Nevin Manimala

Pak J Med Sci. 2025 Jun;41(6):1743-1748. doi: 10.12669/pjms.41.6.11856.

ABSTRACT

OBJECTIVE: To investigate clinical efficacy of novel biogenically fabricated titania nanoparticles enriched mouth wash in treating dentin sensitivity of patients.

METHODS: Tripple blinded randomized clinical trial was conducted at School of Dentistry Islamabad from 6^th June 2024 to 6^th December 2024 incorporating participants (n = 260) with Group-A (n = 130) and Group-B (n = 130). After attaining informed consent and randomization, Visual Analog Scoring system (VAS Value) was induced to check the Dentin hypersensitivity (DH) of the participants at baseline, after one month and three months follow up. Group-A was given Conventional Mouth wash and Group-B was given Novel-Nanoparticles (Nps) Mouth Wash for total three months to treat DH. The primary outcome was calculated as mean VAS Values for both Groups-A and B after one month and three months. Mann-Whitney-U Test was used for comparing DH between these two groups.

RESULTS: According to trial results, significant difference was obtained between Group -A that used Conventional Mouth wash and Group-B that used Novel- Nps Mouth wash after one month (p = 0.001) and three months (p = 0.002).

CONCLUSION: DH declination was more prominent in patients that used Novel- Nps Mouth wash with nanoparticles in comparison to participants that used Conventional Mouth wash without any nanoparticles. This concludes that inclusion of biogenically fabricated titania nanoparticles in clinical dentistry could be beneficial in resolving Dentin Hypersensitivity.

PMID:40621550 | PMC:PMC12223751 | DOI:10.12669/pjms.41.6.11856

Pak J Med Sci. 2025 Jun;41(6):1734-1742. doi: 10.12669/pjms.41.6.12187.

ABSTRACT

BACKGROUND & OBJECTIVE: Recent studies have showed a correlation between hyperglycemia and insulin resistance with adverse outcomes in multiple critical diseases, including sepsis. The triglyceride-glucose index (TyGi) is now recognized as a proxy indicator of insulin therapy resistance. We aimed to ascertain the connection between TyGi and the sepsis prevalence and clinical outcomes in patient’s post-abdominal surgery.

METHOD: Data for this retrospective cohort study was acquired from the Medical Information Mart for Intensive Care IV database from 2008 to 2019. Patients (≥18 years) who had elective major abdominal surgery were included. The primary outcome was the occurrence of sepsis following abdominal surgery. The connection between TyGi and sepsis incidence was investigated with multivariable Cox regression analysis.

RESULTS: One thousand eight hundred eighty-four patients were included in this study. The cumulative incidence of sepsis during hospitalization was 12.3%. The adjusted Cox regression model showed that raised TyGi levels were linked to a greater probability of sepsis incidence (Hazard’s ratio, 1.907; 95% CI, 1.327-2.739; p<0.001). Restricted Cubic Spline analysis demonstrated that TyGi possessed a strong and almost linear connection with the likelihood of postoperative sepsis. Subgroup analysis showed interaction effects in the subgroup with low high-density lipoprotein cholesterol (p for interaction=0.018). Furthermore, the incorporation of TyGi into the existing prediction model shows an enhancement in outcome prediction. The C-statistic elevated from 0.696 to 0.722, p<0.007. The continuous net reclassification improvement (NRI) was 0.203, p=0.005, and the integrated discrimination improvement (IDI) was 0.007, p<0.001.

CONCLUSION: Patients at increased risk of developing sepsis following abdominal surgery may be identified in clinical practice with TyGi.

PMID:40621548 | PMC:PMC12223748 | DOI:10.12669/pjms.41.6.12187

Pharmacoepidemiol Drug Saf. 2025 Jul;34(7):e70177. doi: 10.1002/pds.70177.

ABSTRACT

Multi-database distributed data networks for post-marketing surveillance of drug safety and effectiveness use two main approaches: common data models (CDMs) and common protocols. Networks such as the U.S. Sentinel System, the Observational Health Data Sciences and Informatics (OHDSI) network, and the Data Analysis and Real-World Interrogation Network in Europe (DARWIN-EU) use a CDM approach in which participating databases are translated into a standardized structure so that a single, common analytic program can be used. On the other hand, the common protocol approach involves applying a single common protocol to site-specific data maintained in their native format, with analytic programs tailored to each data source. Some networks, such as the Canadian Network for Observational Drug Effect Studies (CNODES) and the Asian Pharmacoepidemiology Network (AsPEN), use a variety of approaches for multi-database studies. Regardless of the approach, distributed networks support comprehensive pharmacoepidemiologic studies by leveraging large-scale health data. For example, utilization studies can uncover prescribing trends in different jurisdictions and the impact of policy changes on drug use, while safety and effectiveness studies benefit from large, diverse patient populations, leading to increased precision, representativeness, and potential early detection of safety threats. Challenges include varying coding practices and data heterogeneity, which complicate the standardization of evidence and the comparability and generalizability of findings. In this Core Concepts paper, we review the purpose and different types of distributed data networks in pharmacoepidemiology, discuss their advantages and disadvantages, and describe commonly faced challenges and opportunities in conducting research using multi-database networks.

PMID:40619597 | DOI:10.1002/pds.70177

J Dermatolog Treat. 2025 Dec;36(1):2526073. doi: 10.1080/09546634.2025.2526073. Epub 2025 Jul 6.

ABSTRACT

PURPOSE: Onychomycosis, in contrast to other routine superficial dermatophyte infections, is difficult to treat and poor outcomes are not unusual. Few guidelines for onychomycosis management have been published, and these vary considerably from region to region. To meet global antifungal stewardship (AFS) goals, there must be global management guidelines for clinicians to follow in their onychomycosis practice. We aimed to survey current practices for onychomycosis management across a variety of global regions and compare practices to published treatment guidelines, as well as to what degree the management practices may facilitate AFS practices.

MATERIALS AND METHODS: An informal literature review was performed to identify regional onychomycosis guidelines. An online survey of our colleagues was distributed to assess current onychomycosis management practices and challenges for comparison with associated regional guidelines. Guidelines and practices were reviewed for adherence to the general AFS principles.

RESULTS: Our review of current practices shows that, despite guidelines, identification of the infecting species is often not obtained, and treatment provision does not strictly follow existing guidelines. Lack of laboratory access prevents diagnosis and antifungal susceptibility testing that can help provide targeted treatments and resistance surveillance. Better diagnostic methods are needed as a component to improve management decisions, and provide the reliable monitoring required for effective AFS. Broader clinical testing is needed to address knowledge gaps in onychomycosis therapy. Meeting these challenges must be a priority as antifungal resistance is quickly becoming a worldwide problem.

CONCLUSIONS: As a reservoir for resistant strains, onychomycosis represents a significant future medical/economic burden. Future onychomycosis guidelines must address the challenge of resource limitations experienced by clinicians, as well as the challenge of balancing the need for AFS principles with the specific needs of onychomycosis therapy.

PMID:40619586 | DOI:10.1080/09546634.2025.2526073

Anat Sci Educ. 2025 Jul 6. doi: 10.1002/ase.70084. Online ahead of print.

ABSTRACT

Postmortem body donation (BD) plays a central role in medical education and scientific research. Sociocultural, religious, and legal factors can influence attitudes toward BD. In Italy, BD programs are in early development, and recent legislation (Law 10/2020) regulating body donation came into effect in 2021. Although international surveys have explored attitudes toward BD, data specific to the Italian context remain limited. This study provides initial insights into attitudes and willingness to donate among medical academics and students at an Italian university. A cross-sectional study was conducted between February and March 2023 using an online questionnaire. The survey collected data on attitudes, dissection experience, sociodemographic, and academic background. A multivariate logistic regression model was implemented to evaluate factors associated with willingness to donate. Of the 2273 individuals invited, 434 completed the questionnaire (19.4% response rate, 70% female, 88% students). Overall, 72.8% were willing to donate. Knowing organ donors was associated with higher willingness, whereas religious beliefs were negatively associated. Only 32% of participants were aware of the national law regulating BD. This study highlights the predominance of positive attitudes toward BD within a healthcare-oriented academic population and the significant influence of religion and personal experience. The limited awareness of Law 10/2020 underscores the need for targeted educational efforts, even within expert communities. These findings support future initiatives aimed at improving awareness, shaping national policy, and contributing to the global discourse on ethical and practical aspects of body donation.

PMID:40619569 | DOI:10.1002/ase.70084

J Prosthodont. 2025 Jul 6. doi: 10.1111/jopr.14097. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the impact of different complete-arch digital scanning techniques and prosthesis types on the passive fit of computer-aided design and computer-aided manufacturing (CAD-CAM) verification devices.

MATERIALS AND METHODS: Two different maxillary master casts with four multi-unit abutment (MUA) implant analogs (FP-1 and FP-3 prosthesis types) were used as the basis for fabricating verification devices through two impression techniques (OptiSplint and RevEX). Group 1 utilized digital scans of splinted scanbodies reinforced with a light-polymerizing acrylic resin and metal mesh on the FP-1 cast (OptiSplint technique), Group 2 employed the same impression technique as Group 1 on the FP-3 cast, Group 3 applied digital scans of reverse scanbodies connected to a passively fitting interim prosthesis on FP-1 cast (RevEX technique), and Group 4 used the same impression technique as Group 3 on FP-3 cast. A total of 40 milled verification devices were fabricated, with 10 devices allocated to each group. The misfit of verification devices was assessed using visual inspection, tactile sensation, and a one-screw test, with any disagreements between the two primary examiners resolved by a third evaluator. Agreement between the clinicians was assessed using Cohen’s kappa statistics and percent agreement. The percentage of misfits was calculated for each group and compared between groups using Fisher’s exact tests (α = 0.05).

RESULTS: The misfit analysis showed the lowest misfit (10%) in Group 1 (OptiSplint-FP1), followed by Groups 3 (RevEX-FP1) and 4 (RevEX-FP3) at 20%, and the highest (40%) in Group 2 (OptiSplint-FP3), with no significant differences between groups by Fisher’s exact tests (p > 0.05). Odds ratios indicated six times higher misfit odds for FP-3 than FP-1 with OptiSplint, no difference for FP-1 versus FP-3 with RevEX (odds ratio = 1.0), and lower odds with RevEX compared to OptiSplint under FP-3 conditions (odds ratio = 0.375). Inter-examiner agreement was strong, with 90% concordance and a Kappa statistic of 0.66, demonstrating substantial consistency.

CONCLUSION: OptiSplint is preferable for FP1 cases, whereas RevEX suits FP3 cases when intraoral-scanner-based extraoral workflows are used. Despite these recommendations, misfits occurred in every group, suggesting that a verification cast may be prudent when adopting these newer scanning approaches. Clinicians should consider fabricating an additional verification cast with splinted scanbodies or a clinically satisfactory interim implant prosthesis. This cast can confirm implant positions whenever modern scanbodies such as OptiSplint or RevEX are incorporated into the workflow.

PMID:40619568 | DOI:10.1111/jopr.14097

J Prosthodont. 2025 Jul 6. doi: 10.1111/jopr.14098. Online ahead of print.

ABSTRACT

PURPOSE: This study investigated the influence of cement gap size on the marginal and internal fit, and cement gap size and type on retention of additively manufactured zirconia (AM-Z) crowns on titanium bases (Ti-base).

MATERIALS AND METHODS: A total of 135 zirconia crowns were designed with three different cement gap sizes: 20 µm, 30 µm, and 40 µm (n = 45 per group). The crowns were additively manufactured using a lithography-based ceramic 3D printer (Cerafab, Lithoz GmbH, Austria) and a zirconia slurry (LithaCon 3Y 210, Lithoz GmbH, Austria). All crowns, Ti-base (RC Variobase, Straumann, Switzerland), and crown-Ti-base assemblies were scanned, and the marginal and internal gaps were measured using specialized software, following the triple scan protocol. Specimens were further divided into three subgroups based on the resin luting agent used for bonding the crowns to the Ti-bases (n = 15 per subgroup): Group PV21 used Panavia 21 (P21) (Kuraray Noritake Dental Inc., Japan), Group PV5 used Panavia V5 (PV5) (Kuraray Noritake Dental Inc., Japan), and Group MHA used Multilink Hybrid Abutment (Ivoclar Vivadent, Liechtenstein). After cementation, specimens were subjected to thermocycling between 5°C and 55°C. Pull-out forces between the additively manufactured zirconia (AM-Z) crowns and Ti-bases were measured using a universal testing machine. Variance analysis was conducted on root mean square (RMS) values for internal and marginal gaps, as well as pull-out forces (α = 0.05).

RESULTS: The one-way analysis of variance test revealed a statistically significant difference in marginal discrepancy values (p < 0.001). A post-hoc Tukey analysis indicated that the marginal (25.9 µm) and internal discrepancy (24.6 µm) values associated with the 30 µm cement gap size were higher than those obtained with other cement gap sizes (p < 0.01). No significant differences were found between the 20 µm and 40 µm cement gap sizes (p = 0.113). The 30 µm cement gap group demonstrated lower discrepancies. Both cement gap size and cement brand significantly influenced the marginal and internal fit, as well as the pull-out resistance of the crowns. The impact of the cement brand, the cement gap size, and their interaction significantly affected the retention between the Ti-bases and crowns (p < 0.01). The use of P21 with a 30 µm gap resulted in significantly higher pull-out values than P21 with a 20 µm gap (p = 0.008) and P21 with a 40 µm gap (p = 0.004). Retention with a 40 µm cement gap was not significantly different from that with a 20 µm cement gap, regardless of the cement brand (p = 0.089). PV5 presented the lowest pull-out values across all cement gap sizes (p = 0.02).

CONCLUSION: Cement gap size significantly affected the fit, and cement gap size and type significantly impacted the retention between AM-Z crowns and Ti-bases. Cement space of 30 µm and PV21 resin luting agent led to improved adaptation and high bonding strength.

PMID:40619567 | DOI:10.1111/jopr.14098

J Egypt Natl Canc Inst. 2025 Jul 7;37(1):38. doi: 10.1186/s43046-025-00297-9.

ABSTRACT

BACKGROUND: The literature on nutrition support therapy prescribing practices by physicians and the roles of nutrition support pharmacists in palliative and hospice care cancer patients is limited.

METHODS: The study aimed to analyze the prescribing practices of physicians and the roles of clinical pharmacists at a tertiary cancer center. A retrospective analysis of 12527 electronic records of hospice and palliative care cancer patients. All nutrition support therapy prescriptions by physicians and clinical pharmacists’ interventions were recorded. Analysis was conducted utilizing the Jamovi statistical package 2022.

RESULTS: The study population comprised inpatients and homecare patients. The most frequently prescribed nutrition support therapy was vitamins and minerals supplements, followed by enteral nutrition and parenteral nutrition. The total number of nutrition support pharmacist interventions was 660 (5.2%). The acceptance rate of interventions by physicians was 90%. Initiating mineral use was the most frequent intervention, followed by discontinuation of mineral use.

CONCLUSION: Vitamins and mineral supplements are the most prescribed type of nutrition support therapy. The interventions of clinical pharmacists were highly accepted by physicians. Initiating mineral use is the most frequent intervention. Further research is needed to explore the impact of nutrition support therapy on patient outcomes and barriers to its implementation.

PMID:40619553 | DOI:10.1186/s43046-025-00297-9

Sci Rep. 2025 Jul 6;15(1):24115. doi: 10.1038/s41598-025-09362-8.

ABSTRACT

The cortical thickness index (CTI) is a radiological measure and correlates with diminishing local bone quality in the proximal femur. The objective of this study was to assess the association between a lower CTI and the occurrence of peri- and postoperative surgical complications. A total of 228 consecutive patients treated with endomedullary nailing for trochanteric fracture (TFx) (AO/OTA 31A1.1-31A2.3) (n = 99) and hemi-/total hip arthroplasty for femoral neck fracture (AO/OTA 31B1-B3) (FNFx) (n = 129) with a mean age of 82 ± 9.9 (50-99) years were retrospectively reviewed. An evaluation of these cases was conducted to ascertain the presence of any surgery-related complications. Eighteen patients (7.9%) undergoing revision surgery were identified. Patient demographics and radiographic measurements of these groups were compared to the cases without complications (n = 210) and statistically analysed. A total of 18 patients (7.9%) with complications who underwent revision surgery were identified. Among the total number of patients, 10 (55.6%) exhibited mechanical complications. The remaining patients underwent a subsequent revision due to infection (n = 4), seroma/hematoma (n = 3), or a running wound (n = 1). The FNFx group exhibited a lack of intraoperative fractures; however, two periprosthetic fractures occurred subsequent to another fall (36 and 59 days postoperatively). A total of five incisions or extractions of the helical blade were identified in the TFx group. The following factors contributed to the necessity for revision: tractus irritation (n = 2), one intraoperative fracture, one running wound, and one seroma. Among all of the variables that were analyzed, including age, body mass index, and hemoglobin level, only the CTI of the affected side in the TFx group was found to be significantly higher in the complications group, as well as the mechanical complications group (0.51 ± 0.09, 0.58 ± 0.05, 0.58 ± 0.05; p = 0.029). Poor local bone quality, as indicated by a low CTI, is not associated with increased complication rates following surgically managed proximal femoral fractures. Instead, the predominant contributors to mechanical complications seem to emanate from alternative factors, such as insufficient fracture reduction and suboptimal blade positioning.

PMID:40619545 | DOI:10.1038/s41598-025-09362-8

J Robot Surg. 2025 Jul 7;19(1):357. doi: 10.1007/s11701-025-02533-9.

ABSTRACT

The recent meta-analysis by Liu et al. comparing postoperative functional complications and quality of life (QoL) between robot-assisted radical prostatectomy (RARP) and radiotherapy (RT) in localized prostate cancer raises important clinical questions but is constrained by methodological and interpretative limitations. Our commentary identifies four key issues: (1) inadequate adjustment for baseline confounding factors such as age, comorbidities, and androgen deprivation therapy exposure; (2) unstandardized aggregation of patient-reported outcome measures (PROMs), impairing statistical comparability; (3) absence of modality-specific stratification within the RT group, which combines external beam and brachytherapy despite differing toxicity profiles; and (4) overinterpretation of functional outcome trends without accounting for follow-up duration and evolving surgical techniques. These issues undermine the validity of the authors’ conclusions regarding RT’s superiority in functional recovery. We argue that future comparative effectiveness research should employ harmonized PROM frameworks, robust causal inference methodologies, and biologically stratified cohort analyses. Our critique underscores the need for precise, individualized assessment in treatment decision-making for localized prostate cancer and supports the broader scientific imperative for methodologically sound patient-centered outcomes research in robotic and radiotherapeutic oncology.

PMID:40619543 | DOI:10.1007/s11701-025-02533-9