Nevin Manimala

Subst Use Addctn J. 2025 Aug 12:29767342251351751. doi: 10.1177/29767342251351751. Online ahead of print.

ABSTRACT

BACKGROUND: Stigma continues to be a barrier to accessing quality care for many patients with mental health conditions and/or substance use disorder (SUD), commonly referred to as addiction. This paper aims to evaluate the impact that undergraduate medical education (UME) has in reducing stigmatizing language use and potentially mitigating this barrier to care.

METHODS: A systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines identified 2017 articles across 7 databases. Search terms related to stigma surrounding mental health, addiction, and suicide were incorporated into medical education. Blinded, double-reviewed papers meeting the inclusion criteria were further evaluated at full length to obtain information including sample size, variables, and outcomes.

RESULTS: Three studies met the review’s selection criteria: 1 pretest/posttest case series, 1 survey evaluating language stigma, and 1 qualitative essay review to discover common themes in medical students’ experience with patients with SUD. Statistically significant results included changes in characteristic association, attitudes based on language, and the effects of an educational intervention.

CONCLUSIONS: These results reinforce the importance of language and educational exposure in addressing stigma toward patients with mental health diagnoses. Although the results of all studies indicated some level of stigma associated with patients with a mental health diagnosis, there was limited consensus surrounding methods to reduce it in UME. Additional research on the implementation of medical school-focused mental health awareness programs is needed, preferably using rigorous randomized controlled trial study designs, longitudinal follow-up, and critical appraisal of texts to better understand effective interventions on persistent mental health stigma among medical students.

PMID:40792396 | DOI:10.1177/29767342251351751

Eur J Psychotraumatol. 2025 Dec;16(1):2536973. doi: 10.1080/20008066.2025.2536973. Epub 2025 Aug 12.

ABSTRACT

Background: Eye movement desensitisation and reprocessing (EMDR) therapy primarily aims to reduce the emotional intensity or subjective disturbance associated with traumatic memories. However, to date, only one study has investigated whether a reduction in emotional intensity is related to a reduction in post-traumatic stress disorder (PTSD) symptoms.Objective: Therefore, the purpose of the present study was to determine the relationship between changes in emotional intensity of traumatic memories during EMDR therapy and treatment outcomes.Method: One hundred twenty-five patients (88.8% female, M age = 36.4 years, SD = 11.40) with PTSD due to multiple traumatisation participated in a six-day intensive treatment programme consisting of a combination of six 90 min EMDR therapy sessions, six 90 min prolonged exposure sessions, six 60 min sessions of physical activity, and six 60 min psychoeducation sessions delivered at an academic outpatient mental healthcare clinic.Results: The results showed that a greater reduction in the emotional intensity of traumatic memory during EMDR therapy was associated with a larger decrease in PTSD symptoms at four weeks post-treatment.Conclusions: Clinicians should monitor changes in emotional intensity during treatment to assess treatment progress. Furthermore, the findings justify the use of memory disturbance as an outcome measure in experimental studies on EMDR therapy. Future research should focus on EMDR therapy processes and their relationship to treatment outcome, whereas replication of the present findings in other trauma populations is warranted.

PMID:40792392 | DOI:10.1080/20008066.2025.2536973

Phys Occup Ther Pediatr. 2025 Aug 12:1-17. doi: 10.1080/01942638.2025.2543271. Online ahead of print.

ABSTRACT

AIMS: Sensory differences are associated with disruption to daily occupations for both children and families. A one-to-one coaching approach with mothers is effective in increasing performance and satisfaction in children’s daily occupations, and in reducing maternal stress. The study aimed to pilot a brief online group coaching intervention for mothers of children with sensory differences.

METHODS: Eleven mothers participated in a brief online group coaching intervention of four x 90-minute sessions, based on Occupational Performance Coaching (OPC). Mothers gave both quantitative and qualitative feedback on their experience in the group. Mothers reported child occupational goals, maternal stress, and maternal sense of competence pre and post intervention.

RESULTS: Statistically significant improvement in child occupations and aspects of maternal stress were observed. Maternal sense of competence showed improvement but did not reach statistical significance. They valued the sensory focus and found the group safe and supportive; they also gave feedback on how groups could be improved.

CONCLUSIONS: For mothers of children with sensory differences and associated occupational concerns, a brief online group coaching intervention, based on OPC, has the potential to support child occupational performance and reduce maternal stress.

PMID:40792388 | DOI:10.1080/01942638.2025.2543271

Brain Behav. 2025 Aug;15(8):e70761. doi: 10.1002/brb3.70761.

ABSTRACT

OBJECTIVES: Therapeutic effects of hydrogen (H₂) on sepsis-associated encephalopathy (SAE), a severe neuroinflammatory disease, have been reported, but the underlying mechanism remains unclear. Metabolomic and phosphoproteomic analyses were utilized to explore the therapeutic mechanism of H₂.

METHODS: Caecal ligation and puncture (CLP) was used to establish an animal model of sepsis, after which the animals were treated with hydrogen. Mouse brains were obtained for analysis via tandem mass tag-based quantitative proteomics with IMAC enrichment of phosphopeptides and LC-MS/MS analysis to provide a broad overview of the metabolites. The metabolic profiles of mice in the SAE and SAE + H₂ groups were compared by multivariate statistical analysis. Different proteins (or enzymes) were verified by western blot (WB) and immunofluorescence (IF) analyses. ELISA was used to measure the level of DAG and PA. The influence of diacylglycerol kinase ζ (DGKζ) on glycerophospholipid metabolism in the mouse hippocampus was analyzed via coimmunoprecipitation (co-IP), and protein‒protein interactions were detected via LC‒MS/MS analysis.

RESULTS: A total of 1476 metabolites were identified, including 131 metabolic biomarkers in negative ion mode and 41 metabolic biomarkers in positive ion mode. These values were different from the standard, with variable importance for the projection (VIP) > 1 and p < 0.05. The correlated differential phosphoproteins found in the combined metabolomic and phosphoproteomic analyses participated in 131 pathways, and the differentially abundant metabolites were involved in 10 metabolic pathways, eight of which were related. The roles and interactions of these differentially expressed proteins and metabolites suggest that glycerophospholipid metabolism is activated in septic mice after the inhalation of hydrogen. Additionally, we quantified the downregulation of choline-phosphate cytidylyltransferase A (Pcyt1α)/CTP/CCTα and DGKζ and the upregulation of the metabolite sn-glycero-3-phosphoethanolamine in the glycerophospholipid metabolism pathway in mice in the SAE + H₂ group compared with mice in the SAE group. The WB and IF results revealed that DGKζ expression increased in septic mice but decreased after H₂ treatment. The ELISA showed that the expression of DAG was increased in SAE mice compared with Sham mice, while it decreased in SAE + H₂ mice compared with SAE mice. Correspondingly, the PA level was reduced in SAE group compared with Sham group and was increased after the inhalation of H₂. Furthermore, the regulation of DGKζ in hydrogen treatment in septic mice may be related to the interaction with phosphatase and tensin homolog (PTEN).

CONCLUSION: H₂ downregulates the levels of DGKζ and CCTα to alleviate brain damage in septic mice, and changes in DGKζ expression are balancing the transformation between the DAG anf PA, and it might also interact with PTEN. Thus, DGKζ may be a potential target in septic mouse therapy.

PMID:40792381 | DOI:10.1002/brb3.70761

Eur J Psychotraumatol. 2025 Dec;16(1):2535898. doi: 10.1080/20008066.2025.2535898. Epub 2025 Aug 12.

ABSTRACT

Background: Firefighters are considered to be high-risk professionals due to their frequent exposure to traumatic events. Although most firefighters will demonstrate resilience after trauma exposure, others develop symptoms of posttraumatic stress disorder (PTSD) or depressive symptoms. Insight in psychological predictors of these differential trajectories might inform the development of prevention programmes.Objective: To test the predictive validity of risk and protective factors for longitudinal trends of PTSD and depressive symptoms in firefighters using growth mixture modeling.Method: A total of 529 firefighters were followed for 3 years. Risk and protective factors (experiential avoidance, repetitive negative thinking (RNT), meaning in life, resilience and social support) as well as symptoms of PTSD and depression were assessed via self-report at the baseline assessment. PTSD and depressive symptoms were re-assessed over the following 3 years, with intervals of 6-12 months. Mixture growth models assigned individuals to latent classes for PTSD and depression symptoms separately. A 3-step approach was used to predict class membership by the included risk and protective factors.Results: Both for PTSD and depressive symptoms growth models, the 2-class solution showed the best fit. Experiential avoidance predicted both PTSD and depressive class membership, while RNT predicted only depressive class membership.Conclusions: Although the vast majority showed a generally stable low level of symptomatology, increased scores on experiential avoidance and RNT were associated with less favorable trajectories. Targeting these risk factors in prevention programmes might prevent development of posttrauma symptomatology and increase psychological resilience in firefighters and other high-risk professionals.

PMID:40792378 | DOI:10.1080/20008066.2025.2535898

Anesth Pain Med (Seoul). 2025 Jul;20(3):252-265. doi: 10.17085/apm.25264. Epub 2025 Jul 31.

ABSTRACT

BACKGROUND: Combining lidocaine with bupivacaine in brachial plexus blocks seeks to blend rapid onset with extended duration; yet, clinical advantages are uncertain. This systematic review assesses their efficacy against bupivacaine alone in ultrasound-guided brachial plexus blocks.

METHODS: A systematic search of PubMed, EMBASE, and Cochrane databases was conducted in May 2025. Randomized controlled trials (RCTs) comparing lidocaine-bupivacaine mixtures with bupivacaine alone in ultrasound-guided brachial plexus blocks were included. The primary outcome was sensory block onset time. Secondary outcomes included motor block onset time, sensory and motor block durations, and conversion to general anesthesia. Data were analyzed using a random-effects model, with heterogeneity assessed via I² statistics.

RESULTS: Of 1,490 identified articles, 7 RCTs (358 patients) met the inclusion criteria. No significant difference was found in sensory block onset time (mean difference [MD] -1.81 min, 95% confidence interval [CI] -3.92 to 0.29; P = 0.09; I² = 98%) or motor block onset time (MD 0.02 min, 95% CI -2.34 to 2.39; P = 0.99; I² = 95%) between groups. The mixture reduced sensory (MD -172.88 min, 95% CI -215.18 to -130.59; P<0.00001; I² = 90%) and motor block durations (MD -212.13 min, 95% CI -374.99 to -49.28; P = 0.01; I² = 93%).

CONCLUSIONS: No clinical benefit was observed from combining lidocaine with bupivacaine, as there was no improvement in block onset times and a reduction in block durations. Given the very low certainty of evidence, these findings should be interpreted with caution, and further high-quality RCTs are needed.

PMID:40792371 | DOI:10.17085/apm.25264

Anesth Pain Med (Seoul). 2025 Jul;20(3):230-241. doi: 10.17085/apm.25207. Epub 2025 Jul 31.

ABSTRACT

BACKGROUND: Intravenous (IV) fluid therapy is essential and widely used; however, it is associated with high error rates, largely due to human factors, necessitating constant and careful monitoring by medical staff. Gravity-based systems are prone to errors, whereas electronic pumps, though more accurate, are limited by size, cost, and complexity. In this study, the impact of single-drop weight measurement and real-time light source monitoring on the accuracy of gravity-based infusion systems was evaluated.

METHODS: Gravity-based IV sets with IV infusion flow regulators (IIFRs) from three manufacturers were tested using 1,000 ml of 0.9% saline. The drops per min and the drop weight were recorded using a pulse oximeter, which served as a light source. The flow rates from the pulse oximeter group (PO) were compared with those from the manufacturer’s drop volume (C) and the IIFR groups. The mean absolute percentage error (MAPE) of predicted versus actual volumes was analyzed along with correlations between the residual volume and drop rate.

RESULTS: The PO group values were statistically closer to those of the actual measurements than the C and IIFR groups values (P < 0.05), demonstrating higher accuracy and lower MAPE, except at 300 ml/h when than those of the C group, independent of residual volume. The residual volume strongly correlated with the drop rate (r > 0.9).

CONCLUSIONS: Real-time drop measurements using light sources combined with single-drop weight assessment improve the accuracy of these systems. Integrating pulse oximeters into IV sets may enhance clinical precision and reduce provider workload.

PMID:40792368 | DOI:10.17085/apm.25207

Brain Behav. 2025 Aug;15(8):e70758. doi: 10.1002/brb3.70758.

ABSTRACT

OBJECTIVE: To explore the relationship between children’s eating behaviors, parental feeding behaviors, and child temperament among Turkish preschoolers aged 3-6 years.

METHODS: A cross-sectional survey study was conducted between September 2021 and January 2022. Participants included 203 parents of preschool-aged children (aged 3-6 years) attending nursery and kindergartens, as well as those seeking help from the Department of Child and Adolescent Psychiatry. Analyses were performed utilizing IBM SPSS Statistics version 23.0. Categorical variables are summarized in tables, showing counts and percentages in the descriptive statistics section. The association between continuous variables was assessed through Spearman correlation analysis. In this study, a significance level of p < 0.05 was established.

RESULTS: Emotional feeding was positively associated with emotional overeating and a desire to drink in children (r = 0.316, p < 0.01; r = 0.266, p < 0.01). Emotional overeating correlated negatively with instrumental feeding (r = -0.158, p < 0.05) but positively with encouragement feeding (r = 0.215, p < 0.01). The temperamental trait of surgency was positively associated with the desire to drink (r = 0.177, p < 0.05) and satiety responsiveness (r = 0.226, p < 0.01). Negative affect correlated negatively with enjoyment of food (r = -0.255, p < 0.01) and food fussiness (r = -0.225, p < 0.01) but positively with satiety responsiveness (r = 0.347, p < 0.01) and slowness in eating (r = 0.282, p < 0.01). Effortful control exhibited negative associations with emotional overeating (r = -0.207, p < 0.01) and the desire to drink (r = -0.141, p < 0.05).

CONCLUSIONS: This study identifies significant associations between specific parental feeding behaviors and children’s eating habits, along with the influence of child temperament traits on these behaviors. Key findings highlight the positive relationship between emotional feeding and children’s emotional overeating, along with the significant negative impacts of effortful control on emotional overeating and the desire to drink. Other noteworthy results include the strong negative association between negative affect and enjoyment of food, as well as its positive correlation with satiety responsiveness and slowness in eating. These results suggest that both parental feeding strategies and individual temperamental traits significantly influence preschoolers’ eating behaviors. Interventions tailored to enhance parental feeding styles while considering children’s temperaments may promote healthier eating practices in young children.

PMID:40792357 | DOI:10.1002/brb3.70758

Cureus. 2025 Jul 12;17(7):e87786. doi: 10.7759/cureus.87786. eCollection 2025 Jul.

ABSTRACT

Introduction This study addresses the global controversy over routine bone scans for newly diagnosed prostate cancer patients, focusing on the Ghanaian population. It aims to assess the predictive value of prostate-specific antigen (PSA) for bone metastasis and the role of serum alkaline phosphatase (ALP) in enhancing prediction. Methods This study was conducted at Korle Bu Teaching Hospital over 14 months and included 258 treatment-naïve prostate cancer patients. Clinical evaluation, PSA and ALP tests, and technetium-99 bone scans were performed. Chi-square and t-tests identified significant predictors of bone metastasis. The predictors were regressed logistically into a model, which was validated, trained, updated, and programmed into a digital risk calculator. All analysis was at a 0.05 significance level. Findings The mean age of participants was 68.18 ± 7.34 years (68.83 and 67.77 years for the metastatic and non-metastatic groups, respectively). Increasing PSA (OR=4.59, p<0.001), ALP (OR=4.24, p<0.001), DRE risk group (OR=1.60, p<0.05), and International Society of Urological Pathology (ISUP) (OR=1.72, p<0.05) were associated with increasing risk of bone metastasis. A two-unit rise along the D-Amico risk strata was associated with a 28-fold increase in the odds of metastasis (low risk vs high risk, OR=29.56, p<0.001; low risk vs intermediate risk, OR=2.80, p=0.368). Among participants with more than 30% of their core-biopsy volume involved with adenocarcinoma, 54.0% had bone metastasis (OR=1.33, p=0.06). Also, 57% of those with perineural invasion had bone metastasis (OR=4.0, p=0.01). Perivascular invasion was not a statistically significant predictor (p=0.346). All patients with cribriform pattern histology had bone metastasis (100%; OR=9.40, p=0.04). Of those with bone pain, 48.4% had bone metastasis (OR=2.25, p=0.002). PSA and ALP exhibited strong independent associations with bone metastasis, with PSA outperforming other predictors (AUC under ROC curve of 81.65% vs 77.97% for ALP, 69.73% for DRE, and 79.19% for ISUP. On multivariate logistic regression, the combined AUC for PSA and ALP was 89.28%, while that for combined PSA, ALP, DRE, and ISUP was 92.3%). A PSA cut-off of 18.95 ng/mL or an ALP cutoff of 59.48 IU/L, individually, detected 97.5% of bone metastasis. Combining a PSA cut-off of 20.85 ng/mL with an ALP cut-off of 44.0 IU/L yielded a 100% detection rate, while PSA above 20 ng/mL, DRE >T2c, and Gleason score >7 predicted 95% of bone metastasis in this cohort. In a logistic regression model, ALP, ISUP, and DRE stage significantly improved the bone metastasis detection rate of PSA in prostate cancer (z-statistic gain at p=0.05 was 2.41; new AUC=92.29%). The inclusion of bone pain, cribriform pattern histology, perineural invasion, and percentage core involvement of adenocarcinoma yielded just marginal gains (maximum z-statistic gain at p=0.05 was 0.61; new AUC: 93.90%). Conclusion For high-risk prostate cancer, bone scans are recommended. In Ghana, a PSA cut-off of 18.95 ng/mL could safely exclude 20% of bone scans, missing only 2.5% of bone metastases, saving $170 per patient ($55,000 nationally per year). Combining this with an ALP cut-off of 44.0 IU/L (0% false-negative rate) detects 100%. A validated risk model combining PSA, ALP, ISUP, and DRE achieves an AUC of 92.3%, sensitivity of 89.9%, specificity of 78.8%, and accuracy of 85.6%, offering a practical, digitally deployed, decision support tool.

PMID:40792342 | PMC:PMC12338857 | DOI:10.7759/cureus.87786

Cureus. 2025 Jul 12;17(7):e87764. doi: 10.7759/cureus.87764. eCollection 2025 Jul.

ABSTRACT

Introduction Calcium oxalate stone formation is driven by urinary supersaturation, pH, and imbalances in promoters and inhibitors, with acidic nighttime urine (pH <6) promoting crystal nucleation due to low citrate levels. Hence, the purpose of this pilot study was to evaluate the effectiveness of Subap Plus capsule, a polyherbal Ayurvedic formulation, for its preventive effects on early morning pH, 24-hour urinalysis parameters, and supersaturation indices in recurrent calcium oxalate stone formers. Methodology A two-week nonrandomized, uncontrolled pilot study was conducted at Ace Hospital, Pune, India, with 58 patients (20-60 years) with confirmed recurrent calcium oxalate stones. Patients received Subap Plus capsules twice daily alongside dietary advice. Baseline and post-intervention assessments included early morning urinary pH, 24-hour urinalysis (uric acid, oxalate, calcium, citrate, sodium, phosphorus, potassium, and magnesium), and supersaturation indices of calcium oxalate, calcium phosphate, and uric acid. Paired t-tests compared pre- and post-intervention values, and the statistical significance was set to p ≤ 0.05. Results Significant improvements included increased early morning pH (5.55 ± 0.39 to 5.80 ± 0.51, p = 0.001), decreased uric acid (311.38 ± 161.87 mg/day to 275.12 ± 149.82 mg/day, p = 0.017), increased potassium (28.09 ± 14.58 mmol/day to 35.16 ± 16.30 mmol/day, p = 0.002), and decreased uric acid supersaturation (0.53 ± 0.45 to 0.37 ± 0.38, p = 0.006). Citrate showed a trend toward an increase (623.16 ± 429.93 mg/day to 702.99 ± 429.50 mg/day, p = 0.068), and calcium oxalate supersaturation decreased nonsignificantly (2.87 ± 3.27 to 2.37 ± 1.66, p = 0.206). Calcium phosphate supersaturation increased in 37 (63.79%) of patients (p = 0.263). Conclusions The study concluded that the Subap Plus capsule demonstrated effectiveness in modulating early morning pH and urinary parameters to prevent calcium oxalate stone recurrence. The current study supports the role of Ayurvedic polyherbal formulations in urolithiasis management. However, large, randomized controlled trials are essential to confirm efficacy and address limitations, such as the short intervention duration. Hence, future research should optimize the formulation to enhance preventive effects.

PMID:40792340 | PMC:PMC12337062 | DOI:10.7759/cureus.87764