Nevin Manimala

Eur J Clin Microbiol Infect Dis. 2025 Aug 15. doi: 10.1007/s10096-025-05234-1. Online ahead of print.

ABSTRACT

BACKGROUND: Intracranial infections due to carbapenem-resistant organisms (CRO) pose substantial challenges in the neurosurgical intensive care unit (NICU). The increasing prevalence of infections caused by carbapenem-resistant Acinetobacter (CRAB) and carbapenem-resistant Klebsiella pneumoniae (CRKP) necessitates the development of novel treatment strategies. This prospective observational study aims to evaluate the efficacy and safety of intraventricular/intrathecal polymyxin B sulfate (PBS) in NICU patients after neurosurgery.

METHODS: We enrolled patients diagnosed with hospital-acquired post-neurosurgical central nervous system (CNS) infections caused by CRO at Fudan University-affiliated Huashan Hospital between January 2021 and December 2023. Detailed information on demographic characteristics, course of CRO infection treatment and follow-up data was recorded for each patient collected in this study. Upon diagnosis, all external devices were immediately removed. The treatment regimen included local intraventricular/intrathecal PBS injections, systemic antibiotics, and cerebrospinal fluid (CSF) drainage. The Fisher exact test, theχ² test, and the Student t-test were used for statistical analysis as appropriate.

RESULTS: Among the 27 patients included in this study, 13 were infected with CRAB and 14 with CRKP, with a mean age of 49.4 ± 16.54 years. 96.3% patients had undergone surgical procedures prior to diagnosis, of which 66.7% involved combined surgeries. At the onset of infection, the mean Glasgow Coma Scale (GCS) score was 6.0 ± 2.17, the average APACHE II score was 17.3 ± 3.80, and the mean SOFA score was 5.9 ± 2.20. The total bacterial clearance rate of CSF was 81.5% (22/27), with CRAB cases achieving a clearance rate of 92.3% and CRKP cases achieving 71.4% (p = 0.163). The clinical cure rates were 69.2% (9/13) for CRAB and 64.2% (9/14) for CRKP. Importantly, the mean duration from the onset of CNS infection to the initiation of intraventricular/intrathecal injection was 4.3 ± 5.01 days, while the mean duration of treatment was 9.9 ± 3.92 days. The time to achieve negative CSF cultures averaged 10.6 ± 7.02 days. No significant differences were found between the CRAB and CRKP groups, except for variations in sex ratio.

CONCLUSION: The findings of our study verified the efficacy and safety of intraventricular/intrathecal PBS in treating CRO-related intracranial infections in neurosurgical patients. The combination of local PBS administration and systemic antibiotic therapy offers a more efficient treatment approach for these complex infections.

PMID:40815361 | DOI:10.1007/s10096-025-05234-1

Int J Clin Pharm. 2025 Aug 15. doi: 10.1007/s11096-025-01987-z. Online ahead of print.

ABSTRACT

BACKGROUND: The second victim phenomenon, referring to the impact of patient safety incidents on healthcare professionals, also affects pharmacists. Dispensing errors or inadequate counselling cause anxiety, reduced motivation, and staff turnover. Support programmes exist for healthcare professionals, but not specifically for pharmacists.

AIM: To explore pharmacists’ perceptions of tailored education to enhance competencies in overcoming second victim experiences, including (i) potential impacts, (ii) recommended content for professional development and undergraduate curricula, (iii) preferred design and delivery methods, and (iv) experience with existing programmes.

METHOD: A qualitative focus group study using the experiences, opinions, and recommendations approach was conducted in Serbia. Data were collected through a semi-structured guide and a self-reported questionnaire on participation in existing programmes. Discussions continued until saturation. Recordings were transcribed verbatim and analysed using the inductive thematic approach with MAXQDA software. Descriptive statistics summarised programme participation.

RESULTS: Participants perceived tailored education as necessary for improving error response, empowering individuals and the profession, and enhancing pharmaceutical care. Thematic analysis identified four themes: (i) impacts of tailored programmes, (ii) topics for professional development, (iii) topics for undergraduate curricula, and (iv) programme design and delivery. Key areas included soft skills, risk and stress management. Undergraduate education should strengthen communication, motivation, and career development. Preferred methods were workshops and blended learning. Of 25 participants, 20 (80%) attended support programmes; 20 (80%) reported improved competence, and 20 (80%) would recommend them to colleagues.

CONCLUSION: Community pharmacists perceived tailored education addressing second victim experiences as important for professional resilience and improving pharmaceutical care.

PMID:40815352 | DOI:10.1007/s11096-025-01987-z

Food Environ Virol. 2025 Aug 15;17(3):44. doi: 10.1007/s12560-025-09659-x.

ABSTRACT

Cosavirus (CoSV) and Salivirus (SalV) are two novel picornaviruses that are associated with human diseases. However, epidemiological data on these viruses in China remain limited. In this study, we conducted the first simultaneous investigation of CoSV and SalV in a city of eastern China by wastewater-based epidemiology (WBE) method. From 2021 to 2023, a total of 21 influent wastewater samples were collected. After virus concentration and molecular detection, 71.43% (15/21) and 80.95% (17/21) of samples tested positive for CoSV and SalV, respectively. The sequences of CoSV were determined to be CoSV-A and CoSV-D, and SalV were all genotyped to be SalV-A1. Phylogenetic analysis showed that UTR region of CoSV-D and 3D region of CoSV-A can be divided into several clusters. UTR region of CoSV-A, UTR and 3D region of SalV-A1 were not clustered. Furthermore, the sequences in this study were closely related to some strains from human samples in China and wastewater samples in other countries. These findings reveal that CoSV and SalV circulated at a high prevalence in the local population and demonstrate that WBE is an effective method for novel picornaviruses research.

PMID:40815335 | DOI:10.1007/s12560-025-09659-x

Lasers Med Sci. 2025 Aug 15;40(1):336. doi: 10.1007/s10103-025-04583-9.

ABSTRACT

This study aimed to investigate the synergistic effects of Er, Cr: YSGG laser and fluoride varnish (Duraphat) on the remineralization of demineralized enamel in vitro. The study further compared the combined treatment with the individual effects of the laser and Duraphat, providing a theoretical foundation and technical insights for early caries management. A randomized controlled study was conducted, involving 50 extracted teeth assigned to four groups: control, laser only, Duraphat only, and a combination of laser and Duraphat. Following standardized demineralization protocols, samples underwent respective remineralization treatments. The mineralization level was quantified using a DIAGNOdent pen, and enamel surface microstructural changes were assessed via scanning electron microscopy (SEM). Data were analyzed using one-way ANOVA and paired-sample t-tests, with statistical significance set at P < 0.05. The laser and Duraphat combination group exhibited the most pronounced remineralization effects, as indicated by a significant reduction in DIAGNOdent values (P < 0.05), outperforming both the laser-only and Duraphat-only groups. SEM analysis demonstrated uniform and dense crystal deposition on the enamel surface, nearly sealing demineralized pores. In contrast, the Duraphat group showed surface-concentrated crystal deposition with limited depth, while the laser group primarily improved enamel surface microstructure without significantly increasing mineralization depth. No notable changes were observed in the control group.The combination of Er, Cr: YSGG laser and Duraphat significantly enhances remineralization by optimizing enamel microstructure and improving fluoride penetration depth and mineralization efficiency, surpassing the efficacy of individual treatments.

PMID:40815334 | DOI:10.1007/s10103-025-04583-9

Environ Geochem Health. 2025 Aug 15;47(9):389. doi: 10.1007/s10653-025-02686-4.

ABSTRACT

The increasing adoption of photovoltaic farms is driven by the growing demand for clean, renewable energy. As advancements in solar technology continue and costs decrease, large-scale solar farms are becoming essential for reducing carbon emissions and enhancing energy security. While PV farms offer a sustainable energy solution, they also pose environmental risks. During their operational lifetime, PV panels can be damaged, potentially releasing hazardous materials into the environment. Additionally, stormwater runoff from solar installations may carry pollutants into soil and water sources. Mitigating these risks is crucial to ensuring that solar energy remains both sustainable and environmentally responsible. This work aims to evaluate PV panels’ environmental impact, especially on the soil in one of the oldest PV installations in Poland, comparing it with other sources of pollution in the region, such as mining. Therefore, soil and water samples underwent chemical analysis, statistical analysis, pollution indices assessment, and geospatial analysis to determine potential pollution sources for the observed elemental chemical matrix. Also, the chemical composition of PV material was analyzed. The results indicate that In and Sb are emerging pollutants at moderate levels, potentially originating from long-term use of PV installations. In contrast, elements such as Cd, Cr, Pb, and Zn, which come from mining and smelting activities, present significantly higher environmental risks. This study suggests conducting further similar research across various geological backgrounds to draw broader conclusions. Besides, it is vital to develop experiments that assess the impact of PV panels as hazardous waste materials on soil and water.

PMID:40815333 | DOI:10.1007/s10653-025-02686-4

Discov Ment Health. 2025 Aug 15;5(1):122. doi: 10.1007/s44192-025-00244-z.

ABSTRACT

BACKGROUND: Recognizing the importance of spiritual health in professional practice is crucial for providing effective patient care. This study examines the relationship between spiritual health and professionalism among Iranian operating room interns in 2024.

METHODS: A cross-sectional study investigated the relationship between spiritual health and professionalism among Iranian operating room interns in 2024. A random sample of 151 students completed a three-part questionnaire assessing demographics, the Spiritual Well-Being Scale (SWBS) developed by Ellison (1983), and the Penn State Professionalism Questionnaire (PSPQ) developed by Black et al. (2007). Data analysis, using SPSS version 26.0, included descriptive statistics and correlation analyses.

RESULTS: Participants had a mean (standard deviation) age of 23.24 (6.23) years, predominantly female (67.5%), mostly in their eighth semester (64.2%), with 70.2% achieving an average grade below 18 (out of 20 points). Mean (SD) scores indicated spiritual well-being at 89.23 (18.93) and professionalism at 137.75 (15.08), with religious well-being 47.66 (10.47) exceeding existential well-being 41.57 (9.66). Among professionalism dimensions, respect (25.36 ± 3.33) and honor and integrity (23.89 ± 3.39) ranked highest, while altruism (20.97 ± 3.05) and duty (21.79 ± 3.36) were lower. A significant relationship was found between religious well-being and all professionalism dimensions, while existential well-being correlated with accountability, duty, and excellence.

CONCLUSION: The findings suggest that enhancing spiritual well-being, particularly religious aspects, may foster professionalism in medical practice, ultimately contributing to improved patient care and intern development in the healthcare setting.

PMID:40815331 | DOI:10.1007/s44192-025-00244-z

Eur Radiol. 2025 Aug 15. doi: 10.1007/s00330-025-11929-y. Online ahead of print.

ABSTRACT

OBJECTIVES: This study evaluates the efficiency, accuracy, and cost-effectiveness of radiology reporting using audio multimodal large language models (LLMs) compared to conventional reporting with speech recognition software. We hypothesized that providing minimal audio input would enable a multimodal LLM to generate complete radiological reports.

MATERIALS AND METHODS: 480 reports from 80 retrospective multimodal imaging studies were reported by two board-certified radiologists using three workflows: conventional workflow (C-WF) with speech recognition software to generate findings and impressions separately and LLM-based workflow (LLM-WF) using the state-of-the-art LLMs GPT-4o and Claude Sonnet 3.5. Outcome measures included reporting time, corrections and personnel cost per report. Two radiologists assessed formal structure and report quality. Statistical analysis used ANOVA and Tukey’s post hoc tests (p < 0.05).

RESULTS: LLM-WF significantly reduced reporting time (GPT-4o/Sonnet 3.5: 38.9 s ± 22.7 s vs. C-WF: 88.0 s ± 60.9 s, p < 0.01), required fewer corrections (GPT-4o: 1.0 ± 1.1, Sonnet 3.5: 0.9 ± 1.0 vs. C-WF: 2.4 ± 2.5, p < 0.01), and lowered costs (GPT-4o: $2.3 ± $1.4, Sonnet 3.5: $2.4 ± $1.4 vs. C-WF: $3.0 ± $2.1, p < 0.01). Reports generated with Sonnet 3.5 were rated highest in quality, while GPT-4o and conventional reports showed no difference.

CONCLUSION: Multimodal LLMs can generate high-quality radiology reports based solely on minimal audio input, with greater speed, fewer corrections, and reduced costs compared to conventional speech-based workflows. However, future implementation may involve licensing costs, and generalizability to broader clinical contexts warrants further evaluation.

KEY POINTS: Question Comparing time, accuracy, cost, and report quality of reporting using audio input functionality of GPT-4o and Claude Sonnet 3.5 to conventional reporting with speech recognition. Findings Large language models enable radiological reporting via minimal audio input, reducing turnaround time and costs without quality loss compared to conventional reporting with speech recognition. Clinical relevance Large language model-based reporting from minimal audio input has the potential to improve efficiency and report quality, supporting more streamlined workflows in clinical radiology.

PMID:40815310 | DOI:10.1007/s00330-025-11929-y

Eur Radiol. 2025 Aug 15. doi: 10.1007/s00330-025-11927-0. Online ahead of print.

ABSTRACT

OBJECTIVES: To explore the different criteria of integrating diffusion-weighted imaging (DWI) for predicting pathologic complete response (pCR) of rectal cancer on post-chemoradiotherapy (CRT) MRI.

MATERIALS AND METHODS: In this multi-center retrospective study, five radiologists reviewed pre- and post-CRT MRIs of patients with rectal cancer diagnosed in 2017-2021. In addition to mrTRG, three criteria were assessed: “AND” criterion (mrTRG 1-2 and absence of DWI restriction considered as CR), “OR” criterion (mrTRG 1-2 or absence of restriction), and a modified MR tumor regression grade (modMR-TRG). A crossed random effects model was used to pool sensitivity and specificity across five radiologists. F1 score and positive predictive value (PPV) were analyzed across varying pCR rates.

RESULTS: In 146 patients (median age [IQR], 63 [57-70] years; 87 men), the AND criterion yielded higher specificity (77.4% [63.3-80.0%] vs 75.3% [60.5-79.0%], p = 0.001) without significant difference in sensitivity (63.9% [42.8-75.3%] vs 67.5% [45.3-76.0%], p = 0.063) compared with mrTRG. OR criterion yielded higher sensitivity (86.1% [65.3-89.3%]; p < 0.001) but lower specificity (49.5% [36.2-62.6%]; p < 0.001). The modMR-TRG demonstrated similar effects to the OR criterion. Assuming a 20% pCR rate, PPV and F1 score of the AND criterion (point estimate of 41.4% and 50.3%, respectively) were higher than those of the OR criterion (PPV, 29.9%; F1 score, 44.4%), although the difference diminished with increasing pCR rate.

CONCLUSION: The AND criterion-which utilizes DWI complementarily to further exclude patients with residual tumors after initial screening on T2WI-should be preferred over other criteria giving greater emphasis on DWI.

KEY POINTS: Question How should diffusion-weighted images be combined with T2-weighted images in predicting complete tumor response of rectal cancer on MRI following CRT? Findings Compared to mrTRG, the AND criterion yielded higher specificity without a significant difference in sensitivity, while the OR and modMR-TRG criteria yielded higher sensitivity but lower specificity. Clinical relevance Our study explores practical strategies for integrating DWI with T2WI that can be applied in daily practice. The AND criterion by using DWI conservatively is preferred over OR criteria, which results in a disproportionately higher number of additional false-positives than additional true-positives.

PMID:40815309 | DOI:10.1007/s00330-025-11927-0

Glob Health Sci Pract. 2025 Aug 14;13(1):e2400177. doi: 10.9745/GHSP-D-24-00177. Print 2025 Aug 14.

ABSTRACT

INTRODUCTION: Gender-based violence (GBV) not only poses significant public health and human rights challenges but is also closely associated with HIV. GBV acts as a barrier to HIV prevention, testing, and treatment adherence, and fear of GBV inhibits disclosure of HIV status to sexual partners. In Malawi, where both GBV and HIV prevalence is high, integrating GBV services into HIV care is crucial. We describe the integration of GBV services into Lighthouse Trust’s HIV testing and treatment clinics in Malawi, including screening, documentation, intervention implementation, outcomes, and lessons learned.

METHODS: We conducted a retrospective analysis from January 2020 to June 2024. Data on cases identified, post-GBV services, and perpetrator demographics were collected from the GBV register. We used descriptive statistics to describe the intervention outcomes.

RESULTS: We documented 9,045 reported GBV cases among males and females from January 2020 to June 2024. Adolescent girls aged 10-19 years constituted a significant proportion of survivors. Psychosocial services were the most common type of service that was offered to GBV survivors (25%), followed by HIV testing (19%) and sexually transmitted infection screening (18%). Perpetrators were mostly known to survivors.

CONCLUSION: We successfully integrated GBV services into the Lighthouse Trust HIV clinics in close collaboration with the one-stop centers in Malawi. Training health care providers enhanced support for GBV survivors, with a focus on increasing awareness, especially for children and adolescents. Recommended actions include improving access to GBV services, enhancing documentation, and promoting multi-sectoral collaboration to ensure comprehensive care aimed at creating a safer, more dignified health care environment for all, particularly GBV survivors.

PMID:40813243 | DOI:10.9745/GHSP-D-24-00177

J Nucl Med. 2025 Aug 14:jnumed.124.269234. doi: 10.2967/jnumed.124.269234. Online ahead of print.

ABSTRACT

Deep learning (DL) represents a promising technique for image restoration. We explored its ability to restore ultra-low-count [¹⁸F]FDG PET studies of the brain in subjects with dementia and in healthy subjects to allow for reduced scan durations or administered activities without compromising diagnostic performance. Methods: Various DL models using the content aware image restoration approach of CSBDeep toolbox (3D U-nets) were trained with subvolumes of 1,000 random subjects. On the basis of 10-min list-mode PET data after injection of 208 ± 10 MBq of [¹⁸F]FDG, we reconstructed reduced scan durations of 2 min, 1 min, 30 s, 20 s, and 10 s. The resulting models were applied to [¹⁸F]FDG PET scans of subjects with Alzheimer disease (n = 15), frontotemporal dementia (n = 14), and healthy controls (n = 13). We explored the effect of reduced scan times on individual regional measures in diagnostically relevant regions and on voxel-based group contrasts. Three independent readers rated all datasets with regard to assessability, diagnosis, and diagnostic confidence. Results: Individual mean regional [¹⁸F]FDG uptake remained largely unchanged. The SD strongly increased with shorter scan duration without application of DL (mean increase ≤ 48%), whereas it slightly decreased with DL (≥-7%). In group contrasts, the number of significant voxels strongly decreased with shorter scan time without DL (≥-41%), which was partially offset by DL (≥-27%). On visual reads, the fraction of assessable images steeply fell to only 4% (10-s scan) for scan durations below 2 min without DL, whereas every single image restored with DL was assessable. The diagnostic confidence continuously declined with shorter scan durations without DL, whereas diagnostic confidence only negligibly changed with DL (intermediate-to-high confidence ratings: 0%-54% vs. 80%-84%; 83% for the 10-min scan). The diagnostic accuracy of PET reads dropped from 90% to 4% without and remained high with DL (90%-93%; 90% for the 10-min scan). Conclusion: Our study demonstrates the compelling performance of DL to restore cerebral [¹⁸F]FDG PET datasets with ultra-low-count statistics for quantitative regional, voxel-based group, and clinical visual analyses. Consequently, DL enables a dramatic reduction of scan durations or administered activities (e.g., 10-min scan with 3.5 MBq, equivalent to ∼60 µSv) for [¹⁸F]FDG PET in patients with dementia and possibly other indications.

PMID:40813236 | DOI:10.2967/jnumed.124.269234