Nevin Manimala

Trop Med Health. 2026 Jun 6. doi: 10.1186/s41182-026-00994-8. Online ahead of print.

ABSTRACT

BACKGROUND: The potential re-emergence of Mpox poses an increasing public health concern in the Horn of Africa, particularly in Ethiopia. This study examined perceptions of preparedness among surveyed surveillance professionals in Ethiopia regarding the disease surveillance system’s ability to detect and respond to a potential Mpox outbreak.

METHODS: A descriptive cross-sectional survey design was employed, utilizing a structured 58-item questionnaire that assessed preparedness across five domains: general awareness and understanding, surveillance infrastructure and resources, coordination and communication, preparedness and response, and policy, training, and equity. The survey was distributed to disease surveillance professionals at both federal and regional levels through purposive sampling. The data were analyzed using descriptive statistics, Mann-Whitney U tests, Cramér’s V, and content analysis.

RESULTS: Among the 42 surveyed surveillance professionals, 45.3% believed that the surveillance system could effectively respond to an Mpox outbreak, while 54.7% disagreed, reflecting divided perceptions within the sample. Respondents identified several perceived gaps, including limited awareness of Mpox-specific protocols, insufficient training, inadequate diagnostic capacity, and fragmented coordination across sectors. A substantial proportion of respondents reported system-related challenges, with 83.3% perceiving laboratory facilities as inadequate and 78.6% noting the absence of contingency plans. In addition, 57.1% indicated that their organizations lacked staff trained on Mpox, and 59.5% reported no stockpiles of personal protective equipment. Overall, the surveyed professionals expressed mixed perceptions of preparedness, with notable concerns regarding resource allocation, infrastructure, and policy implementation.

CONCLUSIONS: The study identifies perceived gaps among the 42 surveyed surveillance professionals regarding Mpox preparedness in Ethiopia, highlighting the need for enhanced training, strengthened infrastructure, improved coordination, and more equitable resource distribution. Addressing these gaps through targeted interventions may help strengthen disease surveillance capacity and improve the ability to detect, respond to, and manage emerging health threats such as Mpox.

PMID:42251460 | DOI:10.1186/s41182-026-00994-8

J Pharm Health Care Sci. 2026 Jun 6. doi: 10.1186/s40780-026-00592-0. Online ahead of print.

ABSTRACT

BACKGROUND: Antibiotic resistance has emerged largely due to the improper use of antibiotics in clinical practice, although most acute diarrheal diseases resolve without antibiotic treatment and should be reserved for cases of invasive bacterial or dysenteric diarrhea. This study aimed to assess the patterns of antibiotic use for acute diarrheal diseases at Nigist Elleni Mohammed Memorial Teaching Hospital (NEMMTH) in Central Ethiopia.

METHODS: A retrospective cross-sectional study was conducted to assess patients treated for diarrhea between January 1 and June 30, 2023. The appropriateness of antibiotic prescriptions for diarrhea was evaluated according to the Ethiopian Standard Treatment Guidelines. Data were collected using a structured abstraction form, and patient charts were selected through systematic random sampling. The analysis was performed using the Statistical Package for Social Sciences version 25.

RESULTS: Among 302 patients evaluated, 53.3% were female and 46.4% were children under five years old. Of the 302 patients, 57.6% had watery diarrhea. A total of 74.5% of patients received at least one antibiotic, of whom 73.5% received a single antibiotic during the treatment of acute diarrheal cases. The most commonly prescribed antibiotics were metronidazole (18.2%), cotrimoxazole (17.5%), and ciprofloxacin (11.6%). The proportion of inappropriate antibiotic prescribing was 77.1%.

CONCLUSIONS: This study found a high level of inappropriate antibiotic use for acute diarrheal disease at NEMMTH. Metronidazole and cotrimoxazole are the most commonly prescribed antibiotics. Ensuring proper management by adhering to the standard treatment guidelines is crucial.

PMID:42251448 | DOI:10.1186/s40780-026-00592-0

AIDS Res Ther. 2026 Jun 6. doi: 10.1186/s12981-026-00895-0. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence on COVID-19 among people living with HIV (PLWH) remains mixed and context-dependent.

METHODS: We prospectively followed 64 PLWH receiving antiretroviral therapy at a tertiary university hospital in Martin, Slovakia (September 2020-September 2021). SARS-CoV-2 infection was confirmed by RT-PCR.

RESULT: COVID-19 was diagnosed in 54 of 64 participants (84.4%) and was generally mild; none required intensive care, and no deaths were reported. There were no statistically significant differences between PLWH who did and did not develop COVID-19 with respect to age, duration of HIV infection, CD4 cell count, or viral suppression. Participants who developed COVID-19 were more likely to have at least one documented comorbidity; however, this did not appear to translate into severe outcomes in this small cohort. Among those with COVID-19, exploratory comparisons showed no clear differences in short-term outcomes according to mRNA vaccination status.

CONCLUSIONS: In this small exploratory cohort of ART-treated individuals in Slovakia, we did not identify clear clinical or HIV-related predictors of COVID-19 outcomes; however, the study was underpowered and the findings should be interpreted cautiously.

PMID:42251430 | DOI:10.1186/s12981-026-00895-0

AIDS Res Ther. 2026 Jun 6. doi: 10.1186/s12981-026-00893-2. Online ahead of print.

ABSTRACT

We assessed the association between dolutegravir (DTG)-based antiretroviral therapy and kidney abnormalities among young people living with HIV in Kampala, Uganda. Cross-sectional albumin-creatinine ratio (ACR), proteinuria, and estimated glomerular filtration rate (eGFR) were measured. Among 483 participants, the mean serum creatinine was higher (0.68 vs. 0.59) and creatinine-based eGFR lower (118.8 vs. 113.9), among those on TDF/DTG. Cystatin C-based eGFR, prevalences of elevated ACR (9.6% vs. 13.0%), proteinuria (28.3% vs. 30.2%), and eGFR < 90 ml/min/1.73 m² (40.1% vs. 46.9%) were similar. Kidney abnormalities were not associated with regimen, supporting the need for longitudinal studies to clarify progression risk.

PMID:42251428 | DOI:10.1186/s12981-026-00893-2

J Cardiothorac Surg. 2026 Jun 6. doi: 10.1186/s13019-026-04309-0. Online ahead of print.

ABSTRACT

BACKGROUND: Preoperative intravenous iron has become increasingly popular as a strategy to optimize hemoglobin before major surgery. However, its potential benefit in non-anaemic patients undergoing cardiac surgery remains unclear. To address this uncertainty, we conducted a systematic review and meta-analysis to investigate whether preoperative IV iron reduces red blood cell transfusion requirements and improves hematologic and clinical outcomes in adults with normal baseline hemoglobin undergoing cardiac surgery.

METHODS: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library until October 2025 for randomized controlled trials. Eligible studies compared preoperative IV iron to a control (placebo, saline, or standard care) in non-anaemic (per WHO definition) adult patients (≥ 18 years) undergoing cardiac surgery. The primary outcomes were the incidence of postoperative RBC transfusion and the number of units transfused. Secondary outcomes included postoperative hemoglobin level, Postoperative iron indices, length of ICU stay, length of hospital stay (LOS), overall postoperative infection, All-cause mortality, and adverse events possibly related to IV iron (hypersensitivity, anaphylaxis). We used the Cochrane ROB 2 tool for bias assessment and for evidence certainty. Pooled Risk ratios, odds ratios, mean difference, and standardized mean difference with 95% confidence intervals were calculated using random-effects models, with the fixed-effects model applied when heterogeneity was absent or low (I² < 10%).

RESULTS: From 529 initial records, 3 RCTs met the inclusion criteria, encompassing 338 patients. The overall risk of bias was low to moderate. Preoperative IV iron significantly reduced the incidence of postoperative RBC transfusion compared to the control group (Risk Ratio [RR] = 0.62; 95% CI 0.43-0.88; p = 0.008; I² = 0%), representing a 38% relative risk reduction. Furthermore, IV iron significantly decreased the mean number of RBC units transfused (Mean Difference [MD] = – 1.08 units; 95% CI – 1.61 to – 0.54; I² = 0%). While no significant difference was observed in hemoglobin levels at 48 h or one week postoperatively, the IV iron group showed significantly higher hemoglobin at 4-6 weeks (MD = 0.84 g/dL; 95% CI 0.41-1.26; p = 0.0001). IV iron also significantly increased postoperative serum ferritin and transferrin saturation. There were no statistically significant differences in overall postoperative infection rates (RR = 1.16; 95% CI 0.64-2.08) or all-cause mortality (Risk Difference = – 0.00; 95% CI – 0.03 to 0.03). The GRADE certainty of evidence for the primary outcome was moderate.

CONCLUSION: In non-anaemic adult patients undergoing cardiac surgery, preoperative IV iron administration significantly reduces the incidence of postoperative RBC transfusion and the total volume of blood transfused. This intervention also improves hemoglobin levels during the 4-6 week recovery period without an increased risk of infection or mortality. The moderate-certainty evidence suggests this is a beneficial strategy, though further adequately powered RCTs are warranted to strengthen these findings.

PROSPERO REGISTRY REFERENCE: CRD420251161421.

PMID:42251415 | DOI:10.1186/s13019-026-04309-0

BMC Palliat Care. 2026 Jun 6. doi: 10.1186/s12904-026-02184-z. Online ahead of print.

ABSTRACT

BACKGROUND: Advance care planning (ACP) is important in cancer care, but discussions are often delayed or inconsistently implemented. Online ACP decision aid programmes may support ACP participation, although their effects in adults with cancer remain unclear.

METHODS: A systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, the Cochrane Library, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and supplementary sources was conducted from inception to 10 March 2026. Quantitative studies evaluating online ACP decision aid programmes for adults with cancer were included. Risk of bias was assessed using appropriate tools according to study design. Meta-analyses were performed using fixed- or random-effects models.

RESULTS: Twelve studies met the eligibility criteria, including 10 randomised controlled trials, 1 pre-post study, and 1 single-arm quantitative evaluation study. Most studies were conducted in the USA. Pooled evidence showed that online ACP decision aid programmes significantly improved ACP documentation (OR = 2.06, 95% CI 1.29 to 3.27, p = 0.002) and ACP engagement (MD = 0.28, 95% CI 0.15 to 0.40, p < 0.0001). No statistically significant effects were found for AD completion (OR = 1.37, 95% CI 0.54 to 3.45, p = 0.50), satisfaction (MD = 0.15, 95% CI -0.25 to 0.55, p = 0.47), decisional conflict (MD=-0.72, 95% CI -5.87 to 4.43, p = 0.78), or anxiety (MD=-0.76, 95% CI -1.67 to 0.16, p = 0.11). Sensitivity analyses suggested that the findings for ACP documentation and ACP engagement were relatively robust, whereas the results for satisfaction and anxiety were less stable.

CONCLUSIONS: Online ACP decision aid programmes may support ACP in adults with cancer, particularly by improving ACP engagement and ACP documentation. However, evidence for benefits beyond ACP process outcomes remains limited or inconsistent. Further rigorous studies are needed to identify effective programme features and implementation strategies.

PMID:42251411 | DOI:10.1186/s12904-026-02184-z

J Orthop Surg Res. 2026 Jun 6. doi: 10.1186/s13018-026-06965-3. Online ahead of print.

ABSTRACT

BACKGROUND: The rapid adoption of electric bicycles (EB) has led to a significant increase in related injuries, posing a growing public health challenge. In Anhui Province, China, EB-related orthopedic injuries represent a major component of traffic trauma burden. However, systematic data on injury patterns, anatomical distribution, and demographic variations remain limited, hindering optimized clinical management. This study aims to characterize the clinical spectrum of orthopedic injuries associated with EB that necessitate surgical management.

METHODS: This single-center retrospective cohort study analyzed data from the Hospital Information System (HIS) for patients with EB-related orthopedic injuries between January, 2020, and December, 2025. Among 3,412 vehicle-related injuries, 1,735 cases met inclusion criteria. Injury types were classified into six categories (e.g., fractures, dislocations), and anatomical sites were categorized into 16 regions. Statistical analyses included descriptive statistics and chi-square tests to identify factors associated with severe injuries.

RESULTS: The study included 1,735 patients (59.20% male; mean age 48.65 ± 15.73 years), with a bimodal age distribution peaking in the 31-44 and 45-59 groups. Fractures predominated (85.01% of cases), followed by combined injuries such as open fractures with soft tissue damage (4.67%). The most frequent anatomical sites were the clavicle, tibiofibula, and hand/foot. Female patients were significantly older than males (95% CI: 3.44, 6.38; p < 0.001), and young males had higher injury rates.

CONCLUSIONS: EB-related orthopedic injuries predominantly affect middle-aged and elderly populations (1,735 patients; mean age 48.65 ± 15.73 years, bimodal peaks at 34.65 ± 9.41 years and 57.28 ± 6.72 years), with fractures accounting for 85.01% of cases and combined trauma (e.g., open fractures with soft tissue damage) representing 4.67%. The clavicle, tibiofibula, and hand/foot are the most commonly injured sites. These findings provide foundational insights for orthopedic clinical practice pertaining to EB-related injuries, suggesting that age-stratified triage protocols and prioritized evaluation of high-risk anatomical sites (clavicle, lower limbs) warrant further investigation to optimize resource allocation and patient outcomes in clinical settings. However, this study has several limitations, including its single-center retrospective design, absence of severity validation scores, and insufficient data on protective measures/devices/follow-up and so on. Therefore, prospective multicenter studies are warranted to validate and optimize clinical practice.

PMID:42251405 | DOI:10.1186/s13018-026-06965-3

BMC Psychol. 2026 Jun 6. doi: 10.1186/s40359-026-04940-5. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Amid increasing social pressures, the importance of psychological resilience as a key resource for stress coping has become prominent. Although exercise is considered a potential means to enhance resilience, a systematic quantitative assessment of moderating factors influencing its effect is lacking. This meta-analysis aimed to systematically evaluate the effect of exercise interventions on enhancing psychological resilience and explore the moderating roles of intervention duration, age, and study design.

METHODS: Following PRISMA guidelines, relevant databases were searched up to January 2026. Randomized controlled trials or quasi-experimental studies were included. Study quality was assessed using standardized tools. Analyses were conducted using a random-effects model, subgroup analyses, and heterogeneity tests.

RESULTS: Ten studies were included. Exercise intervention had a significant positive effect on psychological resilience (pooled SMD = 0.49, 95% CI: 0.33-0.65). Intervention duration was a statistically significant moderator (p = 0.01) that survived Bonferroni correction for multiple subgroup tests (α < sub > adjusted < /sub > = 0.017), with long-term interventions (> 8 weeks, SMD = 0.64) yielding significantly larger effects than short-term interventions (≤ 8 weeks, SMD = 0.30). The intervention was effective across all age groups. Randomized controlled trials yielded a numerically larger effect size (SMD = 0.56) than non-randomized studies (SMD = 0.35), but the subgroup difference was not statistically significant (p = 0.21). No publication bias was detected.

CONCLUSION: Exercise intervention is an effective approach to enhancing psychological resilience. Subgroup analyses confirmed that intervention duration is a statistically significant moderator, with long-term interventions yielding significantly greater benefits. This provides an empirical basis for designing personalized, long-term exercise programs for different populations.

PMID:42251398 | DOI:10.1186/s40359-026-04940-5

BMC Health Serv Res. 2026 Jun 6. doi: 10.1186/s12913-026-14834-2. Online ahead of print.

ABSTRACT

BACKGROUND: Intravenous (IV) albumin is widely used in intensive care units (ICUs), yet its use often deviates from evidence-based recommendations, leading to unnecessary costs. This study evaluates the indications for the use of IV albumin in critically ill patients, compliance with the 2024 “Use of Intravenous Albumin” guidelines, and the associated cost burden.

METHODS: A prospective, point prevalence-based observational study was conducted across seven hospitals in Türkiye over one week. Data on IV albumin utilization, guideline compliance, patient demographic and clinical characteristics, and associated costs were collected and analyzed. Statistical analyses included the Kruskal-Wallis test for comparisons of albumin utilization and logistic regression to assess factors influencing its use.

RESULTS: Among 385 ICU patients monitored, 56 (14.5%) received IV albumin therapy. The median age was 68 years (Interquartile range-IQR: 54.2-77.7), and 67.9% were male. The most common physician-reported indications for initiating albumin therapy were low serum albumin levels (41.1%), fluid shifts or intravascular volume support (21.4%), and sepsis or septic shock (14.3%). The desired clinical target was achieved in 73.2% of cases; however, guideline compliance was 0%. Albumin use differed significantly across ICU types (p = 0.049), with a median consumption of 667 (IQR: 250-1,083) vials per 1,000 patient-days and an estimated cost of $70,617.86. Logistic regression identified total hospital stay (p = 0.028) and Acute Physiology and Chronic Health Evaluation (APACHE) II score (p = 0.040) as significant predictors, while mechanical ventilation (MV) duration showed borderline significance (p = 0.070). The model’s classification accuracy was 78.6%.

CONCLUSION: This study highlights widespread non-compliance with guidelines for IV albumin use in ICUs, resulting in substantial costs. These findings underscore the need to improve compliance with evidence-based guidelines to optimize albumin utilization and reduce economic burden. Future studies should explore the potential impact of targeted interventions, including pharmacist involvement, on improving prescribing practices.

CLINICAL TRIAL NUMBER: Not applicable.

TRIAL REGISTRATION: Not applicable.

PMID:42251397 | DOI:10.1186/s12913-026-14834-2

BMC Psychol. 2026 Jun 6. doi: 10.1186/s40359-026-04892-w. Online ahead of print.

ABSTRACT

BACKGROUND: Smartphone use has become deeply embedded in daily life, particularly among university students, who may adopt it as a coping mechanism for psychological distress. Excessive or maladaptive use may lead to smartphone addiction, a growing public health concern linked to adverse mental health outcomes. This study aimed to determine the prevalence of smartphone addiction and examine its association with depression, anxiety, and loneliness among public university students in Malaysia.

METHODS: A cross-sectional online survey was conducted between July 2022 and January 2024 among 7,278 students from 20 Malaysian public universities. Data were collected using validated instruments, including the Smartphone Addiction Scale-Short Version (SAS-SV), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the De Jong Gierveld Loneliness Scale (DJGLS-6). Descriptive statistics were used to estimate prevalence, and multivariable logistic regression was performed to identify associated factors of smartphone addiction.

RESULTS: The prevalence of smartphone addiction was 30.1%. Depression (42.6%), anxiety (41.9%), and loneliness (83.8%) were also highly prevalent. After adjustment, factors associated with smartphone addiction included female gender (AOR 1.148; 95% CI 1.021-1.291), Bumiputera Sabah or Sarawak ethnicity (AOR 1.235; 95% CI 1.031-1.479), higher academic year, and daily smartphone use exceeding 10 h (AOR 5.277; 95% CI 3.514-7.925). Depression (AOR 1.968; 95% CI 1.745-2.218), anxiety (AOR 2.060; 95% CI 1.789-2.372), and loneliness (AOR 1.438; 95% CI 1.207-1.714) were independently associated with smartphone addiction.

CONCLUSION: Smartphone addiction is common among Malaysian university students and is strongly associated with demographic factors, psychological distress, and excessive smartphone use. Interventions addressing mental well-being and promoting healthier digital behaviors are essential to reduce addiction risk in this population.

PMID:42251394 | DOI:10.1186/s40359-026-04892-w