Category: Nevin Manimala

BMC Glob Public Health. 2026 Jan 9;4(1):5. doi: 10.1186/s44263-025-00238-7.

ABSTRACT

BACKGROUND: Hypoxemia, a mortality predictor and hallmark of pediatric acute respiratory distress syndrome (PARDS), is disproportionately common in resource-constrained settings (RCS). The burden of PARDS in RCS is likely substantial considering the high prevalence of known clinical triggers (e.g., sepsis, pneumonia, trauma), but it is challenging to diagnose due to limited diagnostic resources. We aimed to: (1) describe respiratory care resource availability in RCS hospitals and test whether availability was associated with mortality; (2) determine the proportion of children who presented to RCS hospitals with hypoxemia and their associated outcomes; and (3) test whether, in children with hypoxemia, having a PARDS trigger was associated with mortality.

METHODS: We developed and applied operational definitions for five tiered respiratory care resource bundles. Through a secondary analysis of Global Paediatric Acute Critical Illness Point Prevalence Study (PARITY) data, we performed descriptive statistics, hypothesis testing (i.e., chi-square and Wilcoxon rank-sum tests), and logistic regression analyses.

RESULTS: Among the entire Global PARITY cohort (n = 7538), 763 (10.1%) were admitted with hypoxemia. Seventy percent (n = 531) were treated at a site with the intermediate or less respiratory care resource bundle available. Mortality was 6.8% (n = 52) and inversely associated with respiratory resource availability. The odds of mortality were higher for patients treated at sites with the intermediate bundle or less compared to those with the advanced or expert bundle available (adjusted odds ratio [OR] 18, 95% confidence interval [CI] 4.1-83). Fifty-six percent (n = 430) had a PARDS trigger, most commonly pneumonia (n = 256), bronchiolitis (n = 116), and sepsis (n = 58). There was no association between the presence of a PARDS trigger and mortality. Ninety-four percent of patients with a PARDS trigger (n = 405/430) had insufficient data available for a PARDS-related diagnosis according to the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines.

CONCLUSIONS: Children with hypoxemia treated at hospitals with respiratory care resource constraints in countries with lower socio-demographic index (SDI) had significantly higher mortality. These findings highlight the importance of ongoing work to improve resource availability, strengthen health systems, and support pediatric healthcare providers in identifying PARDS in order to help clinicians risk stratify children, focus resources, and tailor management to optimize outcomes.

PMID:41514371 | DOI:10.1186/s44263-025-00238-7

Genome Med. 2026 Jan 9;18(1):3. doi: 10.1186/s13073-025-01575-w.

ABSTRACT

BACKGROUND: Inflammatory bowel disease (IBD) is an incurable immune-mediated inflammatory disease, affecting the gut with a high rate of primary- and secondary- loss-of-response to therapy. By investigating the T cell receptor repertoire of individuals with IBD, novel therapeutic and preventive strategies can be identified, and a better understanding of IBD can be obtained.

METHODS: To identify and validate T cell clonotypes implicated in the pathogenesis of IBD, we profiled the T cell receptor alpha (TRA) repertoire of three cohorts containing treatment-naive, treated individuals, and individuals living with the disease for >20 years, resulting in an exhaustive dataset containing the TRA repertoire of 1,732 individuals.

RESULTS: Using the generated datasets, we were able to replicate previous findings describing the expansion of Crohn’s-associated invariant T (CAIT) cells in individuals with Crohn’s disease (CD) in the three cohorts. Using a hypothesis-free statistical testing framework, we identified clonotypes that were associated with the disease at its different stages, e.g., at the time of diagnosis and decades post-diagnosis. By conducting a meta-analysis across the three cohorts, we were able to identify a set of clonotypes that were associated with the disease regardless of its stage. We validated our findings in a previously published independent test dataset from a German cohort, showing the robustness of the identified clonotypes.

CONCLUSIONS: The identified clonotypes are novel therapeutic targets to treat IBD, for example, through targeted depletion. By identifying antigens recognized by these T cells, a better understanding of the etiopathology of IBD, particularly CD, can be obtained.

PMID:41514338 | DOI:10.1186/s13073-025-01575-w

Environ Health. 2026 Jan 9. doi: 10.1186/s12940-025-01252-w. Online ahead of print.

NO ABSTRACT

PMID:41514328 | DOI:10.1186/s12940-025-01252-w

Cardiooncology. 2026 Jan 9. doi: 10.1186/s40959-025-00420-8. Online ahead of print.

ABSTRACT

OBJECTIVE: This ambispective cohort study evaluates the effectiveness of cardioprotective strategies in reducing anthracycline-induced cardiotoxicity in pediatric patients with acute lymphoblastic leukemia (ALL).

METHODS: We conducted a single-center, historically controlled ambispective cohort study at Kunming Children’s Hospital. Children with newly diagnosed ALL treated with the CCLG-ALL2018 protocol between May 2018 and May 2020 comprised the retrospective historical control cohort (no dexrazoxane). After institutional adoption of dexrazoxane, consecutive eligible patients treated between May 2020 and May 2022 were prospectively enrolled and followed according to a prespecified cardiac monitoring schedule. The exposure (use of dexrazoxane) was determined by calendar time rather than randomization.

RESULTS: The combination therapy group exhibited significantly lower rates of electrocardiogram and echocardiogram abnormalities (P < 0.01 and P < 0.01, respectively), suggesting a notable cardioprotective effect. Although baseline cardiac markers did not show significant differences between the groups, post-treatment levels of cardiac troponin T were significantly improved in the combination therapy group (P < 0.05). Additionally, trends toward improved left ventricular ejection fraction and Creatine Kinase-Myocardial Band levels were observed, although these did not reach statistical significance. Importantly, the use of the cardioprotective agent did not lead to a significant increase in adverse reactions.

CONCLUSION: Incorporating a cardioprotective strategy into pediatric ALL treatment protocols appears to lower the risk of anthracycline-induced cardiotoxicity without compromising safety, hence boosting patient outcomes. These findings should be interpreted in light of the historically controlled, nonrandomized design and potential time-related confounding.

PMID:41514325 | DOI:10.1186/s40959-025-00420-8

BMC Oral Health. 2026 Jan 10. doi: 10.1186/s12903-025-07647-y. Online ahead of print.

ABSTRACT

OBJECTIVE: Flowable composite resins are widely used in dentistry, and their biocompatibility is a critical factor. This study aimed to evaluate the cytotoxicity of flowable composite resins with different compositions using an MTT assay on L929 mouse fibroblast cultures.

MATERIALS AND METHODS: In this study, four types of flowable composite resins with different compositions were used: nanoparticle-containing (Filtek Supreme – FS), self-adhesive (Vertise Flow – VF), highly filled (G-aenial Universal Injectable – GUI), and fibre-reinforced (EverX Flow – EF) resins. A total of 28 disc samples (seven from each material), each with a diameter of 5 mm and a thickness of 2 mm, were prepared and polymerized. Five different dilutions (1:1, 1:2, 1:4, 1:8, and 1:16) of the test materials were added to the L929 mouse fibroblast culture medium. The effects of the test materials on cell viability were evaluated using the MTT assay at three different time points (24, 48, and 72 h). The optical densities of the cells were measured with a spectrophotometer. The calculated viability percentages (%) were statistically analysed along with their standard deviations. The effects of the materials’ dose and incubation time on cell viability were evaluated using two-way ANOVA. A Bonferroni post hoc test was applied to determine which factor or interaction group the difference originated from (p < 0.05 was considered statistically significant).

RESULTS: FS, GUI, and EF materials showed no cytotoxic effects at any of the tested concentrations and incubation times; cell viability was found to be above 70% under all conditions. In contrast, undiluted VF material showed cytotoxic effects at all time points, while the 1/2 concentration exhibited cytotoxicity at 72 h.

CONCLUSION: FS, GUI, and EF materials are considired to be biocompatible based on ISO 10993-5 criteria, However, the dose- and time-dependent cytotoxicity observed for the VF material limits its biocompatibility. This may be attributed to differences in monomer and filler composition, highlighting the importance of evaluating the biocompatibility of flowable composite resins before clinical use.

PMID:41514287 | DOI:10.1186/s12903-025-07647-y

BMC Med Educ. 2026 Jan 9. doi: 10.1186/s12909-025-08546-0. Online ahead of print.

ABSTRACT

AIM: The migration of nurses has become a critical concern for Iran’s healthcare system. However, the roots of this challenge may emerge early-during nursing education-when students begin forming attitudes toward working abroad. This study aimed to identify key predictors of Iranian nursing students’ attitudes toward brain drain using a validated multivariate approach.

METHOD: In this cross-sectional study, a total of 296 bachelor’s and master’s nursing students from two nursing schools were recruited through convenience sampling between April and June 2025. Data were collected via an online questionnaire, which included demographic information, educational characteristics, life-related variables, migration-related factors, and the Attitudes toward brain drain scale. Multiple linear regression analysis was performed to examine the predictors of attitudes toward brain drain. Data were analyzed using IBM SPSS Statistics v.26.

RESULTS: The average age of students was 22.7 years. Half of the students reported a moderate level of interest in the profession. Canada was the most frequently chosen destination country (33.5%). The average attitude score toward brain drain was 59.25 ± 11.97. In addition, language proficiency (β = 0.498, p < .001) positively predicted attitudes toward brain drain, whereas life satisfaction (β = -0.192, p < .001) and family connectedness (β = -0.125, p = .014) were negative predictors.

CONCLUSION: These findings highlight the role of both personal and contextual factors in shaping migration attitudes among nursing students. Academic institutions should enhance educational experiences and support students’ psychological well-being to foster more positive professional engagement within the country.

PMID:41514275 | DOI:10.1186/s12909-025-08546-0

BMC Public Health. 2026 Jan 10. doi: 10.1186/s12889-025-26033-5. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to examine the relationship between empowering motivational climate in physical education and adolescents’ social-emotional competence, and to analyze the chain mediation effect of teacher-student relationship and physical activity level.

METHODS: A questionnaire survey was conducted with 1,145 adolescents from first-tier (Guangzhou), second-tier (Foshan), and third-tier (Qingyuan) cities in Guangdong Province, using scales measuring empowering motivational climate in physical education, teacher-student relationship, physical activity level, and social-emotional competence. Data were statistically analyzed using IBM SPSS 29.0 and IBM AMOS 26.0 software.

RESULTS: (1) empowering motivational climate in physical education was positively correlated with social-emotional competence and had a direct predictive effect on it; (2) empowering motivational climate in physical education could indirectly influence adolescents’ social-emotional competence through the partial mediating effects of teacher-student relationship and physical activity level; (3) empowering motivational climate in physical education may also indirectly affect adolescents’ social-emotional competence through the chain mediation of “teacher-student relationship and physical activity level.”

CONCLUSION: The empowering motivational climate in physical education can not only directly predict social-emotional competence but also exert indirect effects through the mediating roles of teacher-student relationship and physical activity level, thereby providing theoretical support and practical evidence for promoting the development of adolescents’ social-emotional competence.

PMID:41514274 | DOI:10.1186/s12889-025-26033-5

BMC Oral Health. 2026 Jan 10. doi: 10.1186/s12903-025-07442-9. Online ahead of print.

ABSTRACT

BACKGROUND: Diabetes Mellitus (DM) is a chronic metabolic disorder that has been linked to an increased risk of periodontal disease. Among the oral manifestations associated with DM, periodontal disease has been the most extensively studied. Dental calculus, which forms when dental plaque mineralizes over time, is known to trap biological substances and may preserve biochemical markers indicative of systemic health. Therefore, it could provide valuable information about patients’ overall health. In this study, we analyzed the elemental composition of dental calculus in diabetic and non-diabetic (control) patients using scanning electron microscopy (SEM) combined with energy dispersive X-ray spectroscopy (EDX), with a specific focus on potassium (K) content.

PATIENTS AND METHODS: We analyzed 57 dental calculus samples, including 17 from individuals diagnosed with type 2 diabetes and 40 from non-diabetic controls. The elemental composition was assessed using scanning electron microscopy paired with energy-dispersive X-ray spectroscopy (SEM-EDX), targeting standardized 100 × 100 μm regions. Potassium content, along with other elemental data, was reported in both mass and atomic percentages.

RESULTS: The results showed elevated potassium levels in diabetic patients compared to controls, with the difference reaching the treshold of statistical significance (0.484 ± 0.710 wt.% versus 0.186 ± 0.320 wt.%). A similar trend was observed in atomic percentage values (0.249 ± 0.387 versus 0.092 ± 0.174; p = 0.0555). Notably, potassium was present in 100% of the diabetic samples. Carbon and oxygen were the predominant elements in both groups, with the diabetic group exhibiting a slight increase in oxygen and lower levels of calcium and phosphorus.

CONCLUSION: These findings suggest that potassium concentration in dental calculus could serve as a potential biomarker for diabetes. They also highlight the feasibility of incorporating dental calculus analysis after routine dental treatments- which involve the removal of calculus-for early diabetes detection. This approach provides a cost-effective and painless alternative to traditional diagnostic methods. However, we note that while the data are still preliminary, the results indicate a potential biochemical link that warrants further exploration in larger, well-controlled studies.

PMID:41514271 | DOI:10.1186/s12903-025-07442-9

Diabetol Metab Syndr. 2026 Jan 9. doi: 10.1186/s13098-025-02049-0. Online ahead of print.

ABSTRACT

BACKGROUND: Diabetic Foot Ulcers (DFUs) represent a global healthcare challenge, imposing substantial socioeconomic burdens due to their increasing incidence and associated mortality. This study evaluates the efficacy and safety of external phytotherapy (utilizing various plant-derived compounds, including Chinese herbal medicines and plant-derived liposomes, administered topically) for the treatment of DFUs.

METHODS: Relevant studies were identified from major electronic databases (PUBMED, EMBASE, WOS, and the Cochrane Library) that were searched up to April 30, 2024. Randomized controlled trials (RCTs) that evaluated the effects of external phytotherapy for DFUs. The treatment group was treated with external phytotherapy plus conventional treatment, while the control group received conventional treatment alone. Two evaluators independently screened and selected literature, extracted data, and assessed the risk of bias. The outcome measures included complete ulcer healing, ulcer improvement, ulcer area reduction, and healing time. Weighted mean difference (WMD), standardized mean difference (SMD), and relative risk (RR) with 95% confidence intervals (CI) were used for data analysis. Heterogeneity was quantified using I² statistics, with appropriate application of fixed-effects or random-effects models. Methodological quality was ensured through Review Manager and Stata software, complemented by GRADE evidence assessment.

RESULTS: Twenty studies with a total of 1,854 participants were identified. Our analysis suggested that compared with conventional treatment, external phytotherapy significantly enhances complete ulcer healing (RR: 1.84; 95% CI: 1.55 to 2.19), promotes ulcer improvement (RR: 1.32; 95% CI: 1.11 to 1.57), reduces ulcer area (WMD: -1.14; 95% CI: -1.45 to -0.83), and accelerates healing time (WMD: -3.93; 95% CI: -7.48 to -0.39). Safety profiles and ulcer depth measurements showed no significant intergroup differences. GRADE assessments indicated high-certainty evidence for most primary outcomes, whereas the evidence for percentage ulcer reduction was of low certainty due to serious inconsistency and imprecision.

CONCLUSION: External phytotherapy demonstrates potential as an adjunctive treatment for diabetic foot ulcers, improving primary outcomes like complete healing with moderate to high certainty of evidence. Nevertheless, regional bias-with most evidence derived from East Asia-warrants caution in generalizing these results. Further rigorous, multi-regional trials are needed to solidify the evidence base and refine clinical application.

PMID:41514269 | DOI:10.1186/s13098-025-02049-0

BMC Complement Med Ther. 2026 Jan 9. doi: 10.1186/s12906-025-05243-9. Online ahead of print.

ABSTRACT

PURPOSE: Continuous positive airway pressure (CPAP) therapy remains the cornerstone of obstructive sleep apnea (OSA) treatment, considerably reducing the risk of cardiovascular complications and improving patient outcomes. However, adherence to CPAP therapy is a major challenge and poor compliance limits its efficacy. This study investigated the potential of aromatherapy, a noninvasive, cost-effective intervention, to improve CPAP adherence and enhance sleep quality in patients with OSA.

METHODS: A prospective observational pilot study was conducted in patients with obstructive sleep apnea who demonstrated poor CPAP adherence (< 70% usage and < 4 h/night). Participants were exposed to lavender or cypress aroma oil during sleep. Pre- and post-intervention subjective sleep measures Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and objective CPAP usage metrics were collected. Normally distributed variables were analyzed using paired t-tests, and non-normally distributed variables were analyzed using the Wilcoxon signed-rank test. Statistical significance was set at p < 0.05. A post hoc power analysis was performed based on observed effect sizes for the primary outcomes.

RESULTS: Eight patients with OSA (mean age 53.5 years; 4 males, 4 females) participated in the study. Following 67 days of treatment, the median PSQI score significantly improved from 9.0 to 6.5 (p = 0.006), and the median ESS score decreased from 9.0 to 6.5 (p = 0.034). Additionally, CPAP for more than 4 h increased from 5.0% to 25.7% (p = 0.028). The median usage duration improved from 149 to 231 min (p = 0.018). No significant change in apnea hypopnea index (AHI) was observed during CPAP use, decreasing from 3.2 events/h to 1.3 events/h (p = 0.226), which is consistent with the understanding that appropriately applied CPAP maintains effective control of respiratory events.

CONCLUSION: Aromatic stimulation with essential oils shows promise in improving both CPAP adherence and sleep quality, offering a novel approach to enhance OSA treatment efficacy.

PMID:41514226 | DOI:10.1186/s12906-025-05243-9