p < 0.02).

CONCLUSIONS: Students expressed a lack of confidence in selecting and treating patients requiring implant dentistry. The quantity of theoretical content and the quality of Sim-Lab experiences were the factors that notably enhanced the satisfaction of students. Some of the obstacles identified by ACW 14 years ago persist in undergraduate dental education.

PMID:41047492 | DOI:10.1002/jdd.70061

Odontology. 2025 Oct 5. doi: 10.1007/s10266-025-01223-0. Online ahead of print.

ABSTRACT

The aim of this study was to evaluate the effect of chitosan (Cht), gelatin (Gel) and silver nanoparticles (AgNPs) at different concentrations as a medicament for the release of basic fibroblast growth factor (bFGF) from infected dentin. Fifty-two single-rooted premolar teeth were standardized to 12 ± 1 mm in length and prepared up to size #100 with K-hand files. The root segments were infected with Enterococcus faecalis for 21 days. Two root segments were used to confirm the mature biofilm formation by scanning electron microscope. After irrigation with 1.5% NaOCl (20 mL/5 min), the samples were randomly divided into five groups (n = 10) based on the intracanal medicament: control group (non-dressed), calcium hydroxide (Ca(OH)₂), Cht/Gel/AgNPs1 (0.18 g Cht/54 μg /mL AgNPs), Cht/Gel/AgNPs2 (0.16 g Cht/108 μg/mL AgNPs), and Cht/Gel/AgNPs3 (0.14 g Cht/162 μg/mL AgNPs). The samples were incubated for two weeks and then irrigated with 17% EDTA (20 mL/5 min). They were then placed in sterile Eppendorf tubes with 1 mL Hank’s balanced salt solution at 37°C, and bFGF levels were measured using an enzyme-linked immunosorbent assay at 24 hours. Each root canal volume was assessed using cone-beam computerized tomography to calculate the final bFGF concentration. Statistical analysis was performed using Shapiro-Wilk, one-way ANOVA, and Tukey tests (p < 0.05). A significant difference was found between the control and the other medicament groups (p < 0.01). The Ca(OH)₂ group showed significantly lower bFGF release levels among all Cht/Gel/AgNPs groups (p < 0.05). A statistically significant difference was observed between the Cht/Gel/AgNPs2 and Cht/Gel/AgNPs1 groups (p = 0.019), as well as between the Cht/Gel/AgNPs2 and Cht/Gel/AgNPs3 groups (p = 0.007). Cht/Gel-containing AgNP medicaments may represent promising agents for revascularization protocols.

PMID:41047431 | DOI:10.1007/s10266-025-01223-0