Nevin Manimala

Trans R Soc Trop Med Hyg. 2025 Jan 3:trae085. doi: 10.1093/trstmh/trae085. Online ahead of print.

ABSTRACT

Snakebite envenomation continues to affect lives globally, with >1.2 million envenomations and approximately 120 000 annual mortalities. Unfortunately, low- and middle-income countries (LMICs) contribute to >80% of these global statistics. With different targets set to minimize the impact of snakebite envenoming, such as halving the envenoming cases by 2030 from the World Health Organization (WHO), multiple initiatives are inevitable. Gender intersectionality and tropical disease research for infectious diseases of poverty, developed by the WHO, has championed the exploration of neglected diseases, stratifying them using gendered domains. However, minimal research using the gender intersectionality framework has been conducted to explore snakebite envenoming, especially among LMICs. Exploring snakebite envenomation through a gendered lens is critical in developing gender-specific interventions for the prevention and treatment of envenomation. This narrative review explores the available literature about snakebite envenomation in LMICs through a gender intersectionality lens. It provides insights into the existing gaps, especially regarding research using intersectionality frameworks and the gendered matrix. It further proposes avenues of research using these domains to understand snakebite envenomation, especially through the intersectionality lens.

PMID:39749529 | DOI:10.1093/trstmh/trae085

Trans R Soc Trop Med Hyg. 2025 Jan 3:trae112. doi: 10.1093/trstmh/trae112. Online ahead of print.

ABSTRACT

BACKGROUND: Snakebite envenoming is a neglected tropical disease that causes significant morbidity and mortality in rural sub-Saharan Africa. However, there is a notable lack of data concerning the management and treatment outcomes for those affected. This study addresses this gap by examining the management and treatment outcomes of snakebite victims in Uganda.

METHODS: We reviewed retrospective data of 532 snakebite cases attending 16 Ugandan health facilities from January 2017 to December 2021. Demographic characteristics and clinical data were extracted from patient records and summarized using descriptive statistics.

RESULTS: The snakebite victims had a median age of 26 y, most were male (55.3%) and had bites of unidentified snake species (92.3%). Among the 465 treated patients, 71.6% received antibiotics, 66.0% hydrocortisone, 36.3% analgesics and only 6.9% antivenom. No adverse antivenom reactions were documented. The majority (89.5%) were discharged; 1.3% died and 5.5% had unknown outcomes.

CONCLUSIONS: These results suggest that snakebite envenoming affects vulnerable Ugandans, particularly young males and children. Treatment is primarily supportive, with antibiotic overuse and infrequent antivenom administration. Health provider training on appropriate snakebite management is needed to optimize outcomes.

PMID:39749485 | DOI:10.1093/trstmh/trae112

Eur J Psychotraumatol. 2025 Dec;16(1):2444745. doi: 10.1080/20008066.2024.2444745. Epub 2025 Jan 3.

ABSTRACT

Background: A number of studies have tested the factor structure of the suggested ICD-11 symptom criteria for PTSD and complex PTSD (CPTSD) across various trauma populations, finding support for two different models in line with the ICD-11 theoretical rationale.Objective: Here, we aim to explore the factor structure of the Danish version of the International Trauma Questionnaire (ITQ) by testing two alternative factor models that have previously gained support in a large sample of treatment-seeking veterans.Method: Treatment-seeking Danish soldiers and veterans (N = 599) recruited from the Military Psychology Department in the Danish Defence completed the International Trauma Questionnaire (ITQ). Confirmatory factor analysis (CFA) was used to assess fit of a first-order and a second-order model.Results: Both models fit the data well but displayed latent variable correlations above 1 and negative variances (known as Heywood cases), indicating model misspecification or other problems. The specification problems included the latent variable Affect Dysregulation.Conclusions: Based on our results and results reported in previous CFAs of the ITQ, we suggest consideration of the proposed models. While many previous studies did find support for the models with no indications of misfit, others find Heywood cases concerning the same items and latent variables as our analysis. Hence, models of (C)PTSD based on the ITQ should be carefully evaluated and interpreted.

PMID:39749481 | DOI:10.1080/20008066.2024.2444745

Genet Epidemiol. 2025 Jan;49(1):e22608. doi: 10.1002/gepi.22608.

ABSTRACT

Biological datasets often consist of thousands or millions of variables, e.g. genetic variants or biomarkers, and when sample sizes are large it is common to find many associated with an outcome of interest, for example, disease risk in a GWAS, at high levels of statistical significance, but with very small effects. The False Discovery Rate (FDR) is used to identify effects of interest based on ranking variables according to their statistical significance. Here, we develop a complementary measure to the FDR, the priorityFDR, that ranks variables by a combination of effect size and significance, allowing further prioritisation among a set of variables that pass a significance or FDR threshold. Applying to the largest GWAS of type 1 diabetes to date (15,573 cases and 158,408 controls), we identified 26 independent genetic associations, including two newly-reported loci, with qualitatively lower priorityFDRs than the remaining 175 signals. We detected putatively causal type 1 diabetes risk genes using Mendelian Randomisation, and found that these were located disproportionately close to low priorityFDR signals (p = 0.005), as were genes in the IL-2 pathway (p = 0.003). Selecting variables on both effect size and significance can lead to improved prioritisation for mechanistic follow-up studies from genetic and other large biological datasets.

PMID:39749473 | DOI:10.1002/gepi.22608

J Orthod. 2025 Jan 3:14653125241309654. doi: 10.1177/14653125241309654. Online ahead of print.

ABSTRACT

AIM: To compare microleakage beneath ceramic and metal brackets prepared with either acid etching or laser conditioning.

DESIGN: An in vitro study.

SETTING: Department of Orthodontics, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt.

METHODS: A total of 40 intact human premolars were selected and divided into four equal groups. The groups received the same adhesive-application procedures with different surface treatments and type of brackets: groups 1 (AM) and 3 (AC) underwent phosphoric acid etching; groups 2 (LM) and 4 (LC) underwent laser enamel conditioning using a Er,Cr:YSGG laser. Metal brackets were then bonded to the teeth in groups 1 (AM) and 2 (LM) and ceramic brackets in groups 3 (AC) and 4 (LC). Subsequently, they were placed in fuchsin dye solution. Each premolar was sectioned longitudinally in the occluso-gingival direction at right angles to the brackets. The dye penetration depth was calculated using a stereomicroscope. Microleakage was measured along the enamel-adhesive interface at each section’s gingival and occlusal levels. For group comparisons, the Tukey test was utilised as a post hoc test to determine statistical significance between groups. The independent sample t-test was utilised for comparing both subgroups.

RESULTS: The results demonstrated significantly more microleakage under metal and ceramic brackets bonded to enamel prepared with laser conditioning than with acid etching at both the gingival and occlusal surfaces and in total. The AC group exhibited the lowest amount of microleakage, but the LC group demonstrated the highest amount of microleakage.

CONCLUSION: The ceramic bracket group treated with acid etching exhibited the lowest level of microleakage. Microleakage values on the gingival and occlusal surfaces were higher in both bracket types for the laser etched groups.

PMID:39749464 | DOI:10.1177/14653125241309654

J Appl Lab Med. 2025 Jan 3;10(1):13-25. doi: 10.1093/jalm/jfae136.

ABSTRACT

BACKGROUND: Efforts to appropriately utilize laboratory tests have been underway for several decades. However, limited information is available regarding the status of laboratory stewardship at academic medical centers. Prior to initiating a laboratory stewardship committee, a study was initiated to gain insights from peer institutions.

METHODS: An online REDCap survey was created and emailed to US pathology department leaders at 94 academic medical centers.

RESULTS: Response rate was 40%. Sixty-eight percent (n = 26) of respondents indicated that they have a laboratory stewardship committee. There was variability among academic medical institutions regarding governance, committee structure and responsibilities, and assessment of laboratory stewardship committee performance. There was consensus for inclusion of: hospital administration and clinical leadership; informatics (IT) support, and a multidisciplinary clinical team combined with laboratory medicine expertise. Of the 32% (n = 12) without a committee, 4 started one but found it unsustainable, and 6 were unsuccessful at starting a program. Respondents without a current laboratory stewardship program cited lack of leadership support, insufficient management and IT resources, and unclear vision and goals as major factors. Fifty-eight percent of those without a laboratory stewardship committee predicted their hospital would establish one within the next 5 years.

CONCLUSIONS: Survey results provide insights into the status of laboratory stewardship efforts at peer institutions. Awareness of the structural and leadership components critical to successful and sustained initiatives will improve the quality and value of clinical laboratory services.

PMID:39749454 | DOI:10.1093/jalm/jfae136

J Appl Lab Med. 2025 Jan 3;10(1):4-12. doi: 10.1093/jalm/jfae121.

ABSTRACT

BACKGROUND: Referral (send-out) laboratories support clinical needs but may cause issues for hospitals or health systems related to regulations and governance, specimen logistics, test result availability, and cost and reimbursement. The use of a “miscellaneous” referral test order can increase risks of specimen collection or processing errors, result delays, and repeat testing.

METHODS: We established an approved referral laboratory test list and a digital form for providers to request new referral tests. We collated laboratory stewardship committee decisions over a 20-month period. Separately, we retrospectively reviewed referral tests ordered as miscellaneous across our health system over 1 year. Subject matter experts identified appropriate tests to build as discretely orderable in the electronic health record. Following targeted provider notification of the new tests, we assessed their uptake and impact on result turnaround times for the first 5 built tests over 6 months.

RESULTS: Our laboratory stewardship committee approved 16 of 27 provider requests to build new referral tests over the first 20 months following implementation of the new request process. In addition, 37 of the 100 most frequently ordered miscellaneous tests were recommended to be built as discrete orders. Uptake of the first 5 built tests (relative to providers continuing to use miscellaneous orders) averaged 64% over the first 6 months. Result turnaround times improved by an average of 1.1 days when the discrete orders were used.

CONCLUSIONS: We successfully established oversight of referral laboratory testing across our health system, pivoted orders away from miscellaneous, and observed improvements in turnaround times.

PMID:39749453 | DOI:10.1093/jalm/jfae121

J Appl Lab Med. 2025 Jan 3;10(1):79-91. doi: 10.1093/jalm/jfae129.

ABSTRACT

BACKGROUND: The US healthcare system is complex and includes a number of entities and systems that provide services to patients and to pay for them. While improving health and well-being are accepted goals of healthcare, the 3 stakeholder groups relevant to healthcare-patients, providers, and payers-often have different perspectives on how care should be utilized, performed, and paid for. These differing perspectives are discussed as they relate to clinical laboratory testing.

CONTENT: Patients expect that the laboratory tests performed on them are necessary and covered by their insurance. Providers expect that they will be able to carry out what they believe to be the standard of care for their patients, and they furthermore expect that the systems in place from laboratories and payers will support their efforts without exposing their patients or their practice to financial toxicity. Payers, finally, desire to meet the needs of their customers, who are both patients as well as employers, by providing access to necessary healthcare services at a fair cost. Aligning these desires and perspectives is challenging in a fragmented healthcare system, and in the face of substantial opportunities for secondary gain from disreputable practices such as fraud, waste, and abuse.

SUMMARY: Within the constraints of a US healthcare system based on competition and susceptible to misalignment, opportunities nonetheless exist for all relevant stakeholders in the laboratory testing space (patients, providers, and payers) to align and agree on practices that provide reasonably priced, fairly distributed, and medically necessary healthcare.

PMID:39749451 | DOI:10.1093/jalm/jfae129

J Appl Lab Med. 2025 Jan 3;10(1):48-58. doi: 10.1093/jalm/jfae123.

ABSTRACT

BACKGROUND: In prolactinoma diagnosis, current guidelines recommend prolactin (PRL) assessment, considering values exceeding 200 ng/mL highly suggestive of prolactinoma. However, subtler hyperprolactinemia is more common, and to rule out potential prolactinomas, pituitary resonance magnetic imaging (MRI) studies are necessary. These present limitations in terms of availability, costs, and delays in diagnosis. We aimed to evaluate the screening utility of the metoclopramide (MCP) test in identifying patients with moderate hyperprolactinemia for whom MRI studies might be unnecessary.

METHODS: We retrospectively selected patients with moderate hyperprolactinemia, with an MCP test and a pituitary MRI within the same assistance, and with no interfering pharmacological treatment. Increases in PRL (ΔPRLMax) and thyrotropin (ΔTSHMax) after MCP infusion were compared according to MRI findings: patients with microadenoma (<10 mm; n = 23), with macroadenoma (≥10 mm; n = 5), or without adenoma (n = 39).

RESULTS: ΔPRLMax exceeds baseline PRL capability to identify patients with an adenoma (area under the curve = 0.872 vs 0.776). ΔPRLMax below 220% identifies 100% of these patients with 71% of specificity. This screening would have avoided 42% of MRI, resulting in a cost savings of 34%. Analysis of ΔTSHMax only slightly increased specificity when considered as a secondary criterion. Test duration can be shortened to 30 min without compromising its screening capability.

CONCLUSIONS: A short MCP test is a useful and cost-effective screening tool to avoid unnecessary MRI. Its simplicity allows its performance in almost any clinical facility to easily rule out prolactinoma in an important percentage of patients, something of upmost importance especially in regions where MRI facilities or their access are limited.

PMID:39749449 | DOI:10.1093/jalm/jfae123

J Appl Lab Med. 2025 Jan 3;10(1):148-161. doi: 10.1093/jalm/jfae135.

ABSTRACT

BACKGROUND: As clinical laboratories struggle to maintain their financial footing and as patients face mounting out-of-pocket expenses for diagnostic testing, being able to perform financial analysis of laboratory stewardship efforts has become an increasingly important skill.

CONTENT: Understanding the revenue cycle as it relates to diagnostic testing is fundamental to selecting, designing, implementing, and evaluating laboratory stewardship interventions for maximum financial return. Leveraging the data and processes driving the revenue cycle can inform informatics-based interventions (such as clinical decision support) and allow deliberate financial analyses of stewardship-focused projects. For labs striving not only to ensure their own financial health but also to help their patients avoid financial toxicity, the most effective strategies often depend on developing productive partnerships with key players along the revenue cycle.

SUMMARY: Financial laboratory analytics is an emerging skill set that can power laboratory stewardship efforts and whose benefits accrue to patients, clinicians, laboratories, and health systems.

PMID:39749448 | DOI:10.1093/jalm/jfae135