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Nevin Manimala Statistics

Using language to evaluate curricular impact: a novel approach in assessing clinical reasoning curricula

Diagnosis (Berl). 2025 Jan 6. doi: 10.1515/dx-2024-0181. Online ahead of print.

ABSTRACT

OBJECTIVES: Published clinical reasoning curricula are limited, and measuring curricular impact has proven difficult. This study aims to evaluate the impact of a broad-reaching, multi-level reasoning curricula by measuring utilization of clinical reasoning terminology in published abstracts.

METHODS: In 2014, the University of Pittsburgh Medical Center (UPMC) created a clinical reasoning curriculum with interventions at the student, resident, and faculty levels with the goal of bringing reasoning education to the forefront. This study was a retrospective analysis of published clinical vignettes of the Society of General Internal Medicine prior to local curricular intervention (2014), post-curricular intervention (2018), and on follow-up (2022). UPMC-affiliated abstracts were compared to abstracts containing reasoning terms from all other institutions, at each time point.

RESULTS: There was a statistically significant increase in the use of clinical reasoning terms by UPMC-affiliated participants from 2014 to 2018. Non-UPMC submissions, saw a smaller, but still significant increase in the use of clinical reasoning terms. There was a decline in clinical reasoning term use from 2018 to 2022, both at UPMC and nationally.

CONCLUSIONS: This study demonstrates that widespread clinical reasoning curricula can increase interest in and use of clinical reasoning terminology. Further work is needed to develop creative assessment tools for reasoning curricula.

PMID:39754715 | DOI:10.1515/dx-2024-0181

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Nevin Manimala Statistics

Correlations Between Spirituality, Anxiety, and Depression in Hemodialysis Patients in Saudi Arabia: A Cross-Sectional Study

J Relig Health. 2025 Jan 4. doi: 10.1007/s10943-024-02239-6. Online ahead of print.

ABSTRACT

Spirituality is widely recognized as a potential moderator of the adverse effects of hemodialysis on mental health. Understanding its impact on mental health in Saudi Arabia and the Arab world, however, remains a significant research gap. Hence, this study aims to explore the correlations between spirituality, anxiety, and depression among Saudi Arabian patients undergoing hemodialysis. Using a cross-sectional design, 121 hemodialysis patients were recruited. Self-administered surveys were employed to capture demographic data, as well as a Depression and Anxiety Scale, and a Spiritual Well-being Scale. Descriptive and inferential statistics, along with multivariate regression, were utilized to analyze the data. Results show that the majority of respondents (77.7-87.6%) report moderate levels of religious well-being (RBW) and existential well-being (EWB), while 76.8-15.7% showed low-to-moderate levels of depression, respectively. Additionally, 20.7% of patients experienced moderate-to-severe anxiety. Significant negative correlations were found between RWB/EWB and depression (r = – 0.459, r = – 0.601, p < 0.001, respectively) and between RWB / EWB and anxiety (r = – 0.341, r = – 0.536, p < 0.001). The RWB accounted for 54.9% of the religious score variance, showing a strong correlation with existential score (β = 0.655, p < 0.001), but not with anxiety or depression. Similarly, the EWB accounted for 63.7% of the EWB variance, showing a correlation with religious score (β = 0.528, p < 0.001) and anxiety score (β = – 0.199, p < 0.05), but not with depression. In contrast, the depression explained 71.2% of the variation in depression scores, as well as showing strong correlations with anxiety (β = 0.663, p < 0.05). The anxiety accounted for 66.8% of the variance in anxiety scores, with depression being a significant predictor (β = 0.763, p < 0.001). This study highlights the importance of integrating spirituality into holistic care for hemodialysis patients because its presence positively influences both mental and physical health outcomes.

PMID:39754693 | DOI:10.1007/s10943-024-02239-6

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Nevin Manimala Statistics

The effect of the COVID-19 pandemic on clinical and pathologic stages of patients diagnosed with breast cancer

Ir J Med Sci. 2025 Jan 4. doi: 10.1007/s11845-024-03860-w. Online ahead of print.

ABSTRACT

AIM: This study aimed to investigate the effect of the COVID-19 pandemic on the clinical and pathological stages of patients diagnosed with breast cancer.

METHOD: In this retrospective study, a total of 298 male and female patients over the age of 18 who were diagnosed with breast cancer and who were continuing surgical and oncologic treatment were included.

RESULTS: Of the 298 patients diagnosed with breast cancer, 186 (62.4%) belonged to the pre-COVID period and 112 (37.6%) to the COVID period, and there was a 39.7% decrease in the number of diagnosed patients. Statistical analyzes revealed significant differences in family history, smoking, histopathologic grade, disease stage, type of surgery performed and Cerb-B2 ovarian expression (p = 0.005, p = 0.001, p = 0.018, p = 0.035, p < 0.001, p = 0.047). During the pandemic period, tumor size (T), axillary lymph node metastasis rate, neoadjuvant chemotherapy rate, and distant metastasis rate increased, but there was no statistically significant difference (p = 0.535, p = 0.070, p = 0.148, p = 0.153, respectively).

CONCLUSIONS: In pandemic situations such as COVID-19, restrictions in social life and fear of contamination can prolong the time of admission to the hospital. This may cause delays in the diagnosis of malignant diseases such as breast cancer and progression in the disease stage. In these and similar outbreaks, public awareness should be raised, and the public should be encouraged to comply with screening and follow-up programs in order to continue outpatient clinic activities and screening programs without interruption by taking contamination measures.

PMID:39754685 | DOI:10.1007/s11845-024-03860-w

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Nevin Manimala Statistics

Unveiling the Burden of Sickle Cell Anemia: A Pilot Study Validating Dried Blood Spots for Newborn Screening

Indian J Pediatr. 2025 Jan 4. doi: 10.1007/s12098-024-05392-8. Online ahead of print.

ABSTRACT

This hospital-based cross-sectional study aimed to screen newborns for sickle cell anemia immediately after birth and validate dried blood spot (DBS) samples against conventional venous blood samples (CBS) for hemoglobin variant analysis by HPLC. Among 751 newborns, 2.93% were found to have sickle cell trait. Hemoglobin variants were analyzed in both DBS and CBS samples, showing good agreement with 100% sensitivity and 100% specificity. Passing Bablok regression indicated minimal proportional bias, while Bland-Altman analysis showed a bias of 0.67, but the line of equality within the 95% CI of the bias indicated acceptable minimal systematic bias. The concordance correlation coefficient was 0.91 (p < 0.0001), Pearson’s ρ (precision measure) was 0.967, and Cohen’s kappa statistics gave a weighted kappa of 0.93, confirming no significant differences between the two methods. This study supports DBS as a reliable method for universal neonatal screening for sickle cell disease, demonstrating its potential for widespread clinical use.

PMID:39754675 | DOI:10.1007/s12098-024-05392-8

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Nevin Manimala Statistics

Associations between stress hyperglycemia and outcomes in patients with ischemic stroke and TIA: the data comes from the Third China National Stroke Registry (CNSR-III)

Metab Brain Dis. 2025 Jan 4;40(1):82. doi: 10.1007/s11011-024-01499-1.

ABSTRACT

In the acute stage of stroke, stress hyperglycemia is common in both diabetic and nondiabetic patients. The associations between stress hyperglycemia and functional outcomes, as well as stroke recurrence were heterogeneous in previous studies. We aimed to demonstrate these associations in a general population of patients with ischemic stroke and transient ischemic attack (TIA). We included patients with complete data on blood glucose and hemoglobin from The Third China National Stroke Registry. The stress hyperglycemia ratio (SHR) was calculated using fasting blood glucose (mmol/L) divided by glycosylated hemoglobin A1c (%). Outcomes included functional disability, recurrent ischemic stroke and TIA, combined vascular events, and all-cause mortality at 90 days. In total, 7186 patients were included (median age: 62 [54-70] years, male: 4864 [67.69%], TIA: 589 [8.20%]). SHR levels were significantly associated with functional disability (adjusted OR: 1.69, 95%CI: 1.22-2.33). For every 1 standard deviation increment in SHR, the risk of functional disability increased by 13%. Compared to the patients in SHR Tertile 1, those in Tertile 3 had a 1.31-fold increased risk of functional disability (95%CI: 1.08-1.60). There was a trend indicating that the risk of functional disability increased with higher SHR tertiles (P for trend = 0.0074). Stroke severity explained 42.94% of the total excess association between SHR and functional disability. However, neither SHR levels nor SHR tertiles were associated with recurrent ischemic stroke and TIA, combined vascular events, or all-cause mortality. This study found that admission stress hyperglycemia was associated with functional disability, which was partially mediated by stroke severity.

PMID:39754666 | DOI:10.1007/s11011-024-01499-1

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Nevin Manimala Statistics

Dynamic characteristics of high-risk HPV infection in women with low-grade cervical intraepithelial neoplasia, based on a community longitudinal study

Eur J Clin Microbiol Infect Dis. 2025 Jan 4. doi: 10.1007/s10096-024-05036-x. Online ahead of print.

ABSTRACT

BACKGROUND: High-risk human papillomavirus (HR-HPV) infection is the primary cause of cervical cancer and precancerous lesions. Approximately 35% of women with low-grade cervical intraepithelial neoplasia (CIN1) may experience persistence or progression to high-grade lesions. Yet, the dynamic characteristics of HR-HPV infection in women with CIN1 remain unclear.

METHODS: A total of 564 women diagnosed with CIN1, recruited from a community-based cohort, underwent a 24-month follow-up at 6th, 12th, and 24th month intervals. Hazard ratios (HRs) with 95% confidence interval (CI) were calculated to evaluate the risk of HR-HPV infection prognosis and their associated factors. Kaplan-Meier survival curves illustrated the dynamic changes of HR-HPV infection and association between HR-HPV infection prognosis and various influencing factors.

RESULTS: HPV16 was the predominant carcinogenic genotype, followed by HPV58 and HPV52. Over the 24-month follow-up, persistent HPV16 infection occurred in 10.6% of women, with 14.4% converting from positive to negative and 4% developing HPV16 positivity from baseline HR-HPV negativity. Rates of persistent infection for HPV58, 52, 18, and 56 decreased over time, with HPV58, 52, and 31 infections more likely to turn HR-HPV negative. Additionally, rates of positive conversion from negative for HPV58, 56, 33, and 66 increased with extended follow-up time. Variables associated with dynamic characteristics of HR-HPV infection prognosis included personal hygiene, age of first menarche, age at first sexual intercourse, educational level, age, and menopausal status (all P < 0.05).

CONCLUSIONS: These findings contribute to understanding the dynamic characteristics of HR-HPV infection prognosis in women with CIN1 and its association with non-viral factors.

PMID:39754612 | DOI:10.1007/s10096-024-05036-x

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Nevin Manimala Statistics

Risk of Suicide Among Patients With Major Physical Disorders Considering Comorbidities of Mental Disorders: An Instrumental Variable Analysis

Omega (Westport). 2025 Jan 4:302228241312744. doi: 10.1177/00302228241312744. Online ahead of print.

ABSTRACT

Suicide is an important health concern. Excepting cancer, the association between physical disorders and suicidal risk is comparatively less explored. Instrumental variable analysis has been suggested as a powerful technique to deal with possible bias caused by unmeasured confounders in observational research. This population-based study set out to assess the suicidal risk of patients with major physical disorders by employing the instrumental variable analysis. Data were retrieved from the National Health Insurance Research Database and the Death Certification Registry in Taiwan (years 2010-2018). The Cox proportional hazards model with an instrumental variable estimator was performed, adjusting for comorbidities of mental disorders and other covariates. Analytical results showed that compared to their counterparts, patients with major physical disorders had an elevated risk of death by suicide within one year and three years after diagnosis of physical illness. Only did epilepsy not demonstrate a statistically significant impact on the risk of suicide.

PMID:39754563 | DOI:10.1177/00302228241312744

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Nevin Manimala Statistics

The effect of eight weeks of aerobic training with vitamin C on some apoptotic markers in the hippocampus tissue of rats with Alzheimer’s disease; an experimental study

Neurol Res. 2025 Jan 4:1-10. doi: 10.1080/01616412.2024.2448624. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to investigate the effect of eight weeks of aerobic training (AT) and vitamin C supplementation (VC) on apoptotic markers in hippocampus tissue of AD rats treated with trimethyltin (TMT).

MATERIALS AND METHODS: In this experimental study, 32 Sprague- Dawley rats (mean age: 14-18 months and mean weight 270-320 g) were treated with (10 mg/kg) TMT and divided into 4 groups including: 1) ADcontrol, 2) VC, 3) AT and 4) AT+VC groups. In order to investigate the effects of AD induction on research variables, 8 healthy rats selected as healthy control group (HC). Groups 3 and 4 trained for eight weeks, three sessions per week and each session lasted 15-48 minutes with an intensity of 10-24 m/min. Groups 2 and 4 received 4 mg/kg VC orally. One-way ANOVA with Tukey’s post- hoc tests were used for statistical analysis of data (p ≤ 0.05).

RESULTS: The gene expression levels of Caspase 3, FasL, Cyt-C and AP-1 in the AT, VC and AT+VC groups were significantly lower than TMT group (p ≤ 0.05); Caspase 3, FasL and Cyt-C levels were significantly lower in the AT+VC group compare to VC and ET groups (p ≤ 0.05). CytC levels in AT group were significantly lower than VC group (p = 0.002). Also, AP-1 levels in AT+VC group were significantly lower than AT group (p = 0.01).

CONCLUSIONS: It seems that AT and VC, both alone and interactively, can probably induce their anti-apoptotic effects in the hippocampus tissue of rats with AD via a common signaling pathway.

PMID:39754544 | DOI:10.1080/01616412.2024.2448624

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Nevin Manimala Statistics

Enhanced myocardial perfusion in late gestation fetal lambs with impaired left ventricular inflow

J Physiol. 2025 Jan 4. doi: 10.1113/JP286685. Online ahead of print.

ABSTRACT

Robust preclinical models of asymmetric ventricular loading in late gestation reflecting conditions such as hypoplastic left heart syndrome are lacking. We characterized the morphometry and microvascular function of the hypoplastic left ventricle (LV) and remaining right ventricle (RV) in a sham-controlled late gestation fetal lamb model of impaired left ventricular inflow (ILVI). Singleton fetuses were instrumented at ∼120 days gestational age (dGA; term is ∼147 days) with vascular catheters, an aortic flow probe and a deflated left atrial balloon. Balloons in ILVI fetuses were inflated over the 8 day study until aortic output was eliminated; Sham balloons remained deflated. At the study end-point (∼134 dGA), cardiac function was assessed by echocardiography, microvascular perfusion of each free wall was measured by myocardial contrast echocardiography (MCE) and terminal morphometric data were collected. During the chronic study, flow through the ascending aorta of ILVI fetuses fell from 389 to -48 mL min-1 with minimal changes to other haemodynamics or blood chemistry. End-point echocardiography and morphometry similarly showed significant and meaningful reductions in ILVI LV chamber volume and wall mass without statistically significant changes in RV size relative to Shams. MCE revealed modestly increased LV perfusion and profoundly increased RV perfusion in ILVI fetuses. Our model displays effective LV hypoplasia with preserved overall fetal health, and our finding of increased RV myocardial perfusion may indicate active vascular remodelling in response to the experimental lesion. KEY POINTS: Hypoplastic left heart syndrome can be caused by insufficient inflow of blood to the fetal left ventricle. We found that eliminating fetal left ventricular input for 8 days reduced left ventricular size and volume, with minimal effects on the right ventricle or overall fetal health. Blood and oxygen delivery increased significantly in the right ventricle and slightly in the hypoplastic left ventricle. Our results suggest functional and anatomical adaptation of the fetal coronary microvasculature to univentricular right heart conditions.

PMID:39754538 | DOI:10.1113/JP286685

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Nevin Manimala Statistics

Echocardiographic Evaluation of the Effect of Long-Term Methylphenidate Use on Cardiovascular Functions

J Atten Disord. 2025 Jan 4:10870547241307680. doi: 10.1177/10870547241307680. Online ahead of print.

ABSTRACT

OBJECTIVE: ADHD is one of the most common neurodevelopmental disorders, seen in children and adolescents, and is often treated with various pharmacological agents, especially methylphenidate. There are differing opinions in the literature regarding the cardiovascular safety of long-term methylphenidate use. Studies suggest that the drug may increase the risk of hypertension, myocardial infarction, ventricular arrhythmia, sudden cardiac death, cardiomyopathy, heart failure (HF), pulmonary hypertension, and stroke. This study aimed to compare the clinical and echocardiographic characteristics of patients diagnosed with ADHD who have been using long-acting methylphenidate for an extended period with age-gender matched healthy volunteers.

MATERIALS AND METHODS: A total of 70 patients diagnosed with ADHD, who had been using long-acting methylphenidate for 2 years or more, and 51 healthy volunteers, who were referred to our clinic, were included in our study. Patients were evaluated with basic and advanced techniques such as Motion Mode (M-mode), two-dimensional (2D), Doppler, and 2D-Speckle Tracking (STE) using transthoracic echocardiography. All other data were evaluated instantly after the processing with the strain images analysis program.

RESULTS: Statistically significant differences were observed between the case and control groups in terms of body mass index (BMI) and systolic blood pressure (SBP), with BMI negatively correlated and SBP positively correlated with methylphenidate use duration. There was no significant difference between the groups in apical four-chamber, three-chamber, two-chamber, and global longitudinal strain (GLS) values obtained by 2D-STE technique indicating early deterioration. The Left Ventricular (LV) lateral E’ value, which indicates diastolic dysfunction, was lower in the drug group, but still within normal limits. The lateral LV E’, Right Ventricular (RV) E’, and RV A’ values showed a significant negative correlation with the duration of drug use and remained within normal limits. Other parameters evaluating systolic/diastolic function such as E/E’, left ventricular ejection fraction (LVEF), myocardial performance index (MPI), and tricuspid/mitral annular plane systolic excursion (TAPSE/MAPSE) did not differ significantly between the groups and were within normal limits. Valve structures and regurgitations were also not significantly different between the two groups.

CONCLUSION: Considering all parameters, we conclude that long-term use of long-acting methylphenidate does not cause cardiovascular dysfunction in late adolescent and early adult individuals. The observed differences in the E’ lateral value between the case and control groups, as well as the slight correlation of lateral LV E’, RV E’, and RV A’ values with the duration of use, do not directly indicate cardiac dysfunction.

PMID:39754497 | DOI:10.1177/10870547241307680