Tag: nevin manimala

Intern Emerg Med. 2025 Nov 1. doi: 10.1007/s11739-025-04161-5. Online ahead of print.

ABSTRACT

People with mental health issues (MHI) are disproportionately dependent on tobacco smoking and experience higher rates of smoking-related mortality compared to the general population. Mental health workers (MHWs) are well placed to address this burden, yet many lack the knowledge, confidence, or skills to support smoking cessation or tobacco harm reduction (THR). This study aimed to evaluate the impact of a structured THR training session on the knowledge and attitudes of mental health workers in Malawi. A quasi-experimental pre-post study was conducted among 48 mental health professionals at two psychiatric hospitals in Malawi. Participants attended a structured training session on tobacco harm reduction. Baseline and end-line surveys assessed demographics, prior tobacco harm reduction exposure, knowledge, and attitudes. Knowledge scores were analysed using the Wilcoxon signed-rank test, with descriptive statistics summarising categorical shifts and attitudinal changes. Only 25% of the participants had received prior training on tobacco harm reduction. A statistically significant increase in median knowledge scores from baseline (median = 6, interquartile range [IQR] = 5-7) to end line (median = 8, IQR = 7-9), Z = -5.72, p < 0.001, with a large effect size (r = 0.62) was observed. The proportion of participants classified as having ‘Good’ knowledge increased substantially from 21.3% at baseline to 68.1% at end line, while the ‘Poor’ knowledge category decreasing from 6.4 to 0%. A brief, well-structured training on tobacco harm reduction can help improve knowledge among mental health workers. Scaling up such training could help close a major gap in patient care for people with mental illness in Malawi and similar settings.

PMID:41176585 | DOI:10.1007/s11739-025-04161-5

Target Oncol. 2025 Nov 1. doi: 10.1007/s11523-025-01184-y. Online ahead of print.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitors (ICIs) are now standard for various cancers, and preclinical studies suggest beta-blockers (BBs) may boost the efficacy of ICIs. However, prior clinical studies had small sample sizes, requiring large-scale validation.

OBJECTIVE: We aimed to evaluate the efficacy and safety of combining BBs with ICIs in patients with solid tumors through a systematic review and meta-analysis.

METHODS: A systematic search of PubMed/MEDLINE and Embase was conducted for studies on BBs plus ICIs for solid tumors up to July 2024. Outcomes of interest were overall survival, progression-free survival, and adverse events. Hazard ratios with 95% confidence intervals were pooled using a random-effects model meta-analysis, with heterogeneity assessed by I² statistics.

RESULTS: Overall, 12 clinical studies involving 4293 patients with solid tumors were included, with 1463 patients receiving both BBs and ICIs and 2830 patients receiving ICIs alone. The combination of BBs and ICIs was not associated with a longer overall survival (hazard ratio 1.02; 95% confidence interval 0.84-1.23; p = 0.87; I² = 69%) or progression-free survival (hazard ratio 0.98; 95% confidence interval 0.80-1.20; p = 0.81; I² = 71%). Subgroup analyses by cancer types and BB types showed no significant heterogeneity in the hazard ratios for overall survival across different cancer types (I² = 0%, p for heterogeneity = 0.44) and BB types ⁽I² = 0%, p for heterogeneity = 0.67). The combination of BBs plus ICIs did not seem to increase toxicity.

CONCLUSIONS: Despite positive preclinical findings, this meta-analysis showed that adding BBs to ICIs was not associated with longer survival. We await the results of ongoing prospective trials assessing this strategy. PROSPERO REGISTRATION: CRD42024574043.

PMID:41176581 | DOI:10.1007/s11523-025-01184-y

Mol Psychiatry. 2025 Nov 1. doi: 10.1038/s41380-025-03330-4. Online ahead of print.

ABSTRACT

Machine learning (ML) is revolutionising our ability to decode the complex genetic architectures of brain disorders. In this review we examine the strengths and limitations of ML methods, highlighting their applications in genetic prediction, patient stratification, and the modelling of genetic interactions. We explore how ML can augment polygenic risk scores (PRS) through advanced techniques and how integrating functional genomics and multimodal data can address challenges like rare variants and weak genetic effects. Additionally, we discuss the importance of embedding biological knowledge into ML models to enhance interpretability and uncover meaningful insights. With the ongoing expansion of phenotype-genotype datasets and advances in federated learning, ML is poised to compete with and surpass classical statistical methods in disease risk prediction and identifying genetically homogenous subgroups. By balancing the strengths and weaknesses of these approaches, we provide a roadmap for leveraging ML to unravel the genomic complexity of brain disorders and drive the next wave of discoveries.

PMID:41176580 | DOI:10.1038/s41380-025-03330-4

Eur Arch Otorhinolaryngol. 2025 Nov 1. doi: 10.1007/s00405-025-09679-0. Online ahead of print.

ABSTRACT

PURPOSE: Intraoperative identification of parathyroid adenomas can be challenging due to their anatomical variability and the limitations of preoperative imaging. This study aimed to evaluate the impact of indocyanine green (ICG) fluorescence imaging on operative efficiency and surgical outcomes in parathyroidectomy, employing a standard near-infrared (NIR) endoscopic system.

METHODS: We conducted a prospective interventional study with retrospective controls. Patients undergoing parathyroidectomy for primary hyperparathyroidism were included. The study group received intravenous ICG for intraoperative fluorescence imaging to aid parathyroid gland identification. Standard protocols, including preoperative imaging, intraoperative quick parathyroid hormone (qPTH) measurements, and frozen section analysis, were followed in both groups. Operative times and clinical outcomes were compared between ICG-assisted and standard procedures.

RESULTS: Seventy-six patients were included: 19 in the ICG group and 57 in the control group. The median net operative time (cutting-to-end) was significantly shorter in the ICG group (59 vs. 79 min; p = 0.002), while entry-to-cutting time was slightly longer (44 vs. 35 min; p = 0.014). Although the total operative time was shorter in the ICG group (109 vs. 123 min), this difference was not statistically significant (p = 0.060). A ≥ 50% reduction in qPTH was achieved in 94.7% vs. 89.5% (p = 0.672), and adenoma confirmation was 100% vs. 96.5% (p = 1.0), respectively.

CONCLUSION: ICG fluorescence is a cost-effective adjunct to standard parathyroidectomy, offering real-time gland visualization and potentially reducing operative times. Its integration into the routine surgical workflow may enhance intraoperative efficiency and outcomes.

PMID:41176564 | DOI:10.1007/s00405-025-09679-0

Eur Arch Otorhinolaryngol. 2025 Nov 1. doi: 10.1007/s00405-025-09547-x. Online ahead of print.

ABSTRACT

OBJECTIVE: We conducted this systematic review and meta-analysis to investigate the efficacy and safety of the use of serial intralesional steroid injection (SILSI) in patients with subglottic stenosis (SGS).

DATA SOURCES: PubMed, Web of Science, and Scopus databases, from inception until December 2024.

REVIEW METHODS: Database search used the following keywords: “Subglottic stenosis” AND “Intralesional.” The meta-analysis pooled the mean difference (MD) and standardized mean difference (SMD) for outcomes measured on different scales, based on pre-operative and post-operative values, with 95% confidence interval (CI). For categorical variables, we used Open MetaAnalyst software to calculate the rate of different outcomes and the effect estimates. Heterogeneity was assessed using the I² statistic.

RESULTS: The use of SILSI in SGS patients increases the surgery-free survival duration with a MD = 395.27 days (95% CI: 166.14, 624.39, p = 0.0007), I² = 81%, p = 0.0003. Additionally, the use of SILSI was associated with an increase in peak expiratory flow (PEF: MD = 30.6; 95% CI: 16.1, 45.1; p < 0.0001), I² = 100%, p < 0.00001. The effect estimates for categorical outcomes were success rate (0.92; 95% CI: 0.872, 0.969), adverse events (0.257; 95% CI: -0.043, 0.556), and recurrence rate (0.451; 95% CI: -0.058, 0.960).

CONCLUSION: SILSI has shown a high success rate, extended surgery-free survival, and improved PEF, with a relatively low recurrence rate and minimal risk of adverse events. Given this high efficacy and favorable safety profile, SILSI is recommended for use in SGS.

PMID:41176560 | DOI:10.1007/s00405-025-09547-x

Eur Arch Otorhinolaryngol. 2025 Nov 1. doi: 10.1007/s00405-025-09785-z. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to compare the evaluation of obstructive sleep apnea (OSA) by ten super-experts using responses from a 10-question survey answered by 3 different artificial intelligence chatbots, Chat GPT-3.5, Chat GPT-4.0, Gemini, and a panel of 100 otolaryngologists specialized in sleep medicine.

METHODS: A 10-question survey regarding OSA management was answered by Chat GPT-3.5, Chat GPT-4.0, Gemini, and a panel of 100 otolaryngologists. The responses were assessed by ten super-experts in sleep medicine for their agreement with expert consensus, using a Likert scale. Statistical analyses were performed to evaluate the level of agreement and significance.

RESULT: Expert consensus had the highest mean score (4.5 ± 0.9), significantly outperforming all AI models. ChatGPT-3.5 was the best among AI systems, with a score of 4.1 ± 1.2 (p=0.003), followed by ChatGPT-4 with 3.9 ± 1.4 (p<0.001) and Gemini with 3.6 ± 1.5 (p<0.001). Perfect agreement with expert consensus was achieved in specific scenarios, particularly regarding indications for bariatric surgery and lateral pharyngoplasty. However, there were significant differences in complex clinical scenarios that required integration of multiple factors, particularly in therapeutic management questions where the performance of AI models was significantly below that of expert consensus (p<0.01).

CONCLUSIONS: Although AI models are promising in the management of OSA, especially for well-defined clinical scenarios, they at present serve best as complementary tools rather than replacements for expert clinical judgment. Most surprisingly, ChatGPT-3.5 outperformed its newer versions in many aspects, indicating that model updates with general capabilities may not always lead to better performance in specialized medical domains. These findings emphasize the potential of AI as a supportive resource while emphasizing the continuing need for human expertise in complex clinical decision-making.

PMID:41176557 | DOI:10.1007/s00405-025-09785-z

Eur Arch Otorhinolaryngol. 2025 Nov 1. doi: 10.1007/s00405-025-09793-z. Online ahead of print.

ABSTRACT

BACKGROUND: The auricular cough reflex (Arnold’s reflex) is a vagally mediated somato-visceral response triggered by stimulation of the external auditory canal (EAC). While classically considered rare, its clinical relevance in otologic procedures remains underexplored.

OBJECTIVE: This study aimed to evaluate the prevalence, lateralization, and potential risk factors of the Arnold reflex during routine otologic examinations, with particular attention to examiner handedness, hearing aid use, and EAC inflammation.

METHODS: In this prospective observational study, 404 consecutive patients undergoing bilateral ear wax removal in a university otology clinic were assessed for reflex-induced coughing. Reflex occurrence, laterality, instrument type, hearing aid use, signs of local infection, age, and sex were documented. Statistical analyses included chi-square tests, logistic regression, and McNemar’s test.

RESULTS: A cough reflex was elicited in 52 patients (12.9%), predominantly right-sided (73.1%, p < 0.001). The reflex was most frequently triggered by curettes (84.6%). No significant association was found between reflex presence and hearing aid use, local infection, age, or sex. The strong right-ear predominance, observed exclusively with a right-handed examiner, suggests that handedness and canal wall anatomy may influence reflex induction.

CONCLUSION: The Arnold cough reflex occurs more commonly than historically reported, with a notable right-sided predominance potentially linked to examiner handedness and procedural factors. Routine otologic variables such as age, sex, hearing aid use, and local inflammation had no measurable effect. These findings underscore the importance of examiner awareness and gentle technique in the EAC. Future studies should explore anatomical mapping, neurophysiological mechanisms, and the potential role of habituation in chronic ear stimulation.

PMID:41176556 | DOI:10.1007/s00405-025-09793-z

Eur Arch Otorhinolaryngol. 2025 Nov 1. doi: 10.1007/s00405-025-09756-4. Online ahead of print.

ABSTRACT

PURPOSES: Allergic rhinitis (AR) is increasingly recognized for its broader impacts on health, including possible links to various vestibular disorders. This study aims to investigate the association between prior AR and peripheral vestibular disorder (PVD) within Taiwan’s National Health Insurance system.

METHODS: Utilizing the Longitudinal Health Insurance Database 2010, this case-control study analyzed data from patients diagnosed with PVD (n=78,503) and 235,509 propensity-score-matching controls. To evaluate the association between prior AR and PVD, we carried out multiple logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS: The Chi-squared test indicates a notable contrast in prior AR occurrence between individuals with PVD and those under control (32.2% vs. 22.8%, p<0.001). Furthermore, our findings reveal significant statistical differences in AR prevalence among patients with Meniere’s disease (32.1% vs. 22.8%, p<0.001), benign paroxysmal positional vertigo (32.2% vs. 22.8%, p<0.001) as well as vestibular neuritis (32.6% vs.22.8, p <0.001) relative to controls. The adjusted OR for prior AR among sampled PVD patients was found to be 1.605 (95% CI=1.577~1.634). After making similar adjustments for MD, BPPV, and VN cases; we discovered that adjusted ORs of AR were respectively recorded as: 1.598 (95% CI=1.530~1.668), 1.597 (95% CI=1.534~1.662), and finally at 1.636 (95 % CI =1.552 ~1.725).

CONCLUSION: The study suggests a significant link between prior AR and the occurrences of PVD. However, given the distinct pathophysiological mechanisms of these disorders and the high prevalence of AR in the general population, the findings should be interpreted with caution. These results are hypothesis-generating and underscore the need for prospective and mechanistic studies to clarify whether the observed associations reflect causal relationships or coincidental comorbidity.

PMID:41176555 | DOI:10.1007/s00405-025-09756-4

Eur Radiol. 2025 Nov 1. doi: 10.1007/s00330-025-12092-0. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the diagnostic performance of ¹⁸F-fluoro-L-ascorbic acid ([¹⁸F]FAA) positron emission tomography-computed tomography (PET/CT) in detecting metastatic differentiated thyroid cancer (DTC) and compare it with ¹⁸F-fluorodeoxyglucose ([¹⁸F]FDG) PET/CT.

MATERIALS AND METHODS: Data were retrospectively collected from patients who were clinically suspected or diagnosed with postoperative metastatic DTC between September 2023 and May 2024. Quantification was performed using the maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR). Histopathological outcomes and clinical follow-up served as the reference standard for final diagnosis. Diagnostic accuracy was compared using McNemar’s test, and tracer uptake was analyzed via the Wilcoxon signed-rank test.

RESULTS: A total of 85 participants (median age, 51 years; IQR, 38-61 years; 45 women) were evaluated. For cervical lymph nodes (LNs), [¹⁸F]FAA showed superior sensitivity (88% vs. 67%), accuracy (82% vs. 69%), and negative predictive value (78% vs. 57%) (all p < 0.001), with comparable specificity (72% vs. 74%, p = 0.64) and positive predictive value (84% vs. 81%; p = 0.44) than [¹⁸F]FDG. For distant metastases, [¹⁸F]FAA PET/CT demonstrated higher sensitivity than [¹⁸F]FDG for pulmonary metastases (53% vs. 27%), and bone metastases (72% vs. 21%) (all p < 0.001). Semiquantitatively, [¹⁸F]FAA had higher SUVmax in the cervical LN metastasis (10.3 vs. 5.4), pulmonary metastasis (4.7 vs. 2.8), and bone metastasis (16.1 vs. 3.0), as well as higher TBR in cervical LN (18.1 vs. 6.8) and bone metastasis (6.9 vs. 1.9) (all p < 0.01).

CONCLUSION: [¹⁸F]FAA PET/CT outperforms [¹⁸F]FDG PET/CT in the depiction of metastatic thyroid cancer, particularly in neck LNs, pulmonary, and bone metastases.

KEY POINTS: Question Is 6-Deoxy-6-[¹⁸F]fluoro-L-ascorbic acid PET/CT ([¹⁸F]FAA) PET/CT an imaging method that can identify metastatic lesions after thyroid cancer surgery, and is it superior to [¹⁸F]FDG PET/CT? Findings [¹⁸F]FAA exhibited higher sensitivity and elevated SUVmax values compared to [¹⁸F]FDG in the detection of lymph node, lung, and bone metastases of metastatic thyroid cancer. Clinical relevance [¹⁸F]FAA is a reliable diagnostic tool that can accurately locate metastatic sites after thyroid cancer surgery. This helps tailor treatment plans and predict prognosis based on different metastatic scenarios.

PMID:41176553 | DOI:10.1007/s00330-025-12092-0

Eur Radiol. 2025 Nov 1. doi: 10.1007/s00330-025-12115-w. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess treatment response in osteosarcoma, two automated convolutional neural networks (CNNs) were developed to quantify tumour volumes and predict response to induction chemotherapy using histopathology as the reference standard.

MATERIALS AND METHODS: This retrospective, multicentre study included magnetic resonance imaging (MRI) scans from osteosarcoma patients acquired between January 2006 and July 2024. A 3D U-Net CNN segmented tumours and calculated volumes at baseline and post-chemotherapy. A second CNN predicted treatment response based on MRI-derived tumour volume changes using histopathologic necrosis (≥ 90%) as the reference standard. Both models were trained on 162 scans from 81 patients (Centre A) and validated on 40 scans from 20 patients (10 per centre) with Centre B as the external test set. Human readers measured 3D tumour diameters and volumes, compared with CNN-derived volumes using Spearman’s correlation, Bland-Altman plots, and Dice coefficients. Prediction performance was assessed using accuracy, sensitivity, and specificity, with significance determined by agreement metrics.

RESULTS: Patients from Centre A had a mean age of 15 ± 5 years (52 males), and from Centre B a mean age of 13 ± 0 years (8 males). CNN- and human-derived tumour volumes showed strong correlation (Centre A: r = 0.98, Centre B: r = 0.95; p < 0.001). Dice coefficients were 0.86 (Centre A) and 0.81 (Centre B), with median Hausdorff distances of 15.0 mm and 14.2 mm. The response prediction model classified 16/20 cases (80% accuracy) with 90% sensitivity and 70% specificity.

CONCLUSION: CNN-derived tumour volume measurements were comparable to human assessments. CNN-based volume changes predicted histopathologic response to chemotherapy in paediatric osteosarcoma.

KEY POINTS: Question Accurate, noninvasive assessment of treatment response in paediatric osteosarcoma is limited by its reliance on manual tumour measurements and post-surgical histopathology. Findings Automated deep learning accurately measured tumour volumes on MRI and predicted chemotherapy response with 80% accuracy, 90% sensitivity, and 70% specificity. Clinical relevance Automated deep learning enables accurate tumour volume assessment and prediction of chemotherapy response in paediatric osteosarcoma, offering a noninvasive tool to support and refine patient management.

PMID:41176552 | DOI:10.1007/s00330-025-12115-w