Nevin Manimala

Am J Hosp Palliat Care. 2025 Jun 3:10499091251346479. doi: 10.1177/10499091251346479. Online ahead of print.

ABSTRACT

BackgroundPhysicians’ unpreparedness to conduct conversations around serious illness creates a barrier to initiating effective goals of care conversations. Teaching primary palliative care communication skills in medical school is paramount to overcome this barrier.ObjectiveTo evaluate the effectiveness of an innovative, immersive primary palliative care communication skills workshop for fourth-year medical students and to incorporate professional actors with teaching experience into the medical school curriculum.MethodsAn interactive, scenario-based, day-long workshop utilizing professional actors as faculty was developed and conducted multiple times annually for 4 years. Students completed online surveys before, immediately after, and 3-6 months after the workshop. Likert scales assessed student self-perceived comfort with skills learned and short response queries evaluated student experiences. Descriptive statistics and one-way ANOVA repeated measures test were used. Qualitative data was double coded and thematically analyzed.Results226 students participated in the workshop; 100%. Responded to the pre-survey, 170 (75.2%) responded to the post-survey, and 133 (58.8%) responded to the post-3-6 months survey. The mean self-perceived comfort between the pre-survey and both post- and post-3-6 months surveys was statistically significant (P < 0.05) for all skills taught. Students reported integrating learned skills and found subjective success in their improved approaches to communication with patients.ConclusionAn innovative primary palliative care communication skills workshop using trained professional actors improved and maintained fourth-year medical students’ self-perceived primary palliative care communication skills. Widespread education of primary palliative care communication skills to medical students with trained actors as faculty could improve physician-patient communication around goals of care.

PMID:40459857 | DOI:10.1177/10499091251346479

Traffic Inj Prev. 2025 Jun 3:1-6. doi: 10.1080/15389588.2025.2458589. Online ahead of print.

ABSTRACT

OBJECTIVE: Despite the mandatory use of seatbelts in Korea, their prevalence remains comparatively low. This study examines whether DUIA, a leading risk factor for road traffic injuries, predicts seatbelt usage by analyzing the prevalence of seatbelt use among individuals who have experienced DUIA compared to those who have not.

METHODS: This cross-sectional study utilized data from 9,227 driver’s license holders aged 20 years or older from the Korea National Health and Nutrition Examination Survey (KHANES) conducted between 2019 and 2021. Multivariable logistic regression analysis was conducted to investigate the association between experience of DUIA and seatbelt use while adjusting for individual-level covariates. A stratified analysis was conducted based on sociodemographic variables. Finally, a subgroup analysis was performed to examine the association between experience of DUIA and frequency of seatbelt use in each seat type (the driver’s seat, the front passenger seat, and the rear seat).

RESULTS: This study showed that having an experience of DUIA is significantly associated with not wearing seatbelts. (aOR, 3.53 [95% CI, 2.55-4.88]). Stratification based on sociodemographic variables showed that one’s job type (pink collar: aOR, 5.67 [95% CI, 2.03-15.88]; blue collar: aOR, 5.35 [95% CI, 3.03-9.47]), and smoking status (current smokers: aOR, 5.67 [95% CI, 2.72-11.82]) increase the prevalence of experience of DUIA. Furthermore, experience of DUIA was associated with an increased prevalence of not wearing seatbelts in all seat types.

CONCLUSION: The prevalence of experience of DUIA can be established as a statistically significant independent predictor of seatbelt usage among Korean adults.

PMID:40459850 | DOI:10.1080/15389588.2025.2458589

Eur Arch Paediatr Dent. 2025 Jun 3. doi: 10.1007/s40368-025-01056-z. Online ahead of print.

ABSTRACT

OBJECTIVES: Given the prevalence of physical abuse toward the head and face, dental care settings are frequently the first point of contact for victims of violence. Dentists, like other medical practitioners, have a primary responsibility to safeguard patient health and life, hence they can be crucial in identifying and reporting violent victims. Therefore, this study was directed to assess the attitudes and perceptions of Palestinian dentists regarding child abuse and to investigate professional characteristics associated with the identification of suspected child abuse.

MATERIALS AND METHODS: A questionnaire was sent to the 745 dentists of Palestine and 380 (51.0%) were returned. Demographic data, profiles of dentists, information regarding their knowledge and attitudes concerning child abuse, and the obstacles that may stop them from reporting abuse cases were collected. Descriptive analysis was performed, and associations were tested by chi-square and Fisher’s exact tests.

RESULTS: Most dentists were general practitioners (88.9%), nine of whom were boarded paediatric dentists. 217 (58.2%) considered themselves fit to identify signs of abuse even so, 93.5% do not report the abuse cases. A statistically higher proportion of specialist dentists, working in the public sector, having more practice and who have children had suspected cases of child abuse.

CONCLUSIONS: Although dentists considered themselves able to identify cases of child maltreatment, a high proportion of them do not report the abuse cases, this is related to many factors, such as less experience, little information, no training, and less confidence to report child abuse. Improved training in forensic and legal dentistry is needed, together with the establishment of detection and reporting protocols.

PMID:40459842 | DOI:10.1007/s40368-025-01056-z

Bull Math Biol. 2025 Jun 3;87(7):90. doi: 10.1007/s11538-025-01458-6.

ABSTRACT

Melanoma progression can be effectively modeled through mathematical frameworks, making it a pivotal focus for enhancing our understanding of cancer dynamics and informing personalized treatment strategies. The present research investigates the growth dynamics of melanoma by analyzing 16 individual melanoma cell lines, utilizing in vivo clinical data that spans a range of metastatic stages from primary melanoma to stage IV. The study estimates growth rates across these cell lines by implementing a power law model through nonlinear least squares, uncovering distinct mathematical patterns linked to melanoma stages. Furthermore, the research evaluates the efficacy of various treatment strategies tailored to each disease stage through a chemoimmunotherapy mathematical model. For primary and early-stage melanoma, where tumors are localized, surgical excision is identified as the most effective intervention, often enhanced by CD4⁺T cell immunotherapy. In cases of low to moderately metastatic melanoma, a combination of low-dose chemotherapy with CD8⁺T cell immunotherapy effectively targets metastatic lesions, reducing systemic toxicity while promoting a strong immune response. For highly metastatic melanoma, which presents significant treatment challenges, a combination therapy involving both CD8⁺T and CD4⁺T cell immunotherapy is recommended. This dual approach utilizes the direct tumor-killing effects of CD8⁺T cells alongside the supportive actions of CD4⁺T cells, resulting in improved treatment efficacy and survival outcomes. Overall, this research provides a comprehensive analysis of melanoma cell lines at various stages, integrating mathematical modeling with treatment efficacy to enhance personalized treatment strategies in melanoma management.

PMID:40459814 | DOI:10.1007/s11538-025-01458-6

Doc Ophthalmol. 2025 Jun 3. doi: 10.1007/s10633-025-10026-1. Online ahead of print.

ABSTRACT

PURPOSE: To describe the association between nystagmus characteristics and pattern-reversal VEP (prVEP) P100 amplitude and peak time in patients with albinism.

METHODS: We analyzed the prVEP (60′ and 15′ checksize) and nystagmus recordings from 47 patients with albinism, 17 with a relatively good visual acuity (≤ 0.3 logMAR), and 30 with a relatively poor visual acuity (≥ 0.6 logMAR). The nystagmus waveforms were classified into two types: dominantly pendular and dominantly jerk. We correlated the nystagmus type, amplitude, frequency, and percentage of low velocity (PLOV) to P100 amplitude and peak time.

RESULTS: For most patients (87%), reproducible responses were observed for the large checks (60′). Among patients with good visual acuity, 94% had reproducible responses of which the majority (82%) of P100 amplitudes fell within the normal reference range. In contrast, although 83% of patients with poor visual acuity showed reproducible responses, only a minority (17%) of P100 amplitudes were within the normal range. The P100 amplitude to 60’check sizes was statistically correlated with PLOV (r = 0.58, p < 0.0001), nystagmus type (r = -0.55, p < 0.0001), and nystagmus amplitude (r = -0.39, p = 0.0092). Patients with relatively good visual acuity and jerk nystagmus exhibited the highest PLOV and the largest P100 amplitude (p < 0.0001). In contrast, there was no significant correlation between P100 peak time and any nystagmus parameters in patients with good or poor visual acuity.93% normal peak time. For the small checks (15′), 76% of patients with good visual acuity, still showed reproducible responses, with the majority (71%) of P100 amplitudes falling within the normal reference range. In contrast, among patients with poor visual acuity, only 3% (1 patient) showed reproducible responses, but with amplitudes below the normal range. For the patients with good visual acuity, PLOV showed a significant correlation with P100 amplitude. P100 peak time was normal for 77% (10/13) of these patients.

CONCLUSIONS: For the prVEP with 60′ checks, nystagmus in patients with albinism predominantly affects the P100 amplitude but not the P100 peak time. For 15′ checks the amplitude is often so small that clear responses are no longer discernable, especially in patients with poor visual acuity.

PMID:40459803 | DOI:10.1007/s10633-025-10026-1

Discov Ment Health. 2025 Jun 3;5(1):83. doi: 10.1007/s44192-025-00209-2.

ABSTRACT

INTRODUCTION: Epidermolysis bullosa (EB) is a rare, chronic, incurable, multisystemic genetic disorder characterized by skin fragility, resulting in blistering from minimal trauma or spontaneously. Despite its physical impact, little is known about the mental health and quality of life (QoL) of those affected. This study aims to investigate these aspects in individuals with EB.

METHODS: A cross-sectional study was conducted in Brazil using a self-administered questionnaire and a convenience sample. Data on clinical-epidemiological characteristics, QoL (DLQI-BRA and QoLEB), and depression indicators (PHQ-9) were collected. Descriptive statistics and the Chi-square test were used, with a significance level of p < 0.05.

RESULTS: The sample consisted of 31 patients, predominantly women (89.3%), with a mean age of 33.32 ± 11.3 years. The recessive dystrophic subtype was most common (54.8%), and depressive symptoms were present in 71%. PHQ-9 results revealed 29% had “mild depression,” 16.1% “moderate depression,” 22.6% “moderately severe depression,” and 3.2% “severe depression.” QoLEB indicated significant impairment in functional domains, while DLQI showed that 45.2% of patients experienced severe QoL impact. The most affected domains were leisure, symptoms and feelings, and daily activities.

CONCLUSION: The findings highlight the substantial impact of EB on mental health, QoL, and personal relationships. These results reinforce the need for early mental health screening and the integration of multidisciplinary care to optimize patient outcomes. Implementing structured psychological support, along with comprehensive dermatological and medical management, could mitigate the burden of the disease and enhance the overall well-being of affected individuals.

PMID:40459790 | DOI:10.1007/s44192-025-00209-2

Environ Monit Assess. 2025 Jun 3;197(7):722. doi: 10.1007/s10661-025-14177-1.

ABSTRACT

This research examines trends in air quality in Delhi from 2018 to 2023 based on geospatial tools and statistical techniques, such as violin plot analysis, one-way analysis of variance (ANOVA), Tukey honestly significant difference (HSD), and Kriging interpolation. Air pollution measurements from 38 monitoring stations were evaluated to identify spatial and temporal patterns in the major pollutants (PM_2.5, PM₁₀, NO₂, SO₂, and ozone). The reports show a massive decline in the levels of PM_2.5 from 242.91 µg/m³ in 2018 to 99.51 µg/m³ in 2022, with similar downward trends being reflected for PM₁₀ (214.66 µg/m³ in 2019 to 106.88 µg/m³ in 2023) and NO₂ (46.61 µg/m³ in 2018 to 14.99 µg/m³ in 2023). SO₂ was comparatively static, with irregular industrial spikes, while the level of ozone varied, touching a high of 160 µg/m³ in some zones. COVID-19 lockdown contributed to a major decrease in levels of pollution, with PM_2.5 and PM₁₀ falling by more than 40%. Violin plot analysis showed fluctuations in pollutant concentrations between various regions, where localized changes were evident. One-way ANOVA and Tukey HSD tests also certified statistically significant variation in pollutant levels between varied phases, underlining the effects of lockdown practices. Spatial interpolation by Kriging resulted in high-resolution concentration maps, giving a complete picture of the distribution of pollution. The findings help deepen knowledge of air quality trends and guide policy interventions to reduce pollution and enhance public health in Delhi.

PMID:40459779 | DOI:10.1007/s10661-025-14177-1

Parasitol Res. 2025 Jun 3;124(6):59. doi: 10.1007/s00436-025-08506-z.

ABSTRACT

Dirofilaria immitis, also known as canine heartworm, contains an endosymbiont, Wolbachia, in all life stages. The antibiotic, doxycycline, has been incorporated into heartworm treatment protocols to eliminate Wolbachia. Previous studies indicate that subsequent infection cannot be established using viable third-stage larvae (L3) developed from doxycycline-treated microfilariae (mf). The stages in which the development of larvae is impacted by doxycycline remain unknown. We examined the impact of doxycycline on the third-stage to fourth-stage larval molt, as it is the first molt of D. immitis after it invades the vertebrate host. Microfilaremic blood was collected weekly from D. immitis-infected dogs with or without doxycycline treatment at 10 mg/kg as recommended by the American Heartworm Society. Blood was collected weekly until the end of doxycycline treatment. The blood was used for L3 production and mf isolation. Wolbachia levels in mf and L3 were measured using real-time quantitative PCR. L3 were cultured in vitro for 9 days to assess whether molting occurred. The Fisher’s exact test and Bonferroni correction were used for statistical analysis. The molting of L3 from the doxycycline-treated groups did not show a significant difference compared to the L3 from the control group at weeks 0, 1, 2, 3, and 4. The Wolbachia levels in mf and L3 decreased starting from 7 days post-treatment and remained less than five percent of controls throughout the treatment. Doxycycline treatment can eliminate Wolbachia in both mf and subsequently developed L3. The molts of the mf to L3 in the mosquito and the L3 to L4 molt in vitro do not appear to be impacted by the reduction or elimination of Wolbachia.

PMID:40459778 | DOI:10.1007/s00436-025-08506-z

Trop Anim Health Prod. 2025 Jun 3;57(5):240. doi: 10.1007/s11250-025-04479-4.

ABSTRACT

This study aims to explore farm-level losses of cattle, goats and sheep and relevant risk factors in the mixed crop-livestock and pastoral production systems in Ethiopia. Data from 1,528 cattle farms, 868 goat farms and 749 sheep farms, spanning the year 2018/19, were analysed in this study. A farm was defined as a case farm if it lost at least one cattle/goat/sheep in the past 12 months. The 12-month incidence of livestock loss was calculated for each region and production system. Logistic regression analysis was employed to assess risk factors contributing to livestock loss in the farms. Forty-five percent of goat farms, 36% of sheep farms and 23% of cattle farms reported losing at least one animal in the past 12 months. Cattle loss in the pastoral system was associated with not using vaccines (Odds Ratio = 7, P < 0.01). In the mixed crop-livestock system cattle loss was associated with the absence of a roofed house (Odds Ratio = 1.40, P < 0.05). Risk factors for goat loss in the mixed crop-livestock system were selling live goats in the past 12 months (Odds Ratio = 1.58, P < 0.05). For sheep loss in the pastoral system, the identified risk factor was having cattle on farm (Odds Ratio = 2.40, P < 0.05). These findings provide valuable insights into the scale and the drivers of livestock loss within the major cattle and small ruminants production systems in Ethiopia.

PMID:40459774 | DOI:10.1007/s11250-025-04479-4

Hernia. 2025 Jun 3;29(1):194. doi: 10.1007/s10029-025-03385-w.

ABSTRACT

INTRODUCTION: For primary bilateral inguinal hernias, international guidelines favor a laparoscopic posterior mesh repair due to relatively lower risk of acute and chronic pain, faster recovery, and favorable biomechanical properties compared to open anterior approaches (Lichtenstein, plug and patch, etc.). However, studies comparing open mesh-based bilateral inguinal hernia repairs to bilateral laparoscopic and robotic mesh-based approaches are limited. The Abdominal Core Health Quality Collaborative (ACHQC) registry includes longitudinal data on bilateral inguinal hernia repairs performed via open as well as laparo-endoscopic approaches. We hypothesize that outcomes for bilateral inguinal hernia repair are similar between open and laparo-endoscopic approaches in the ACHQC registry.

METHODS: Data from 2012 to 2024 was obtained from the ACHQC registry for individuals who underwent open and laparo-endoscopic bilateral inguinal hernia repair. After adjusting for confounding covariates, 3:1 propensity score-based matching was performed to compare patient-reported quality of life using EuraHS scores between the open, robotic, and laparoscopic bilateral inguinal hernia repair cohorts. Postoperative complications and hernia recurrences were also compared between these cohorts.

RESULTS: In the matched analysis between laparoscopic, robotic, and open repair groups, 575, 524, and 208 individuals, respectively, were included. In the combined analysis comparing laparo-endoscopic to open repairs, data was included for 627 and 211 individuals, respectively, after propensity score matching with 3-year follow up. The open cohort comprised of approximately 40% open preperitoneal and 60% Lichtenstein repairs. The mean age of individuals in this study was 63 years (± standard deviation of 8 years), with nearly 92% of the patients being male (772/838). EuraHS scores up to the 3-year follow-up timepoint did not show statistical or clinical differences between the study cohorts (p = 0.19). There were also no significant differences between the rates of hernia recurrence at 3-year follow up, 30-day surgical site occurrences, postoperative bleeding, peripheral nerve injury, venous thromboembolic events, and urinary tract infections between the three cohorts.

CONCLUSION: For individuals undergoing primary bilateral inguinal hernia repair, all three approaches- laparoscopic, robotic, and open- are comparable in surgical and patient-reported outcomes in the ACHQC registry. Given the high percentage of open preperitoneal repairs in this study, further investigation is warranted to understand if the “open” cohort outcomes are skewed by the combination of both anterior and posterior open repairs in the same group.

PMID:40459773 | DOI:10.1007/s10029-025-03385-w