Category: Nevin Manimala

West Afr J Med. 2024 Sep 30;41(9):919-926.

ABSTRACT

BACKGROUND: Strabismus is a potential cause of ocular morbidity.

OBJECTIVE: The aim of this study was to determine the frequency, types of manifest strabismus and co-morbidities among patients attending a referral paediatric ophthalmology and strabismus clinic in Calabar, Nigeria.

METHODS: A retrospective review of case-notes of patients attending the paediatric ophthalmology and strabismus clinic from January 1, 2017 to December 31, 2019 was done. Collected data was analyzed using chi square test (or Fisher’s Exact Test) and multivariate binary regression. A p-value of <0.05 was considered statistically significant.

RESULTS: Of the 4644 patients reviewed, 169 patients (3.6%) had strabismus during the study period but only 136 (80.4%) met the eligibility criteria for inclusion into this study. Most patients (89.0%) were aged below 16 years. Females (52.2%) were proportionately more. Sixty-three (46.3%) had one ocular comorbidity, 56(41.2%) had two while 16(11.8%) had three. The most common ocular comorbidity was amblyopia (31.6%), followed by hypermetropia (27.7%). Twenty-nine (21.3%) had systemic comorbidities. Sensory and infantile esotropia were the most common types; 35.3% and 32.4% respectively. Others included intermittent exotropia (16.2%) and sensory exotropia (6.6%). Primary strabismus was more common among those aged 16 years and above compared with those aged below 16 years (66.7% versus 57.0%), p=0.475. There were statistically significant relationships between strabismus and cataracts, retinoblastoma, hypermetropia, astigmatism among others. Amblyopia (AOR: 3.339; 95% CI: 1.100-10.131), hypermetropia (AOR: 10.615; 95% CI: 2.393-47.077), and myopia (AOR: 0.109; 95% CI: 0.016 to 0.732) were predictors of strabismus.

CONCLUSION: The prevalence of strabismus in this study revealed a higher burden than previously reported in Nigeria. Some comorbidities serve as predictors of strabismus, and their presence may aid timely case finding. Treatment of causes of secondary strabismus may reduce the burden of avoidable causes of strabismus and associated visual loss.

PMID:39862386

Clin Oral Investig. 2025 Jan 25;29(1):91. doi: 10.1007/s00784-025-06167-x.

ABSTRACT

OBJECTIVES: The purpose of this study was to propose a new difficulty score for the treatment of multiple gingival recessions (GRs) with Modified Coronally Advanced Tunnel (MCAT), and to test the score’s reliability.

MATERIAL AND METHODS: A difficulty score was developed for the assessment and grading of 13 relevant anatomical parameters at baseline. Six experienced dental practitioners evaluated existing GRs in three patients. The scale was assessed at two levels: for each single tooth, and seven days later for whole quadrants. Accuracy was estimated using Fleiss’ kappa statistics and intraclass correlation coefficients (ICC) to determine the inter- and intra-examiner agreement.

RESULTS: During the evaluation of individual teeth, all parameters exhibited very good to excellent agreement, with Fleiss’ kappa statistics ranging between 0.74 and 1. Only recession type, CEJ detectability, and cervical step displayed minor variations. The total MCAT score also produced a minor discrepancy (kappa = 0.78). During the evaluation of whole quadrants, excellent reproducibility was recorded for individual parameters (kappa 0.9-1). Minor variation was observed for recession type and CEJ detectability. Excellent reliability in the total MCAT scores was noted between examiners (kappa = 0.9). Overall intra-examiner agreement values were very high (0.75-1).

CONCLUSIONS: The reliability of the proposed difficulty score was assessed between very good and excellent. Some difficulties arose in the evaluation of recession type, CEJ detectability and cervical step.

CLINICAL RELEVANCE: The presented score may be considered for assessing the difficulty of multiple GRs treatment using MCAT in order to improve the process of clinical decision-making.

PMID:39862381 | DOI:10.1007/s00784-025-06167-x

Ann Intensive Care. 2025 Jan 25;15(1):17. doi: 10.1186/s13613-025-01424-4.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is common in critically ill patients and is associated with increased morbidity and mortality. Its complications often require renal replacement therapy (RRT). Invasive mechanical ventilation (IMV) and infections are considered risk factors for the occurrence of AKI. The use of IMV and non-invasive ventilation (NIV) has changed over the course of the pandemic. Concomitant with this change in treatment a reduction in the incidences of AKI and RRT was observed. We aimed to investigate the impact of IMV on RRT initiation by comparing critically ill patients with and without COVID-19. Furthermore, we wanted to investigate the rates and timing of RRT as well as the outcome of patients, who were treated with RRT.

RESULTS: A total of 8,678 patients were included, of which 555 (12.8%) in the COVID-19 and 554 (12.8%) in the control group were treated with RRT. In the first week of ICU stay the COVID-19 patients showed a significantly lower probability for RRT initiation (day 1: p < 0.0001, day 2: p = 0.021). However, after day 7 a reversed HR was found. In mechanically ventilated patients the risk was significantly higher for the initiation of RRT over the entire stay. While in non-COVID-19 patients this was a non-significant trend, in COVID-19 patients the risk for RRT was significantly increased. The median delay between initiation of IMV and requirement of RRT was observed to be longer in COVID-19 patients (5 days [IQR: 2-11] vs. 2 days [IQR: 1-5]). The analysis restricted to patients with RRT showed a significantly higher risk for ICU death in patients requiring IMV compared to patients without IMV.

CONCLUSION: The analysis demonstrated that IMV as well as COVID-19 are associated with an increased risk for initiation of RRT. The association between IMV and risk of RRT initiation was given for all investigated time intervals. Additionally, COVID-19 patients showed an increased risk for RRT initiation during the entire ICU stay within patients admitted to an ICU due to respiratory disease. In COVID-19 patients treated with RRT, the risk of death was significantly higher compared to non-COVID-19 patients.

PMID:39862353 | DOI:10.1186/s13613-025-01424-4

Sci China Life Sci. 2025 Jan 22. doi: 10.1007/s11427-024-2748-4. Online ahead of print.

ABSTRACT

Genomic sources from China are underrepresented in the population-specific reference database. We performed whole-genome sequencing or genome-wide genotyping on 1,207 individuals from four linguistically diverse groups (1,081 Sinitic, 56 Mongolic, 40 Turkic, and 30 Tibeto-Burman people) living in North China included in the 10K Chinese People Genomic Diversity Project (10K_CPGDP) to characterize the genetic architecture and adaptative history of ethnic groups in the Silk Road Region of China. We observed a population split between Northwest Chinese minorities (NWCMs) and Han Chinese since the Upper Paleolithic and later Neolithic genetic differentiation within NWCMs. The observed population substructures among ethnically/linguistically diverse NWCMs suggested that differentiated admixture events contributed to the differences in their genomic and phenotypic diversity. We estimated that the Dongxiang, Tibetan, and Yugur people inherited more than 10% of the Western Eurasian ancestry, which is much greater than that of the Salar and Tu people (<7%), while Han neighbors showed less West Eurasian ancestry (∼1%-3%). Male-biased admixture introduced Western Eurasian ancestry in the Dongxiang, Tibetan, and Yugur populations. We found that the eastern-western admixture in NWCMs occurred ∼800-1,100 years ago, coinciding with intensive economic and cultural exchanges during the Tang and Song dynasties. Additionally, we identified the signatures of natural selection associated with cardiovascular system diseases or lipid metabolism and developmental/neurogenetic disorders. Moreover, the EPAS1 gene showed relatively high population branch statistic values in NWCMs. The well-fitted demographical models presented the vast landscape of complex admixture processes of the Silk Road people, and the newly reported functionally important variations suggested the importance of including ethnolinguistically diverse populations in Chinese genetic studies for uncovering the genetic basis of complex traits/diseases.

PMID:39862346 | DOI:10.1007/s11427-024-2748-4

Mol Cell Pediatr. 2025 Jan 25;12(1):2. doi: 10.1186/s40348-025-00189-x.

ABSTRACT

BACKGROUND: Patent ductus arteriosus is one of the most common cardiac conditions affecting the neonates. Considering the lack of studies done on this topic in healthcare settings in Khyber Pakhtunkhwa province, this study aims to find out the comparative effectiveness of paracetamol and ibuprofen in management of PDA in our healthcare setting to conclude a better management option for the condition.

OBJECTIVE: To find and compare the effectiveness of paracetamol and ibuprofen in the closure of patent ductus arteriosus in preterm neonates.

METHODOLOGY: This randomized controlled trial was conducted in the Department of Nursery and Neonatal Intensive Care Unit, Khyber Teaching Hospital, Peshawar, Pakistan, from 10th April 2024 to 10th October 2024. A total of 256 neonates of both genders with patent ductus arteriosus were included. Group A received oral paracetamol, and Group B received oral ibuprofen. The effectiveness of the treatments was evaluated at the end of the treatment period.

RESULTS: The age range in this study was from 48 to 96 h, with a mean age of 71.79 ± 13.10 h in Group A and 73.40 ± 11.81 h in Group B. Efficacy was observed in 107 (83.6%) patients in Group A compared to 90 (70.3%) patients in Group B, showing a statistically significant difference (P = 0.011).

CONCLUSION: Our study has concluded that paracetamol is more effective than ibuprofen in closing patent ductus arteriosus. The trials were retrospectively registered at NIH Trial Registry (NCT06601114) https://clinicaltrials.gov/study/NCT06601114 dated 15/09/2024.

PMID:39862321 | DOI:10.1186/s40348-025-00189-x

Ann Med. 2025 Dec;57(1):2457522. doi: 10.1080/07853890.2025.2457522. Epub 2025 Jan 25.

ABSTRACT

BACKGROUND: Several randomized controlled trials (RCTs) have investigated the benefits of atrial fibrillation (AF) screening. However, since none have shown a significant reduction in stroke rates, the impact of screening on clinical outcomes remains uncertain.

MATERIALS AND METHODS: We conducted a systematic review and meta-analysis of RCTs reporting clinical outcomes of systematic AF screening in participants without known AF. Pooled risk ratios (RRs) were computed for all-cause stroke or systemic embolism, major bleeding, and all-cause mortality, comparing screening with no screening.

RESULTS: Seven RCTs encompassing 76 458 participants were identified. One trial utilized implantable loop recorders for rhythm monitoring, while the others employed non-invasive screening methods. Pooled results indicated that AF screening was associated with a significant reduction in all-cause stroke or systemic embolism (RR 0.932, 95% CI 0.873-0.996, I² = 0%, p = 0.037), but had no effect on major bleeding (RR 0.996, 95% CI 0.935-1.060, I² = 0%, p = 0.876) or all-cause mortality (RR 0.987, 95% CI 0.945-1.031, I² = 0%, p = 0.550). We estimated a number needed to screen of 148 to prevent one stroke or systemic embolism over a 10-year period in a population of 75-year-olds. When only non-invasive screening methods were considered, the reduction in strokes was not statistically significant (RR 0.942, 95% CI 0.880-1.008, I² = 0%, p = 0.083).

CONCLUSIONS: Systematic AF screening is associated with a modest yet statistically significant 7% relative reduction in stroke and systemic embolism, with no observed impact on major bleeding or all-cause mortality.

PMID:39862317 | DOI:10.1080/07853890.2025.2457522

Clin Oral Investig. 2025 Jan 25;29(1):90. doi: 10.1007/s00784-025-06166-y.

ABSTRACT

OBJECTIVE: This study investigated the associations among endodontic instruments, ultrasonic tips and various final irrigation protocols for removing intracanal and intratubular biofilms in long oval canals.

METHODOLOGY: One hundred mandibular premolars inoculated with Enterococcus faecalis were divided into two groups: the control group (CG: n = 10), which received no treatment; and the test groups (n = 30), which included saline (SS), sodium hypochlorite (2.5% NaOCl) and chlorhexidine (2% CHX). The samples were prepared with Reciproc^® Blue 25/0.08, Flatsonic, Clearsonic and Reciproc Blue 40/0.06. Each test group was divided into three subgroups (n = 10): conventional irrigation (CI) with syringes and needles, passive ultrasonic irrigation (PUI) and continuous ultrasonic irrigation (CUI) with an Irrisonic tip. The root canals were examined using confocal laser scanning microscopy. Mann‒Whitney and Kruskal‒Wallis tests followed by Dunn post hoc tests (p < 0.05) were used for statistical analysis.

RESULTS: NaOCl and CHX were effective for intracanal and intratubular decontamination. Saline showed significant decontamination in the intratubular areas when CUI was used. The CI method was the least effective for intracanal decontamination.

CONCLUSION: The use of Flatsonic and Clearsonic ultrasonic tips is promising for root canal disinfection.

CLINICAL RELEVANCE: The disinfection techniques in endodontic treatment focus on the removal of biofilms from long oval canals, which is crucial for effective cleaning during root canal procedures.

PMID:39862315 | DOI:10.1007/s00784-025-06166-y

Updates Surg. 2025 Jan 25. doi: 10.1007/s13304-025-02109-0. Online ahead of print.

ABSTRACT

Clinical risk prediction models are ubiquitous in many surgical domains. The traditional approach to develop these models involves the use of regression analysis. Machine learning algorithms are gaining in popularity as an alternative approach for prediction and classification problems. They can detect non-linear relationships between independent and dependent variables and incorporate many of them. In our work, we aimed to investigate the potential role of machine learning versus classical logistic regression for the preoperative risk assessment in proctological surgery. We used clinical data from a nationwide audit: the database consisted of 1510 patients affected by Goligher’s grade III hemorrhoidal disease who underwent elective surgery. We collected anthropometric, clinical, and surgical data and we considered ten predictors to evaluate model-predictive performance. The clinical outcome was the complication rate evaluated at 30-day follow-up. Logistic regression and three machine learning techniques (Decision Tree, Support Vector Machine, Extreme Gradient Boosting) were compared in terms of area under the curve, balanced accuracy, sensitivity, and specificity. In our setting, machine learning and logistic regression models reached an equivalent predictive performance. Regarding the relative importance of the input features, all models agreed in identifying the most important factor. Combining and comparing statistical analysis and machine learning approaches in clinical field should be a common ambition, focused on improving and expanding interdisciplinary cooperation.

PMID:39862313 | DOI:10.1007/s13304-025-02109-0

J Med Syst. 2025 Jan 25;49(1):17. doi: 10.1007/s10916-024-02138-z.

ABSTRACT

Predicting health-related outcomes can help with proactive healthcare planning and resource management. This is especially important on the older population, an age group growing in the coming decades. Considering longitudinal rather than cross-sectional information from primary care electronic health records (EHRs) can contribute to more informed predictions. In this work, we developed prediction models using longitudinal EHRs to inform resource allocation. In this study, we developed deep-learning-based prognostic models to predict 1-year and 5-year all-cause mortality, nursing home admission, and home care need in people over 65 years old using all the longitudinal information from EHRs. The models included attention mechanisms to increase their transparency. EHRs were drawn from SIDIAP (primary care, Catalonia (Spain)) from 2010-2019. Performance on the test set was compared to that from baseline models using cross-sectional one-year history only. Data from 1,456,052 individuals over 65 years old were considered. Cohen’s kappa obtained using longitudinal data was 3.4-fold (1-year all-cause mortality), 10.3-fold (5-year all-cause mortality), 1.1-fold (5-year nursing home admission), and 1.2-fold (5-year home care need) higher than that obtained by the one-year history baseline models. Our models performed better than those not considering longitudinal data, especially when predicting further into the future. However, nursing home admission and home care need in the long term were harder to predict, suggesting their dependence on more abrupt changes. The attention maps helped to understand the predictions, enhancing model transparency. These prediction models can contribute to improve resource allocation in the general population of aging adults.

PMID:39862306 | DOI:10.1007/s10916-024-02138-z

Matern Child Health J. 2025 Jan 25. doi: 10.1007/s10995-025-04039-0. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to determine the effect of supplemental nursing system on, sucking success, weight gain findings and bilirubin levels in newborns.

DESIGN AND METHODS: The study was conducted as a randomized controlled trial. The population of the research consisted of 71 infants who received care and treatment at the Neonatal Intensive Care Clinic of the hospital located in a province in eastern Turkey between February and June 2023. In the study, the “Infant Follow-up Form” to access the birth-related characteristics of infants and mothers, the “LATCH Breastfeeding Diagnostic Scale,” to diagnose the process of switching to full breastfeeding and the “Mother-Infant Communication Form” were used. The body weights of the infants were monitored using a Charder baby scale and bilirubin levels were measured using a Drager brand transcutaneous bilirubin measuring device.

RESULTS: The difference between the groups in terms of the mean sucking success, weight gain findings and bilirubin levels scores was statistically significant (p < 0.05).

CONCLUSIONS: Feeding an infant with the supplemental nursing system had a positive effect on sucking success, weight gain findings and bilirubin levels.

PMID:39862297 | DOI:10.1007/s10995-025-04039-0