Category: Nevin Manimala

Glob Health Res Policy. 2025 Sep 29;10(1):48. doi: 10.1186/s41256-025-00447-5.

ABSTRACT

BACKGROUND: Routine childhood vaccination coverage under the National Immunization Program of the Philippines is well below the target of 95% with a high number of zero-dose children. Declining immunization rates led to outbreaks of vaccine-preventable diseases such as measles, polio, and pertussis. This study aimed to identify the factors affecting childhood vaccine uptake by exploring the perspectives of community members, program managers, and coordinators.

METHODS: Three regions with low vaccine coverage in the Philippines were selected as study sites. We conducted focus groups with adult caregivers of vaccinated and unvaccinated children aged 0-11 years recruited by barangay (community) health workers. Key informant interviews were also conducted with immunization program managers and coordinators from different administrative levels. Focus group and interview guides were informed by the World Health Organization’s Behavioural and Social Drivers (BeSD) of Vaccination framework. Transcripts were analysed by themes and deductive axial coding was used to categorize themes into BeSD domains and socioecological levels.

RESULTS: Twelve focus groups (n = 143) and 57 key informant interviews were done. Various behavioural and social drivers of vaccination present at different levels of the socioecological model affect vaccine decisions both positively and negatively. Under the ‘Thinking and feeling’ domain of the BeSD, at the intrapersonal level, the perception of benefits and negative side effects of routine vaccines were clear drivers of vaccination. In the ‘Social processes’ domain, factors at multiple socioecological levels such as the influence of family, barangay health workers, and community leaders were identified. Practical issues such as the availability of vaccines and accessibility of vaccination sites remain a barrier to vaccination.

CONCLUSIONS: Availability of routine vaccines and accessibility to vaccination sites are major challenges in the Philippines. Acceptability of routine vaccines continue to be affected by previous controversies around the Dengue vaccine and the recent COVID-19 pandemic. Findings suggest that enhancing advocacy for immunization through continuing communication training for health care workers on health promotion and education regarding vaccination may contribute to increased vaccine uptake. Integration of immunization with other population-based health programs could be explored.

PMID:41016961 | DOI:10.1186/s41256-025-00447-5

Lasers Med Sci. 2025 Sep 29;40(1):391. doi: 10.1007/s10103-025-04596-4.

ABSTRACT

Photobiomodulation therapy (PBMT), which involves both stimulatory and inhibitory biological responses to light, represents a critical area of research requiring further in-depth exploration. This study aimed to evaluate and compare the effects of 650 nm and 450 nm diode lasers on wound healing following tooth extraction in a rabbit model. Local anesthesia was used. A continuous-wave (CW) diode laser with wavelengths of 650 then 450 were used on wound after tooth extraction in 30 rabbits divided into three groups randomly and equally separated groups: control group (G1), 650 nm group (G2) and 450 nm group (G3), with laser parameters determined based on a prior pilot study in rabbits. The energy density for a 30-second exposure was 7.64 J/cm². The power output and the power density were 200 mW and 254 mW per cm², respectively. By day 7, 70% of rabbits in the G2 exhibited pink gingival tissue, compared to only 40% in the G3.Healing outcomes demonstrated statistically significant (p < 0.05) in G2in the gingival color and thickness relative to those G1 and G3.By day 14, none of theG1 displayed severe congestion, whereas G2 showed normal tissue recovery without pathological secretion(only two rabbits in G3 showed suppuration).Histopathological analysis revealed that 650 nm PBMT stimulated partial epithelialization and collagen deposition by day 7, with further enhancement by day 14. The 650 nm wavelength demonstrated superior healing effects, characterized by increased pink gingival tissue, reduced bleeding, and absence of inflammation. Photobiomodulation therapy (PBM) accelerates wound healing and is effective in reducing inflammation. Further research is needed to optimize wavelength selection.Clinical trial number Not applicable.

PMID:41016952 | DOI:10.1007/s10103-025-04596-4

Clin Oral Investig. 2025 Sep 29;29(10):478. doi: 10.1007/s00784-025-06572-2.

ABSTRACT

OBJECTIVES: An in vitro study to verify the potential effectiveness of an orthodontic adhesive incorporating a polybetaine zwitterionic mixture in preventing biofilm formation.

MATERIALS AND METHODS: 2-methacryloyloxyethyl phosphorylcholine (MPC) and sulfobetaine methacrylate (SBMA), were added to An adhesive at 1 wt% (MS1) And 3 wt% (MS3). The MS0 group had no zwitterions. Flowability measurement, shear bond strength (SBS), the adhesive remnant index (ARI), and the contact angle were assessed. Bracket bonding was performed, and cross-sections were examined using scanning electron microscopy (SEM). Biofilm formation was analyzed using confocal laser scanning microscopy. Statistical analyses were conducted using R software. Wilcoxon tests with the Holm correction were used for non-parametric data, and pairwise t-tests with the Bonferroni correction were used for parametric data. Significance was set at P < 0.0001.

RESULTS: Flow analysis showed no significant differences in the experimental groups compared to the MS0 group (P > 0.05). The SEM images confirmed uniform bonding in all groups. SBS decreased significantly with higher MS content (P < 0.0001), And ARI scores shifted with the addition of zwitterionic mixtures, increasing scores to 1 And 2. MS3 showed a significantly lower contact angle compared to MS0 (P < 0.05). MS3 exhibited reduced biofilm formation and lower fluorescence intensity (P < 0.05).

CONCLUSIONS: Despite reductions in SBS, all adhesives remained at minimum acceptable levels. The 3 wt% zwitterionic adhesive effectively suppressed biofilm formation and may help prevent demineralization.

CLINICAL RELEVANCE: An orthodontic adhesive containing a zwitterionic mixture can satisfy clinical properties and prevent side effects due to biofilm formation.

PMID:41016948 | DOI:10.1007/s00784-025-06572-2

J Neurol. 2025 Sep 29;272(10):659. doi: 10.1007/s00415-025-13383-8.

ABSTRACT

OBJECTIVE: About 30% of patients with isolated adult-onset dystonia report an improvement of their motor symptoms after the consumption of alcohol. In this cross-sectional study, we sought to investigate whether the observed improvement is attributable to the anxiolytic, euphoric, and analgesic properties of alcohol, rather than or in addition to its effect on dystonic movements, as psychiatric symptoms and pain frequently occur in dystonia patients and as emotional stress is a well-established trigger for symptom exacerbation.

METHODS: We analyzed data from 339 prospectively enrolled participants with recently diagnosed isolated dystonia (mean age: 55.2 ± 12.5 years, 228 female) of the Natural History Project of the Dystonia Coalition, a large international multicenter study. Alcohol responsiveness was determined by patients´ self-report. Symptoms of depression, as well as generalized and social anxiety, were assessed using the Hospital Anxiety and Depression Scale and the Liebowitz Social Anxiety Scale. Severity of pain was measured using question 21 of the RAND 36-Item Health Survey.

RESULTS: Participants with more severe pain reported greater response to alcohol than those with less severe pain (p = .004), whereas symptoms of depression (p = .986), generalized anxiety (p = .395) and social anxiety (p = .953) were not associated.

CONCLUSION: Alcohol responsiveness in isolated dystonia is associated with higher levels of pain, whereas self-reported alcohol-related improvements in dystonic movements or tremor do not depend on the euphoric or anxiolytic effects of alcohol. This finding underscores the potential role of pain management in alleviating motor symptoms in dystonia.

PMID:41016940 | DOI:10.1007/s00415-025-13383-8

Oral Maxillofac Surg. 2025 Sep 29;29(1):162. doi: 10.1007/s10006-025-01449-w.

ABSTRACT

PURPOSE: This study aimed to compare the postoperative clinical outcomes between the conservative bone trocar and open conventional techniques for iliac crest bone harvesting for alveolar bone grafting.

METHODS: The study included 20 unilateral cleft patients aged between 8 and 11 years, just before canine eruption, who suffered from oro-nasal communication, and were divided into two groups. Group A: ten patients using the open technique with a 4 cm incision at the anterior superior iliac crest for harvesting bone chips. Group B: ten patients using a conservative technique with a 1 cm incision at the anterior superior iliac crest using a special bone trocar extractor and curette. Postoperative evaluation included the Visual Analogue Scale (VAS) for pain assessment to compare the level of pain postoperatively. Also Vancouver scale was used for scar wound evaluation through clinical examination of wound size and concerning tissue vascularity, pigmentation, pliability, and height.

RESULTS: There were no postoperative complications observed, including infection, dehiscence, and graft resorption in both groups. Two weeks postoperative: Group A reported significantly higher pain (7.8 ± 0.79) compared to Group B (3.6 ± 0.97) & p < 0.001, indicating statistically significant lower pain levels in Group B. Regarding the Vancouver Scar Scale, two weeks postoperative: Group A had significantly higher scar severity (9.1 ± 0.88) compared to Group B (3.0 ± 0.82) and p < 0.001, suggesting better scar satisfaction in Group B. One month postoperatively, Group B over time confirmed better scar appearance.

CONCLUSION: Autogenous iliac crest using a conservative technique with a bone trocar is significantly more beneficial, less painful, and provides better wound scar healing satisfaction than the standard open approach in terms of VAS pain scale and Vancouver scar scale.

PMID:41016933 | DOI:10.1007/s10006-025-01449-w

J Pediatr Urol. 2025 Sep 16:S1477-5131(25)00486-3. doi: 10.1016/j.jpurol.2025.09.012. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) in the management of overactive bladder (OAB) in children by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS: A systematic search of PubMed, Embase and the Cochrane Library was conducted to identify RCTs comparing TENS with standard therapies (urotherapy, sham TENS, or oxybutynin) in children with OAB. Inclusion criteria encompassed RCTs published between 2004 and 2024, reporting TENS as a primary intervention. Data were pooled using a meta-analysis framework, and heterogeneity was assessed using I² statistics. Risk of bias was evaluated using the ROBVIS tool.

RESULTS: Nine RCTs involving 382 children were included. Five studies compared active TENS with sham TENS, of which three reported superior efficacy for TENS, while two found no difference. Two studies compared TENS with oxybutynin; one demonstrated TENS superiority, while the other found comparable efficacy. One study showed TENS to be as effective as urotherapy, and another found that TENS combined with oxybutynin was superior to either treatment alone. The meta-analysis revealed that TENS significantly increased the likelihood of a full response compared to other treatments (OR 3.96, 95 % CI 2.46-6.38, p < 0.001). TENS was effective both as a standalone therapy (OR 4.34) and as an adjunct (OR 3.27). Parasacral TENS demonstrated a higher response rate than posterior tibial TENS.

CONCLUSION: TENS is an effective, non-invasive therapy for pediatric OAB, either as monotherapy or in combination with urotherapy or medication. However, variability in study protocols and limited long-term follow-up data highlight the need for standardized treatment protocols and larger RCTs to assess long-term outcomes, including relapse rates.

PROSPERO REGISTRATION NUMBER: CRD420251114932.

PMID:41016899 | DOI:10.1016/j.jpurol.2025.09.012

Urol Oncol. 2025 Sep 27:S1078-1439(25)00351-5. doi: 10.1016/j.urolonc.2025.08.029. Online ahead of print.

ABSTRACT

OBJECTIVES: To provide an updated analysis of trends and outcomes for these approaches using data from the SEER database (2000-2021).

METHODS: Patients diagnosed with localized T1a renal cell carcinoma (RCC) were identified from the SEER database. Management strategies were categorized as PN, RN, AT, or non-surgical management (NSM), including AS. Descriptive statistics assessed patient demographics and tumor characteristics. Logistic regression models identified predictors of NSM, adjusting for age, race, tumor grade, histology, and socioeconomic factors. Kaplan-Meier survival analysis and Cox proportional hazards regression evaluated associations between management type and 5-year overall survival.

RESULTS: RN usage declined sharply from ∼75% in 2000 to ∼14% in 2021, while PN steadily increased, surpassing RN around 2017 and reaching ∼50% by 2021. Notably, younger patients (<60 years) demonstrated a more rapid shift toward partial nephrectomy over time, whereas the oldest patients (>75 years) showed a slower uptake of partial nephrectomy and a higher ongoing utilization of non-surgical management. AT and NSM showed gradual adoption, peaking at ∼10% and ∼15% to 20%, respectively, by 2021. PN was associated with the best overall survival, followed by RN and AT, while NSM had the poorest outcomes. Predictors of NSM included advanced age (>75 years, OR = 3.54) and black race (OR = 1.63).

CONCLUSION: PN has become the most widely used management for SRMs, aligned with AUA and EAU guidelines. AS remains a viable and guideline-recommended option for select patients with SRMs <2 cm. The variable use of AT and NSM, coupled with the poorer prognosis of NSM, underscores the importance of individualized patient selection and close follow-up to ensure optimal outcomes.

PMID:41016894 | DOI:10.1016/j.urolonc.2025.08.029

Pain Manag Nurs. 2025 Sep 27:S1524-9042(25)00271-1. doi: 10.1016/j.pmn.2025.09.002. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to compare the effect of auditory distraction and virtual reality (VR) on pain severity and physiological indicators during burn dressing changes among adult patients.

DESIGN: A single-center, randomized controlled trial.

METHODS: A total of 60 patients were randomly assigned to the auditory distraction (n = 20), VR (n = 20), and control (n = 20) groups. All patients in the three groups received intravenous morphine at a dose of 0.05 mg/kg body weight, 15 minutes prior to the dressing change. The auditory distraction group listened to music during the dressing, while the VR group used a headset to view nature images throughout the dressing procedure. Data collection tools were the numeric pain scale, a checklist form of the physiological Indicators, and a pulse oximetry device.

RESULT: Statistically significant differences in pain severity were observed among the VR, auditory distraction, and control groups during dressing changes (p < .05). Despite all patients receiving intravenous morphine (0.05 mg/kg), both interventions led to greater pain reduction. Oxygen saturation and respiratory rates also differed significantly across groups (p < .05), with posthoc analysis confirming that both interventions were equally effective and superior to standard care.

CONCLUSIONS: This study’s findings demonstrated that auditory distraction was as effective as VR techniques in reducing fluctuations in physiological indicators and pain severity during dressing changes in adult patients.

CLINICAL IMPLICATIONS: Nonpharmacological interventions can serve as effective adjuncts alongside pharmacological treatments in pain management nursing.

PMID:41016886 | DOI:10.1016/j.pmn.2025.09.002

Dig Liver Dis. 2025 Sep 27:S1590-8658(25)01085-0. doi: 10.1016/j.dld.2025.09.007. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Tofacitinib, commonly used for ulcerative colitis, has shown promising results in the management of chronic pouchitis (CP). We performed a pooled analysis of the efficacy and safety of tofacitinib for CP.

METHODS: We searched multiple databases for articles reporting the outcomes of tofacitinib for the treatment of CP and conducted a meta-analysis.

RESULTS: 8 studies including 99 subjects (mean age: 37.5 years and 55.6 % males) were analyzed. The pooled clinical and endoscopic response rate was 47.7 % [Cl 33.3-62.6 %; I2= 40 %] and 51.7 % [Cl 37.4-65.7 %; I2=34 %], respectively. The remission rate was 41.2 % [Cl 26.6-57.6 %; I2= 0 %]. Clinical PDAI score improved markedly post-tofacitinib (Pre: 3.35 [Cl 2.9-3.7; I2 = 68 %] vs Post: 2.0 [Cl 1.59-2.4; Cl = 0 %], p-value <0.001). There was a significant reduction in endoscopic PDAI score (Pre: 4.5 [Cl 3.7-5.2; I2 = 84 %] vs Post: 2.5 [Cl 1.7-3.3; Cl = 64 %], p-value < 0.001) and total PDAI score (Pre: 7.4 [Cl 5.3-9.6; I2 = 96 %] vs Post: 4.3 [Cl 2.8-5.9; Cl = 84 %], p-value < 0.001). The pooled adverse events and discontinuation rates were 30.9 % [Cl 17.5-48.5; I2=24 %] and 43 % [Cl 25-63.1; I2=40 %] respectively.

CONCLUSION: Based on this meta-analysis, tofacitinib caused statistically significant changes in PDAI scores with favourable response and remission rates. Although adverse event and discontinuation rates are high, this is similar to or less frequent than those of other biologics. Future studies are required to evaluate the long-term safety profile of tofacitinib before considering it as an effective alternative for the treatment of CP.

PMID:41016876 | DOI:10.1016/j.dld.2025.09.007

Med Phys. 2025 Oct;52(10):e70011. doi: 10.1002/mp.70011.

ABSTRACT

BACKGROUND: One of the main challenges of utilizing spot-scanning proton arc therapy (SPArc) is treatment delivery efficiency. Previous studies focus on reducing the number of energy layers by ascending switching to shorten the beam delivery time. However, this is not true of all proton therapy systems. The new energy layer switching system was recently upgraded in the University Medical Center Groningen (UMCG), which enables a fast energy layer ascending switching (ELAS).

PURPOSE: We introduce a novel adaptive energy switching SPArc optimization algorithm (SPArc-_AES) based on the machine-specific delivery characteristics of proton therapy systems.

METHODS: The SPArc-_AES optimization algorithm is based on the polynomial increasing feature of energy layer ascending switching. K-Medoids clustering analysis and simulated annealing algorithm were used to optimize the energy delivery sequence. Ten cases were selected to evaluate the plan quality, plan robustness, and the delivery efficiency compared with the previously SPArc energy sequence optimization algorithm, SPArc_seq.

RESULTS: Without extra constraints in the energy ascending constraints, the SPArc-_AES offers a better plan quality and robustness, while the treatment delivery efficiency was significantly improved compared to the SPArc_seq. More specifically, SPArc-_AES effectively shortened the energy layer switching time and the beam delivery time by 34.03% and 31.10%, respectively, while offering better target dose conformality and generally lower dose to organs-at-risk.

CONCLUSIONS: Based on the machine-specific delivery characteristics, we introduced a novel adaptive energy switching algorithm for efficient SPArc optimization, which could significantly improve delivery efficiency while enhancing the plan quality by eliminating no longer necessary constraints on the total number of energy layer ascending switching.

PMID:41016831 | DOI:10.1002/mp.70011