Category: Nevin Manimala

Microbiome. 2026 Apr 10. doi: 10.1186/s40168-026-02337-5. Online ahead of print.

ABSTRACT

BACKGROUND: Salivary agglutinin, also known as deleted in malignant brain tumors 1 (DMBT1), is an anti-microbial protein. DMBT1 is low in saliva from patients with oral squamous cell carcinoma (OSCC) and dramatically increases after treatment, with accompanying microbial changes. While this suggests an association between DMBT1 suppression and changes in the oral microbiota, causation has not been established. DMBT1 is also a tumor suppressor protein; its loss promotes OSCC progression, but its role in OSCC development is unknown. In this study, OSCC development was investigated in a murine carcinogen model that simulates human OSCC. Microbiota were standardized between Dmbt1 knockout (Dmbt1^-/-) and wild-type (Dmbt1^+/+) mice via interbreeding and co-housing. Saliva was collected at baseline and at 4, 8, 12, 16, and 22 weeks post-carcinogen initiation (stopped at 16 weeks). Tongues were harvested at week 22 for histopathology, and the salivary microbiome was profiled by 16S rRNA sequencing. Microbial diversity metrics and conditional dependence networks assessed community structure, while longitudinal patterns were analyzed using a locally sparse varying coefficient mixed model and functional principal component analysis (fPCA).

RESULTS: Despite microbiota standardization, Dmbt1^-/- and Dmbt1^+/+ displayed differences in microbiome composition based on β-diversity metrics. At endpoint, carcinogen-treated Dmbt1^-/- showed higher OSCC prevalence and more aggressive invasion than Dmbt1^+/+. Several OTUs, including those from Lachnospiraceae, Sphingomonas, Carnobacteriaceae, and Candidatus Saccharibacteria families, demonstrated differential abundance patterns over time, either genotype-specific, diagnosis-specific, or both. Notably, Sphingomonas and Lachnospiraceae exhibited time-dependent abundance differences in mice that developed OSCC. fPCA identified taxa with abundance trajectories that were different between OSCC and precancer and genotype specific.

CONCLUSIONS: Thus, DMBT1 shapes salivary microbiota composition and protects against OSCC development. Dynamic, genotype-specific microbial shifts during carcinogenesis underscore the complex interplay between the oral microbiota and cancer progression. Video Abstract.

PMID:41964098 | DOI:10.1186/s40168-026-02337-5

Ital J Pediatr. 2026 Apr 10;52(1):56. doi: 10.1186/s13052-026-02236-3.

ABSTRACT

BACKGROUND: Antimicrobial resistance (AMR) represents a threat to global public health. The antibiotics’ effectiveness against a variety of infections consequently has been declined with increasing morbidity, mortality, and treatment failure. To combat this, the implementation of Antimicrobial Stewardship Programs (ASPs) is essential for slowing the spread of resistant pathogens.

AIM OF THE WORK: The current study aimed to assess the outcomes following implementation of Antimicrobial Stewardship Program (ASP) at Alexandria University Children’s Hospital.

METHOD: The study was conducted over nine months in a general pediatric ward. First, the medical records and microbiological reports were reviewed to establish tailored antibiotic guidelines. During the intervention phase, the ASP focused on prospective audits and physicians’ education. The program’s impact was evaluated through several key metrics: adherence to the guidelines, patient outcome (mortality rate and length of stay) and antibiotic consumption (expenditure, days of therapy, and treatment duration). All statistical analyses were conducted using IBM SPSS version 20.0.

RESULTS: 219 patients in the preintervention phase were compared to 214 patients (post-intervention). Following ASP, the use of single antibiotics increased in post-intervention (69.6% versus 26%). During the study period, 70 interventions were required with a high acceptance rate (59%). The mean length of hospital stays decreased [10.80 (3-26) versus 12.89 (4-33) days], and both DOT/1000 patients and the average cost of antibiotics decreased (27.82% and 44.94%, respectively). Following ASP, the use of Tigecycline (-100%), Meropenem (-57.79%), and Vancomycin (-46.35%) reduced with an increase in the use of Cefotaxime (80.43%), Ceftriaxone (20.27%), and Ceftazidime (62.87%).

CONCLUSION: The implementation of institutional guidelines along with Prospective Audit and Feedback (PAF) was associated with improvements in antibiotic utilization, particularly in the resource-limited settings.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41964087 | DOI:10.1186/s13052-026-02236-3

Nurs Open. 2026 Apr;13(4):e70525. doi: 10.1002/nop2.70525.

ABSTRACT

AIM: To identify the factors influencing nurses’ Evidence-based practices (EBP) competencies and clinical decision-making (CDM) levels.

DESIGN: A convergent parallel mixed-methods study.

METHODS: The quantitative data were collected from 387 nurses via the EBP Competence Questionnaire and the Clinical Decision-Making in Nursing Scale, while qualitative data were gathered from semi-structured interviews with 20 nurses. Quantitative data were analysed using descriptive statistics, ANOVA, and multiple linear regression, and qualitative data were subjected to thematic content analysis.

RESULTS: Regression analysis revealed that higher education, research involvement, and following scientific publications positively influenced EBP competencies. Working in inpatient units and clinical nursing roles negatively affected EBP and CDM abilities. A significant positive correlation was found between EBP competence and CDM skills. Qualitative findings identified four themes: Implementation Areas of EBP, Competence in EBP, Impacts of EBP, and Facilitators and Barriers to EBP.

CONCLUSION: Strengthening nurses’ EBP competencies and CDM requires targeted strategies such as education, access to organizational resources and supportive policies.

IMPLICATIONS FOR THE PROFESSION: Addressing barriers and fostering a culture of continuous learning can enhance patient care and nursing outcomes.

IMPACT: By addressing gaps in EBP implementation and decision-making skills, the findings serve as a benchmark for policymakers, educators and healthcare administrators to create supportive infrastructures, promote continuous professional development, and foster a culture of evidence-based practice worldwide.

REPORTING METHOD: The study was reported in accordance with the GRAMMS guidelines.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:41964064 | DOI:10.1002/nop2.70525

Arthroplasty. 2026 Apr 10;8(1):26. doi: 10.1186/s42836-026-00383-w.

ABSTRACT

BACKGROUND: Dislocation is a serious complication that should be avoided in total hip arthroplasty (THA). Combined anteversion (CA) of the cup and stem is a concept for appropriate implant positioning; however, the effect of functional changes in femoral rotation has not been well investigated. In this study, we investigated whether functional CA, considering femoral rotation, is associated with dislocation in patients who underwent revision THA.

METHODS: Overall, 82 patients who underwent revision THA and had at least one year of follow-up with pre-operative and post-operative supine computed tomography imaging were included. The cup and stem were placed with a target combined angle of 37.3° using Widmer’s formula. Anatomical and functional CAs were calculated post-operatively. Functional CA was defined as the sum of cup anteversion and stem anteversion, with femoral external rotation. Patient demographics, component alignment parameters, CA, and their association with post-operative dislocation were statistically evaluated.

RESULTS: Dislocation was observed in 12 patients. In these dislocated cases, there were no significant differences in cup angle, stem angle, and anatomical CA compared to non-dislocated cases. However, dislocated cases showed significantly higher values of functional CA (50.0 ± 17.4° [range, 5.5-67.6] vs. 35.6 ± 13.0° [range, 4.0-68.8], p = 0.022) and significant deviation from identical CA [15.0 ± 8.9° [range, 3.1-31.8] vs. 7.5 ± 8.1° [range, 0.1-33.3], p = 0.014).

CONCLUSIONS: Functional CA, considering femoral rotation, was associated with post-operative dislocation after revision THA. Therefore, consideration of femoral rotation may be important for implant positioning in revision THA.

PMID:41964056 | DOI:10.1186/s42836-026-00383-w

BMC Health Serv Res. 2026 Apr 10. doi: 10.1186/s12913-026-14512-3. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to evaluate the effectiveness of an intelligent interaction voice prompting system (IIVPS) for guiding medical staff in the removal of personal protective equipment (PPE).

METHODS: A total of 152 medical staff members were enrolled via convenience sampling. Using a one-group pretest-posttest design, system effectiveness was evaluated by comparing pre- and post-intervention PPE removal accuracy, psychological stress, and operational fatigue, with nonparametric tests for statistical analyses. User experiences and suggestions for improvement were collected via questionnaires and face-to-face interviews.

RESULTS: All participants achieved correct PPE-removal procedure adherence while using the IIVPS. The use of the IIVPS was associated with a significant increase in PPE-removal accuracy from 78% to 100% (P < 0.001). The median psychological stress score decreased from 3.00 (3.00, 4.00) to 2.00 (1.00, 2.00) (Z = -8.610, P < 0.001), and the median operational fatigue score decreased from 3.00 (3.00, 4.00) to 1.50 (1.00, 2.00) (Z = -9.172, P < 0.001). Significant differences in system mastery were observed based on PPE training history and familiarity (P < 0.05), while learning acceptance varied by age, work experience, and PPE familiarity (P < 0.05). Analysis of qualitative feedback revealed overwhelmingly positive responses (95.39%), with key themes including “effective operational guidance” and “stress reduction”.

CONCLUSIONS: The IIVPS may effectively guide medical staff in standardised PPE removal and potentially reduce psychological stress and operational fatigue. However, this study’s one-group design and short-term evaluation limit causal inferences, and long-term effectiveness requires verification via randomised controlled trials (RCTs). The system shows promising potential for clinical application and training.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41964050 | DOI:10.1186/s12913-026-14512-3

Arthroplasty. 2026 Apr 10;8(1):25. doi: 10.1186/s42836-026-00380-z.

ABSTRACT

PURPOSE: Evaluate the impact of patient age, body mass index (BMI), medial/central patellofemoral arthritis, and anterior cruciate ligament (ACL) deficiency on five-year patient-reported outcome measures (PROMs) of fixed-bearing medial unicompartmental knee arthroplasty (UKA).

METHODS: A consecutive group of 229 patients (240 knees) received fixed-bearing medial UKA. At minimum two (n = 231 knees) and five years (n = 221 knees), patients completed the Oxford Knee Score (OKS), the EuoQol-5D (EQ-5D), Knee injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), University of California, Los Angeles (UCLA) activity score, Forgotten Joint Score (FJS), and their level of satisfaction. Sub-group analyses compared PROMs in patients based on: (i) Grade III/IV vs. Grade 0-III medial/central patellofemoral arthritis, (ii) ACL deficiency vs. intact ACL, (iii) age groups (< 50, 50-59, 60-69, 70-79, > 80), and (iv) BMI categories (< 30, 30-35, 35-40, ≥ 40).

RESULTS: Satisfaction rates remained consistent at the 2- and 5-year follow-up points, with 96% being satisfied or very satisfied. The OKS, EQ-5D, KOOS PS, or FJS-12 were not statistically significantly different between 2 and 5 years. Five-year UCLA activity scores differed significantly across age groups (50-59 vs 80 + (MD = 1.5; p = 0.027), 60-69 vs 70-79 (MD = 0.9; p = 0.014), and 60-69 vs 80 + (MD = 1.7; p = 0.004)), and between patients with a BMI < 30 vs ≥ 40 (MD = 2.3; p = 0.045). These findings were supported by multivariable regression, which showed that increasing age and higher BMI were independently associated with worse UCLA activity scores. Grade III/IV patellofemoral arthritis was associated with worse EQ-5D scores but was not associated with worse OKS, UCLA, KOOS-PS, or FJS-12. ACL deficiency was associated with higher KOOS-PS scores.

CONCLUSION: Five-year outcomes following fixed-bearing medial UKA demonstrated high patient satisfaction, unchanged from two years. Although older age was associated with lower activity and higher BMI (> 40) with worse function, the effect sizes were small and not clinically meaningful. Patellofemoral arthritis and ACL deficiency had no negative functional impact. Therefore, age, BMI, patellofemoral arthritis, and ACL status should not be considered contraindications; instead, broad selection criteria for fixed-bearing UKA are supported.

PMID:41964036 | DOI:10.1186/s42836-026-00380-z

Lipids Health Dis. 2026 Apr 10. doi: 10.1186/s12944-026-02948-9. Online ahead of print.

NO ABSTRACT

PMID:41964021 | DOI:10.1186/s12944-026-02948-9

Perioper Med (Lond). 2026 Apr 11. doi: 10.1186/s13741-026-00679-0. Online ahead of print.

ABSTRACT

BACKGROUND: Perioperative diastolic dysfunction has been proposed as an independent predictor of postoperative major adverse cardiac events (MACE) after noncardiac surgery. However, prior studies have largely focused on elective procedures and employed heterogeneous echocardiographic approaches to assess diastolic function. We sought to evaluate the association between abnormal diastolic echocardiographic parameters and postoperative MACE and mortality in patients undergoing hip fracture surgery using a contemporary, multiparametric assessment of diastolic function.

METHODS: In this retrospective cohort study, adult patients undergoing hip fracture repair between April 2016 and June 2021 with available preoperative transthoracic echocardiography were included. Abnormal diastolic parameters were defined as average E/e’ >14, tricuspid regurgitant velocity (TRV) > 2.8 m/s, and left atrial volume index (LAVI) > 34 mL/m². Patients were stratified by the number of abnormal parameters into two groups: 0-1 abnormal versus 2-3 abnormal. The primary outcome was postoperative MACE, defined as myocardial infarction, heart failure, pulmonary edema, or death within 30 days of surgery. Secondary outcomes included 1-year and 2-year all-cause mortality.

RESULTS: Among 148 patients included in the analysis, postoperative MACE occurred in 15.5%. Patients with 2-3 abnormal diastolic parameters experienced higher rates of MACE compared with those with 0-1 abnormal parameter (23.9% vs. 8.6%, P = 0.011). One-year and two-year mortality were also higher in the 2-3 abnormal parameter group (31.3% vs. 13.6%, P = 0.009; and 43.3% vs. 19.8%, P = 0.002, respectively). Kaplan-Meier survival analysis demonstrated lower survival among patients with multiple abnormal diastolic parameters, with separation of survival curves evident early in the postoperative period and persisting throughout follow-up, although the overall time-to-event analysis did not reach statistical significance.

CONCLUSIONS: In patients undergoing hip fracture surgery, a higher burden of abnormal echocardiographic diastolic parameters is associated with increased risk of postoperative MACE and higher short- and intermediate-term mortality. The early separation of survival curves suggests that abnormal diastolic parameters identify patients at heightened risk during the immediate postoperative period, highlighting a potentially important window for targeted perioperative risk stratification and management.

PMID:41963984 | DOI:10.1186/s13741-026-00679-0

BMC Med Educ. 2026 Apr 10. doi: 10.1186/s12909-026-09132-8. Online ahead of print.

ABSTRACT

BACKGROUND: Proper margin width is one of the key factors determining the correct fabrication of a prosthetic crown. Digital technologies, such as intraoral scanners, are increasingly used to assess parameters of tooth preparation for prosthetic crowns. The study aimed to evaluate the conservativeness of tooth preparation performed by third-year dental students on phantom teeth based on margin width and the utility of an intraoral scanner for its assessment.

METHODS: A total of 432 model teeth (KaVo) prepared for crowns by third-year dental students were tested: 216 maxillary right first molars (tooth 16) with a chamfer, and 216 maxillary right first premolars (tooth 14) with a classical shoulder. Tooth 16 was prepared first, followed by tooth 14 one week later. After each preparation, students were evaluated and received instructor feedback. All teeth were scanned using a 3Shape TRIOS 3 intraoral scanner, finish line widths were measured and compared to ideal crown preparation standards. Continuous variables are presented as medians and interquartile ranges, and categorical variables are presented as counts and percentages. Margin widths were compared using the Mann-Whitney U test (with rank-biserial effect sizes), and categorical classifications were analyzed with the chi-square test. A significance level of p < 0.05 was adopted. Calculations were performed using IBM SPSS Statistics 29 and R software (version 4.4.2).

RESULTS: For tooth 16, median chamfer margin widths were: mesial 1.08 mm [IQR: 0.80-1.45], distal 1.17 mm [IQR: 0.79-1.55], lingual 1.17 mm [IQR: 0.87-1.41], and buccal 1.07 mm [IQR: 0.86-1.35]. Optimal widths were achieved by 22.9% (mesial), 21.9% (distal), 16.7% (lingual), and 15.7% (buccal) of students. For tooth 14, median widths were: mesial 0.67 mm [IQR: 0.51-0.93], distal 0.87 mm [IQR: 0.63-1.29], lingual 0.80 mm [IQR: 0.63-1.06], and buccal 0.78 mm [IQR: 0.60-1.01], with optimal widths achieved by 40% (mesial), 32.4% (distal), 41.4% (lingual), and 11.9% (buccal).

CONCLUSIONS: The study revealed significant variability in finish line width among students and tooth surfaces, with most preparations being excessively wide. An intraoral scanner may be a useful tool for assessing the margin width in prepared phantom teeth.

PMID:41963983 | DOI:10.1186/s12909-026-09132-8

BMC Nurs. 2026 Apr 10. doi: 10.1186/s12912-026-04622-y. Online ahead of print.

NO ABSTRACT

PMID:41963977 | DOI:10.1186/s12912-026-04622-y