Nevin Manimala

Indian J Pathol Microbiol. 2025 Jun 7. doi: 10.4103/ijpm.ijpm_174_24. Online ahead of print.

ABSTRACT

BACKGROUND: Oral cancer is the common reason for the poor prognosis in head and neck carcinomas and the increase in morbidity and mortality rates. The biological behavior of cancer is a complex process. About 50-60% of solid tumors exhibit hypoxic areas within the tumor stroma, which was influenced by the transcriptional activity of hypoxia inducible factor (HIF). HIF promotes stemness and the proliferation of vessel-like structures in tumors, which leads to invasion and metastasis.

AIM: To evaluate and correlate the expression of HIF- 1α, MCT1, NESTIN, and SALL2 in the tumor proper and tumor periphery of non- metastatic, metastatic, and recurrent OSCC.

MATERIALS AND METHODS: A Total of 60 proven OSCC cases with proper tumor center and periphery were collected. Among them, 25 were nonmetastatic, 25 were metastatic, and 10 were recurrent cases of OSCC. Immunohistochemical analysis of HIF- 1α, MCT1 NESTIN, SALL2, and CD31/PAS double staining was done.

RESULTS: Depending on the extent of stained tumor cells, the intensity of staining, and the index score, the expressions of both MCT1, SALL2, and NESTIN were highly significant in the periphery of OSCC with a P value of 0.001. The total number of vessels expressed in non-metastatic, metastatic, and recurrent OSCC were not significant, but overall expression of CD31/PAS was statistically significant in the periphery of the tumor with P value -0.024.

CONCLUSION: Based on the above results, it is observed that the role of hypoxia helped in cancer stem cell (CSC) maintenance with the formation of vessel-like structures by tumor cells at an early stage of cancer promotes its development and recurrence.

PMID:40485407 | DOI:10.4103/ijpm.ijpm_174_24

Am J Hum Biol. 2025 Jun;37(6):e70075. doi: 10.1002/ajhb.70075.

ABSTRACT

OBJECTIVE: The relationship between cesarean delivery and infant growth is controversial. Therefore, the aim of this study was to evaluate the association between the type of delivery and the growth trajectory of Brazilian infants in the first year of life.

MATERIALS AND METHODS: This was a prospective cohort study conducted between 2016 and 2021 as part of the Araraquara Cohort Study that assessed quarterly anthropometry of 719 and 667 infants to evaluate, respectively, the effects of type of delivery on weight gain velocity (WGV) and length gain velocity (LGV) using generalized estimating equations.

RESULTS: The type of delivery was not associated with WGV or LGV in the first year of life. Higher mean WGV was observed among infants born to mothers with higher education, male infants, formula-fed infants, and those with the lowest birth weight, while infants with diarrhea had lower mean WGV. Higher mean LGV was found among formula-fed infants and infants born to taller mothers, while infants with the highest length at birth had lower LGV.

CONCLUSION: The factors that explain WGV and LGV in this population are more closely related to maternal characteristics such as height and educational attainment, birth characteristics, feeding behavior, and morbidity than to the type of delivery.

PMID:40485396 | DOI:10.1002/ajhb.70075

J Integr Complement Med. 2025 Jun 9. doi: 10.1089/jicm.2024.0744. Online ahead of print.

ABSTRACT

Background: Evidence regarding the optimal dosage of forest therapy is limited. The aim of this study was to compare the effects of two dosages of standardized forest therapy sessions on participant-reported outcomes in the general population. This study also explored whether these effects depended on a specific forest location. Methods: In this randomized controlled multisite trial taking place in three different German forests, participants of the general population were assigned to either a two-session group (2SG) of forest therapy of 2 h each with a break-day in between or three consecutive sessions (3SG) of forest therapy of 2 h each. The primary outcome was the between-group difference of 2SG versus 3SG of forest therapy on Total Mood Disturbance (TMD) using the Profile of Mood States (POMS) at day 3, immediately postintervention. Secondary outcomes were vitality (SVS-G), self-efficacy (GSE), physical/mental health (PH/MH), anxiety (STAI), physical symptoms (BLR/BLR’), perceived stress (PSQ), and perceived benefits of nature (PBNQ). A subset of questionnaires was used before and after each session (POMS, STAI, SVS-G, and PSQ). Pre- and postintervention differences were computed for comparisons within each group and between them using t test statistics, while analysis of variance (ANOVA) tested for differences between forests. Results: One hundred and seventy-one participants (91 in 2SG and 80 in 3SG; 56.1 ± 14.5 years) were included in the intention-to-treat analysis. No significant group differences were found for the TMD (p = 0.99), although there was an overall improvement in both groups (TMD: within-group p < 0.001 for both, 2SG: d = 0.95, 3SG: d = 0.81). No significant group differences were found for any secondary outcomes, although significant improvements were seen within groups for most outcomes. The ANOVA revealed neither statistically significant interactions between the three forests nor statistically significant interactions between the factors “group” and “location” for TMD. Conclusions: Participation in two versus three sessions of standardized forest therapy sessions with 2 h each may have similar beneficial effects on physical/mental health parameters in the general population. A low-dose approach may already achieve beneficial effects on mental health. These findings can provide evidence for the possible implementation of forest therapy as a therapy form in Germany.

PMID:40485383 | DOI:10.1089/jicm.2024.0744

Indian J Pathol Microbiol. 2025 Jun 7. doi: 10.4103/ijpm.ijpm_383_24. Online ahead of print.

ABSTRACT

BACKGROUND: Colorectal carcinoma (CRC) is a heterogeneous disease caused by multiple genetic and environmental alterations. One of these molecular alterations is microsatellite instability (MSI) caused by mutation of MMR proteins (MLH1, PMS2, MSH2, and MSH6). This study aimed to evaluate immunohistochemical (IHC) expression of MMR proteins in CRC and its correlation with clinicopathological findings in a sample of Iraqi patients.

MATERIALS AND METHODS: A retrospective study included 35 patients with CRC from January 2023 to January 2024. Sections from formalin-fixed paraffin-embedded tissue were used and stained immunohistochemically using (MLH1, PMS2, MSH2, and MSH6) markers.

RESULTS: The mean age of CRC was 59.7 ± 9.9 years, 45.7% of cases were located in the rectosigmoid. Most cases (88.6%) were adenocarcinoma and (97.1%) were moderately differentiated, 54.3% had T3 stage, and 65.7% had no lymphovascular invasion. Six cases (17.12%) had MSI (8.6% had loss of MSH6 and 8.6% had combined loss of MLH1 and MSH2), all were under 50 years of age, four (66.6%) cases were females, three (50%) cases located in the descending colon, four cases (66.6%) had mucinous carcinoma, three (50%) cases had T3 stage, three (50%) had nodal metastasis, and four cases (66.6%) had lymphovascular invasion.

CONCLUSION: This study shows that MSI has a highly significant association with young age and mucinous carcinoma. The combined loss of MLH1 and MSH2 was statistically and highly significant than other combinations. IHC is a simple process to detect MSI status and guide oncologists in determining treatment options such as conventional chemotherapy or immunotherapy.

PMID:40485379 | DOI:10.4103/ijpm.ijpm_383_24

J Am Geriatr Soc. 2025 Jun 9. doi: 10.1111/jgs.19569. Online ahead of print.

ABSTRACT

BACKGROUND: Antipsychotic medications (APMs) are frequently prescribed for persons living with dementia despite limited benefits and increased risks. This study examined patient characteristics of those prescribed APMs, indications for initiation, and survival outcomes.

METHODS: This retrospective cohort study of community-dwelling patients enrolled in a comprehensive dementia care program (2012-2014) focused on 190 patients not on an APM at baseline, with survival analyses including 200 additional patients on an APM at program entry. Patients were followed for 2 years for APM initiation and until January 2024 for mortality. Baseline measures included patient and caregiver demographics, Mini-Mental State Exam (MMSE), Functional Activities Questionnaire (FAQ), Modified Caregiver Strain Index (MCSI), caregiver Patient Health Questionnaire-9 (PHQ-9), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Indications for APM initiation were abstracted from electronic health records. Logistic regression models examined associations between baseline characteristics and APM initiation. Survival was assessed using Kaplan-Meier estimates and Cox proportional hazards models.

RESULTS: Among 190 patients (mean [SD] age, 81.2 [8.4] years; 60% female, and 80% Alzheimer’s or dementia not otherwise specified) who were not on APMs at program enrollment, 65 (34%) initiated and 125 (66%) did not initiate an APM. NPI-Q severity (AOR 1.10, 95% CI 1.04-1.16) and NPI-Q distress (AOR 1.06, 95% CI 1.02-1.10) were associated with APM initiation. Agitation and psychotic symptoms were the most common indications, with quetiapine being the most frequently prescribed APM. Median survival was 37.8 months (IQR 19.3-63.2) for patients on an APM at baseline, 63.1 months (IQR 28.4-86.8) for patients initiating an APM, and 68.9 months (IQR 50-97.9) for patients not initiating an APM (p < 0.001).

CONCLUSIONS: APM initiation was common despite enrollment in a comprehensive dementia care program that prioritizes non-pharmacologic strategies. Survival differences underscore the need for risk-benefit discussions of APMs and goals of care discussions with caregivers.

PMID:40485369 | DOI:10.1111/jgs.19569

Indian J Pathol Microbiol. 2025 Jun 7. doi: 10.4103/ijpm.ijpm_217_24. Online ahead of print.

ABSTRACT

OBJECTIVES: 1) To perform a retrospective histological evaluation of renal allograft biopsies diagnosed as recurrent/denovo IgA nephropathy from January 2011 to January 2019 and calculate individual MESTC scores and Banff scores for all cases. 2) To perform clinicopathological and statistical evaluation of histological variables of the updated oxford scoring system with variables of estimated glomerular filtration rate, proteinuria, and serum creatinine, recorded at the time of the last follow-up.

MATERIALS AND METHODS: This was a retrospective cohort study conducted at a tertiary hospital. 53 cases of IgA nephropathy were selected including 11 cases of recurrent disease and 42 cases which arose denovo, including those with unknown native kidney disease. The updated oxford score and Banff criteria were applied to all cases and correlated with clinical data and transplantation details available from the online database using univariate and multivariate analysis. Statistical analysis was done using STATA version 16.0.

RESULTS: Patients with interstitial fibrosis/tubular atrophy were associated with significantly higher creatinine, proteinuria, and lower eGFRs at the time of biopsy. Cox hazard ratio showed that patients with interstitial fibrosis/tubular atrophy had a significantly higher chance of progressing to end-stage kidney disease. Patients with either endocapillary hypercellularity, interstitial fibrosis/tubular atrophy, or multiple lesions also progressed significantly faster to end-stage kidney disease.

CONCLUSION: Interstitial fibrosis/tubular atrophy and segmental sclerosis were indicators of poor graft survival. Patients with combined lesions, particularly chronic lesions progress significantly faster to end-stage kidney disease. Patients with endocapillary hypercellularity had improved outcomes when treated with adequate immunosuppression. We conclude that the updated oxford classification be used for prognostication in addition to the Banff criteria being already in use.

PMID:40485360 | DOI:10.4103/ijpm.ijpm_217_24

Work. 2025 Jun 9:10519815251346421. doi: 10.1177/10519815251346421. Online ahead of print.

ABSTRACT

BackgroundPrivacy is one of the most important principles that should be protected during nursing interventions. It is also very important for maintaining a professional stance in professional life.ObjectiveThe aim of this study was to determine the privacy awareness levels of nurses and nursing students and the factors affecting them.MethodThe sample of the study consisted of 157 nurses and 342 nursing students. Data were collected using Personal Information Form and Privacy Awareness Scale. Data were analyzed using descriptive statistics, chi-square, Mann-Whitney U, Kruskal-Wallis test, Dunn test and multiple linear regression analysis.ResultsThe mean privacy awareness score of the nurses was 50.20 ± 4.71 and that of the students was 49.94 ± 4.88, and no significant difference was found between nurses and students in terms of privacy awareness levels (p < 0.05). Privacy awareness towards oneself was higher in female nurses and privacy awareness towards others was higher in nurses in their 30 s and married women. Total privacy awareness was highest in nurses aged 30-39 years, followed by nurses aged 20 and 40 years. The level of behavior to protect the privacy of others was higher in second-year students than in third-year students.ConclusıonsIn order to keep the privacy awareness of nurses high, appropriate physical conditions, educational opportunities, evaluation of requests and wishes by the institution, and emphasizing that students have the same moral responsibility as nurses in all professional course practices are necessary.

PMID:40485351 | DOI:10.1177/10519815251346421

Head Neck. 2025 Jul;47(7):1807-1815. doi: 10.1002/hed.28092. Epub 2025 Jan 31.

ABSTRACT

BACKGROUND: Time from surgery to initiation of postoperative radiation therapy (PORT) of less than 6 weeks was recently instituted as the first quality metric within head and neck cancer care.

METHODS: We performed a retrospective single institution cohort study to investigate predictors of PORT delay and the impact of PORT delay on survival.

RESULTS: PORT delay rate was 73.2%, with a median time to treatment initiation of 51 days. Outside radiation facility treatment was independently associated with increased likelihood of PORT delay (OR 1.94, 95% CI 1.03-3.74, p = 0.043). PORT delay and location of radiation treatment did not impact OS or PFS.

CONCLUSIONS: In this single institution study, most patients experienced PORT delay. Patients that were treated at outside radiation facilities were more likely to experience delay. However, PORT delay did not result in statistically significant difference in OS and PFS which contrasts with the current literature.

PMID:40485334 | DOI:10.1002/hed.28092

Biom J. 2025 Jun;67(3):e70062. doi: 10.1002/bimj.70062.

ABSTRACT

Outlying studies are prevalent in meta-analyses of diagnostic test accuracy studies and may lead to misleading inferences and decision-making unless their negative effect is appropriately dealt with. Statistical methods for detecting and down-weighting the impact of such studies have recently gained the attention of many researchers. However, these methods dichotomize each study in the meta-analysis as outlying or non-outlying and focus on examining the effect of outlying studies on the summary sensitivity and specificity only. We developed and evaluated a robust and flexible random-effects bivariate finite mixture model for meta-analyzing diagnostic test accuracy studies. The proposed model accounts for both the within- and across-study heterogeneity in diagnostic test results, generates the probability that each study in a meta-analysis is outlying instead of dichotomizing the status of the studies, and allows assessing the impact of outlying studies on the pooled sensitivity, pooled specificity, and between-study heterogeneity. Our simulation study and real-life data examples demonstrated that the proposed model was robust to the existence of outlying studies, produced precise point and interval estimates of the pooled sensitivity and specificity, and yielded similar results to the standard models when there were no outliers. Extensive simulations demonstrated relatively better bias and confidence interval width, but comparable root mean squared error and lesser coverage probability of the proposed model. Practitioners can use our proposed model as a stand-alone model to conduct a meta-analysis of diagnostic test accuracy studies or as an alternative sensitivity analysis model when outlying studies are present in a meta-analysis.

PMID:40485332 | DOI:10.1002/bimj.70062