Nevin Manimala

J Neurooncol. 2025 Aug 11. doi: 10.1007/s11060-025-05199-3. Online ahead of print.

ABSTRACT

PURPOSE: The implications of intratumoural cystic change on management and treatment outcomes in vestibular schwannoma (VS) remain uncertain. This retrospective analysis aims to compare the treatment outcomes of solid and cystic tumours treated with linear accelerator (LINAC)-based stereotactic radiosurgery (SRS).

METHODS: Sixty-eight patients were analysed including 22 with cystic tumours. All received a marginal dose of 12 Gy to the 80% isodose line (range: 70-90%) delivered in a single fraction. Local progression was defined as a maximum linear dimension (MLD) enlargement of > 2 mm persisting for over 2 years, pseudoprogression as an MLD enlargement of > 2 mm within the first 2 years followed by stability or reduction.

RESULTS: With an average follow-up of 92.2 months, crude tumour control rates were similar: 95.5% for cystic and 93.5% for solid tumours. Pseudoprogression occurred in 7 patients (10.3%), 2 with solid (4.3%) and 5 with cystic VS (22.7%). The mean MLD reduction was 4.2 mm for solid tumours and 5.0 mm for cystic tumours (p = 0.51). Only pretreatment size correlated with the percentage reduction in tumour diameter (p = 0.025). Although a higher proportion of cystic tumours demonstrated at least a 10%, 20%, and 30% size reduction compared to solid tumours, none of these differences were statistically significant.

CONCLUSION: LINAC-based SRS achieves similar tumour control for both cystic and solid VS. Despite cystic tumours being typically of higher Koos grade, they may demonstrate numerically greater reduction after SRS. Future studies should aim to standardise the criteria for classifying cystic tumours.

PMID:40788563 | DOI:10.1007/s11060-025-05199-3

Calcif Tissue Int. 2025 Aug 11;116(1):106. doi: 10.1007/s00223-025-01416-3.

ABSTRACT

Heterotopic ossification (HO) frequently occurs after procedures such as hip replacements, acetabular fractures, and elbow fractures. While radiotherapy (RT) has been a longstanding preventive measure against HO, its efficacy remains controversial, with some studies questioning its effectiveness and noting potential side effects. Previous research has predominantly focused on total hip arthroplasty (THA), leading to a gap in comprehensive evaluation of RT’s efficacy and safety across other conditions. This systematic review and meta-analysis were conducted strictly adhering to PRISMA guidelines, utilizing the PICO framework to critically assess randomized clinical trials. A thorough literature search was executed across PubMed, Embase, Cochrane Library, and Web of Science). Methodological integrity was ensured through structured data extraction and quality assessment using validated criteria. The protocol was prospectively registered with INPLASY, ensuring full methodological transparency. A total of seven studies with 933 patients were included in the analysis, comprising 594 patients receiving RT and 339 patients in the control condition. Subgroup analyses included 784 patients undergoing THA and 149 patients receiving other surgical interventions. Overall findings supported RT’s efficacy in significantly reducing severe HO formation. Notably, subgroup analysis of patients who underwent non-THA procedures indicated no statistically meaningful reduction in the incidence of mild-to-moderate HO (Brooker I-II) after RT treatment compared to controls. Conversely, an increased risk of nonunion was specifically noted among patients receiving elbow RT. Our meta-analysis strongly supports the preventive effect of RT on HO, especially for high-risk patients and in cases that other treatments, like NSAIDs, are contraindicated or avoided. However, the risk of nonunion in elbow treatments warrants caution. Further prospective randomized controlled trials, particularly focusing on non-hip joints, are necessary to validate these findings.

PMID:40788554 | DOI:10.1007/s00223-025-01416-3

Phys Eng Sci Med. 2025 Aug 11. doi: 10.1007/s13246-025-01618-x. Online ahead of print.

ABSTRACT

Alzheimer’s disease (AD) is a neurodegenerative disorder that challenges early diagnosis and intervention, yet the black-box nature of many predictive models limits clinical adoption. In this study, we developed an advanced machine learning (ML) framework that integrates hierarchical feature selection with multiple classifiers to predict progression from mild cognitive impairment (MCI) to AD. Using baseline data from 580 participants in the Alzheimer’s Disease Neuroimaging Initiative (ADNI), categorized into stable MCI (sMCI) and progressive MCI (pMCI) subgroups, we analyzed features both individually and across seven key groups. The neuropsychological test group exhibited the highest predictive power, with several of the top individual predictors drawn from this domain. Hierarchical feature selection combining initial statistical filtering and machine learning based refinement, narrowed the feature set to the eight most informative variables. To demystify model decisions, we applied SHAP-based (SHapley Additive exPlanations) explainability analysis, quantifying each feature’s contribution to conversion risk. The explainable random forest classifier, optimized on these selected features, achieved 83.79% accuracy (84.93% sensitivity, 83.32% specificity), outperforming other methods and revealing hippocampal volume, delayed memory recall (LDELTOTAL), and Functional Activities Questionnaire (FAQ) scores as the top drivers of conversion. These results underscore the effectiveness of combining diverse data sources with advanced ML models, and demonstrate that transparent, SHAP-driven insights align with known AD biomarkers, transforming our model from a predictive black box into a clinically actionable tool for early diagnosis and patient stratification.

PMID:40788534 | DOI:10.1007/s13246-025-01618-x

J Immigr Minor Health. 2025 Aug 11. doi: 10.1007/s10903-025-01758-y. Online ahead of print.

ABSTRACT

This study evaluated the effectiveness of a culturally- and linguistically-adapted, patient navigator-led telehealth model in expanding mental health access and reducing depression and anxiety symptoms among Afghan refugees resettled across several U.S. states. We conducted a retrospective chart review of electronic medical records from 679 Afghan patients, assessing changes in PHQ-9 and GAD-7 scores using paired samples t-tests. Additionally, we explored which patients benefited most, analyzing variations in outcomes based on treatment plans, age, and gender. We observed statistically significant reductions in depression and anxiety symptoms between baseline and follow-up for all treatment groups (p < .001), with large effect sizes ranging from d = 0.80 to 1.06. For example, high-need patients showed a mean PHQ-9 reduction of 4.44 points (d = 1.05) and a GAD-7 reduction of 3.70 points (d = 0.94). The model was equally effective across genders and age groups. This patient navigator-led model demonstrates a promising strategy for improving mental health outcomes among Afghan newcomers. Its success highlights the potential for scalable mental health care solutions to address both clinical symptoms and structural barriers to care.

PMID:40788524 | DOI:10.1007/s10903-025-01758-y

Ann Intensive Care. 2025 Aug 11;15(1):117. doi: 10.1186/s13613-025-01536-x.

ABSTRACT

BACKGROUND: As healthcare emerges as the world’s fifth-largest carbon emitter, intensive care units (ICUs) represent environmental challenges due to their high resource consumption and energy demands. Reducing greenhouse gas (GHG) emissions is necessary to limit global warming. This study aimed to quantify the carbon footprint of ICU care during the first 24 h of admission for trauma patients. By establishing a baseline “carbon cost” for ICU trauma care, we seek to provide a framework for future studies assessing sustainable care strategies.

METHODS: We conducted a prospective observational pilot study in a French trauma ICU, categorizing patients into three standardized care pathways. The GHG emissions have been quantified using a hybrid life cycle assessment approach across various scope categories. Statistical analyses included correlation testing between the different groups and severity scores.

RESULTS: Total carbon footprints ranged from 86 to 248 kg of CO₂e per patient over the first 24 h. Medications, medical devices, and transportation were the primary contributors, while energy and waste represented a smaller portion of the emissions. There was a significant positive correlation between emissions and severity scores.

CONCLUSION: The carbon footprint of ICU care of a trauma patient during the first 24 h is significant, and it is necessary to conduct assessments in each ICU to identify levers for environmental improvement. The carbon cost should be integrated into the standardization of care and research protocols to enable more sustainable care practices.

PMID:40788522 | DOI:10.1186/s13613-025-01536-x

Can J Rural Med. 2025 Jul 1;30(3):119-124. doi: 10.4103/cjrm.cjrm_60_24. Epub 2025 Aug 13.

ABSTRACT

INTRODUCTION: A retrospective quantitative study of emergency department (ED) management of patients diagnosed with sepsis in a rural hospital in northwest Ontario was conducted to understand the management of sepsis guidelines and department performance.

METHODS: Our study includes all adult ED patients (18+) receiving an ED diagnosis of sepsis as identified by hospital medical records coding according to National Ambulatory Care Reporting System diagnostic codes from January 1, 2021 to December 31, 2021. Charts were reviewed for patient demographics, initial presentation, timing of ED management and outcomes. Statistical analysis involved descriptive methods.

RESULTS: Twenty-five adults were eligible, 16 female, average age 53.1 years (standard deviation [SD] = 21.9). Mortality rate was 28%. The average age of the 7 non-survivors was 64 (SD = 14.73). Time to nursing assessment averaged 8 min (SD = 7.27); time to MD assessment was 41 min (SD = 30.93). Canadian Triage and Acuity Scale scores were urgent or higher in 20 of 23 cases. Retrospective Systemic inflammatory Response Syndrome scores were elevated in 17/25 cases. Average time to fluids administration was 85 min (SD = 79.41). Sixteen of the 23 patients with recorded times of antibiotic delivery received them in 180 min or less.

CONCLUSION: Patients with sepsis present with a variety of clinical features, and laboratory findings. Awareness of the urgency of sepsis treatment and an organised departmental approach is important in the management of potentially septic patients.

INTRODUCTION: Une étude quantitative rétrospective sur la prise en charge aux urgences des patients diagnostiqués avec une septicémie dans un hôpital rural du nord-ouest de l’Ontario a été menée afin de comprendre les directives en matière de prise en charge de la septicémie et les performances du service.

MTHODES: Notre étude porte sur tous les patients adultes (âgés de 18 ans et plus) admis aux urgences et ayant reçu un diagnostic de septicémie selon le codage des dossiers médicaux de l’hôpital, conformément aux codes diagnostiques du Système national d’information sur les soins ambulatoires (SNISA), entre le 1er janvier 2021 et le 31 décembre 2021. Les dossiers ont été examinés afin de recueillir des données démographiques sur les patients, les premiers symptômes, le moment de la prise en charge aux urgences et les résultats. L’analyse statistique a été réalisée à l’aide de méthodes descriptives.

RSULTATS: Vingt-cinq adultes étaient admissibles, dont 16 femmes, avec un âge moyen de 53.1 ans (écart-type = 21,9). Le taux de mortalité était de 28%. L’âge moyen des seven patients décédés était de 64 ans (écart-type = 14,73). Le délai moyen avant l’évaluation infirmière était de 8 min (écart-type = 7,27); le délai avant l’évaluation médicale était de 41 min (écart-type = 30,9). Les scores de l’échelle canadienne de triage et d’acuité étaient urgents ou supérieurs dans 20 cas sur 23. Les scores rétrospectifs du syndrome de réponse inflammatoire systémique étaient élevés dans 17 cas sur 25. Le délai moyen avant l’administration de liquides était de 85 min (écart-type = 79,41). Seize des 23 patients pour lesquels le délai d’administration des antibiotiques a été enregistré les ont reçus en 180 min ou moins.

CONCLUSION: Les patients atteints de septicémie présentent divers signes cliniques et résultats de laboratoire. Il est important de connaître l’urgence du traitement de la septicémie et d’adopter une approche organisée au sein du service pour prendre en charge les patients potentiellement septiques.

PMID:40785656 | DOI:10.4103/cjrm.cjrm_60_24

Am J Hematol. 2025 Aug 11. doi: 10.1002/ajh.70033. Online ahead of print.

ABSTRACT

T cells engineered with CD19-directed chimeric antigen receptors (CD19 CAR) T cells have become standard treatment for patients with high risk, relapsed or refractory (R/R) large B-cell lymphomas (LBCL). However, outcomes in patients with rare subsets of LBCL, such as primary mediastinal large B-cell lymphoma (PBMCL), have not been well characterized. The impact of prior immune checkpoint inhibitor (ICI) treatment, commonly used to treat R/R PMBCL, is also unknown. To address these gaps, we retrospectively analyzed CIBMTR registry data including PMBCL patients undergoing CD19 CAR T-cell therapy per standard-of-care. A total of 135 PMBCL adults from 66 centers were included. Median age at the time of CAR T-cell therapy was 32. Thirty-nine patients (28.9%) had received an ICI prior to CAR T-cell therapy. The best overall and complete response (CR) rates after CD19 CAR T-cell therapy were 79% and 67.7%, respectively. The 2-year progression-free (PFS) and overall survival (OS) were 58.6% (95% CI, 49.7-67.3) and 80.8% (95% CI, 72.6-87.8), respectively. The 2-year cumulative incidence (CI) of relapse and non-relapse mortality (NRM) were 36% (95% CI, 27.8-44.7) and 5.4% (95% CI, 1.9-10.5), respectively. We observed grade ≥ 3 CRS and ICANS in 6.1% and 14.7%, respectively. Prior ICI exposure was associated with lower 2-year CI of relapse (ICI-exposed, 21.7%; ICI-naïve, 41.6%; p = 0.03) and higher 2-year NRM (ICI-exposed, 11.7%; ICI-naïve, 2.8%; p = 0.03). We could not confirm statistically different PFS (p = 0.19) or OS (p = 0.26) between ICI-exposed and ICI-naïve patients. CD19 CAR T-cell therapy led to high rates of durable responses in PMBCL patients with low rates of severe toxicities.

PMID:40785644 | DOI:10.1002/ajh.70033

Nurs Crit Care. 2025 Sep;30(5):e70132. doi: 10.1111/nicc.70132.

ABSTRACT

BACKGROUND: Early mobilisation (EM) in mechanically ventilated (MV) patients is a safe and feasible, evidence-based practice with positive health outcomes. It decreases intensive care unit (ICU)-acquired weakness and delirium, hospital length of stay, duration of mechanical ventilation, readmissions and billings, morbidity and mortality. It improves the physical and mental health of critically ill patients. Healthcare professionals’ education and readiness are key in establishing EM for practice. Although it is practised in many high-income countries, it has not yet been introduced as a standard care approach in ICUs of Pakistan, a low/middle-income country.

AIM: This study aimed to assess the knowledge and attitude of healthcare professionals regarding EM of MV patients at an adult ICU through electronic learning (E-learning).

STUDY DESIGN: A quasi-experimental pre/posttest design was employed on a sample of 57 multidisciplinary healthcare professionals. The study was conducted in the medical and surgical adult ICU of a tertiary care hospital in Karachi, Pakistan. A total population sampling strategy was deployed. A questionnaire was administered to assess the knowledge and attitude of healthcare professionals regarding the EM of MV patients. After expert review and pilot testing, the study questionnaire was contextually modified. A self-developed E-learning module inspired by Kirkpatrick’s framework was utilised as an intervention. The duration of the intervention was 120 min, with the participants completing the module at their convenience. Paired t-test and descriptive statistics from the Statistical Package for the Social Sciences version 21 were used to analyse the results. Knowledge and attitude scores were evaluated.

RESULTS: Demographic data revealed that the majority of participants were critical care registered nurses (71.9%), having 3-4 years of ICU work experience (38.6%) and working in a surgical ICU (54.4%). Only a few participants received EM training (19.3%). The majority of participants’ level of education was Undergraduate Nursing (61.4%), with an average age of 29 years, and female gender (56.1%). A statistically significant change (p value < 0.01) in overall knowledge was identified, specifically for items related to the impact of EM in reducing delirium (p value = 0.01), improving patients’ awareness (p value = 0.007), requiring less sedation (p value < 0.01), initiating on patients that can respond to verbal commands (p value = 0.03), promoting feasible (p value = 0.001) and safe practice (p value = 0.004), and requiring a multidisciplinary team approach (p value = 0.03). However, overall attitude (p value = 0.096) was unchanged with E-learning.

CONCLUSION: The study reflected an increase in knowledge among healthcare professionals. E-learning was seen to be a useful strategy for knowledge improvement. EM in MV patients was a new concept for the participants. Participants became aware of the benefits of the EM process and acknowledged the role of multidisciplinary collaboration. There is evidence to upscale the study to test the intervention and expand to other tertiary care hospitals in Pakistan to attain generalisability of results.

RELEVANCE TO CLINICAL PRACTICE: The study has assessed and generated knowledge among healthcare professionals, predominantly critical care nurses, and has baseline data for devising institutional policies and protocols, educational interventions and research avenues for EM implementation. It also gave an optimistic approach to using a combination of E-learning and high-fidelity simulation for capacity building. Implementing EM in MV patients is crucial for critical care nurses, promoting proactive and preventive nursing care that improves patient outcomes and reduces immobility-related complications. It would also increase multidisciplinary collaboration while enhancing nursing empowerment and professional satisfaction.

PMID:40785634 | DOI:10.1111/nicc.70132

Health Commun. 2025 Aug 11:1-11. doi: 10.1080/10410236.2025.2544239. Online ahead of print.

ABSTRACT

The d/Deaf and hard-of-hearing (DHH) population, of all ages, is at increased risk for poor dietary habits that may lead to health complications, given the lack of accessible and inclusive nutrition education from a range of providers. Given these challenges and the urgent need for inclusive health education, this systematic scoping review critically assessed the nature, scope, effectiveness, and best practices of nutrition-focused interventions tailored for the general DHH population. Using the PICOS search method of 16 bibliographic databases for articles between 2000 and 2024 focusing on nutrition-related interventions tailored to the DHH population, eight studies were identified. Studies employed various intervention approaches, focus areas of nutrition, location, and participants. One study used a theoretical framework. Most interventions addressed multiple aspects of dietary behavior, while others focused on specific concerns such as healthy food choices and exercise. Interventions were delivered through in-person educational sessions by public health professionals and nutritionists. Only one of the eight studies reviewed did not report statistically significant improvements in dietary behavior or health outcomes following the intervention. Future research should integrate established behavior change theories to strengthen the design, implementation, and longer-term follow-up and evaluation of nutrition interventions for DHH populations. There is a surprising lack of research in this area, exacerbated by additional challenges in reaching the DHH population. Improving nutrition education for DHH individuals requires interventions that address communication barriers, cultural inclusivity, and accessibility by all types of providers, and reaching such groups in a range of places.

PMID:40785618 | DOI:10.1080/10410236.2025.2544239

Khirurgiia (Mosk). 2025;(8):45-54. doi: 10.17116/hirurgia202508145.

ABSTRACT

OBJECTIVE: To assess the effectiveness of local treatment of venous trophic ulcers in gerontological patients.

MATERIAL AND METHODS: We analyzed treatment venous trophic ulcers in 4 groups of elderly and senile patients. All patients received conservative therapy. In the 1^st group (n-74), local injection of 0.1% polyhexanide-betaine gel throughout 7-10 days was followed by liposomal antioxidant-phospholipid complex «Flamena». In the 2^nd group (n-69), immune correction with «Imunofan» was carried out along with local therapy. In the 3^rd group (n-69), local treatment was combined with pulsed high-intensity optical irradiation of the wound. In the 4^th group (n-69), local treatment was combined with immune correction and pulsed high-intensity optical irradiation. Cytological analysis was performed to estimate effectiveness of treatment. Statistical analysis was performed using nonparametric Friedman and Mann-Whitney tests.

RESULTS: The number of leukocytes, lymphocytes and macrophages increased by the 7^th day of treatment. Activation of inflammation was more pronounced in groups 2, 3 and 4 (p< 0.0083). By the 15^th day, leukocyte count decreased. The number of macrophages and lymphocytes remains high; the number of fibroblasts increases. Cytograms were mainly inflammatory and inflammatory-regenerative. By the 22^nd day, cytograms corresponded to regenerative-inflammatory and regenerative types with the lowest number of neutrophils, moderate number of lymphocytes, macrophages and fibroblasts.

CONCLUSION: Complex local treatment of venous trophic ulcers with local immunomodulatory therapy and pulsed high-intensity optical irradiation contributes to conversion of chronic inflammation to acute one with initiation of reparation processes and tissue regeneration.

PMID:40785606 | DOI:10.17116/hirurgia202508145