Tag: nevin manimala

Allergy Asthma Clin Immunol. 2025 Sep 24;21(1):41. doi: 10.1186/s13223-025-00981-4.

ABSTRACT

BACKGROUND: Unverified drug allergy labels are common and associated with significant patient harm, yet infrastructure and testing practices vary across clinical settings in Canada.

OBJECTIVE: To characterize variability in drug allergy management among allergists in Canada and identify setting-specific barriers to drug allergy testing and desensitization.

METHODS: We developed a peer-reviewed 40-item survey, distributed via the Canadian Society of Allergy and Clinical Immunology, to assess practice patterns, testing modalities, and perceived barriers among allergists. Descriptive statistics and Fisher’s exact test were used to evaluate responses by practice setting.

RESULTS: Sixty-six allergists responded (30% estimated response rate), with 48.4% solely practicing in community clinics and 21.9% solely in hospital-based clinics. While 87.9% performed some form of drug allergy testing, hospital-based allergists were significantly more likely to perform intradermal (81.1% vs. 48.7%, p = 0.004) and patch testing (38.2% vs. 8.8%, p = 0.009), as well as non-oral drug challenges (63.6% vs. 20.0%, p = 0.0005). Common barriers included a lack of nursing support and inadequate reimbursement.

CONCLUSION: Drug allergy management practices vary substantially across Canada, with drug allergy testing being more frequently performed by allergists practicing in hospital-based clinics than by those in community-based clinics. Findings support the need for equitable access to testing infrastructure and system-level investments in improving drug allergy testing services.

PMID:40993713 | DOI:10.1186/s13223-025-00981-4

Cardiovasc Diabetol. 2025 Sep 24;24(1):367. doi: 10.1186/s12933-025-02826-1.

ABSTRACT

OBJECTIVES: The triglyceride-glucose index (TyG) is an emerging marker of metabolic health, yet its association with mortality across different glucose metabolism statuses remains unclear. This study aimed to investigate the relationship between the TyG and the risk of all-cause and cardiovascular mortality among individuals with normoglycemia, dysglycemia, and diabetes mellitus.

METHODS: Participants from nine cycles of the National Health and Nutrition Examination Survey (NHANES) were included and categorized into three groups: normoglycemia, dysglycemia, and diabetes. Cox regression and restricted cubic spline (RCS) analyses were performed to evaluate the linear and nonlinear associations between TyG and mortality. To assess the predictive power of TyG and the atherogenic index of plasma (AIP) for mortality, time-dependent receiver operating characteristic (ROC) curves were constructed. Subgroup analyses were conducted based on age, sex, and blood pressure status.

RESULTS: During a median follow-up of 9.2 years, a total of 2199 all-cause deaths and 606 cardiovascular deaths were documented. In the normoglycemic group, a single standard unit increase in TyG was associated with a 35% higher risk of all-cause mortality and a 38% higher risk of cardiovascular mortality (HR: 1.35, 95% CI 1.17-1.56; HR: 1.38, 95% CI 1.04-1.84, respectively). Among participants with diabetes, RCS analysis revealed a U-shaped association between TyG and all-cause/cardiovascular mortality, with an inflection point at 9.1. No significant associations were observed in the dysglycemia group. TyG demonstrated superior predictive performance compared to the AIP for 3-year mortality in both normoglycemic and diabetic individuals. Subgroup analyses identified significant interaction effects of age and sex on the association between TyG and mortality.

CONCLUSION: TyG was associated with an increased risk of all-cause and cardiovascular death in the normoglycemic subgroup, but not in the dysglycemic subgroup. In the diabetes subgroup, the association between the TyG and mortality was nonlinear. The predictive value of TyG across different glucose metabolism statuses provides new evidence for medical practice.

PMID:40993712 | DOI:10.1186/s12933-025-02826-1

Eat Behav. 2025 Sep 11;59:102031. doi: 10.1016/j.eatbeh.2025.102031. Online ahead of print.

ABSTRACT

This study aimed to compare eating pathology between heterosexual and sexual minority (SM) undergraduate women and explore the relation between eating pathology and minority stress in SM undergraduate women. Undergraduate women at a Southeastern university (N = 547; 38 % SM, 62 % heterosexual) completed a one-time online survey (2023-2024) measuring eating pathology, internalized stigma, and stigma concealment. We analyzed descriptive statistics and Analyses of Covariance (ANCOVAS). SM undergraduate women reported more body dissatisfaction and shape/weight overvaluation (p < .001) and no difference in dietary restraint (p = .78) compared with their heterosexual counterparts. For SM undergraduate women, dietary restraint was linked to stigma concealment (p < .05). These findings suggest that although SM undergraduate women experience unique stressors related to eating pathology, they are at similar risk of restrictive eating pathology to heterosexual undergraduate women. In addition to typical university life stressors, providers should be aware of the potential impact of stigma on SM female students’ eating behaviors/cognitions.

PMID:40992020 | DOI:10.1016/j.eatbeh.2025.102031

Arch Oral Biol. 2025 Sep 19;180:106400. doi: 10.1016/j.archoralbio.2025.106400. Online ahead of print.

ABSTRACT

OBJECTIVE: This project aimed to evaluate the immunoexpression pattern of murine double minute 2 (MDM2) in solid ameloblastomas compared to unicystic ameloblastomas.

METHODS: The review followed PRISMA guidelines and was registered in the PROSPERO database. PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar were comprehensively searched. Original cross-sectional studies were included. The meta-analysis was performed using STATA V15 and RevMan. Positivity rates were pooled using a random-effects model (REM), the labeling index was analyzed using mean difference under a REM, and expression intensity (moderate-strong) was assessed as categorical data using a REM with Hartung-Knapp adjustment. Heterogeneity was evaluated with the Chi² test and I² statistic. The methodological quality and certainty of the evidence were assessed using the Joanna Briggs Institute items and the GRADE system.

RESULTS: Nine studies (n = 438 specimens) were analyzed, of which 325/438 (74.2 %) were ameloblastoma biopsies. MDM2 positivity was detected in 403/438 cases (92 %). A statistically significant association in favor of solid ameloblastoma was observed (RR = 2.08; 95 %CI [1.66-2.60]; p = 0.005), indicating a twofold probability of finding high MDM2 expression in solid compared to unicystic ameloblastomas. Four of the nine studies (44.4 %) were considered to be of low quality, and the certainty of evidence was low to very low.

CONCLUSIONS: MDM2 expression was prevalent in both types of ameloblastomas, with a higher intensity of expression observed in solid cases. However, due to study heterogeneity, further investigations with more robust methodological designs are recommended to assess the diagnostic potential of MDM2 in ameloblastomas.

PMID:40992015 | DOI:10.1016/j.archoralbio.2025.106400

Biomed Pharmacother. 2025 Sep 23;192:118598. doi: 10.1016/j.biopha.2025.118598. Online ahead of print.

ABSTRACT

Alzheimer’s disease (AD) is a neurodegenerative disorder characterized by a complex pathobiology that includes neuroinflammation, the accumulation of extracellular amyloid-beta (Aβ) plaque, and intracellular neurofibrillary tangles comprising tau. Increasing evidence suggests that the aberrant activation of glial cells, including microglia and astrocytes, is a significant early characteristic that accelerates neuroinflammatory processes in the development of AD. Protocatechuic acid (PCA), a natural phenolic compound, has been investigated for its anti-inflammatory properties in various pathological conditions. Here, we demonstrated that administration of PCA significantly ameliorated neuroinflammation as well as cognitive deficits in the 5 ×FAD mouse model of AD, which overexpresses human amyloid precursor protein (APP) and presenilin-1 (PSEN1) genes carrying five familial Alzheimer’s disease (FAD) mutations, leading to accelerated Aβ deposition. We further confirmed that PCA treatment significantly reduced microglial activation and downregulated the production of pro-inflammatory cytokines, astrogliosis, and tau hyperphosphorylation, thereby preserved the integrity of hippocampal neurons. Our RNA sequencing analysis revealed that PCA treatment restored the transcriptomic profile of hippocampal tissues in 5 ×FAD mice, particularly by downregulating genes associated with innate immune and inflammatory responses. Moreover, PCA alleviated gut dysbiosis and enhanced the integrity of the intestinal barrier. The findings suggest that PCA may serve as a promising therapeutic agent for early intervention in AD to mitigate its progression.

PMID:40991989 | DOI:10.1016/j.biopha.2025.118598

Breast. 2025 Sep 17;84:104581. doi: 10.1016/j.breast.2025.104581. Online ahead of print.

ABSTRACT

BACKGROUND: Adjuvant radiotherapy (RT) for early-stage breast cancer is associated with increased major cardiovascular (CV) events. This study investigates cardiac toxicity in an Asian breast cancer cohort, focusing on the interplay between RT, cardiovascular risk factors, and systemic treatments, a topic less explored in regions with lower cardiovascular disease (CVD) prevalence.

METHODS: Patients with breast cancer who underwent adjuvant RT between January 2004 and November 2014 were included in this single-institutional retrospective study. Patients were categorized by CVD risk factors, including obesity, smoking history, prior CVD incidents, chronic kidney disease (CKD), diabetes mellitus, hypertension, and dyslipidemia. The primary outcome was the incidence of major CV events, defined as conditions requiring intervention, including heart failure, arrhythmia, and ischemic heart disease. Kaplan-Meier methods, log-rank tests, and Cox regression models were used for statistical analysis.

RESULTS: Among the 975 patients, the 10-year cumulative incidence of major CV events was 3.7 %, with no significant difference (p = 0.892) between right-sided (3.8 %) and left-sided RT (3.4 %). Patients with low, intermediate, and high CVD risk factors had 10-year cumulative incidences of 0.7 %, 2.5 %, and 13.7 %, respectively. Multivariate analysis revealed that hypertension, CKD, and previous CVD were significantly associated with major CV events. In patients without CVD risk factors, the 10-year incidence of CV events was higher in those undergoing left-sided RT compared to right-sided RT (1.3 % vs. 0.0 %, p = 0.032).

CONCLUSIONS: Major CV events incidences following RT in this Asian cohort with low baseline CVD risk were modest. However, the impact was more pronounced in patients without baseline CVD risk factors, emphasizing the need for personalized risk assessment in RT planning.

PMID:40991981 | DOI:10.1016/j.breast.2025.104581

Am J Sports Med. 2025 Sep 24:3635465251376586. doi: 10.1177/03635465251376586. Online ahead of print.

ABSTRACT

BACKGROUND: The femoral attachment of the anterolateral ligament (ALL) reported by anatomic studies is posterior and proximal to the lateral femoral epicondyle.

PURPOSE: To assess the femoral positioning of the ALL graft while performing a percutaneous technique and evaluate the correlation between this positioning and the graft rupture rate, as well as clinical and functional outcomes.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: A total of 211 patients undergoing combined anterior cruciate ligament (ACL) and ALL reconstruction were included. Radiological measurements, Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, and graft failure rate were collected at 24 months after surgery.

RESULTS: The rate of anatomic positioning of ALL femoral anchors was 79.1% (n = 167). The mean proximal and posterior distances relative to the ALL anatomic femoral position were 1.4 ± 2.8 mm and 0.2 ± 0.2 mm, respectively. The rate of outliers, defined as >5 mm from the anatomic position, was 20.85% (n = 44). The mean KOOS and IKDC score were 84 ± 10.9 and 80.1 ± 11.3, respectively. No statistically significant difference in KOOS and IKDC score was observed between the group of patients with anatomic positioning and the group of outliers (P = .1). The rate of ACL rerupture for all patients was 3.79% (n = 8). Of these, 87.5% (n = 7) were outliers. The correlation between ALL femoral malpositioning and ACL rerupture was statistically significant (P < .00001).

CONCLUSION: Independent ALL reconstruction while performing a percutaneous technique enabled anatomic positioning of the ALL graft in 79% of cases. The femoral malpositioning was correlated with a higher ACL graft rerupture rate but not with a decrease in the functional outcomes.

PMID:40991962 | DOI:10.1177/03635465251376586

Ultrasound Obstet Gynecol. 2025 Sep 24. doi: 10.1002/uog.70099. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the risk of adverse obstetric and neonatal outcomes in patients with unexplained recurrent implantation failure (uRIF) who had a singleton live birth.

METHODS: This multicenter retrospective cohort study reviewed 49 372 embryo-transfer cycles leading to a singleton live birth at three fertility centers in China between January 2014 and July 2021. Patients were categorized into the uRIF group if they had a history of at least three failed transfers of unknown cause with at least four good-quality embryos, while the control group comprised women who had experienced fewer than three failed implantation cycles. Obstetric and neonatal outcomes were collected via telephone interviews using a standardized questionnaire. Propensity score matching (PSM) and multivariate logistic regression analysis were used to control for potential confounders.

RESULTS: After exclusions, 1244 patients with a history of uRIF and 36 644 controls were included in the study. All baseline characteristics were balanced following PSM, with 1243 patients retained in each group. Compared with the control group, the uRIF group exhibited significantly higher odds of placenta previa (2.7% vs 1.4%; adjusted odds ratio (aOR), 2.01 (95% CI, 1.01-4.00)), placental abruption (0.3% vs 0%; aOR, 6.51 (95% CI, 1.57-26.91)), Cesarean delivery (76.6% vs 71.8%; aOR, 1.27 (95% CI, 1.06-1.53)) and preterm birth (10.1% vs 7.3%; aOR, 1.44 (95% CI, 1.08-1.91)). The results remained consistent on sensitivity analysis using prematched data with multivariate adjustment.

CONCLUSIONS: A history of uRIF was associated with increased risks for placenta previa, placental abruption, Cesarean delivery and preterm birth. While statistically significant, the absolute differences in the rates of these complications were modest and the clinical relevance of our findings should be interpreted with caution. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

PMID:40991952 | DOI:10.1002/uog.70099

JMIR Med Educ. 2025 Sep 24;11:e70726. doi: 10.2196/70726.

ABSTRACT

BACKGROUND: Burnout among emergency room health care workers (HCWs) has reached critical levels, affecting up to 43% of HCWs and 35% of emergency medicine personnel during the COVID-19 pandemic. Nurses were most affected, followed by physicians, leading to absenteeism, reduced care quality, and turnover rates as high as 78% in some settings such as Thailand. Beyond workforce instability, burnout compromises patient safety. Each 1-unit increase in emotional exhaustion has been linked to a 2.63-fold rise in reports of poor care quality, 30% increase in patient falls, 47% increase in medication errors, and 32% increase in health care-associated infections. Burnout is also associated with lower job satisfaction, worsening mental health, and increased intent to leave the profession. These findings underscore the urgent need for effective strategies to reduce stress and burnout in emergency care.

OBJECTIVE: This study aimed to evaluate the effectiveness and effect size of a multimodal learning approach-Emergency Room Virtual Simulation Interprofessional Education (ER-VIPE)-that integrates medical movies, massive online open courses (MOOCs), and computer- or virtual reality (VR)-based simulations with co-debriefing for reducing burnout and stress among future health care professionals compared with approaches lacking co-debriefing or using only movies and MOOCs.

METHODS: A single-blind, quasi-experimental study was conducted at a university hospital from August 2022 to September 2023 using a 3-group treatment design. Group A (control) participated in a 3D computer-based, simulation-based interprofessional education (SIMBIE) without debriefing. Group B received the ER-VIPE intervention. Group C received the same as Group B, but the computer-based SIMBIE was replaced with 3D VR-SIMBIE. SIMBIE activities simulated a COVID-19 pneumonia crisis. Outcomes included the Dundee Stress State Questionnaire (DSSQ) and the Copenhagen Burnout Inventory, with trait anxiety as a behavioral control. Stress and burnout were measured at baseline, pre-intervention, postintervention, and 1-month follow-up. Generalized estimating equations were used to analyze group differences, with statistical significance set at P<.05.

RESULTS: We randomized 87 undergraduate students from various health programs into the 3 groups (n=29 each). Participants’ mean age was 22 years, with 71% (62/87) as women. After the 1-month post-SIMBIE follow-up, adjusted analyses revealed positive trends in DSSQ-engagement across all groups, with Group B showing a significant increase compared with Group A (mean difference=3.93; P=.001). DSSQ-worry and DSSQ-distress scores decreased nonsignificantly across all groups. Burnout scores also improved across groups, with Group B having a significantly lower score than Group A (mean difference=-2.02; P=.02). No significant burnout differences were found between Group C and Groups A or B.

CONCLUSIONS: A multimodal learning approach combining medical movies, MOOCs, and 3D computer-based SIMBIE with co-debriefing effectively improved engagement, reduced stress, and lowered burnout among future health care professionals. This scalable educational framework may help enhance well-being and resilience in high-pressure clinical environments.

PMID:40991944 | DOI:10.2196/70726

JMIR Res Protoc. 2025 Sep 24;14:e75796. doi: 10.2196/75796.

ABSTRACT

BACKGROUND: According to the World Health Organization’s infant and young child feeding guidelines, infants should be exclusively breastfed for the first 6 months of life. Despite public health campaigns to increase exclusive breastfeeding (EBF) rates, socioeconomic inequities persist among low-income breastfeeding mothers, especially in countries with large wealth and health gaps, such as Brazil. Social transfer programs are initiatives that provide financial support to individuals or households to improve their well-being and reduce financial burdens. These may be conditional, requiring recipients to meet specific criteria to receive the transfer, or unconditional, in which recipients receive the transfer without prerequisites. Evidence suggests that conditional and unconditional social transfers may help increase EBF rates while addressing the economic challenges breastfeeding mothers face. A randomized controlled trial (RCT) conducted in Vientiane, Lao People’s Democratic Republic, found that a social transfer program significantly improved both EBF rates at 6 months and EBF duration. Building on this study, we aim to evaluate the impact of this intervention in a different socioeconomic and cultural context.

OBJECTIVE: This protocol aims to implement an RCT to assess whether conditional and unconditional social transfers improve EBF rates at 6 months postpartum for mothers in low-income communities in São Paulo, Brazil.

METHODS: A prospective RCT will be conducted among 400 mothers who gave birth in the last 72 hours and plan to exclusively breastfeed. Participants will be recruited in São Paulo at the University Hospital of São Paulo and Amparo Maternal. Participants will be randomly assigned to one of the following groups: (1) control group-no social transfer; (2) intervention group 1-an unconditional social transfer at 6 months postpartum; and (3) intervention group 2-a social transfer at 6 months postpartum, conditional upon mothers’ EBF. All groups will receive educational materials supporting EBF. The study will have visits at birth, 1 month, 6 months, 1 year, and 2 years and will include a questionnaire and biological collections of breast milk samples, infant fecal samples, and blood samples (finger pricks) from both the mother and infant. The main study outcomes are the prevalence of EBF at 6 months and the duration of EBF across the 3 groups, where we hypothesize higher rates of EBF among mothers in the conditional group.

RESULTS: Recruitment began on March 6, 2024. As of September 2025, we enrolled 204 participants. Our goal is to recruit 400 mother-infant dyads by October 2025, with study visits expected to be completed by October 2027.

CONCLUSIONS: We hypothesize that the Social Transfers for Exclusive Breastfeeding in Brazil (STEBB) intervention will positively impact breastfeeding mothers in São Paulo. If successful, the program may inform national policy to enhance Brazil’s existing social transfer program for new mothers.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06157697; https://clinicaltrials.gov/study/NCT06157697.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/75796.

PMID:40991943 | DOI:10.2196/75796