Category: Nevin Manimala

Front Med (Lausanne). 2026 Mar 17;13:1772299. doi: 10.3389/fmed.2026.1772299. eCollection 2026.

ABSTRACT

OBJECTIVE: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD), Acute Exacerbation of Asthma(AEA), and acute bronchitis (AB) are known as the common acute airway inflammatory illnesses. This study seeks to systematically assess the effective rate and safety of Qingke Pingchuan Granules (QKPC) in treating these three illnesses in order to give evidence-based recommendations for therapeutic practice.

METHODS: Web of Science, PubMed, Cochrane Library, Elsevier ScienceDirect, CNKI, Wanfang Data, and VIP databases were all thoroughly scoured between their creation and November 2025. Leveraging the Cochrane Risk of Bias tool, two reviewers independently sifted through the reports, retrieved study data, and assessed the methodological rigor. RevMan 5.4 and Stata 17.0 software were used for statistical analyses, and effect sizes were reported as RR or MD with 95% CIs. The Cochrane Q test and the I² statistic were used to evaluate heterogeneity.

RESULTS: 21 RCTs with 2087 individuals were incorporated into this study. The findings demonstrated that QKPC in conjunction with conventional treatment considerably improved clinical outcomes, including overall response rate, FEV₁%, and FVC, as compared to conventional Western medicine alone. Additionally, it decreased the inflammatory factor (CRP). QKPC significantly improved the CAT score, mMRC score, 6MWT distance, and PaO₂ for AECOPD-specific outcomes (all p < 0.05). It decreased serum IgE and increased PEF for AEA. It reduced the time it took for AB to resolve their cough, and also reduced TNF-α and IL-1β levels. The incidence of adverse events (mainly gastrointestinal reactions and skin rashes) did not differ significantly between the two groups (RR = 0.73, 95% CI [0.49, 1.09]), with no significant abnormalities in liver or kidney function observed. The results’ robustness was validated by sensitivity analysis, and publication bias adjustment had no effect on the importance of the main conclusions.

CONCLUSION: In patients with AECOPD, AEA, and AB, QKPC in conjunction with traditional Western medicine treatment can dramatically enhance clinical efficacy, lung function, and inflammatory status without raising the risk of adverse reactions. For these acute airway inflammatory illnesses, it is a safe and effective adjuvant therapy alternative that indicated to significantly improve symptoms, lung function, and quality of life in individuals with AECOPD.

SYSTEMATIC REVIEW REGISTRATION: Unique Identifier (CRD420251229191), (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251229191).

PMID:41924750 | PMC:PMC13036208 | DOI:10.3389/fmed.2026.1772299

Front Med (Lausanne). 2026 Mar 20;13:1761997. doi: 10.3389/fmed.2026.1761997. eCollection 2026.

ABSTRACT

BACKGROUND: Children’s minds are immature, making them more susceptible to severe anxiety when separated from their parents before surgery. Alleviating preoperative anxiety in children is essential for providing comfort-oriented healthcare. Remimazolam is a novel ultra-short-acting benzodiazepine. Existing studies have identified the effective dose for 50% of patients (ED₅₀) when administering intravenous remimazolam to alleviate preoperative anxiety in children. However, the 90% effective dose (ED₉₀) is clinically more meaningful. This study aims to determine the ED₉₀ of intravenous remimazolam in alleviating preoperative anxiety in pediatric patients aged 1-6 years.

METHODS: From April to August 2025, pediatric patients undergoing elective surgery under general anesthesia were enrolled and stratified into two age groups: a younger group (YG, aged 1 to <4 years) and an older group (OG, aged 4-6 years inclusive). We employed the biased coin design (BCD) to determine target doses, defining a positive response as effective relief of preoperative anxiety [Parent Separation Anxiety Scale (PSAS) score < 3]. The initial dose for the first patient was 0.2 mg/kg. For subsequent pediatric patients, the dose was adjusted by increasing or decreasing by 0.05 mg/kg based on sedation response of the previous case. Isotonic regression and bootstrapping methods were used to estimate the ED₉₀ and 90% confidence interval (CI), respectively.

RESULTS: Eighty children completed the study, 40 in YG group and 40 in OG group. Statistical analysis indicated that the ED₉₀ (90% CIs) values for remimazolam used for alleviating preoperative anxiety in pediatric patients were 0.20 mg/kg (0.17-0.24) in the YG group and 0.15 mg/kg (0.11-0.17) in the OG group. Given that the 83% CIs for the ED₉₀ showed no overlap between the YG group (0.18-0.24) and the OG group (0.12-0.17), the difference between the two groups is considered statistically significant.

CONCLUSION: The ED₉₀ of intravenous remimazolam for preoperative anxiolysis was 0.20 mg/kg in children aged 1 to <4 years and 0.15 mg/kg in those aged 4-6 years. Notably, older children require even lower weight-based doses.

CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn/bin/project/edit?pid=252632, identifier ChiCTR2500098747.

PMID:41924742 | PMC:PMC13036471 | DOI:10.3389/fmed.2026.1761997

Front Med (Lausanne). 2026 Mar 17;13:1752369. doi: 10.3389/fmed.2026.1752369. eCollection 2026.

ABSTRACT

OBJECTIVE: Clavicle hook plates are widely used for internal fixation of clavicle fractures, yet little biomechanical evidence exists to guide optimal plate contouring, screw selection, and screw-hole management. This study aimed to systematically evaluate the biomechanical effects of plate bending configuration, screw type, empty hole location, and invalid hole placement on clavicle hook plate fixation strength to optimize surgical strategies for clavicle fracture fixation.

METHODS: This was a controlled bench-top biomechanical study. A series of biomechanical tests were conducted using an electronic universal testing machine. Clavicle hook plates were fixed onto synthetic clavicle models under different experimental conditions: (1) plate bending (forward bend, no bend, reverse bend), (2) screw type (common screws vs. locked screws), (3) empty screw hole location (distal vs. proximal), and (4) invalid hole placement (under the plate vs. beyond the plate). Axial force was applied to the distal hook until fracture occurred, and the maximum fracture force was recorded. One-way ANOVA with post-hoc Bonferroni correction was used for statistical analysis (p < 0.01 considered significant).

RESULTS: Plate bending significantly influenced fixation strength, with the forward bend group exhibiting the highest fracture force (202.75 N), significantly greater than the no bend and reverse bend groups (p < 0.01). Common screws provided greater mechanical stability than locked screws, with significantly higher fracture force (204.08 N vs. 145.76 N, p < 0.0001). Distal empty screw holes significantly reduced fixation strength (135.38 N) compared to proximal empty holes (160.3 N, p < 0.0001). Invalid holes beyond the plate weakened structural integrity more than holes under the plate (144.75 N vs. 169.27 N, p < 0.0001).

CONCLUSION: The study demonstrates that forward bending of the plate, the use of common screws, and avoiding distal empty screw holes or invalid holes beyond the plate significantly improve fixation strength in clavicle hook plate fixation. These findings provide critical biomechanical insights to enhance surgical decision-making and reduce the risk of implant failure. Future research should focus on clinical validation, multi-axial loading analysis, and long-term fatigue testing to further refine fixation techniques for optimal patient outcomes.

PMID:41924735 | PMC:PMC13035774 | DOI:10.3389/fmed.2026.1752369

Front Med (Lausanne). 2026 Mar 17;13:1710087. doi: 10.3389/fmed.2026.1710087. eCollection 2026.

ABSTRACT

STUDY OBJECTIVE: The study aimed to explore the potential of routinely collected pre-procedural clinical and ultrasonographic parameters (age, classification, baseline fibroid volume, and baseline Doppler score) in predicting treatment response following transvaginal radiofrequency ablation (RFA). We employed a combined machine learning-based feature ranking and regression interpretability approach to provide a proof-of-concept for future data-driven predictive models.

DESIGN: This study was designed as a single-center retrospective case series.

SETTING: The study was conducted at a public hospital in Romania, where RFA was introduced as a minimally invasive alternative for uterine fibroid treatment.

PATIENTS: Twenty-two fibroids were treated in women aged 28-52 years (mean age 38), who were selected based on the presence of symptoms or documented fibroid growth.

INTERVENTIONS: Transvaginal ultrasound-guided radiofrequency ablation was performed using the VIVA RF system. Baseline and post-procedural measurements included fibroid size and volume, vascularity as measured by Doppler score, and anatomical classification according to FIGO criteria.

MEASUREMENTS AND MAIN RESULTS: Fibroid volume decreased from a mean of 60.82 cm³ to 28.3 cm³ (-54.0%), while the Doppler score decreased from 3.59 to 1.41 (-59.8%). An exploratory feature-based analysis using four pre-procedural variables (age, FIGO classification, baseline fibroid volume, and baseline Doppler score) was conducted as a proof-of-concept, highlighting the challenges of robust modeling in small cohorts. In the multivariable logistic regression analysis, no statistically significant association was observed between treatment outcome and patient age or FIGO classification.

CONCLUSION: This proof-of-concept study demonstrates the potential of using routinely collected pre-procedural data for predictive analytics in RFA of uterine fibroids. The successful outcomes observed in two submucosal fibroids (G0 and G1) suggest that RFA followed by hysteroscopic myomectomy may serve as a viable two-step fertility-preserving treatment approach. However, the small sample size and class imbalance highlight the critical need for larger, prospective, multicentric studies to develop clinically valid predictive models for minimally invasive fibroid treatment.

PMID:41924728 | PMC:PMC13036101 | DOI:10.3389/fmed.2026.1710087

Front Vet Sci. 2026 Mar 17;13:1807749. doi: 10.3389/fvets.2026.1807749. eCollection 2026.

ABSTRACT

INTRODUCTION: Respiratory diseases are a major health concern in intensive lamb production, leading to significant economic losses and compromised animal welfare. This study aimed to characterize the hematological and biochemical profiles of lambs affected by ovine respiratory complex according to disease severity assessed by clinical, ultrasonographic, and post-mortem scoring systems.

METHODS: 89 Lacaune lambs from a single farm were evaluated using a clinical respiratory score, lung ultrasound examination, and macroscopic post-mortem lung assessment, with severity classified into four categories, scores 0 to 3. Blood samples were collected for complete blood count and serum biochemistry analysis. Statistical comparisons were performed using one-way ANOVA and Tukey’s post hoc test.

RESULTS: Diseased lambs showed significant increases in WBC counts and NEU percentages, with concurrent lymphocytopenia and eosinophilia. RBC parameters varied with disease stage, showing anemia in moderate cases and compensatory increases in severe chronic cases. Biochemically affected lambs exhibited hypoglycemia, decreased ALP activity, hypoalbuminemia, hyperglobulinemia, and hypophosphatemia. Ultrasonographic scores demonstrated greater concordance with post-mortem findings and blood profile alterations compared to clinical scores.

DISCUSSION: These results indicate that combining lung ultrasound with hematological and biochemical analysis provide a more efficient evaluation of respiratory disease severity in lambs than a clinical evaluation.

PMID:41924725 | PMC:PMC13035490 | DOI:10.3389/fvets.2026.1807749

Front Health Serv. 2026 Mar 13;6:1774099. doi: 10.3389/frhs.2026.1774099. eCollection 2026.

ABSTRACT

INTRODUCTION: Obesity has emerged as a global public health epidemic with far-reaching health consequences. While metabolic bariatric surgery (MBS) is an established therapeutic modality for moderate-to-severe obesity and associated metabolic disorders, enabling rapid weight reduction and metabolic improvement, postoperative weight regain remains a critical barrier to sustaining long-term treatment efficacy. Indeed, the durability of surgical outcomes is heavily contingent upon patients’ ability to engage in sustained self-management behaviors.

AIMS: To characterize the patterns of self-management behavior among patients after metabolic bariatric surgery using latent profile analysis, and to examine the relationships among these latent profiles.

METHODS: A cross-sectional study was carried out at one general hospital. A total of 242 patients after metabolic bariatric surgery completed the socio-demographic questionnaire, Bariatric Surgery Self-Management Questionnaire, General Self-efficacy Scale, and International Physical Activity Questionnaire.

RESULTS: Three latent profiles were identified: high self-management behavior group (n = 28, 11.57%), moderate self-management behavior group (n = 156, 64.46%) and low self-management behavior group (n = 58, 23.97%). The ANOVA and chi-square tests demonstrated significant differences among three groups concerning age and educational level. Multinomial logistic regression analysis indicated that employment condition, smoking and drinking history significantly predicted self-management behavior.

CONCLUSIONS: The statistical analysis indicated that the majority of patients fall into the moderate self-management group. Further regression analysis demonstrated significant associations between self-management proficiency and both age and educational level. These findings highlight the need for tailored interventions targeting specific patient profiles.

PMID:41924715 | PMC:PMC13036972 | DOI:10.3389/frhs.2026.1774099

Front Psychiatry. 2026 Mar 17;17:1785988. doi: 10.3389/fpsyt.2026.1785988. eCollection 2026.

ABSTRACT

INTRODUCTION: The diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) largely relies on clinical interviews and parent/teacher-report rating scales, which are vulnerable to subjective bias. Therefore, there is an increasing need for objective measures to complement existing assessment approaches. The aim of this study was to objectively quantify children’s body movement during a controlled, semi structured interaction, to examine differences between children with and without ADHD, and to evaluate the cross-sectional discriminative capacity of these movement-based features using machine learning methods.

METHODS: This study employed a cross-sectional, observational case-control design including 37 children diagnosed with ADHD and 29 typically developing children aged 7-11 years. Psychiatric diagnoses were established using the DSM-5-based K-SADS PL interview. Video recordings were obtained during a standardized 5-minute instructional interaction using a researcher-worn point-of-view (POV) camera. Body movement measures of the head, upper limbs, and lower limbs were extracted from the video recordings using MediaPipe Pose. Movement data were statistically compared between groups, followed by classification analyses using machine learning algorithms.

RESULTS: The global activity index was significantly higher in the ADHD group compared to the control group (p = 0.003). Regional analyses revealed significant group differences in shoulder, elbow, ankle, foot, and head movements. A significant positive correlation was found between the global activity index and parent-reported hyperactivity scores (r = 0.28, p = 0.025). In the machine learning analyses, the AdaBoost classifier demonstrated the highest performance, achieving an accuracy of 81.82% and a ROC-AUC value of 0.85.

DISCUSSION: This study demonstrates that video-based movement analyses obtained during controlled, semi-structured interactions may capture motor activity patterns associated with ADHD. The findings are expected to contribute to the development of digital behavioral markers that may complement existing clinical assessment approaches in the context of ADHD evaluation.

PMID:41924709 | PMC:PMC13035793 | DOI:10.3389/fpsyt.2026.1785988

Glob Public Health. 2026 Dec 31;21(1):2648960. doi: 10.1080/17441692.2026.2648960. Epub 2026 Apr 1.

ABSTRACT

To conduct a systematic review and meta-analysis on the observed test positivity rates, risk factors, clinical manifestations and management of Mpox in paediatric populations globally. We searched relevant articles from databases, including PubMed, the Cochrane Library, Scopus, Web of Science and ProQuest, as well as gray literature sources, for studies published between 2023 and 2024. The inclusion criteria encompassed primary studies (including case reports) focused on paediatric mpox, with an emphasis on epidemiology, clinical manifestations and management. Data extraction was performed independently by two reviewers. We calculated pooled positivity rates and identified and reported risk factors and clinical manifestations (PROSPERO id: CRD42024600945). Among the 1414 records from databases and 24 from gray literature, 22 studies met the inclusion criteria. Paediatric mpox cases show considerable variability in PCR positivity rates, ranging from 6.95% in non-endemic regions to 35.6% in endemic areas. The clinical manifestations include progressive skin lesions and fever, with younger children being more susceptible to severe complications. The key risk factors included close household contact, coinfections and socioeconomic factors. Paediatric Mpox poses significant challenges, particularly in endemic regions. The observed frequency of infection and severity of complications emphasise the need for age-specific public health interventions, improved diagnostic capabilities and harmonised clinical guidelines to reduce morbidity and improve clinical outcomes.

PMID:41922934 | DOI:10.1080/17441692.2026.2648960

J Sch Health. 2026 May;96(5):e70142. doi: 10.1111/josh.70142.

ABSTRACT

This commentary summarizes the evidence base, equity implications, and implementation considerations for later school start times (SSTs) in Alabama. In Alabama, almost half of children report sleep durations below age-based recommendations. Of the 138 school districts in Alabama, few have middle and high schools adhering to the 8:30 am or later SSTs recommended by the American Academy of Sleep Medicine and the National Sleep Foundation. Historically designed to meet Industrial Revolution-era schooling needs, current SSTs are largely dictated by tradition and fail to promote the health and well-being of modern-day students. Adolescent chronotype shifts later, producing later sleep onset and wake time. Given their naturally delayed chronotype, early SSTs often lead to poor sleep quality and shorter total sleep duration in adolescents, which can negatively impact metabolic and cardiovascular health. Earlier SSTs negatively impact social development as well. Earlier SSTs can result in shorter sleep duration, which has been associated with adolescent suicidal behavior and substance use. Early SSTs are also correlated with poorer academic achievement. The literature provides substantial evidence supporting a relation between later SSTs and improved adolescent physical and mental health, social development, academic outcomes, and decreased motor vehicle accident incidence. Given prolific racial/ethnic and socioeconomic disparities in Alabama, later SSTs may offer a practical and sustainable pathway for addressing health inequities in Alabama. The prioritization of the health, well-being, and development of students warrants legislative discussion in Alabama regarding later start times for middle and high schools, along with strategic planning to overcome logistical challenges.

PMID:41922927 | DOI:10.1111/josh.70142

Nat Commun. 2026 Apr 1. doi: 10.1038/s41467-026-71252-y. Online ahead of print.

ABSTRACT

Sleep is essential for health and regulated by genetic and environmental factors. We perform genome-wide association studies of device-measured sleep duration, efficiency, and accelerometer-derived rapid eye movement (REM) and non-rapid eye movement (NREM) sleep in 80,013 UK Biobank participants. We identify 20 autosomal loci, 12 of which have not been previously reported, including genome-wide significant associations for REM and NREM sleep duration. MEIS1 shows strong opposing effects on REM and NREM durations and is intolerant to loss-of-function mutations, suggesting an essential role in the regulation of REM/NREM sleep balance. Functional enrichment analysis identifies statistically significant pathways related to chromatin remodelling, lipid metabolism, and metal ion homeostasis while tissue enrichment analysis highlights significant signals in the hypothalamus and frontal cortex. Sex-stratified analyses identify distinct loci, including FOXP2 and NRXN3 in females and LRP1B, NPBWR2, and PABPC4 in males. Mendelian randomization supports associations between shorter sleep duration and higher cardiometabolic risk. These findings highlight sex- and phase-specific regulators of human sleep architecture, providing biological insights and potential therapeutic targets.

PMID:41922918 | DOI:10.1038/s41467-026-71252-y