Nevin Manimala

Adv Med Educ Pract. 2025 Jul 12;16:1217-1227. doi: 10.2147/AMEP.S528051. eCollection 2025.

ABSTRACT

PURPOSE: This study aims to assess the level of interest in pathology among medical students in Saudi Arabia and identify factors influencing their decision to pursue pathology as a career.

PATIENTS AND METHODS: This cross-sectional study was conducted across multiple universities in Saudi Arabia, including Umm Al Qura University, King Faisal University, King Saud bin Abdulaziz University for Health Sciences, Imam Abdulrahman bin Faisal University, Jazan University, and King Khalid University. Data was collected from medical students at different academic levels, including first-year students through interns using an online questionnaire via Google Forms. Responses were cleaned in Microsoft Excel and analyzed using SPSS version 23. Descriptive statistics and Chi-square tests were used, with significance set at p < 0.05.

RESULTS: A total of 612 valid responses were received, with an almost equal distribution of male (49.8%) and female (50.2%) participants. Overall, 45.3% of students expressed interest in pathology, while 54.7% were not interested. Female students (52.1%) showed a greater interest compared to males (38.4%). The most influential factors attracting students to pathology included lifestyle (37.4%), research opportunities (35.9%), and fewer on-call duties (33.2%). The most common deterring factors reported by those interested in pathology was the perceived challenge of the discipline (56.9%), other career interests (41.5%), and limited job opportunities (35.3%).

CONCLUSION: Several factors influence medical students’ decisions regarding pathology as a career choice. Notably, female students demonstrated a higher level of interest in pathology than their male counterparts. Future studies should explore strategies to enhance the visibility and appeal of pathology, such as increasing early exposure to the field within the medical curriculum.

PMID:40678713 | PMC:PMC12267822 | DOI:10.2147/AMEP.S528051

AlterNative (Nga Pae Maramatanga (Organ)). 2024 Mar;20(1):167-177. doi: 10.1177/11771801241235206. Epub 2024 Mar 11.

ABSTRACT

Today, the Hawaiian community faces high rates of health disparities, as well as loss of land, language, and culture due to colonization. However, Hawaiians continue to keep their culture alive, and cultural reclamation theory argues that Indigenous Peoples are healthier when they have opportunities to engage with their cultural practices. This theory points to culture as a possible intervention. We analyze data from the 2019 Native Hawaiian Survey, which examines Hawaiian identity through a sample of over 1,000 participants across Hawai’i who are 18 years or older and have Hawaiian ancestry. Drawing upon what it means to identify as Hawaiian, we expect a positive relationship between activities that increase connection to Hawaiian culture and life satisfaction. We find statistical significance in consideration of sacred spaces, pride in being Hawaiian, and sense of belonging to America and discuss implications for Hawaiian well-being based on these findings.

PMID:40678700 | PMC:PMC12269521 | DOI:10.1177/11771801241235206

EClinicalMedicine. 2025 Jun 27;85:103314. doi: 10.1016/j.eclinm.2025.103314. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Children lacking parental protection may tend to miss out on essential services. We investigated whether orphans and children without parental care were at risk of sub-optimal vaccination.

METHODS: Cross-sectional analyses of 189 UNICEF Multiple Indicator Cluster Surveys from 82 predominantly low- and middle-income countries, conducted from January 1, 2005 to December 31, 2022. We used two-level logistic fixed-effects models with individual community-dwelling children aged 12-59 months nested within MICS sampling cluster to estimate the effects of orphanhood (one or both parents deceased) and lack of parental care (children residing with no biological parents) on missed vaccinations. We report the adjusted odds of being a “zero-dose” child (failure to receive any diphtheria-tetanus-pertussis-containing (DTP) vaccine doses), an under-immunised child (failure to receive three DTP doses), failure to receive any measles-containing vaccine (MCV), and failure to receive all eight basic vaccine doses.

FINDINGS: The analysis included 739,506 children of which 20.6% (n = 152,314) were zero-dose, 50.4% (n = 372,568) were under-immunised, 50.3% (n = 372,089) had not received any MCV, and 57.8% (n = 427,558) had not received all 8 basic vaccine doses. Orphans had a consistently higher risk of sub-optimal vaccination. Adjusted odds ratios were similar for all binary outcomes (zero-dose (OR_adj 1.59; 95% CI: 1.48-1.71, p < 0.001), no DPT3 (OR_adj 1.46; 95% CI: 1.38-1.54, p < 0.001), and no MCV and basic incomplete (OR_adj 1.42; 95% CI: 1.34-1.50, p < 0.001 for both)). Children lacking parental care experienced similarly elevated risks of sub-optimal vaccination (p < 0.001 for all outcomes).

INTERPRETATION: To better support children at risk and uphold their rights, vaccination programmes should prioritise service delivery to orphans and children lacking parental care.

FUNDING: Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Canadian Institutes for Health Research.

PMID:40678695 | PMC:PMC12269469 | DOI:10.1016/j.eclinm.2025.103314

Explor Res Clin Soc Pharm. 2025 Jun 24;19:100627. doi: 10.1016/j.rcsop.2025.100627. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Opioids and benzodiazepines (BZDs) are among the most prescribed medications that contribute to falls in older adults; however, little guidance exists on their safe prescribing and deprescribing. Although some resources are available to assist providers with opioid and BZD deprescribing, many report lack of confidence as a barrier. The objective of this study was to assess PCPs’ confidence in their ability to deprescribe opioids and BZDs before and after an intervention.

METHODS: We modified a validated deprescribing self-efficacy survey to assess primary care provider (PCP) confidence in deprescribing opioids and BZDs in older adults before and after a consultant pharmacist educational intervention. The survey consisted of 35 questions divided into three sections: deprescribing opioids (10 questions), deprescribing BZDs (10 questions), and deprescribing under potentially impeding circumstances [UPIC] (15 questions). The survey was sent to 88 PCPs using a modified Dillman method. We evaluated providers’ confidence on a 100-point scale pre- and post-intervention, comparing the difference-in- differences (DID) in scores between the intervention and control groups.

RESULTS: A total of 41 PCPs (46.6 %) completed the survey both pre-and post-intervention. The intervention group (n = 21) showed an improvement in their knowledge and self-efficacy skills by an average of 19.7 out of 100 points, while the control group (n = 20) improved by an average of 5.2 points. The DID in self-efficacy improvement between the two groups was +14.5 points (p = 0.003) overall. For each of the opioid-, BZD-, and UPIC-specific scores, the intervention group had a statistically significant DID compared to the control group (+15.8, p = 0.004; +14.2, p = 0.017; +13.9, p = 0.016, respectively).

CONCLUSION: This consultant pharmacist educational intervention improved PCPs’ confidence in deprescribing opioids and BZDs in older adults.

PMID:40678679 | PMC:PMC12269610 | DOI:10.1016/j.rcsop.2025.100627

Palliat Support Care. 2025 Jul 18;23:e134. doi: 10.1017/S1478951525100370.

ABSTRACT

OBJECTIVES: As cancer incidence and survival rates rise, caregivers responsible for providing diverse support face increased burden and reduced quality of life (QoL). Although research on web-based interventions for this group is expanding, the impact of these interventions on caregiver burden and QoL remains unclear. This study aims to investigate the effects of web-based interventions on the caregiver burden and QoL of caregivers of patients with cancer.

METHODS: Searches were conducted in PubMed, Web of Science, Cochrane Library, CINAHL, Embase, and PsycINFO from database inception to 10 June 2024. Two reviewers independently assessed each study and extracted data. The risk-of-bias in the studies was evaluated using Cochrane’s Risk-of-Bias tool for randomized controlled trials. The intervention effects were calculated using R package Meta version 4.0.3, utilizing standardized mean differences (SMD; Hedge’s ĝ) to calculate pooled effect sizes with 95% confidence intervals (CI). Publication bias assessment and sensitivity analysis were conducted to ensure the robustness of the results.

RESULTS: We reviewed 13 randomized controlled trials; our analysis indicated a small effect size of web-based interventions on caregiver burden (SMD = -0.19, 95% CI: -0.36 to -0.01). However, sensitivity analysis concluded that the effect was very small or nearly absent. Additionally, there was no statistically significant effect on QoL (SMD = 0.15, 95% CI: -0.05 to 0.36).

SIGNIFICANCE OF RESULTS: Web-based interventions did not significantly reduce caregiver burden or improve caregivers’ QoL. To improve caregiver burden and QoL in the future, comprehensive and tailored web-based interventions for this population are needed.

PMID:40676719 | DOI:10.1017/S1478951525100370

BMC Psychol. 2025 Jul 17;13(1):800. doi: 10.1186/s40359-025-03150-9.

ABSTRACT

BACKGROUND: The recent surge in suicide rates of children and adolescents in Korea has become a social problem. Suicide and suicide attempts begin in children and adolescents and continue to progress, leading to serious suicide and suicide attempts, so early intervention is essential. This study investigated the effects of group sandplay therapy on depression, anxiety, and self-esteem in children at a risk of suicidal ideation.

METHODS: This was a non-randomized, controlled trial. After recruiting 63 subjects at risk for suicidal ideation through convenience sampling based on a preliminary survey, the subjects were divided into a sandplay group therapy (SGT) group and a control group. The control group did not receive interventional therapy, whereas the SGT group received 10 sessions of sandplay therapy once a week, 40 min each. The clinical assessment instruments used were the Suicidal Ideation Questionnaire-Junior (SIQ-JR), Center for Epidemiologic Studies Depression Scale for Children (CES-DC), Revised Children’s Manifest Anxiety Scale (RCMAS), and Rosenberg’s Self-Esteem Scale (RSES). Statistical analysis was performed using IBM SPSS version 25.0, and multivariate analysis of variance (MANOVA) was used.

RESULTS: Sandplay group therapy significantly reduced depression and anxiety in the SGT group at risk of suicidal thoughts compared to the control group, and also significantly improved self-esteem.

CONCLUSION: 10-week sandplay group therapy was effective in reducing depression and anxiety in children and improving self-esteem in children at risk of suicidal thoughts. The results of these interventions, first attempted in Korea, suggest that sandplay group therapy in schools can be an effective intervention for children and adolescents at risk of suicide. (Clinical Research Information Service (CRiS) of Republic of Korea, Registration Number: KCT0010738, Registration Date: 2025.07.09.).

PMID:40676714 | DOI:10.1186/s40359-025-03150-9

Nutr Metab (Lond). 2025 Jul 17;22(1):79. doi: 10.1186/s12986-025-00969-2.

ABSTRACT

BACKGROUND: Bifidobacterium longum subsp. longum BL21 has demonstrated promise in alleviating gut microbiota disturbances and metabolic regulation in high-fat diet-induced obesity and type 2 diabetes mellitus models. However, the effect of probiotic B. longum BL21 on overweight and obese individuals remain unclear.

METHODS: A randomized, double-blind, placebo-controlled trial was performed, and 66 adult individuals were assigned to receive either BL 21 (2*10¹⁰ colony-forming units per day along with 3 g of maltodextrin) or placebo (3 g of maltodextrin daily) for 8 weeks. Multi-omics analyses were employed to evaluate the impact of the B. longum strain BL21 on gut microbiota, serum metabolomics, body weight and lipids profiles in overweight and obese participants.

RESULTS: Following the intervention, both the BL21 group (1.22 ± 2.78, P = 0.02) and placebo group (0.98 ± 2.06, P = 0.01) demonstrated significant body weight reductions, with no statistically significant intergroup difference observed (P = 0.81). Notably, only the BL21 group exhibited a significant reduction in triglyceride levels compared to baseline (0.21 ± 1.09, P = 0.04). Microbiota analysis indicated that BL21 intervention significantly changed the β-diversity at week 8 compared with placebo group. The genera of Parasutterella, Parabacteroides, Blautia, Dorea, Butyricicoccus enriched in BL21 group. Metabolomics results indicated that sphingolipid metabolism, biotin metabolism and protein digestion and absorption were the top altered pathway in BL21 group compared with placebo group after intervention.

CONCLUSION: B. longum subsp. longum BL21 may be a beneficial candidate to modulate the gut microbiota and triglyceride metabolism of overweight and obese individuals.

TRIAL REGISTRATION: Clinical trial registration number: NCT06140641. Date of registration: November 17, 2023.

PMID:40676704 | DOI:10.1186/s12986-025-00969-2

Eur J Med Res. 2025 Jul 18;30(1):639. doi: 10.1186/s40001-025-02911-x.

ABSTRACT

BACKGROUND: Compared with paroxysmal atrial fibrillation, persistent atrial fibrillation (AF) is more harmful and difficult to treat, and the efficacy of different catheter ablation for both also varies greatly. So this study aimed to systematically evaluate the efficacy and safety of cryoballoon (CB) and radiofrequency (RF) ablation in the treatment of persistent AF.

METHODS: We searched the PubMed, Embase, and Cochrane library databases for studies comparing the efficacy and safety between CB and RF ablation for persistent AF. All included studies met our inclusion criteria.

RESULTS: A total of 11 studies, 2551 patients were enrolled in this study, including 1256 patients in CB group and 1295 patients in RF group. Meta-analysis results showed that the freedom from atrial tachyarrhythmia (ATA) recurrence was similar between the CB and RF groups (OR 1.00, 95% CI 0.85 to 1.18, I² 16%). The results of repeated ablation events in the two groups were similar (OR 0.85, 95% CI 0.64 to 1.12, I²45%), while the operative time in the CB group was shorter than that in the RF group (mean reduction 45.27 min, 95% CI 61.34 to 29.20 min, I² 95%). There was no significant difference in fluoroscopy time between the two groups (mean difference 2.12 min, 95% CI 7.83 to 12.07 min, I² 99%). The incidence of total complications was similar between the two groups (OR 1.08, 95% CI 0.74 to 1.58, I² 0%), but phrenic nerve palsy (PNP) was more likely to occur in the CB group (OR 4.84, 95% CI 1.84 to 12.71, I² 0%). The incidence of pericardial tamponade was not statistically different between the two groups (OR 0.72, 95% CI 00.32 to 1.58, I² 0%).

CONCLUSIONS: CB can be used as an alternative therapy to RF for persistent AF, both of which have considerable efficacy and safety. CB can significantly reduce the operation time with the probability of high PNP.

PMID:40676688 | DOI:10.1186/s40001-025-02911-x

Int J Retina Vitreous. 2025 Jul 17;11(1):81. doi: 10.1186/s40942-025-00707-z.

ABSTRACT

BACKGROUND: A macular hole (MH) is a retinal condition affecting the central macula, leading to progressive visual impairment. Pars plana vitrectomy with internal limiting membrane (ILM) peeling is the standard surgical treatment, while the inverted ILM flap technique has emerged as a promising alternative. However, the effectiveness of this technique was still debated.

METHODS: Randomized controlled trials (RCTs) comparing ILM peeling and inverted ILM flap for MH were identified through searches in PubMed, ScienceDirect, Cochrane Library, and ClinicalTrials.gov in the last 15 years that compared ILM peeling and inverted ILM flap procedure. The primary outcome was anatomical closure, and the secondary outcome was visual acuity (VA) post-procedure. Data synthesis was performed using Review Manager (RevMan) 5.4.1 with odds ratio (OR) for anatomical closure and mean difference (MD) for VA with 95% confidence interval (CI). Statistical significance is achieved when the p-value is below 0.05.

RESULTS: Twelve RCTs involving 719 patients were included. The inverted ILM flap showed superior anatomical closure (OR 0.28; 95% CI: 0.15-0.52; p < 0.0001). VA post-procedure, based on follow-up time (3-, 6-, and 12-month), revealed no statistically significant difference in visual outcomes. Sensitivity analyses confirmed anatomical and visual benefits of the inverted flap in large MHs (≥ 400 μm).

CONCLUSION: The inverted ILM flap technique offers better anatomical outcomes than ILM peeling, especially for larger MHs. Visual improvement is variable and may depend on MH chronicity and retinal recovery. Further high-quality studies are needed to confirm these findings.

PMID:40676682 | DOI:10.1186/s40942-025-00707-z

Crit Care. 2025 Jul 17;29(1):310. doi: 10.1186/s13054-025-05528-y.

ABSTRACT

BACKGROUND: Admissions of immunocompromised patients to intensive care units (ICUs) are on the increase. The main reason for admission is acute respiratory failure, predominantly of infectious origin. In such circumstances, early and appropriate antibiotic therapy guarantees a better prognosis. Rapid diagnostic techniques such as multiplex polymerase chain reaction (PCR) have shown their value in both diagnosis and treatment in immunocompetent patients. To date, little data are available on immunocompromised patients.

METHODS: In this retrospective, single-center study, we analyzed data from critically ill immunocompromised patients admitted for acute respiratory failure requiring invasive ventilation, in whom a respiratory specimen was taken and processed simultaneously by BioFire FilmArray Pneumonia Panel multiplex PCR (BFPPm PCR) and conventional culture (CC). Samples had to be taken from deep respiratory tracts less than 48 h after mechanical ventilation. The primary endpoint was the evaluation of the diagnostic performance of BFPP mPCR compared with CC. The secondary endpoint was the therapeutic impact of the results of BFPP mPCR.

RESULTS: One hundred and fourteen patients were included, with immunosuppression mainly of a hematological (35.1%) and oncological (35.1%) nature. The mPCR positivity rate was 36.8%, with the majority identifying enterobacteria (51%) and a median turnaround time of between 2h30 and 4 h. Comparison of rapid techniques with CC showed sensitivity of 89%, specificity of 83%, predictive positive value of 52% and negative predictive value of 98%. Concordance between the two techniques was complete in 84.2% of cases. mPCR enabled antibiotic therapy to be modified in 17.5% of cases, mainly de-escalation.

CONCLUSION: The use of mPCR in the diagnosis of pneumonia in immunocompromised patients shortens the time required to obtain results, and is particularly effective in eliminating the presence of multi-resistant germs. Bacteria detected in culture and not included in the mPCR spectrum were mostly bacteria of low pathogenicity or sensitive to the antibiotics usually prescribed. The mPCR technique could reduce exposure to broad-spectrum antibiotics in this population.

PMID:40676679 | DOI:10.1186/s13054-025-05528-y