Nevin Manimala

Sci Rep. 2025 Jul 20;15(1):26359. doi: 10.1038/s41598-025-09479-w.

ABSTRACT

Appropriate healthcare utilization and compliance with the WHO treatment guidelines can significantly reduce diarrhea-related childhood mortality and morbidity, while overuse of antibiotics notably increases antibiotic resistance. We studied care-seeking behavior and antibiotic use for childhood diarrhea by analyzing data from 8294 diarrheal episodes of 1-59-month-old children visiting a tertiary-care hospital in rural Bangladesh. Overall, 55% of the study children received antibiotics, while only 6% had dysentery. Notably, 77% of the antibiotics were obtained from a local pharmacy without a prescription. Antibiotics alone, without zinc or ORS, were used by more children with dysentery than watery diarrhea (15% vs. 9%; p < 0.001). While 85% of the children received ORS, only 7% received zinc and ORS without antibiotics. Children who received antibiotics before seeking care at the hospital had a significantly higher rate of hospitalization than those who did not have antibiotics (20% vs. 13%; p < 0.001). The factors that influenced the caregivers’ decision to seek care from the pharmacy were the desire for early recovery, traditional practices, faith in seeking care at pharmacies, and distance to a healthcare facility. Our findings warrant that reducing unnecessary antibiotic consumption requires increasing public awareness and strengthening laws on the sale of over-the-counter antibiotics.

PMID:40685382 | DOI:10.1038/s41598-025-09479-w

Epilepsy Behav. 2025 Jul 19;171:110598. doi: 10.1016/j.yebeh.2025.110598. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the lateralizing value of shoulder dislocation in seizure semiology of patients with focal epilepsy.

METHODS: We retrospectively reviewed the charts of patients with shoulder dislocation secondary to seizures who were seen at our institution from April 1, 2002 to October 15, 2023.

RESULTS: A total of 87 patients met the inclusion criteria. Forty-four (50.6 %) had generalized epilepsy with tonic-clonic seizures, 22 (25.3 %) had focal epilepsy, and 21 (24.1 %) had epilepsy with unknown onset tonic-clonic seizures. Of the 22 patients who had focal epilepsy, 20 (91 %) had contralateral shoulder dislocation (95 % CI [71-99 %]). This association between seizure focus laterality and contralateral shoulder dislocation was statistically significant (Fisher’s exact test, p < 0.001).

SIGNIFICANCE: We found that shoulder dislocations were more common in patients with generalized compared to focal epilepsy. More important, most patients with focal epilepsy had contralateral shoulder dislocation. We think that this can serve as a potential novel lateralizing sign during the presurgical epilepsy evaluation, though it requires validation in larger, prospective studies.

PMID:40684517 | DOI:10.1016/j.yebeh.2025.110598

J Hazard Mater. 2025 Jul 18;496:139300. doi: 10.1016/j.jhazmat.2025.139300. Online ahead of print.

ABSTRACT

Aromatic amines are a group of compounds with industrial and environmental significance. The oxidative damage induced by large scale residential exposure to aromatic amines remains poorly characterized, necessitating comprehensive biomonitoring and mechanistic investigations. Herein, this study integrates large scale biomonitoring and cell-based high-throughput PCR array analysis to evaluate the oxidative damage induced by daily exposure to primary aromatic amines (PAAs), emerging aromatic amines (AAs), and their quinone derivatives (PPD-Qs) in the Chinese population. Urinary concentrations of 11 PAAs, 20 AAs, and 6 PPD-Qs were quantified (ΣPAAs > ΣAAs > ΣPPD-Qs) in 397 samples across 31 provinces/municipalities in China, uncovering significant regional variations. Advanced statistical regression analyses (multiple linear regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR)) identified key chemical contributors, correlating with oxidative stress biomarkers (8-oxo-7,8-dihydro-2′-deoxyguanosine (8-OHdG), 8-hydroxyguanosine (8-OHG), dityrosine (di-Y), and malondialdehyde (MDA)), indicative of DNA, RNA, protein, and lipid damage. The WQS model identified several key chemicals driving oxidative stress, including 1,3-Diphenylguanidine (DPG), 1,2,3-Triphenylguanidine (TPG), 1,3-Di-o-tolyguanidine (DTG), 4-Phenylaminodiphenylamine quinone (DPPD-Q), 4-(Cyclohexyl amino) diphenylamine quinone (CPPD-Q), and 2-naphthylamine (2-NA). In vitro experiments demonstrated that these prioritized chemicals elevated reactive oxygen species production by 118 %-241 % and dysregulated 11 oxidative stress-related genes, implicating pathways linked to superoxide metabolism and ferroptosis. This multi-faceted approach advances the understanding of aromatic amine-induced oxidative damage, offering critical insights to support chemical prioritization and regulatory measures to mitigate associated health risks.

PMID:40684506 | DOI:10.1016/j.jhazmat.2025.139300

Curr Pharm Teach Learn. 2025 Jul 19;17(11):102446. doi: 10.1016/j.cptl.2025.102446. Online ahead of print.

ABSTRACT

INTRODUCTION: This study examines pharmacy students’ qualitative faculty and course evaluation (FCE) feedback through an integrated machine learning and human coding approach to uncover insights on faculty teaching, course quality, and areas for improvements, informing instructional enhancement.

METHODS: Between 2019 and 2023, text data from 1267 FCEs were compiled and analyzed using WordStat, a text mining software. The content analysis primarily relied on machine learning techniques, including word clustering, word co-occurrence mapping, phrase extraction, and topic modeling, to uncover patterns in the student feedback data. To enhance interpretive depth and ensure contextual accuracy, a supplemental manual thematic analysis was conducted using both deductive and inductive coding approaches. Descriptive statistics were applied to quantify and interpret the frequency of identified codes and themes.

RESULTS: Word cluster analysis identified commonly cited words and their co-occurrences, including professor, class, students, teaching, great, materials, and lectures. The frequently occurring phrases included excellent professor, great professor, excellent teaching style, knowledgeable professors, caring professors, flexible with students, and goes extra miles. The topics with high coherence values included understanding the materials, great professors, real-life experience, knowledgeable professor, excellent content, waste of time, and reading the slides. The manual coding analysis identified 1088 codes grouped under 38 subthemes constituting three major themes including faculty personal attributes (45.86 % of codes), faculty teaching effectiveness (28.92 %), and course quality (23.24 %).

CONCLUSIONS: This study highlights the value of analyzing open-ended FCE comments by utilizing machine learning to gain meaningful insights that deepen understanding of the student learning experience. Educators and curriculum planners in health professions education can make data-informed decisions, improve curriculum design, and enhance teaching effectiveness by thoughtfully integrating student feedback into program-level reviews.

PMID:40684479 | DOI:10.1016/j.cptl.2025.102446

EBioMedicine. 2025 Jul 19;118:105859. doi: 10.1016/j.ebiom.2025.105859. Online ahead of print.

ABSTRACT

BACKGROUND: Metformin is one of the most used drugs worldwide. Given the increasing use of proteomics in trials, bioresources, and clinics, it is crucial to understand the influence of metformin on the levels of the circulating proteome.

METHODS: We analysed a combined longitudinal proteomics dataset from the IMPOCT, RAMP and S3WP-T2D clinical trials in 98 participants before and after metformin exposure. This discovery analysis contained 372 proteins measured by proximity extension assays (Olink). We followed up experiment-wise statistically significant findings in two cross-sectional cohorts of people with type 2 diabetes comparing metformin treated and untreated individuals: IMI-DIRECT (784 participants, 372 proteins, Olink) and IMI-RHAPSODY (1175 participants, 1195 proteins, SomaLogic).

FINDINGS: Overall, 23 protein analytes were robustly associated with exposure to metformin in the discovery and replication. This includes 11 protein-metformin associations that replicated in both replication sets and platforms (REG4, GDF15, REG1A, t-PA, TFF3, CDH5, CNTN1, OMD, NOTCH3, THBS4 and CD93), with the remaining 12 protein-metformin associations replicated using the Olink platform (EPCAM, SPINK1, SAA-4, COMP, ITGB2, ADGRG2, FAM3C, MERTK, COL1A1, HAOX1, VCAN, TIMD4) but not measured on the SomaLogic platform. Gene-set enrichment analysis revealed that the metformin exposure was associated with intestinal associated proteins.

INTERPRETATION: These data highlight the need to account for exposure to metformin, and potentially other drugs, in proteomic studies and where protein biomarkers are used for clinical care.

FUNDING: Innovative Medicines Initiative Joint Undertaking 2, under grant agreement no. 115881 (RHAPSODY) and the Innovative Medicines Initiative Joint Undertaking under grant agreement no. 115317 (DIRECT), resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007-2013) and EFPIA companies in kind contribution as well as the Swiss State Secretariat for Education Research’ and Innovation (SERI), under contract no. 16.0097 (RHAPSODY).

PMID:40684475 | DOI:10.1016/j.ebiom.2025.105859

Biomol Biomed. 2025 Jul 20. doi: 10.17305/bb.2025.12979. Online ahead of print.

ABSTRACT

A systematic review with meta-analysis (SRMA) represents the pinnacle of evidence, but its validity depends on methodological rigor. This narrative review synthesizes recommendations from major reporting frameworks- Preferred Reporting Items for Systematic Reviews and Meta‑Analyses 2020 (PRISMA‑2020), Meta‑Analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Overviews of Reviews (PRIOR)-into a concise checklist for peer reviewers. The checklist addresses common sources of bias that often escape editorial assessment. Initially, it outlines how reviewers should assess the rationale for an SRMA by identifying existing syntheses on the same topic and determining whether the new work provides substantive novelty or a significant update. Best practices are summarized for protocol registration, comprehensive search strategies, study selection and data extraction, risk-of-bias evaluation, and context-appropriate statistical modeling, with a specific focus on heterogeneity, small-study effects, and data transparency. Case examples highlight frequent pitfalls, such as unjustified pooling of heterogeneous designs and selective outcome reporting. Guidance is also provided for formulating balanced, actionable review comments that enhance methodological integrity without extending editorial timelines. This checklist equips editors and reviewers with a structured tool for systematic appraisal across clinical disciplines, ultimately improving the reliability, reproducibility, and clinical utility of future SRMAs.

PMID:40684471 | DOI:10.17305/bb.2025.12979

Ann Med. 2025 Dec;57(1):2534854. doi: 10.1080/07853890.2025.2534854. Epub 2025 Jul 20.

ABSTRACT

BACKGROUND: Accelerated industrialization globally has intensified air pollution, but the susceptibility periods for extreme air pollution in twin pregnancies remain undefined.

METHODS: This study investigated the association between extreme air pollution exposure and preterm birth risk in twin pregnancies. Data on 3623 twin pregnancies in Chongqing from 2017 to 2022 and air pollution readings from 12 monitoring stations were analyzed using distributed lag non-linear quasi-Poisson regression models. Additionally, four extreme air pollution indices were developed to assess the cumulative effects of lagged exposures on preterm birth risk through multivariate logistic regression.

RESULTS: Compared to the lower quartile, the 95th percentile of extreme air pollution exposure showed a positive correlation between concentrations of PM_2.5, PM₁₀, NO₂, SO₂ and CO and preterm birth risk in twin pregnancies, with O₃ inversely correlated. Sensitive periods for air pollutants were different. 8-12 and 27-35 gestational weeks were identified for PM_2.5; 6-13 and 27-35 gestational weeks were identified for PM₁₀; 5-14 and 21-33 gestational weeks were identified for NO₂; 4-15 and 24-36 gestational weeks were identified for SO₂; 4-11 and 29-33 gestational weeks were identified for CO. PM_2.5, PM₁₀, SO₂ and O₃ showed cumulative effects across short and long lags, while CO showed a long-term effect. Notably, NO₂ exhibited a protective effect during all lag periods.

CONCLUSION: The study highlights gestational windows of 8-11 and 29-33 weeks as highly sensitive to extreme pollution for preterm birth in twin pregnancies, with marked risk increases during 0-3, 0-6 and 0-9-month lag periods.

PMID:40684455 | DOI:10.1080/07853890.2025.2534854

Ann Med. 2025 Dec;57(1):2534522. doi: 10.1080/07853890.2025.2534522. Epub 2025 Jul 20.

ABSTRACT

INTRODUCTION: Accurate breast cancer risk prediction is essential for early detection and personalized prevention strategies. While traditional models, such as Gail and Tyrer-Cuzick, are widely utilized, machine learning-based approaches may offer enhanced predictive performance. This systematic review and meta-analysis compare the accuracy of traditional statistical models and machine learning models in breast cancer risk prediction.

METHODS: A total of 144 studies from 27 countries were systematically reviewed, incorporating genetic, clinical, and imaging data. Pooled C-statistics were calculated to assess model discrimination, while observed-to-expected (O/E) ratios were used to evaluate calibration. Subgroup and sensitivity analyses were conducted to examine heterogeneity and assess the influence of study bias across various populations.

RESULTS: Machine learning-based models demonstrated superior performance, with a pooled C-statistic of 0.74, compared to 0.67 for traditional models. Models that integrated genetic and imaging data showed the highest levels of accuracy, although performance varied by population. Sensitivity analyses excluding high-bias studies showed improved discrimination in models incorporating genetic factors, with the pooled C-statistic increasing to 0.72. Traditional models, such as Gail, exhibited notably poor predictive accuracy in non-Western populations, as evidenced by a C-statistic of 0.543 in Chinese cohorts.

CONCLUSION: Machine learning models provide significantly greater predictive accuracy for breast cancer risk, particularly when incorporating multidimensional data. However, issues related to model generalizability and interpretability remain, particularly in diverse populations. Future research should focus on developing more interpretable models and expanding global validation efforts to improve model applicability across different demographic groups.

PMID:40684451 | DOI:10.1080/07853890.2025.2534522

Ann Med. 2025 Dec;57(1):2534096. doi: 10.1080/07853890.2025.2534096. Epub 2025 Jul 20.

ABSTRACT

BACKGROUND: Robotic surgery represents a notable advancement in the field of minimally invasive gynecological surgery. Although the Kangduo Robot® SR1000 (KD-SR-01) surgical system has shown improved stability and high efficiency, studies describing its use for gynecological surgery are limited. We aimed to review the safety and effectiveness of the KD-SR-01 system in gynecologic surgery and compare it with conventional laparoscopic operation.

MATERIALS AND METHODS: We compared patient characteristics and short-term outcomes in cases of gynecological surgery conducted using the KD-SR-01 system and laparoscopic minimally invasive procedures between March 2024 and October 2024. The short-term clinical efficacies of both surgical modalities were compared by performing statistical analyses.

RESULTS: The KD-SR-01 system was used for total hysterectomy due to benign uterine tumors in 144 cases, ovarian cyst removal surgery due to benign ovarian tumors in 25 cases, unilateral adnexectomy due to benign ovarian tumors or borderline tumors in 25 cases, staging of early endometrial cancer in 24 cases, and radical cervical cancer resection for early cervical cancer in 24 cases. None of the patients showed serious complications (Clavien-Dindo grade ≥ 3). In comparison with traditional laparoscopic surgery, Kangduo robotic surgery resulted in a lower duration of hospitalization, operation time, blood loss, and drainage volume, but the two surgical modalities showed no differences in the complication rate.

CONCLUSION: The Kangduo robotic system was safe and feasible for gynecological surgery. Evidence from additional studies and more surgical experience are required to determine the long-term outcomes and indications for gynecological surgery using this robotic system.

PMID:40684447 | DOI:10.1080/07853890.2025.2534096

Ann Med. 2025 Dec;57(1):2532860. doi: 10.1080/07853890.2025.2532860. Epub 2025 Jul 20.

ABSTRACT

BACKGROUND: Musculoskeletal (MSK) disorders are a leading cause of disability worldwide, particularly prevalent among women of childbearing age (WCBA). Our aim is to comprehensively assess the global, regional, and national burden of MSK disorders in WCBA, and examine the burden of MSK disorders among WCBA at varying levels of the Socio-demographic Index (SDI), then to project the burden of these disorders through to 2045.

METHODS: This study utilized data from the Global Burden of Disease (GBD) 2021 project, focusing on MSK disorders among WCBA (15-49 years). Age-standardized rate was calculated using the World Standard Population proportions. Descriptive analysis was conducted at global, regional, and national levels. SDI associations were explored using smoothing spline models. Projections to 2045 employed age-period-cohort models using R software.

RESULTS: In 2021, the estimated global age-standardized incidence, prevalence, deaths, Years of Life Lost, Years Lived with Disability, and Disability-Adjusted Life Years (DALYs) rates per 100 000 population of MSK disorders in WCBA were 4933.9 (95% UI 3683.7-6454.4), 20145.9 (17 082.6-23 564.4), 0.7 (0.6-0.8), 40.7 (34.1-45.7), 2090.4 (1414.8-2896.2), and 2131.1 (1455.8-2936.8), respectively. From 1990 to 2021, a total of 183 countries exhibited an increase in prevalence rate and 166 countries showed an upward trend in DALYs rate. Between 1990 and 2021, there was a positive association between the SDI and age-standardized DALYs rate for MSK disorders in WCBA, both globally and regionally. By 2045, the age-standardized number of DALYs for MSK disorders in WCBA is expected to reach 48.8 million, with an age-standardized DALYs rate of 2160 per 100,000 population.

CONCLUSION: The burden of MSK disorders among WCBA is already substantial and is expected to increase further in the future. Despite the observed decline in age-standardized incidence rate of MSK disorders among WCBA in half of the regions and countries globally, the age-standardized prevalence and DALYs rates have shown an adverse increasing trend. By 2045, the global number of DALYs for MSK disorders in WCBA is projected to exceed 48 million. To mitigate the future burden of MSK disorders in WCBA, stratified and targeted healthcare strategies are essential to improve early diagnosis and treatment.

PMID:40684443 | DOI:10.1080/07853890.2025.2532860