Nevin Manimala

Psychiatry Res. 2025 Jun 16;351:116595. doi: 10.1016/j.psychres.2025.116595. Online ahead of print.

ABSTRACT

Aggressive behaviours pose a significant threat to both individual and societal security. Increasing evidence suggests that individuals exhibiting such behaviours demonstrate altered neurochemical levels including metabolites, neurotransmitters and receptors. However, findings from previous studies have shown inconsistencies. This study aimed to elucidate these neurochemical alterations through a case-control meta-analysis. A comprehensive literature search was conducted using Web of Science, Medline, and PubMed databases, identifying forty eligible studies (registration number: CRD420251014162). The neurochemicals examined included indictors of serotonin (5-HT), dopamine, N-acetyl aspartate (NAA), glutamate, glutamine, choline, creatine, phosphocreatine, myo-inositol, gamma-aminobutyric acid, homovanillic acid, norepinephrine, 3-methoxy-4-hydroxy-phenylglycol, neuropeptide Y-like immunoreactivity, and substance P-like immunoreactivity. These studies investigated neurochemical changes in the cerebrospinal fluid (CSF) and various brain regions, including the prefrontal cortex, orbital frontal cortex, anterior cingulate cortex, middle temporal gyrus, medial temporal lobe, parietal cortex, striatum, thalamus, amygdala, hippocampus, midbrain, and brainstem. Our meta-analysis revealed a significant reduction in NAA levels in the prefrontal cortex of individuals exhibiting aggressive behaviours compared to controls. Furthermore, NAA levels demonstrated a negative correlation with the severity of aggressive behaviours. The findings for the other neurochemicals all did not reach statistical significance. These findings suggest that reduced prefrontal NAA levels may serve as a neurobiological correlate of aggressive behaviours, with implications for developing assessment tools and targeted interventions.

PMID:40543113 | DOI:10.1016/j.psychres.2025.116595

Auris Nasus Larynx. 2025 Jun 20;52(4):420-425. doi: 10.1016/j.anl.2025.06.001. Online ahead of print.

ABSTRACT

OBJECTIVE: Heightened listening effort in cochlear implant (CI) users may have a significant impact on their balance performance. This study aims to investigate the impact of listening effort on postural control in typical-hearing adults presented with CI-simulated speech in noise.

METHODS: The study participants were fifty-eight adults with typical hearing (aged 20-24 years). Turkish Hearing in Noise Test (HINT) sentences were used as the speech material. The Modified Clinical Test of Sensory Interaction in Balance (mCTSIB) was used to evaluate static balance and it was performed by using Computerized Static Posturography. In the experimental design of the study, healthy participants with typical hearing listened to non-simulated and CI-simulated sentences and repeated what they heard while the participants were performing the mCTSIB test on the force platform of static posturography.

RESULTS: In this study, the participants’ postural sway velocity rates were compared under three task conditions. The results demonstrated a statistically significant increase in participants’ sway velocity rates when listening to 12-channel filtered speech in noise material compared to those from the baseline mCTSIB assessment. There was no statistically significant differences in postural sway rate ratios when listening to unfiltered speech in noise material.

CONCLUSION: Increased listening effort for CI-simulated speech-in-noise resulted in poorer postural balance. A better understanding of such a difficulty may help us to evaluate postural balance from different perspectives and plan an appropriate vestibular rehabilitation program.

PMID:40543097 | DOI:10.1016/j.anl.2025.06.001

Intern Med J. 2025 Jun 21. doi: 10.1111/imj.70123. Online ahead of print.

ABSTRACT

AIM: To determine the status of the current rheumatology workforce and model projections for the future rheumatology workforce in Australia.

BACKGROUND: The rheumatology workforce in Australia is currently facing a significant shortage. Identification of the optimal number of rheumatologists for the Australian population is challenging, and requires assessment of the current workforce.

METHODS: A survey of Australian Rheumatology Association (ARA) full members was undertaken in 2021, collecting demographic data, information about type and location of rheumatology practice and other clinical and non-clinical work, work intentions and job satisfaction. Descriptive statistics and multivariable regression analyses were performed. The clinical full-time equivalent (cFTE) was estimated based on the reported number of half-days worked in clinical rheumatology practice. Using the age and gender distribution of rheumatology specialists from the Department of Health Workforce Data Tool, workforce projections were produced for the period from 2018 to 2038.

RESULTS: A total of 81% (323/404) of full members of the ARA completed the survey. The median (interquartile range (IQR)) rheumatology clinical half-days worked/week was 6 (4-8). Adjusted to survey response, the reported clinical workload equates to the cFTE of 231 adult and 13 paediatric rheumatologists. A current shortfall of 302 adult rheumatologists and 41 paediatric rheumatologists exists relative to optimal care estimates. Furthermore, 38% of rheumatologists are considering reducing clinical hours temporarily or permanently, predominantly within the next 2 years. Based on current supply models, the shortfall will improve but will not reach optimal levels by 2038.

CONCLUSION: Australia has an undersupply of both adult and paediatric rheumatologists compared to optimal care ideals. An ageing workforce, many part-time, and the significant number planning to reduce hours within 2 years will exacerbate this undersupply unless the supply of rheumatologists is substantially increased.

PMID:40543071 | DOI:10.1111/imj.70123

Intern Med J. 2025 Jun 21. doi: 10.1111/imj.70129. Online ahead of print.

ABSTRACT

BACKGROUND: This retrospective cohort study investigated the clinical characteristics, treatment regimens and prognostic factors of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in a single-centre setting between January 2019 and December 2024.

AIMS: The study aimed to identify independent factors affecting prognosis and to provide guidance for clinical practice.

METHODS: The study included 72 patients diagnosed with anti-NMDAR encephalitis. Clinical data – including demographic information, clinical manifestations, laboratory findings and treatment outcomes – were systematically collected. Patients were categorised into good prognosis (mRS ≤ 2) and poor prognosis (mRS ≥ 3) groups based on their 6-month follow-up modified Rankin Scale scores. Statistical analyses comprised univariate analysis and multivariate logistic regression to identify prognostic factors.

RESULTS: Of the 72 patients, 67 (93.1%) had a good prognosis, and five (6.9%) had a poor prognosis. The mean age was 32.72 years, with an equal gender distribution. Significant differences between outcome groups were observed in tumour presence (P < 0.001), blood tumour necrosis factor (TNF) levels (P = 0.0303), cerebrospinal fluid (CSF), interleukin (IL)-8 levels (P = 0.0013) and serum immunoglobulin (Ig) G levels (P = 0.00047). Psychiatric abnormalities were reported in 76.4% of patients and cognitive impairment in 87.5%. Only 29.2% of patients received immunotherapy. The multivariate analysis revealed no significant independent predictors among gender, age, psychiatric abnormality and cognitive impairment, possibly due to the limited sample size in the poor prognosis group.

CONCLUSIONS: The study identified tumour coexistence, elevated inflammatory markers (serum TNF, CSF IL-8) and increased serum IgG levels as substantial factors associated with poor prognosis in anti-NMDAR encephalitis. These findings underscore the importance of early tumour screening and inflammatory marker monitoring in clinical management. However, larger multicentre studies are required to validate these results and provide more comprehensive guidance for clinical practice.

PMID:40543064 | DOI:10.1111/imj.70129

Ann N Y Acad Sci. 2025 Jun 21. doi: 10.1111/nyas.15387. Online ahead of print.

ABSTRACT

Music-based interventions (MBIs) offer promising strategies for addressing speech-language impairments in individuals with nonfluent aphasia. This systematic review summarizes the current literature of MBIs for nonfluent aphasia recovery by types of MBIs to determine the efficacy of MBIs and assesses the risk of bias to identify common methodological limitations. A systematic search was conducted of MEDLINE, PubMed, and APA PsycInfo for the 20 years preceding July 2024. Risk of bias assessment was performed using the revised Joanna Briggs Institute critical appraisal tool for randomized controlled trials (RCTs). Ten RCTs met the inclusion criteria, featuring MBIs such as Melodic Intonation Therapy, Modified Melodic Intonation Therapy, and singing-based approaches. The results highlighted the potential of MBIs in various domains, particularly in enhancing repetition and naming abilities, even when compared to speech therapy. The reviewed studies exhibited a moderate to high risk of bias. Outcome measures varied widely, and functional communication, a critical rehabilitation goal, was examined in just two RCTs. Furthermore, heterogeneous control conditions and statistical methods hindered meaningful comparisons across studies. Future research should prioritize functional communication outcomes and refine intervention protocols to strengthen the evidence base. Addressing these gaps is essential for advancing the potential benefits of these clinical tools for nonfluent aphasia recovery.

PMID:40543062 | DOI:10.1111/nyas.15387

Health Econ. 2025 Jun 21. doi: 10.1002/hec.70004. Online ahead of print.

ABSTRACT

People are sometimes forced to move, and it is plausible that such relocation involves significant psychological costs. The challenge in identifying the mental health consequences of moving is that most moves are (at least partly) voluntary so that the sample of movers is self-selected. We focus on a natural experiment, the government-mandated relocation of some households after all households experienced an exogenous shock. We use this experiment to identify the causal impact of moving on people’s mental health, distinguishing between less severe and more severe health conditions, and between individuals with pre-existing mental health conditions and those without. The event we focus on is the 2011 Christchurch (New Zealand) earthquake, and the consequent decision of the government to relocate about 8000 households from some of the earthquake-affected areas. We use a comprehensive administrative dataset that includes health records with information on hospital attendance, specialist services, and prescribed medications for (almost) every resident in the city and compare the relocated individuals to those who lived elsewhere in the earthquake-damaged city. We examine both the likelihood of receiving mental health treatment (the extensive margin), and the intensity of treatment, measured by the number of visits to a clinic or hospital (the intensive margin). We find a statistically significant increase in the likelihood and frequency of receiving treatment for moderate mental health problems among individuals compelled to relocate, when compared to other residents of the earthquake-affected city who were allowed to remain in situ. This increase persisted to December 2013 for everyone, and remained significant for the elderly to the end of 2018. We found no such increase in health care utilisation for more severe mental health symptoms that required more acute interventions (in clinics or hospitals).

PMID:40543058 | DOI:10.1002/hec.70004

Epilepsia Open. 2025 Jun 21. doi: 10.1002/epi4.70078. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the efficacy and safety of adjunctive, highly purified Cannabidiol (Epidiolex®) in individuals with drug-resistant epilepsy (DRE) due to genetically determined typical Rett Syndrome (RTT) and CDKL5 Deficiency Disorder (CDD).

METHODS: We recruited subjects with genetically confirmed typical RTT and CDD with drug-resistant seizures who received add-on treatment with highly purified Cannabidiol (CBD) through a national collaboration group. CBD treatment was titrated from 5 to 20 mg/kg/day; concurrent antiseizure medications (ASMs) could have been adjusted as clinically indicated.

RESULTS: We enrolled 27 subjects (26 females), carrying a MECP2 genetic variant (14 subjects, 51.9%) or a CDKL5 genetic variant (13 subjects, 48.1%). Median age [IRQ] of individuals was 10.5 [7.9, 18.5] years. The median dose of CBD [IRQ] at last follow-up was 15 [11.12, 18.8] mg/kg/day, in association with a mean of 3 ASMs (range 2-4). The median duration of treatment was 14 [8.5, 20] months. Although not reaching a significant statistical effect, CBD reduced the incidence of seizures with respect to the baseline in 18/27 (66.6%) subjects, with 7 (25.9%) showing a seizure reduction >75%, and 11 (40.7%) >50%. The most relevant adverse events were somnolence seen in 3 subjects, irritability/agitation in 2 subjects, loss of appetite in 2 subjects, and insomnia in 1 individual. Caregivers reported an improvement in attention and reactivity in 12 subjects (44.4%), in sleep quality in 5 subjects (18.5%), and in motor aspects in 3 patients (11.1%).

SIGNIFICANCE: CBD resulted effective in reducing seizure frequency in 66.6% of the study sample, regardless of the pathogenic variant; side effects were mild, and caregivers reported an improvement in behavioral and motor features.

PLAIN LANGUAGE SUMMARY: This study explored the use of highly purified Cannabidiol (CBD, Epidiolex®) as an add-on therapy for individuals with drug-resistant epilepsy due to Rett Syndrome (RTT) or CDKL5 Deficiency Disorder (CDD). Twenty-seven participants received CBD alongside their usual ASMs. After a median treatment duration of 14 months, 66.6% experienced fewer seizures, with some showing over 75% reduction. Side effects were generally mild, mainly sleepiness or irritability. Notably, caregivers reported improvements in attention, responsiveness, sleep, and motor function. While results were not statistically significant, they suggest CBD may benefit seizure control and quality of life in RTT and CDD patients.

PMID:40543048 | DOI:10.1002/epi4.70078

Disabil Rehabil Assist Technol. 2025 Jun 21:1-15. doi: 10.1080/17483107.2025.2522784. Online ahead of print.

ABSTRACT

Pressure injuries (PI) pose a significant risk for individuals with spinal cord injuries. While clinical guidelines recommend periodic pressure redistribution (PR), adherence is often low due to limited real-time monitoring and feedback. In this paper, we present an Android application, integrated with a machine learning-based posture prediction algorithm to enhance real-time monitoring and feedback in a smart seat cushion (SSC) system for wheelchair users. Data from 12 healthy non-wheelchair participants in nine seating postures were collected. Five deep leaning architectures – Multi-Layer Perceptron (MLP), Convolutional Neural Network (CNN), Long Short-Term Memory (LSTM), CNN-LSTM, and Multi-Headed Attention models were trained, and their test performances were compared. An Android application was then developed with Flutter for on-device deployment. The highest performing model (LSTM) was then integrated using TensorFlow Lite to enable real-time posture prediction. We found that LSTM gives an accuracy of 92%, outperforming the other architectures. Also, the Android app was tested on a Google Pixel tablet, which can successfully control seat cushion operations wirelessly, identify user’s seating postures, visualize live pressure maps, generate statistics of user’s seating habits and weight shifting maneuvers, as well as provide guidance during pressure relief protocols to improve adherence. The proposed system provides a solution to low adherence to weight shift protocols observed in other studies by providing a live pressure map view and real-time feedback, thereby promoting consistent PR practice. This innovation represents a significant advancement in the prevention of PI and supports improved user compliance with clinical guidelines.

PMID:40543032 | DOI:10.1080/17483107.2025.2522784

Dermatol Ther (Heidelb). 2025 Jun 21. doi: 10.1007/s13555-025-01464-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Although skin diseases are a significant public health concern, epidemiological data for Poland is still lacking. This study aimed to fill this scientific gap by analyzing the prevalence of skin diseases and associated risk factors in the Polish population.

METHODS: A cross-sectional study was conducted using data from the National Healthy Skin Test (2023), an online questionnaire distributed via the Medonet health platform, involving 27,000 adult Polish internet users. Participants self-reported physician-diagnosed skin conditions. The prevalence of these conditions was assessed, and statistical analysis, including logistic regression, was used to evaluate associations with demographic and socioeconomic factors (age, gender, education level, and urbanization).

RESULTS: The most prevalent skin conditions were herpes labialis (40.6%), dandruff (37.6%), hair loss (34.8%), and acne (32.7%), with 89.5% of participants reporting at least one condition. Striking gender differences were observed, with psoriasis (odds ratio [OR] = 2.10, 95% confidence interval [CI]: 1.80-2.30) and tinea pedis (OR = 2.10, 95% CI: 1.90-2.30) in men, while women were more prone to rosacea (OR = 0.6, 95% CI: 0.50-0.70) and hair loss (OR = 0.70, 95% CI: 0.60-0.70). Higher education was unexpectedly associated with an increased risk of multiple conditions, including acne (OR = 1.50, 95% CI: 1.40-1.60) and non-melanoma skin cancer (OR = 1.40, 95% CI: 1.20-1.80), but a decreased risk of psoriasis (OR = 0.90, 95% CI: 0.80-1.00). Urban residents of cities with > 500,000 inhabitants showed a significantly higher prevalence of atopic dermatitis/eczema (OR = 1.20, 95% CI: 1.00-1.30) and non-melanoma skin cancer (OR = 2.00, 95% CI: 1.40-2.90) compared with other areas.

CONCLUSIONS: This first overview of skin disease epidemiology in Poland reveals significant variations in prevalence based on demographic and socioeconomic factors. These findings have important public health implications, suggesting the need for: (1) gender-specific dermatological education campaigns, (2) age-targeted skin cancer screening programs for those over 65 years, (3) improved access to dermatological care in rural areas, and (4) educational interventions addressing the observed socioeconomic disparities in disease prevalence and detection.

PMID:40543011 | DOI:10.1007/s13555-025-01464-5

Updates Surg. 2025 Jun 21. doi: 10.1007/s13304-025-02287-x. Online ahead of print.

ABSTRACT

BACKGROUND: To compare the safety, efficacy, and economic outcomes of ambulatory with inpatient gasless trans-axillary endoscopic unilateral thyroidectomy (GTEUT).

METHODS: Data were collected from patients who underwent GTEUT in the day surgery or inpatient wards of Xiangya Hospital, Central South University, between January 1, 2021, and January 1, 2024. All surgeries were performed by the same experienced surgical team, using identical inclusion and exclusion criteria.

RESULTS: A total of 458 patients were included in the study, with 322 in the ambulatory GTEUT group and 136 in the inpatient GTEUT group. The overall incidence of postoperative complications was lower in the ambulatory GTEUT group (7.76%) compared to the inpatient GTEUT group (10.29%), although the difference was not statistically significant. Hospitalization expenses in the ambulatory GTEUT group were reduced by approximately 29% compared to the inpatient group, with a statistically significant difference (p < 0.001). The length of hospital stay was significantly shorter for ambulatory group, who were discharged within 24 h (1.01 ± 0.10 days) compared to the inpatient group (5.76 ± 1.64 days) (p < 0.001). Anxiety and depression levels were higher in the ambulatory GTEUT group compared to the inpatient group, with the difference being statistically significant.

CONCLUSION: Ambulatory GTEUT is a safe alternative to inpatient surgical methods. It offers the advantages of shorter hospital stays and improved economic benefits. However, the mental health of patients undergoing daytime surgeries requires further attention.

PMID:40543009 | DOI:10.1007/s13304-025-02287-x