Nevin Manimala

Parasit Vectors. 2024 Dec 30;17(1):548. doi: 10.1186/s13071-024-06629-3.

ABSTRACT

BACKGROUND: The frequent communication between African and Southeast Asian (SEA) countries has led to the risk of imported malaria cases in the China-Myanmar border (CMB) region. Therefore, tracing the origins of new malaria infections is important in the maintenance of malaria-free zones in this border region. A new genotyping tool based on a robust mitochondrial (mt) /apicoplast (apico) barcode was developed to estimate genetic diversity and infer the evolutionary history of Plasmodium falciparum across the major distribution ranges. However, the mt/apico genomes of P. falciparum isolates from the CMB region to date are poorly characterized, even though this region is highly endemic to P. falciparum malaria.

METHODS: We have sequenced the whole mt/apico genome of 34 CMB field isolates and utilized a published data set of 147 mt/apico genome sequences to present global genetic diversity and to revisit the evolutionary history of the CMB P. falciparum.

RESULTS: Genetic differentiation based on mt/apico genome of P. falciparum revealed that the CMB (Lazan, Myanmar) isolates presented high genetic diversity with several characteristics of ancestral populations and shared many of the genetic features with West Thailand (Mae Sot; WTH) and to some extent West African (Banjul, Gambia; Navrongo, Ghana; WAF) isolates. The reconstructed haplotype network displayed that the CMB and WTH P. falciparum isolates have the highest representation (five) in the five ancestral (central) haplotypes (H1, H2, H4, H7, and H8), which are comparatively older than isolates from other SEA populations as well as the WAF populations. In addition, the highest estimate of the time to the Most Recent Common Ancestor (TMRCA) of 42,400 (95% CI 18,300-82100) years ago was presented by the CMB P. falciparum compared to the other regional populations. The statistically significant negative values of Fu’s Fs with unimodal distribution in pairwise mismatch distribution curves indicate past demographic expansions in CMB P. falciparum with slow population expansion between approximately 12,500-20,000 ybp.

CONCLUSIONS: The results on the complete mt/apico genome sequence analysis of the CMB P. falciparum indicated high genetic diversity with ancient population expansion and TMRCA, and it seems probable that P. falciparum might have existed in CMB, WTH, and WAF for a long time before being introduced into other Southeast Asian countries or regions. To reduce the impact of sample size or geographic bias on the estimate of the evolutionary timeline, future studies need to expand the range of sample collection and ensure the representativeness of samples across geographic distributions. Additionally, by mapping global patterns of mt/apico genome polymorphism, we will gain valuable insights into the evolutionary history of P. falciparum and optimised strategies for controlling P. falciparum malaria at international borders.

PMID:39736695 | DOI:10.1186/s13071-024-06629-3

BMC Med Educ. 2024 Dec 30;24(1):1553. doi: 10.1186/s12909-024-06573-x.

ABSTRACT

BACKGROUND: Historically, women have been shown to underestimate their abilities, while men often assess themselves more accurately or overestimate. This study aims to determine self-assessment accuracy during online Objective Structured Clinical Examinations (OSCEs) according to gender.

METHODS: A prospective study was conducted among fourth-year medical students at Paris Cité University during faculty training OSCEs, utilizing Zoom® software for remote participation. Students and evaluators assessed performances using 5-point Likert scales for medical knowledge, interpersonal skills, and overall performance. Additionally, students predicted their grade out of twenty. The assessment covered three independent stations.

RESULTS: This study included 259 medical students (177 women, 81 men, one non-binary (excluded from further analyses)) evaluated by 130 physicians. Evaluator scores did not differ according to students’ gender (total score out of 20: men: 10.25 ± 3.45, women: 10.23 ± 3.44 p = 0.817) nor students’ self-assessments (total score out of 20: men: 11.22 ± 3.02, women: 11.00 ± 3.03; p = 0.466) whatever the domains and stations (all p > 0.05). The difference (delta) between self-assessment and evaluator scores for medical knowledge (men: 0.73 ± 1.00, women: 0.64 ± 1.02; p = 0.296), interpersonal skills (men: 1.02 ± 1.06, women: 0.93 ± 1.09; p = 0.296), and total score (men: 0.98 ± 3.41, women: 0.68 ± 3.42; p = 0.296) showed no gender differences. Further analysis categorized students based on their self-assessment accuracy, revealing that both men and women displayed a high ratio of accurate self-assessments (78.1% for overall performance across all stations), with minimal overestimation observed in both genders (20.9% for overall performance across all stations). Instances of overestimation or underestimation were rare and not consistent over the 3 stations, indicating that such misjudgments are likely situational rather than inherent traits.

DISCUSSION: This study reveals similar self-assessment accuracy according to gender in online training OSCEs suggesting a shift towards gender-equitable self-perceptions among medical students compared to previous studies. Research remains necessary to corroborate these results and explore the underlying factors contributing to this shift in self-perception.

PMID:39736694 | DOI:10.1186/s12909-024-06573-x

Lipids Health Dis. 2024 Dec 31;23(1):427. doi: 10.1186/s12944-024-02415-3.

ABSTRACT

BACKGROUND: With metabolic disorders on the rise globally, the cardiometabolic index (CMI) has emerged as a crucial predictor of mortality risks linked to cancer, cardiovascular disease, and diabetes. This novel index, which combines lipid metabolism and body composition, is the focus of this study, aimed at exploring its association with all-cause and specific mortality in an all-age adult population.

METHODS: A longitudinal cohort study including 5,728 participants aged over 18 from nine cycles between 2001 and 2018 was enrolled and assessed. CMI served as the exposure variable, while outcomes included all-cause mortality and mortality due to cardiovascular disease, cancer, and diabetes. The Cox frailty model and average marginal effects were employed to evaluate the contribution of CMI to all-cause and specific mortality collectively. Restricted cubic spline analyses and stratified analyses were conducted to investigate potential nonlinear effects and interactions.

RESULTS: The decreased participants exhibited considerably higher CMI than the alive’s. A positive association was found between CMI and all-cause mortality (HR=1.05, 95% CI=1.01-1.10). Notably, CMI was linked to an increased risk of cancer mortality (HR=1.02) and a reduced risk of cardiovascular disease mortality (HR=0.85). Furthermore, the average marginal effect of CMI on diabetes mortality was the largest (AME=0.499). The RCS curves revealed that participants had the lowest risk of all-cause mortality at a CMI of 0.618. Sensitivity analyses further supported these findings.

CONCLUSION: This study represents the first comprehensive assessment on the contribution of CMI to mortality across an all-age adult population, providing some insights for the comprehensive assessment of health and disease states.

PMID:39736689 | DOI:10.1186/s12944-024-02415-3

BMC Musculoskelet Disord. 2024 Dec 30;25(1):1093. doi: 10.1186/s12891-024-08233-z.

ABSTRACT

BACKGROUND: This study aims to evaluate the optimal dose of intravenous tranexamic acid (TXA) for reducing blood loss in spinal surgery.

METHODS: A systematic search was conducted in the PubMed, Embase, Cochrane Library database from inception until November 2023. Randomized controlled trials (RCTs) incorporating diverse TXA dosing regimens for spinal surgery were included. The surface under the cumulative ranking curve (SUCRA) analysis was employed to determine ranking order. R software with gemtc package was used for all analyses, with a significance threshold set at P < 0.05.

RESULTS: Twenty-four RCTs were considered eligible and finally included. All TXA treatments demonstrated superior efficacy compared to the placebo, with statistically significant differences (P < 0.05). SUCRA values indicated that Treatment I (100 mg/kg + 10 mg.kg/h) claimed the top rank (SUCRA, 80.3%), followed by Treatment F (15 mg/kg + 2 mg.kg/h) in second place (SUCRA, 76.7%), and Treatment E (10 mg/kg + 2 mg.kg/h) in third place (SUCRA, 75.2%). Conversely, the placebo ranked the lowest (SUCRA, 0.3%). Additionally, Treatment I (100 mg/kg + 10 mg.kg/h) held the top rank (SUCRA, 95.6%), followed by Treatment N (30 mg/kg + 10 mg.kg/h) in second place (SUCRA, 81.0%), and Treatment K (15 mg/kg + 6 mg.kg/h) in third place (SUCRA, 74.8%). Importantly, no statistically significant differences were observed between any TXA treatments and the placebo concerning the occurrence of deep vein thrombosis (DVT) (P > 0.05).

CONCLUSIONS: This network meta-analysis underscores that intravenous TXA is associated with decreased overall blood loss in multilevel spine surgery. Notably, the highest dose in this network meta-analysis (100 mg/kg + 10 mg.kg/h) emerged as the only regimen demonstrating significant benefits in pairwise comparisons with other TXA doses. Although this regimen did not significantly increase DVT risk, careful consideration of safety data for higher doses remains essential.

PMID:39736682 | DOI:10.1186/s12891-024-08233-z

Trials. 2024 Dec 30;25(1):855. doi: 10.1186/s13063-024-08669-7.

ABSTRACT

BACKGROUND: We previously published the protocol and statistical analysis plan for a randomized controlled trial of Proportional Assist Ventilation for Minimizing the Duration of Mechanical Ventilation: the PROMIZING study in Trials ( https://doi.org/10.1186/s13063-023-07163-w ). This update summarizes changes made to the statistical analysis plan for the trial since the publication of the original protocol and statistical analysis plan.

METHODS/DESIGN: The Proportional Assist Ventilation for Minimizing the Duration of Mechanical Ventilation (PROMIZING) study is a multi-center, open-label, randomized controlled trial designed to determine if ventilation with proportional assist ventilation with load-adjustable gain factors will result in a shorter duration of time spent on mechanical ventilation compared to ventilation with pressure support ventilation for patients with acute respiratory failure. The statistical analysis plan for the trial was incorporated into the original publication of the protocol in Trials ( https://doi.org/10.1186/s13063-023-07163-w ) and was based on version 5.0 of the study protocol and version 1.0 of the statistical analysis plan (SAP), which included plans for both frequentist and Bayesian analyses. We have since updated the SAP to refine the Bayesian analysis plan, update the multistate model diagram, and include plans for a cluster analysis to determine if there is heterogeneity of treatment effect. This update summarizes the changes made and their rationale and provides a refined SAP for the PROMIZING trial with additional background information, in adherence with guidelines for the prospective reporting of SAPs for randomized controlled trials.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02447692 prospectively registered May 19, 2015.

PMID:39736673 | DOI:10.1186/s13063-024-08669-7

Cardiooncology. 2024 Dec 31;10(1):93. doi: 10.1186/s40959-024-00299-x.

ABSTRACT

INTRODUCTION: The evolving field of oncology necessitates effective management of cancer-related cardiovascular diseases. In Saudi Arabia, the incidence of cancer is rising, and there is a critical need for cardio-oncology services to address cancer treatment-related cardiovascular toxicity. This study aimed to evaluate the knowledge and practices of healthcare providers (HCPs) in Saudi Arabia regarding cardio-oncology.

METHODS: A cross-sectional study was conducted from January 2024 to April 2024 using an online survey targeting cardiologists, oncologists, and clinical pharmacists. The survey assessed demographics, perceptions of cardio-oncology, availability of services, and current practices. Data were analyzed using descriptive statistics, chi-squared tests, and bivariate analyses.

RESULTS: The survey received responses from 116 HCPs, including cardiologists (63.79%), oncologists (23.28%), and clinical pharmacists (12.93%). Most participants had over six years of experience, and only one had formal cardio-oncology training. While 84.48% recognized the importance of managing cardiac complications in cancer patients, only 42.24% were familiar with existing guidelines. Limited training programs and institutional resources were significant barriers to implementing cardio-oncology services. Despite agreement on the need for cardiotoxicity management, only one-third recommended cardioprotective agents as standard care.

CONCLUSION: There is a notable deficiency in formal training and resources for cardio-oncology in Saudi Arabia. To bridge this gap, integrating cardio-oncology into training programs, establishing institutional guidelines, and adopting multidisciplinary care models are crucial. These measures will enhance the quality of care for cancer patients and improve their cardiovascular outcomes.

PMID:39736669 | DOI:10.1186/s40959-024-00299-x

Virol J. 2024 Dec 30;21(1):339. doi: 10.1186/s12985-024-02615-4.

ABSTRACT

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection globally, with significant implications for various anogenital cancers, such as vulval, vaginal, anal, penile, head and neck cancers. HPV infections have been linked to the induction of inflammation. In contrast, Interleukin-37 (IL-37) is recognized as an anti-inflammatory cytokine. In this study, two distinct types of oral epithelial cells were employed to investigate the impact of HPV on inflammation. The experimental outcomes unequivocally demonstrated that human papillomavirus (HPV) elicited a pronounced and statistically significant induction of inflammatory responses within both varieties of oral epithelial cells under investigation. Interestingly, IL-37 exhibited a mitigating effect, attenuating the HPV-induced inflammation in oral epithelial cells. Further exploration into the molecular mechanisms involved revealed that knockdown (KD) of PI3K compromised the anti-inflammatory effects of IL-37 in response to HPV. Similarly, KD of AKT was found to compromise the regulatory effects of IL-37 on HPV-induced inflammation. Notably, KD of mTOR was identified as a key factor, compromising the anti-inflammatory effects of IL-37 in the context of HPV-induced inflammation. Additionally, the study uncovered that the mTOR inhibitor, rapamycin, could effectively compromise the effects of IL-37 on HPV-induced inflammation. These findings contribute valuable insights into the intricate pathogenesis of HPV-induced inflammation and may pave the way for the development of innovative treatments for this condition.

PMID:39736667 | DOI:10.1186/s12985-024-02615-4

BMC Surg. 2024 Dec 31;24(1):426. doi: 10.1186/s12893-024-02724-5.

ABSTRACT

PURPOSE: This retrospective cohort study aimed to identify factors associated with preoperative deep venous thrombosis (DVT) in elderly patients with femoral neck fractures, and to investigate whether combining these factors could improve the ability to predict DVT.

METHOD: Medical records and laboratory test results were reviewed patients presenting with a femoral neck fracture and receiving routine chemoprophylaxis for DVT between January 2020 and December 2023 in a tertiary referral, university-affiliated hospital. Preoperative DVT was confirmed by Doppler ultrasound or CT venography. Demographic, injury, comorbidity, and laboratory variables were analyzed using univariate and multivariate approaches. The performance of combined predictive factors was evaluated using receiver operating characteristic (ROC) curve analysis.

RESULTS: Among the 499 patients included, 47 (9.4%) were diagnosed with a preoperative DVT. In the univariate analysis, five variables were found to be statistically significant, including alcohol consumption (P = 0.017), history of renal disease (P < 0.001), elevated D-dimer level (both traditional and age-adjusted cut-off used) (P = 0.007 or < 0.003), increased platelet distribution width (PDW) (P < 0.001) and reduced albumin in continuous or categorical variable (P = 0.027, P = 0.002). Multivariate analysis confirmed all except alcohol consumption as independent predictors (all P < 0.05). ROC curve analysis showed that combining these four significant variables with age improved the ability to predict preoperative DVT, with an area under the curve of 0.749 (95% CI: 0.676-0.822, P < 0.001), sensitivity of 0.617, and specificity of 0.757.

CONCLUSION: This study identified several factors associated with preoperative DVT, and combining them demonstrated improved performance in predicting DVT, which can facilitate risk assessment, stratification and improved management in clinical practice.

PMID:39736660 | DOI:10.1186/s12893-024-02724-5

BMC Musculoskelet Disord. 2024 Dec 30;25(1):1094. doi: 10.1186/s12891-024-08256-6.

ABSTRACT

BACKGROUND: The optimal length of thromboprophylaxis after total hip or knee arthroplasty (THA and TKA) is unknown. Fast-track protocols have improved patient care and led to shorter immobilization and length of stay (LOS) after THA and TKA, thereby diminishing venous thromboembolism (VTE) risk. Here, we investigated risk stratification-based thromboprophylaxis after fast-track THA and TKA.

METHODS: A retrospective register study was conducted in two Finnish hospitals using a fast-track protocol for THA and TKA. These hospitals use risk stratification-based planning of thromboprophylaxis, including risk evaluation of patients’ personal VTE risk. Patients at low risk received thromboprophylaxis solely during hospitalization, provided this lasted five days or less. All VTEs and clinically relevant bleedings were obtained from Finnish hospital discharge registers between 1 January 2020 and 31 December 2021 to determine VTE incidences and clinically relevant bleedings 90 days after surgery.

RESULTS: During the study period 3 713 arthroplasties were performed (1 636 THAs and 2 077 TKAs). The 90-day incidence of VTE was 0.7% (CI 0.4 to 0.9), and 25 VTEs occurred within 90 days of surgery. These VTEs comprised 12 pulmonary embolisms and 13 deep vein thromboses, none of which was fatal. The incidence of clinically relevant bleedings (n = 57) within 90 days of surgery was 1.5% (CI 1.1 to 1.9). One intracranial bleeding was fatal. The bleedings typically occurred at the operational site.

CONCLUSION: Risk stratification-based thromboprophylaxis appears safe for fast-track THA and TKA patients as the incidences of VTEs and clinically relevant bleedings were low.

PMID:39736658 | DOI:10.1186/s12891-024-08256-6

BMC Oral Health. 2024 Dec 30;24(1):1573. doi: 10.1186/s12903-024-05267-6.

ABSTRACT

BACKGROUND: Short fiber-reinforced composites (SFRCs) are restorative materials for large cavities claimed to effectively resist crack propagation. This study aimed to compare the mechanical properties and physical characteristics of five commercially available SFRCS (Alert, Fibrafill Flow, Fibrafill Dentin, everX Flow, and everX Posterior) against a conventional particulate-filled composite (PFC, Essentia Universal).

METHODS: The following characteristics were evaluated in accordance with ISO standards: flexural strength and modulus and fracture toughness. FTIR-spectrometry was used to calculate the degree of monomer conversion (DC%). The two-body wear test was performed in a ball-on-flat configuration using a chewing simulator with 15,000 cycles. A non-contact 3D optical profilometer was utilized to measure wear depth. The tensilometer method was used to quantify polymerization shrinkage-stress. Posterior composite crowns (n = 8) were made and quasi-statically loaded until fracture. The microstructure of the SFRCs were assessed using scanning electron microscopy. ANOVA was applied to statistically interpret the results, and then the post hoc Tukey’s analysis was performed.

RESULTS: Among the evaluated composites, SFRC (everX Flow) had the lowermost wear depth (20.4 μm) and uppermost fracture toughness (2.8 MPa m^1/2) values (p < 0.05). Fibrafill Flow (92 MPa) and Fibrafill Dentin (98 MPa) showed the lowest flexural strength values (p < 0.05). The used SFRCs exhibited equivalent values (p > 0.05) of shrinkage stress, except for everX Flow which had the highest value (5.3 MPa). everX Flow composite crowns presented significantly greater fracture resistance (3870 ± 260 N) (p < 0.05) than that of the other SFRCs tested.

CONCLUSION: Significant differences were found between the investigated characteristics of different commercially available SFRCs. It is noteworthy that certain SFRCs exhibited behavior comparable to that of conventional PFC, while others demonstrated superior performance.

PMID:39736654 | DOI:10.1186/s12903-024-05267-6