Category: Nevin Manimala

Indian Pediatr. 2025 Feb 15;62(2):138-142. doi: 10.1007/s13312-025-3379-1.

ABSTRACT

OBJECTIVE: To describe the clinical and metabolic profile and associated risk factors in children with early onset obesity (presenting before five years of age). To identify features that would differentiate primary from secondary obesity in under-five children.

METHODS: A retrospective study analyzed the medical records of children diagnosed with early onset obesity between June 2015 to December 2023 to ascertain the etiological diagnosis and identify the risk predictors. Laboratory profiles and genetic studies, wherever available, were studied. Association of various factors with underlying etiology was done using standard statistical methods.

RESULTS: Out of 530 children presenting with obesity during the study period, 77 (14.5%) were aged less than 5 years. Primary obesity was found in 55 (71.4%) children. Genetic causes of obesity were confirmed in 14 (18.18%) children. Increased screen time (more than 2 hours per day) and acanthosis nigricans correlated positively with the presence of primary obesity. Additionally, a significant association was observed between the presence of obesity in parents and early onset primary obesity, indicating a combined influence of an unhealthy lifestyle and a genetic predisposition.

CONCLUSION: Primary obesity was more common in early onset obesity. Obesity in parents, excess screen time and presence of acanthosis nigricans were significantly associated with primary obesity suggesting a combination of genetic predisposition and unhealthy lifestyle as risk factors.

PMID:39912274 | DOI:10.1007/s13312-025-3379-1

Indian Pediatr. 2025 Feb 15;62(2):131-137. doi: 10.1007/s13312-025-3378-2.

ABSTRACT

OBJECTIVE: To determine the body composition in childhood acute lymphoblastic leukemia survivors (cALLS) using dual-energy x-ray absorptiometry (DEXA) and correlate the same with mid-upper-arm circumference (MUAC) and triceps-skin-fold thickness (TSFT).

METHODS: A cross-sectional study was undertaken to assess body composition in cALLS aged >7 years. Patients who were lost to follow-up after completion of therapy, had relapsed acute lymphoblastic leukemia (ALL), undergone hematopoietic stem cell transplantation and those with neurological disabilities/syndromic diagnosis were excluded. Prevalence of high-adiposity (body fat % > 85th centile), sarcopenia (lean body mass < 5th centile) and sarcopenic obesity (positive fat mass index z-score with negative fat-free mass index z-score); and demographic, therapy-related and endocrine factors were noted.

RESULTS: Fifty-nine cALLS survivors with a median (IQR) age of 66 (38, 91) months at diagnosis were analyzed. At a median (IQR) duration of 14 (3, 43) months following completion of therapy, 36 children (61%) had deranged body composition; high adiposity (n = 28; 47%), sarcopenia (n = 20; 34%), sarcopenic obesity (n = 9; 15%). Metabolic syndrome was seen in 7 (12%). Survivors with lower mean-age at diagnosis and at enrolment had high-adiposity levels and sarcopenia. Sarcopenia was seen more commonly in females, pre-pubertal children and survivors with a lower mean-interval from therapy completion. Obesity, sarcopenia and sarcopenic obesity were not significantly associated with the type of ALL, steroid dose and cranial-irradiation. High leptin levels were seen in survivors with obesity and sarcopenic obesity. MUAC and TSFT correlated well with DEXA-generated markers.

CONCLUSION: The prevalence of deranged body composition in cALLs from a single centre in Northern India was high, indicating need for early and frequent screening. MUAC and TSFT are reliable surrogate measures for body composition.

PMID:39912273 | DOI:10.1007/s13312-025-3378-2

Indian Pediatr. 2025 Feb 15;62(2):121-125. doi: 10.1007/s13312-025-3375-5.

ABSTRACT

OBJECTIVE: To determine the duration of moderate to vigorous physical activity (MVPA), perceived barriers to physicaly activity and examine its association with cardiometabolic risk factors in Indian children.

METHODS: Sociodemographic data, physical activity patterns and the barriers to physical activity were collected using questionnaires, from urban children aged 6-19 years residing in Bengaluru, Karnataka. Anthropometry, body composition, blood pressure, glycated hemoglobin, and lipid profile were measured.

RESULTS: The mean (SD) age of a total of 4004 enrolled children was 13.1 (2.5) years; 17.8% were overweight/obese. The median (IQR) duration of MVPA was 7.7 (0.0, 44.1) minutes/day, with 81% (n = 3252) not meeting the MVPA recommendation, particularly girls (88.6%; n = 1980/2234). In adjusted analysis, children who did not engage in MVPA had elevated systolic blood pressure (mm Hg) [1.07 (95% CI 0.40, 1.35)] and diastolic blood pressure (mm Hg) [1.09 (95% CI 0.40, 1.77)]. Significant barriers to engaging in physical activity included time constraints due to academic work and lack of space/facilities.

CONCLUSION: Indian children do not meet the required daily MVPA recommendations; academic demands and limited access to space/facilities were significant barriers to physical activity. Children who did not engage in any form of MVPA had significantly higher blood pressure.

PMID:39912271 | DOI:10.1007/s13312-025-3375-5

Indian Pediatr. 2025 Feb 15;62(2):116-120. doi: 10.1007/s13312-025-3374-6.

ABSTRACT

OBJECTIVE: To compare the efficacy of a standard dose (1 mg) with 2 mg vitamin K administered by intramuscular (IM) route in reducing subclinical late-onset vitamin K deficiency bleeding (VKDB) assessed using serum protein induced by vitamin K absence (PIVKA II) levels.

METHODS: This was an open-labeled randomized controlled trial that enrolled healthy term neonates delivered vaginally. Neonates delivered to mothers receiving antiepileptics, anti-tuberculous drugs, or warfarin, and those with a family history of bleeding disorder were excluded. Participants were randomized to receive either 1 or 2 mg of vitamin K1 (Phytomenadione) IM at birth. PIVKA II was measured in the cord blood and at 30 and 72 days after birth by ELISA method. PIVKA II level >100 ng/mL was labeled as subclinical VKDB.

RESULTS: Forty-one neonates were recruited in each arm. On the 30 days follow-up visit 9 infants (4 in 1 mg group; 5 in 2 mg group) were lost to follow-up. All babies had PIVKA II levels >100 ng/mL at birth. The median PIVKA II values (ng/mL) in the 1 mg group were 827.68 (cord blood), 678.80 (30 days), and 644.10 (72 days). The corresponding levels (ng/mL) in the 2 mg group were higher, viz., 770.55, 726.35, and 693.14 ng/mL; P > 0.05 for all comparisons. PIVKA II level in the 1 mg group reduced significantly on 72 days of life compared to that observed at birth (cord blood) (P = 0.012). However, the fall in 2 mg group was not statistically significant.

CONCLUSION: There was no difference in PIVKA II levels between neonates receiving 1 mg or 2 mg vitamin K IM suggesting a similar risk for late-onset VKDB in both groups.

PMID:39912270 | DOI:10.1007/s13312-025-3374-6

West J Nurs Res. 2025 Feb 6:1939459251316810. doi: 10.1177/01939459251316810. Online ahead of print.

ABSTRACT

BACKGROUND: Perceived stress during pregnancy has been associated with adverse maternal health and birth outcomes. Compared to White pregnant women, Black pregnant women in the United States report higher levels of perceived stress and experience higher rates of maternal mortality and preterm birth. Mother-father relationship has been associated with perceived stress among pregnant women, though literature among Black pregnant women is limited.

OBJECTIVE: We aimed to examine the associations of mother-father relationship with perceived stress among Black pregnant women.

METHODS: Using a cross-sectional, correlational design, we conducted a secondary analysis of data obtained from 418 Black pregnant women enrolled in the Biosocial Impact on Black Births study. Participants completed questionnaires between 19- and 29 weeks gestation with items related to maternal characteristics, measures of the mother-father relationship, including the level of contact, involvement, closeness, support, and conflict with the father of the baby (FOB), and maternal perceived stress.

RESULTS: Participants who reported lower levels of support (ρ_[416] = -0.279, P < .001) and higher levels of conflict (ρ_[416] = 0.401, P < .001) with the FOB also reported higher levels of perceived stress. Levels of involvement, closeness, support, and conflict with FOB also predicted levels of maternal perceived stress after controlling for covariates.

CONCLUSIONS: These findings suggest that the mother-father relationship significantly influences perceived stress among Black pregnant women, thus warranting further study and intervention.

PMID:39912262 | DOI:10.1177/01939459251316810

Health Promot J Austr. 2025 Apr;36(2):e70010. doi: 10.1002/hpja.70010.

ABSTRACT

INTRODUCTION: Swimming and water safety skills are essential for reducing drowning. Swimming and water safety programs primarily focus on children, despite adults accounting for over 80% of fatal drowning in Australia. This study aims to identify types of adult swimming programs in Australia, who attends these programs, and measure their swimming skill achievement against national benchmarks.

METHODS: A retrospective cross-sectional study of adults attending swimming programs between 2018 and 2021 was conducted. Participant assessment records were analysed against the [Australian] National Swimming and Water Safety Framework and national benchmarks to be achieved by 6 and 12 years old. Descriptive statistics and Chi-square analysis were undertaken.

RESULTS: Of 4914 adults attending swimming lessons, 44% were female, median age was 38 years, and 40% were from high socioeconomic areas. On average, adults attended nine lessons, averaging 4.5 h in the water. At their final assessment, 69% could swim at least 5 m (6-year-old benchmark), and 8% could swim 50 m continuously (12-year-old benchmark).

CONCLUSIONS: Adults of all ages are learning to swim; however, only 8% are achieving the 12-year-old benchmark of swimming 50 m. An equity issue exists, with adults from lower socioeconomic areas and men less likely to be attending swimming programs. Developing and maintaining water safety skills throughout the lifespan is vital for reducing drowning risk among adults. SO WHAT?: Adults are spending time, money and effort learning to swim, however, more is needed to ensure that participants stay in lessons long enough to develop the necessary skills needed to be safe in the water.

PMID:39912253 | DOI:10.1002/hpja.70010

JMIR Hum Factors. 2025 Feb 5;12:e67036. doi: 10.2196/67036.

ABSTRACT

BACKGROUND: Rhinolaryngoscopes are one of the most widely used tools by otolaryngologists and speech-language pathologists in current clinical practice. However, there is limited data on adverse events associated with or caused by the use of rhinolaryngoscopes.

OBJECTIVE: In this study, we used the Manufacturer and User Facility Device Experience (MAUDE) database with the aim of providing insights that may assist otolaryngologists in better understanding the limitations of these devices and selecting appropriate procedures for their specific clinical setting.

METHODS: We characterized complications associated with the postmarket use of rhinolaryngoscope devices from the US Food and Drug Administration MAUDE database from 2016 through 2023.

RESULTS: A total of 2591 reports were identified, including 2534 device malfunctions, 56 injuries, and 1 death, from 2016 through 2023. The most common device problem with rhinolaryngoscopes was breakage (n=1058 reports, 40.8%), followed by fluid leaks (n=632 reports, 24.4%). The third most common problem was poor image quality (n=467 reports, 18%). Other device issues included contamination or device reprocessing problems (n=127 reports, 4.9%), material deformation or wear (n=125 reports, 4.8%), and device detachment (n=73 reports, 2.8%). Of the 63 reported adverse events, the most common patient-related adverse event was hemorrhage or bleeding, accounting for 18 reports, with the root causes including material deformation or wear, breakage, wrinkled rubber, or improper operation.

CONCLUSIONS: Our study offers valuable insights for endoscopists and manufacturers to recognize potential issues and adverse events associated with the use of rhinolaryngoscopes. It emphasizes the need for improving device reliability, training, and procedural protocols to enhance patient safety during diagnostic procedures.

PMID:39912248 | DOI:10.2196/67036

Knee Surg Sports Traumatol Arthrosc. 2025 Feb 6. doi: 10.1002/ksa.12613. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to investigate the impact of increased posterior tibial slope (PTS) on pressure distribution in the medial and lateral tibial plateau. The focus is on compartment-specific effects and potential correlations with cartilage damage, due to altered anterior tibial translation caused by increased PTS.

METHOD: Ten freshly frozen knee specimens were prepared and subjected to biomechanical testing. PTS was modified by inserting 5°, 10°, 15° and 20° polylactic acid wedges into osteotomy gaps. Pressure distribution was measured using Tekscan’s Pressure Mapping Sensor 5040™ beneath the menisci at varying PTS angles. The kinetic data were tracked using the Optotrak Certus® system. Statistical analyses were employed to evaluate the pressure shifts and their significance.

RESULTS: The study revealed that increased PTS significantly shifted the pressure point anteriorly on the lateral tibial plateau, while no significant changes were observed on the medial plateau. The analysis of tibial translation showed a corresponding rise in anterior translation with increasing PTS, especially at higher angles.

CONCLUSION: Increased PTS, particularly above 10°, induces significant anterior translation and altered pressure distribution, primarily affecting the lateral tibial plateau. These findings support the hypothesis that elevated PTS contributes to biomechanical stresses in the knee, potentially increasing the risk of lateral compartment cartilage degeneration. These results highlight the importance of considering PTS in clinical assessments and interventions aimed at optimizing knee joint health.

LEVEL OF EVIDENCE: Level IV.

PMID:39912244 | DOI:10.1002/ksa.12613

BMC Glob Public Health. 2025 Feb 6;3(1):11. doi: 10.1186/s44263-025-00126-0.

ABSTRACT

BACKGROUND: Malaria continues to be a major cause of illness and death worldwide, particularly affecting children under the age of five and those living in high-burden countries like Nigeria. Long-lasting insecticidal nets (LLINs) are one of the effective interventions for malaria control and prevention. In response to funding constraints in the Global Fund Grant Cycle 7, Nigeria’s National Malaria Elimination Programme (NMEP) aimed to develop an approach that maximizes the impact of limited malaria interventions by focusing on areas with the greatest need. We developed an urban LLINs distribution framework and a novel strategy, which was piloted in Ilorin, the capital of Kwara State.

METHODS: A participatory action research approach, combined with abductive inquiry, was employed to co-design a framework for guiding bed net distribution. The final framework consisted of three phases: planning, data review and co-decision-making, and implementation. During the framework’s operationalization, malaria risk scores were computed at the ward level using four key variables, including malaria case data and environmental factors, and subsequently mapped. A multistakeholder dialogue facilitated the selection of the final malaria risk maps. Additionally, data from an ongoing study were analyzed to determine whether local definitions of formal, informal, and slum settlements could inform community-level stratification of malaria risk in cities.

RESULTS: Akanbi 4, a ward located in Ilorin South and Are 2, a ward in Ilorin East consistently had lower risk scores, a finding corroborated during the multistakeholder dialogue. A map combining malaria test positivity rates among children under five and the proportion of poor settlements was identified as the most accurate depiction of ward-level malaria risk. Malaria prevalence varied significantly across the categories of formal, informal, and slum settlements, resulting in specific definitions developed for Ilorin. Thirteen communities classified as formal settlements in Are 2 were de-prioritized during the bed net distribution campaign.

CONCLUSIONS: The framework shows promise in facilitating evidence-based decision-making under resource constraints. The findings highlight the importance of stakeholder engagement in evaluating data outputs, particularly in settings with limited and uncertain data. Enhancing surveillance systems is crucial for a more comprehensive approach to intervention tailoring, in alignment with WHO’s recommendations.

PMID:39910663 | DOI:10.1186/s44263-025-00126-0

J Orthop Surg Res. 2025 Feb 6;20(1):142. doi: 10.1186/s13018-025-05524-6.

ABSTRACT

BACKGROUND: An iatrogenic lateral hinge fracture is a common intraoperative problem that may occur during medial open wedge high tibial osteotomy (MOWHTO). This study aims to assess the significance of using additional crossing lateral K-wires and their advantage in protecting the lateral hinge during MOWHTO procedures.

METHODS: The data of patients fulfilling the inclusion criteria who underwent MOWHTO between May 2021 and August 2022 were retrospectively evaluated. One group had additional lateral hinge crossing K-wires (+ MOWHTO group), while the other did not (-MOWHTO group). Both groups were assessed for rate of intraoperative lateral hinge fractures, knee injury and osteoarthritis outcome score – 12 (KOOS-12), medial proximal tibial angle (MPTA), time of union, and time to return to work. The outcomes were compared using the independent T-test for continuous variables and the Fisher Exact test for nominal variables. A p-value of < 0.05 was considered statistically significant for both tests.

RESULTS: The study included forty-eight patients; twenty-four in each treatment group. The mean follow-up durations were 30.5 ± 3.6 months for + MOWHTO and 31.6 ± 3.2 months for -MOWHTO (p = 0.26). There was no statistically significant difference regarding mean age, sex, KOOS-12, MPTA, and time of surgery between both groups. The + MOWHTO group had a faster time of union (p = 0.001), an earlier return to work (p = 0.002), and a lower rate of intraoperative lateral hinge fractures (p = 0.04).

CONCLUSION: This study demonstrated that using additional crossing lateral K-wires during MOWHTO had a beneficial effect on reducing the rate of iatrogenic lateral hinge fractures, with a faster time of union, and an early return to work. The KOOS-12, MPTA, and mean operative time did not reveal significant differences between treatment groups.

LEVEL OF EVIDENCE: retrospective cohort comparative study; level III.

PMID:39910661 | DOI:10.1186/s13018-025-05524-6