Category: Nevin Manimala

J Cardiothorac Surg. 2026 Jun 4. doi: 10.1186/s13019-026-04323-2. Online ahead of print.

ABSTRACT

BACKGROUND: Tetralogy of Fallot (ToF) is the most common cause of cyanotic congenital heart disease and pulmonary regurgitation (PR) remains its most frequent postoperative complication. The preoperative z score of the pulmonary valve annulus (PVA) has been associated with an increased risk of PR after ToF repair; however, the optimal cut-off value varies among studies and has not been investigated in the Indonesian population. This study aimed to determine the predictive value of the preoperative MSCT-derived PVA diameter z score for early PR after ToF repair.

METHODS: This retrospective cohort study was conducted using secondary data from pediatric patients who underwent ToF repair at the National Cardiac Center Harapan Kita between January 2023 and December 2024. The preoperative PVA diameter was measured using cardiac multislice computed tomography (MSCT). Early PR was assessed via echocardiography within 45 days post-operatively. Multivariable logistic regression was performed and receiver operating characteristic (ROC) curve analyses were performed.

RESULTS: A total of 101 subjects were analysed. Both maximal and minimal diameters of the PVA z scores were associated with moderate or greater PR in the univariate analysis (p = 0.001 and p < 0.001, respectively). However, in multivariate analysis, only transannular patch (TAP) remained an independent predictor (p < 0.001), while PVA z scores were no longer statistically significant. ROC analysis revealed that the minimal diameter of the PVA z score (area under the curve [AUC] 0.701; cut-off – 2.5) demonstrated moderate discriminatory ability, with high specificity (90.6%) but limited sensitivity (42%).

CONCLUSION: Preoperative PVA z score is associated with early PR but does not independently predict the outcome after adjustment, as its effect is largely mediated by surgical strategy, particularly the use of TAP. While the proposed cut-off of – 2.5 demonstrates high specificity, its low sensitivity limits its utility as a screening tool. PVA z score should therefore be interpreted alongside intraoperative factors rather than used as a standalone predictor of postoperative PR, as it reflects a preoperative anatomical parameter that influences surgical decision-making.

PMID:42243828 | DOI:10.1186/s13019-026-04323-2

BMC Surg. 2026 Jun 4. doi: 10.1186/s12893-026-03853-9. Online ahead of print.

ABSTRACT

BACKGROUND: Posterior cruciate ligament (PCL) avulsion fractures at the tibial insertion can cause posterior knee instability and accelerate osteoarthritis. Meyers-McKeever type II/III fractures require surgery. Traditional open approaches are traumatic, while arthroscopic techniques are limited by equipment, learning curves, and fixation efficacy.

OBJECTIVE: To evaluate the short-term clinical outcomes and feasibility of a combined vertical medial posterior incision approach using a small T-plate and high-strength suture fixation for isolated PCL avulsion fractures.

METHODS: We retrospectively reviewed 21 patients with isolated Meyers-McKeever type II/III PCL tibial avulsion fractures treated with posteromedial longitudinal mini-incision fixation using a mini T-plate combined with high-strength suture. Operative parameters, fracture healing, knee ROM, Tegner-Lysholm score, IKDC score, posterior drawer test, and complications were assessed.

RESULTS: The mean surgery duration was 81.5 ± 20.9 min, with an average intraoperative blood loss of 33 ± 11 ml. All fractures achieved anatomical reduction, with an average healing time of 10.9 ± 1.6 weeks. At the final follow-up (mean 10.6 ± 5.2 months), knee ROM improved significantly from 76.5°±12.1° preoperatively to 132.2°±4.2° (P < 0.05). Both Tegner-Lysholm scores (from 45.5 ± 9.3 to 95.5 ± 2.8) and IKDC scores (from 35.9 ± 8.9 to 96.8 ± 1.5) showed statistically significant improvements (P < 0.05). The posterior drawer test was negative in all patients, and no infection, implant failure, or gastrocnemius weakness was observed.

CONCLUSION: Posteromedial longitudinal mini-incision fixation with a mini T-plate combined with high-strength suture achieved satisfactory clinical outcomes for PCL tibial avulsion fractures. The proposed 5T concept summarizes the main practical advantages of this technique. In this descriptive case series (Level IV evidence), the technique achieved satisfactory short-term clinical outcomes for PCL tibial avulsion fractures, particularly in patients with small or comminuted fragments. Further prospective comparative studies are needed to validate its long-term clinical value.

PMID:42243827 | DOI:10.1186/s12893-026-03853-9

BMC Pediatr. 2026 Jun 4. doi: 10.1186/s12887-026-07036-6. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the clinical efficacy and safety of single-port transscrotal laparoscopic orchiopexy combined with a hernia needle (SPLT-Orchiopexy) in children with palpable middle- and low-position undescended testes.

METHODS: A retrospective analysis was conducted on 200 children with palpable middle- and low-position undescended testes who underwent surgical treatment at our hospital between March 2021 and April 2023. Patients were categorized into two groups according to the surgical technique used: the conventional laparoscopic surgery (CLS, n = 120) group and the SP-Orchiopexy group (n = 80). Perioperative indicators, postoperative pain assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Scar outcomes at 6 months postoperatively were evaluated using the Observer Scar Assessment Scale (OSAS) and the Patient Scar Assessment Scale (PSAS), which were compared between two groups. The incidence of postoperative complications was also compared between groups. Logistic regression analysis was performed to identify factors associated with postoperative complications.

RESULTS: The SPLT-Orchiopexy group showed significantly shorter operative time, less intraoperative blood loss, earlier ambulation, and shorter length of hospital stay (t = 11.15-16.91, all P < 0.001). FLACC scores at 6, 12, and 24 h postoperatively were significantly lower in the SPLT-Orchiopexy group (Z = 4.67-6.91, all P < 0.001). At 6-month follow-up, both OSAS and PSAS scores were lower in the SPLT-Orchiopexy group (Z/t = 7.31-7.65, all P < 0.001). The overall incidence of postoperative complications was lower in the SPLT-Orchiopexy group (χ² = 4.68, P = 0.031). The surgical approach did not reach statistical significance as an independent predictor of postoperative complications, but it demonstrated a trend toward reduced complication risk (Wald = 1.49, P = 0.222).

CONCLUSION: SPLT-Orchiopexy may provide advantages in terms of minimal invasiveness, postoperative recovery, pain relief, cosmetic outcomes, and postoperative complications in children with palpable middle- and low-position undescended testes. Further prospective studies are warranted to validate these findings.

PMID:42243819 | DOI:10.1186/s12887-026-07036-6

BMC Pediatr. 2026 Jun 4. doi: 10.1186/s12887-026-07026-8. Online ahead of print.

ABSTRACT

BACKGROUND: Cerebral palsy (CP) is the most common cause of childhood physical disability and is frequently accompanied by comorbidities such as epilepsy and feeding difficulties. In many low-resource settings, hospital-based evidence describing CP clinical subtypes, associated impairments, and care patterns is limited, constraining service planning for rehabilitation and pediatric neurology. We aimed to describe the clinical spectrum, associated impairments, interventions, and documentation patterns of CP at two tertiary referral hospitals in Zambia’s Copperbelt Province.

METHODS: We conducted a multi-centre, hospital-based retrospective record review of children with clinically documented CP at Arthur Davison Children’s Hospital (ADCH), Ndola, and Kitwe Teaching Hospital (KTH), Kitwe. CP motor subtype (spastic, dyskinetic, ataxic, mixed) and topographical distribution were extracted where documented. Associated impairments (including epilepsy) and management (rehabilitation and medications) were recorded based on explicit documentation, with undocumented fields treated as missing rather than absent. Categorical variables were summarized as frequencies and percentages. Between-hospital comparisons used chi-square or Fisher’s exact tests. Statistical significance was set at α = 0.05.

RESULTS: A total of 195 children with CP were identified (ADCH n = 150; KTH n = 45). This study did not estimate incidence or prevalence. Among records with documented subtype, spastic CP predominated at both sites, while dyskinetic CP was the second most frequently documented subtype and accounted for a higher proportion at ADCH than at KTH. CP motor subtype distributions differed significantly between hospitals (χ²=8.28, p = 0.041). Topographical distribution did not differ significantly (χ²=2.51, p = 0.285), with quadriplegia most commonly recorded at both sites. Epilepsy prevalence differed markedly among records with documented epilepsy status (KTH 40.0% vs. ADCH 84.1%; Fisher’s exact p = 0.000025; OR for KTH vs. ADCH = 0.126). Physiotherapy was frequently documented at both hospitals. Documentation completeness varied substantially across sites, particularly for epilepsy status, associated impairments, and functional severity measures (GMFCS) at ADCH.

CONCLUSIONS: In this hospital-based cohort from Zambia’s Copperbelt Province, CP subtype patterns differed between ADCH and KTH, and epilepsy was highly prevalent (especially at ADCH), underscoring the need for integrated rehabilitation and epilepsy services. Substantial variability in documentation completeness suggests a systems-level opportunity to standardize CP assessment and recording to support clinical management and service planning.

PMID:42243818 | DOI:10.1186/s12887-026-07026-8

BMC Oral Health. 2026 Jun 5. doi: 10.1186/s12903-026-08790-w. Online ahead of print.

ABSTRACT

BACKGROUND: Removal of impacted mandibular third molars is associated with postoperative discomfort and delayed bone healing. Er:YAG laser osteotomy has been proposed as a minimally invasive alternative to conventional rotary instrumentation.

AIM: To compare Er:YAG laser osteotomy and conventional rotary osteotomy regarding postoperative radiographic bone density and clinical healing outcomes following impacted mandibular third molar removal (pain, edema, and trismus).

METHODS: Twenty-four patients (n = 24) were randomized equally (laser n = 12; rotary n = 12). CBCT scans were obtained preoperatively and at 3 months for voxel-based grayscale bone density assessment. Standardized 3D ellipsoid VOIs were used. A single trained examiner performed all CBCT measurements twice, two weeks apart (ICC > 0.90). Postoperative pain, edema, and trismus were clinically assessed.

RESULTS: Immediate postoperative bone density showed no significant difference between groups (p = 0.319). At 3 months, bone density was significantly higher in the laser group compared with the rotary group (median: 310.7 vs. 270.0; p = 0.017), with a moderate effect size (r = 0.477). Bone density significantly increased over time in both groups (p = 0.002), with a significantly greater increase observed in the laser group (p = 0.017). Pain scores on day 2 were significantly lower in the laser group (p = 0.020). Edema and trismus showed significant improvement over time within both groups, with no statistically significant differences between groups. Operation time was significantly longer in the laser group.

CONCLUSION: Er:YAG laser osteotomy was associated with lower postoperative pain and higher radiographic grayscale values at 3 months compared with rotary osteotomy. Edema and trismus improved over time in both groups, with no significant differences between the two techniques.

CLINICAL RELEVANCE: Er:YAG laser may improve patient comfort by reducing postoperative pain and may be associated with improved radiographic bone healing. However, further studies are needed to confirm its long-term effects on bone density.

TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT07297043). Registered 09 December 2025 (retrospective).

PMID:42243813 | DOI:10.1186/s12903-026-08790-w

BMC Med. 2026 Jun 5. doi: 10.1186/s12916-026-04965-y. Online ahead of print.

ABSTRACT

BACKGROUND: Preeclampsia (PE) is a pregnancy-specific complication characterized by defective spiral artery remodeling, notably due to the abnormal retention of differentiated vascular smooth muscle cells (VSMCs). Although elevated CD81 levels in the placenta and maternal circulation contribute to this impairment, the definite mechanisms remain elusive. This study aimed to investigate how CD81 overexpression in extravillous trophoblasts (EVTs) contributes to defective VSMC dedifferentiation within uterine spiral arteries, as well as the involved molecular mechanisms.

METHODS: Placental basal plates from severe preeclampsia (sPE) patients and non-PE controls were immunostained for CD81 and VSMC markers. A placental restricted CD81 overexpression mouse model was constructed to evaluate PE-like phenotype and placental pathology. Primary decidual stromal cells (DSCs) and natural killer (dNK) cells were applied to investigate how CD81-overexpressing EVTs interact with them to suppress VSMC dedifferentiation. Additionally, antagonistic and rescue experiments were conducted to identify the function of the key molecules involved.

RESULTS: The proportion of retained differentiated VSMCs in spiral arteries was significantly higher in sPE patients than in normal pregnancies, and was positively correlated with CD81 expression on EVTs. Similarly, pregnant mice with placental restricted CD81 overexpression exhibited PE-like phenotype and showed persistent VSMC retention in spiral arteries. In vitro, conditioned medium (CM) from DSCs pretreated with medium from CD81-overexpressing EVTs increased the expression of differentiated VSMC markers, which was associated with reduced insulin-like growth factor 2 (IGF2) levels in DSCs. Notably, exogenous IGF2 supplementation reversed this effect.

CONCLUSIONS: CD81 upregulation on EVTs prevents VSMC dedifferentiation through a DSC-dependent mechanism. This study represents a pioneering effort to reveal the crucial role of interplay between EVTs, DSCs, and VSMCs in facilitating VSMC dedifferentiation, thereby enabling the completion of spiral artery remodeling.

PMID:42243812 | DOI:10.1186/s12916-026-04965-y

BMC Med Educ. 2026 Jun 4. doi: 10.1186/s12909-026-09591-z. Online ahead of print.

ABSTRACT

BACKGROUND: Medical students often face significant psychological and lifestyle challenges during examination periods, including sleep disruption, increased caffeine intake, altered dietary habits, low physical activity, and higher tobacco use. These behaviors may influence academic performance, yet evidence remains inconsistent.

METHODS: A cross-sectional study was conducted from April to October 2025 among 403 medical students from five universities in Palestine. Data were collected via an Arabic-language, self-administered online questionnaire covering sociodemographic, dietary and beverage habits, smoking, sleep, and physical activity. Academic performance was self-reported for the last two semesters. Statistical analysis included correlation, Mann-Whitney U, and regression models to assess relationships between lifestyle behaviors and academic performance.

RESULTS: Participants reported low sleep duration (< 7 h/day: 89.3%) and low physical activity (19.1%). Caffeine intake was moderate, with most students consuming ≤ 1 cup/day of traditional or instant coffee. Waterpipe smoking was more prevalent than cigarette or e-cigarette use and increased during exams. Regression analysis revealed small but significant negative associations between traditional coffee and tea consumption and average grades. Other dietary habits, energy drinks, sleep, and exercise were not significantly associated with average grades. Waterpipe use was unexpectedly positively associated with average grades, likely due to confounding factors.

CONCLUSION: Examination periods are associated with unhealthy behaviors among medical students, particularly increased caffeine and tobacco use, short sleep, and low physical activity. Among these, only coffee and tea consumption showed a small negative impact on academic performance.

PMID:42243807 | DOI:10.1186/s12909-026-09591-z

BMC Palliat Care. 2026 Jun 4. doi: 10.1186/s12904-026-02176-z. Online ahead of print.

ABSTRACT

BACKGROUND: Globally, breast cancer is the most common cancer among women, with 2.3 million women newly diagnosed in 2020. In Africa, most women present with advanced disease necessitating nurse-led palliative care interventions. This study pilot tested a nurse-led palliative care programme for women receiving palliative chemotherapy for breast cancer at a teaching hospital in the Volta Region of Ghana.

METHODS: An intervention design and pre-test post-test approach was used. The primary outcome focused on unmet palliative care needs and secondary outcomes included pain, quality of life, and spiritual needs, measured by means of the Symptoms Distress Scale (SDC), Brief Pain Inventory (BPI), Spiritual Needs Questionnaire (SpNQ), and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire – Breast Cancer Module 45 items (EORTC QLQ-BR45). Census sampling entered 31 women in the programme but only 24 completed it. Descriptive statistics were used to analyzed the data and the Wilcoxon signed-rank test, with significance set at p ≤ 0.05, compared the medians of the two samples. The study was registered with Pan African Clinical Trial Registry (PACTR202509735988120) on September 29th, 2025.

RESULTS: Results showed positive outcomes post-intervention. Symptom distress decreased from x̄ 2.98 to x̄ 1.97, pain severity reduced from x̄ 9.34 to x̄ 2.75, and quality of life improved from x̄ 2.79 to x̄ 1.94. Spiritual needs increased from x̄ 1.04 to x̄ 3.00.

CONCLUSION: The study provided evidence that a nurse-led palliative care programme, based on the care needs of women with advanced breast cancer receiving palliative chemotherapy in the Volta Region of Ghana, lessened symptom distress, pain and improved quality of life.

PMID:42243806 | DOI:10.1186/s12904-026-02176-z

BMC Surg. 2026 Jun 4. doi: 10.1186/s12893-026-03899-9. Online ahead of print.

ABSTRACT

BACKGROUND: Optimal anatomical sites for temperature monitoring that most closely correlates with cerebral temperature remain debated in cardiac surgery, particularly during cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA) and subsequent rewarming. This experimental study aimed to identify the monitoring site best correlated with intracerebral temperature during the rewarming phase and to assess whether some sites may underestimate cerebral rewarming, thereby increasing the risk of undetected hyperthermia.

METHODS: The study was conducted in six male Landrace pigs (≈58 kg) undergoing CPB with a 45-min DHCA at 18 °C, followed by a gradual rewarming phase. Temperature was monitored throughout the procedure at seven anatomical sites (jugular, bladder, esophageal, rectal, nasopharyngeal, venous, and arterial) and compared with direct intracerebral temperature measured using a Pt1000 probe inserted into the cerebral parenchyma. Correlation analyses were performed between peripheral and intracerebral temperature measurements.

RESULTS: Jugular temperature demonstrated the strongest correlation with intracerebral temperature (r = 0.975), with no statistically significant difference between jugular values and cerebral temperature (p = 0.2189). In contrast, a significant discrepancy was observed between cerebral and esophageal temperatures (p = 0.0247), indicating differences in thermal kinetics during the early rewarming phase. No cases of cerebral hyperthermia were observed.

CONCLUSIONS: This study demonstrated that jugular temperature most accurately reflects cerebral temperature during the rewarming phase of CPB following DHCA. Esophageal and nasopharyngeal measurements, although commonly used, may underestimate cerebral temperature during early rewarming, potentially increasing the risk of cerebral hyperthermia. These findings underscore the value of multisite temperature monitoring and highlight the importance of understanding the mechanisms underlying cerebral thermal dynamics.

PMID:42243805 | DOI:10.1186/s12893-026-03899-9

BMC Med Inform Decis Mak. 2026 Jun 5. doi: 10.1186/s12911-026-03612-z. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to evaluate the effectiveness of deep learning algorithms in simulating standard acquisition time images from shortened acquisition times in ¹⁸F-FDG PET/CT imaging, thereby optimizing both image quality and radiopharmaceutical use.

METHODS: We evaluated 322 patients who underwent ¹⁸F-FDG PET/CT, simulating half-dose conditions and reconstructing images at acquisition times of 30 s, 45 s, 60 s, 75 s, and 90 s while maintaining identical bed positions and anatomical coverage. Images were reconstructed using a residual U-Net architecture with data augmentation to enhance training. Image quality was assessed using a 5-point Likert scale, inter-reader consistency with Cohen’s kappa, and quantitative metrics (PSNR, SSIM, MAE, MSE, RMSE) to compare pre- and post-processing conditions, validating the model’s effectiveness. Lesion detectability was specifically assessed by counting detectable lesions before and after processing, evaluated by two senior nuclear medicine physicians to ensure consistency. Statistical analyses employed Wilcoxon signed-rank tests and kappa statistics, considering p-values less than 0.05 as statistically significant.

RESULTS: Deep learning significantly improved image quality scores in the half-dose group from 3.45 ± 0.48 to 4.33 ± 0.55 and enhanced kappa values from 0.76 to 0.82 (p < 0.05). Quantitative metrics demonstrated marked improvements, with SSIM values rising from 0.75 to 0.87 and PSNR from 37.65 dB to 41.37 dB in half-dose scenarios. Similarly, in the 30s model, SSIM increased from 0.73 to 0.84 and PSNR from 35.38 dB to 40.15 dB. Lesion detectability in small lesions improved by up to 16.3% in shortened acquisition conditions, effectively enhancing the detection of critical pathological features.

CONCLUSIONS: The application of deep learning models in PET/CT imaging may improve scan efficiency and reduce radiopharmaceutical usage while maintaining image quality without apparent loss of diagnostic information. These findings support the potential of AI-enhanced imaging protocols to reduce patient radiation exposure and improve clinical workflow efficiency.

PMID:42243803 | DOI:10.1186/s12911-026-03612-z