Category: Nevin Manimala

BMC Pediatr. 2026 Jun 6. doi: 10.1186/s12887-026-07103-y. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to investigate the clinical utility of the C-reactive protein/albumin ratio (CAR) and the neutrophil/lymphocyte ratio (NLR) in evaluating the severity of sepsis in pediatric patients.

METHODS: A retrospective cohort study was conducted involving 174 pediatric patients hospitalized between June 2022 and November 2025. Sepsis and septic shock were defined according to the 2024 Phoenix criteria. Patients were stratified into a sepsis group (n = 123) and a septic shock group (n = 51). CAR and NLR were calculated from blood samples collected within 24 h of admission. A two-sided p < 0.05 was considered statistically significant. Independent associated factors for septic shock were identified using binary logistic regression analysis. Receiver operating characteristic (ROC) curves were constructed, and the area under the curve (AUC) was calculated to evaluate the diagnostic performance of CAR, NLR, and other relevant biomarkers.The study was conducted in accordance with the STROBE guidelines.

RESULTS: Univariate analysis revealed significantly elevated white blood cell (WBC) count, CAR, and NLR levels in the septic shock group compared to the sepsis group (all p < 0.05). Binary logistic regression analysis confirmed that elevated CAR (OR = 2.893, p < 0.001) and NLR (OR = 1.232, p < 0.001) were independent associated factors for progression to septic shock. ROC curve analysis demonstrated that a model combining CAR and NLR exhibited superior discriminative performance compared to either biomarker alone, with a higher AUC (0.802), sensitivity (74.50%), and specificity (74.80%).

CONCLUSION: CAR and NLR appear to be significant independent biomarkers for assessing severity and predicting septic shock in children with sepsis. The combination of CAR and NLR provides improved predictive accuracy compared with either marker alone, suggesting its potential utility in guiding early clinical decisions.

PMID:42251342 | DOI:10.1186/s12887-026-07103-y

BMC Oral Health. 2026 Jun 6. doi: 10.1186/s12903-026-08766-w. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to evaluate patients’ knowledge-related responses, attitudes, anxiety levels, and radiation risk perceptions regarding dental radiographic imaging methods.

MATERIALS AND METHODS: A structured 30-item questionnaire was administered face-to-face to 410 participants. Anxiety and radiation risk perception were assessed using a 5-point Likert scale, while knowledge-related responses were evaluated using categorical responses. Constructs were analyzed separately as anxiety (emotional response to radiographic procedures), risk perception (radiation-related concerns), and knowledge-related responses (factual awareness of radiation).

RESULTS: A total of 410 participants were included (mean age: 32.98 ± 12.66 years; 58.8% female). Overall anxiety levels regarding radiographic procedures were low; however, increased anxiety was observed in situations involving radiation exposure and absence of protective aprons. Radiation risk perception was generally at a moderate level; however, the tendency to refuse or postpone radiographic examinations recommended by the dentist was low. Female participants had higher radiation risk perception scores; however, this difference was not statistically significant. Regarding knowledge-related responses, participants demonstrated higher awareness of computed tomography (CT) and natural background radiation, while uncertainty was prominent regarding magnetic resonance imaging (MRI) and panoramic radiography (PR) dose.

CONCLUSION: Although patients generally tolerate dental radiographic procedures with low anxiety, uncertainties regarding radiation exposure contribute to increased perceived risk. These findings highlight the need for structured, evidence-based patient information strategies to improve radiation literacy and support informed acceptance of dental imaging procedures.

PMID:42251337 | DOI:10.1186/s12903-026-08766-w

BMC Med Educ. 2026 Jun 6. doi: 10.1186/s12909-026-09543-7. Online ahead of print.

ABSTRACT

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) is considered a reference standard for diagnosing hypertension and is recommended for out-of-office blood pressure assessment, yet internal medicine residents receive limited training in its interpretation. We conducted a needs assessment to identify gaps in hypertension and ABPM education and developed an asynchronous e-learning module to address these deficiencies. We then evaluated its impact on residents’ self-reported confidence and preparedness in outpatient hypertension management.

METHODS: We conducted a single-center quality improvement study among internal medicine residents (PGY1-4) at the University of Toronto between July 2024 and January 2026. A baseline needs assessment evaluated prior exposure to ABPM, confidence in interpretation, and preparedness to diagnose hypertension. An e-learning module was developed, consisting of a structured “Five Steps of ABPM Interpretation” framework and case-based learning. A post-intervention survey assessed self-reported confidence, preparedness, and educational value. Descriptive statistics were used to summarize outcomes. Between-group comparisons of categorical outcomes were performed using chi-square tests.

RESULTS: Sixty-two residents completed the baseline survey, and 26 completed the module and post-intervention survey [1]. At baseline, 56.5% (35/62) reported no prior exposure to ABPM interpretation. Only 22.6% (14/62) felt comfortable interpreting ABPM reports, and 32.3% (20/62) felt prepared to diagnose outpatient hypertension. Following the intervention, 84.6% (22/26) of residents reported feeling comfortable or very comfortable interpreting ABPM, and 92.3% (24/26) reported feeling prepared or very prepared to diagnose hypertension. Learner satisfaction was high, with over 90% of participants reporting that the module was educationally valuable, easy to use, and effective.

CONCLUSIONS: An asynchronous, case-based e-learning module was feasible, well-received, and associated with higher self-reported confidence and preparedness in ABPM interpretation among internal medicine residents. The observational nature and potential for both response and selection bias limits generalizability of the study.

PMID:42251329 | DOI:10.1186/s12909-026-09543-7

BMC Pregnancy Childbirth. 2026 Jun 6. doi: 10.1186/s12884-026-09443-0. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of our study is to compare the markers and parameters obtained from complete blood count between patients diagnosed with missed abortion in the first trimester and a healthy pregnant control group.

MATERIALS AND METHODS: This descriptive, retrospective, case-control study included 166 patients diagnosed with missed abortion according to ultrasound criteria, and an equal number of healthy pregnant controls, who visited the Gynecology and Obstetrics Clinic at a Training and Research Hospital from January 1, 2018, to July 1, 2023. Participants, with 5 to 14 weeks of gestation, were selected using simple random sampling. Data on age, gravida, parity, gestational week, and hemogram results were retrieved from medical records and compared. Statistical significance was set at p < 0.05.

RESULTS: No significant differences were observed between the case and control groups in terms of gravida, parity, age, or gestational week (p > 0.05). Likewise, comparisons of hemogram parameters and derived values, did not show statistically significant differences (p > 0.05). However, the multivariate logistic regression analysis revealed that each unit increase in lymphocyte count was linked to a 2.075 times higher risk of missed abortion (p = 0.040).

CONCLUSION: Our study found no significant differences in complete blood count parameters between the missed abortion and healthy pregnant groups. Although lymphocyte count was significant in the multivariate model, this association should be interpreted with caution, as complete blood count values were obtained at the time of diagnosis. Therefore, it does not indicate predictive value, and prospective studies are needed to determine whether lymphocyte count may serve as a pre-diagnostic marker.

PMID:42251326 | DOI:10.1186/s12884-026-09443-0

Comput Methods Programs Biomed. 2026 Jun 1;285:109473. doi: 10.1016/j.cmpb.2026.109473. Online ahead of print.

ABSTRACT

Reliable quality assessment in digital pathology is essential to ensure the diagnostic usability of whole slide images (WSIs), as artifacts introduced during tissue preparation and scanning can degrade image quality and affect clinical interpretation. In this paper, we propose a framework that combines subjective usability evaluation with an objective no-reference quality assessment method. A dataset was constructed from WSIs of four tissue types (breast, fertility, gastrointestinal, and lung), where pristine patches were systematically degraded using simulated artifacts including blur, contrast, and color variations. A subjective study with eight pathologists was conducted using a five-point diagnostic usability scale, from which Mean Usability Scores (MUS) were derived and statistically validated. An objective metric was then developed based on contrastive learning-driven pseudo-reference generation, followed by a siamese feature extraction and regression model to predict usability. The proposed method shows strong correlation with expert scores and outperforms several existing quality assessment metrics, while demonstrating consistent performance across multiple distortion types and tissue categories. Our proposed model outperforms competing objective metrics, achieving strong consistency with subjective scores with SRCC of 0.945, PLCC of 0.952, and AUC of 0.98 on the benchmark dataset. The proposed objective metric, together with the designed subjective assessment method and the publicly available dataset, provides a reliable framework for expert-aligned quality assessment in digital pathology.

PMID:42250321 | DOI:10.1016/j.cmpb.2026.109473

J Hazard Mater. 2026 May 22;514:142463. doi: 10.1016/j.jhazmat.2026.142463. Online ahead of print.

ABSTRACT

Recent studies have indicated that heavy metals and chlorinated paraffins (CPs) are risk factors for neurodevelopmental disorders. However, evidence regarding their potential combined effects remains limited. To investigate the joint associations of heavy metals and CPs with attention-deficit/hyperactivity disorder (ADHD) symptoms, we recruited 122,965 participants under 18 from the Pearl River Delta in China. We measured concentrations of six heavy metals (Pb, As, Cd, Hg, Mn and Ni) and three types of CPs (SCCPs, MCCPs and LCCPs) in atmospheric particulate matter (PM_2.5) samples. ADHD symptoms was defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Generalized linear mixed-effects models (GLMMs) were used to evaluate the associations between individual pollutants and ADHD symptoms. We investigated the combined effects using a weighted quantile sum (WQS) regression model and examined potential interactions through both multiplicative and additive models. In single-pollutant models, all metals and CPs demonstrated significant positive associations with ADHD symptoms. Additive interaction analyses revealed significant synergistic effects between heavy metals and CPs, particularly between SCCPs and Mn (RERI = 4.63, 95% CI: 4.38, 4.88) and between SCCPs and Pb (RERI = 4.15, 95% CI: 3.92, 4.39). WQS analysis demonstrated a positive association between mixed exposure and ADHD symptoms, with Mn, Pb, and SCCPs as the main contributors. Boys and children younger than 12 years were more susceptible to these combined effects. These findings suggest that heavy metals and CPs may exert synergistic effects on the odds of ADHD symptoms, highlighting the importance of coordinated regulatory strategies targeting both pollutants.

PMID:42250293 | DOI:10.1016/j.jhazmat.2026.142463

Rev Med Virol. 2026 Jul;36(4):e70172. doi: 10.1002/rmv.70172.

ABSTRACT

Metformin has been shown to reduce hospitalisation and symptom duration among adults with COVID-19, but the effect has not been studied. We conducted this meta-analysis to assess the efficacy and safety of metformin in patients with COVID-19. Randomized controlled trials (RCTs) comparing metformin with placebo in COVID-19 were identified through major databases through November 2025. We performed statistical analyses using RevMan 5.4, employing the random-effects model, along with Risk Ratio (RR) and Mean Difference (MD) as the effect measures. Our meta-analysis of four RCTs showed that metformin did not significantly reduce the composite outcome of hospitalisation, emergency department (ED) visits, or death, compared with placebo (RR 0.60, 95% CI 0.40-0.90.21). The incidence of all-cause mortality (RR 1.00; 95% CI 0.06-15.91) and serious adverse events (RR 2.86; 95% CI 0.76-10.76) was also comparable between the two groups. Our meta-analysis, with low to moderate certainty, found that metformin may provide modest benefit in reducing hospitalisation, ED visits, or mortality in patients with COVID-19 without an association with increased serious adverse events. However, these findings should be interpreted cautiously, given the limited number of trials, low event rates, and clinical heterogeneity across studies. Further large RCTs are needed before metformin can be considered for use in COVID-19.

PMID:42250263 | DOI:10.1002/rmv.70172

Int J Geriatr Psychiatry. 2026 Jun;41(6):e70228. doi: 10.1002/gps.70228.

ABSTRACT

OBJECTIVES: Nursing homes in Sweden provide housing and care for people aged 65 years or older who require assistance with everyday activities. An increasing number of nursing home residents have cognitive and functional decline, which can result in additional time needed for care provision. This study aimed to explore changes in resource use and associated factors in Swedish nursing homes over a 5-year period.

METHODS: This repeated cross-sectional study analyzed baseline (2013-2014) and follow-up (2018-2019) proxy-rated data from 4599 participants from the Swedish National Inventory of Care and Health in Residential Aged Care study. Resource use was measured using the Resource Use in Dementia scale. Descriptive statistics, t-tests, chi-square tests, and multiple linear regressions were performed.

RESULTS: Total resource use increased from 7.15 h/day to 7.83 h/day between baseline and follow-up. The number of residents living in a dementia unit increased from 34.6% to 43%. Higher independence in activities of daily living was associated with lower total resource use at follow-up while living in a dementia unit was associated with higher total resource use. Higher total resource use was associated with seven neuropsychiatric symptoms. For residents living in a dementia unit, four neuropsychiatric symptoms were associated with higher total resource use.

CONCLUSIONS: Resource use in Swedish nursing homes increased between baseline and follow-up. These results may inform future policy, financing, and implementation decisions to support resource utilization in nursing homes.

PMID:42250257 | DOI:10.1002/gps.70228

Blood Purif. 2026 Jun 6:1-17. doi: 10.1159/000552429. Online ahead of print.

ABSTRACT

Background Single plasma exchanges (SPE) and double filtration plasmapheresis (DFPP) are commonly used in clinical practice. However, there haven’t been clear recommendations on the selection of SPE or DFPP in treating lupus nephritis (LN) in existing Therapeutic plasma exchange（TPE） related guidelines. Therefore, we aimed to evaluate the efficacy and safety of DFPP and SPE in patients with LN, and analyze the risk factors of ineffective DFPP and SPE in the treatment of LN. Methods: In this single-center, real-world retrospective study, we assessed safety and efficacy of therapy with SPE or DFPP in 67 patients with LN. Changes of laboratory test indicators and statistical indicators before and after treatment were compared, and the occurrence of adverse events (AEs) was observed in these patients. Results： 24 patients were treated with DFPP and 43 patients with SPE. DFPP and SPE showed a comparatively significant treatment response. The effective rate of DFPP was higher than that of SPE (P< 0.05), but the difference was not statistically significant. In both groups, platelet, potassium, chloride, APTT, Fib were significantly lower at baseline, and sodium was significantly higher at baseline (P<0.05), and the difference was statistically significant. The incidence of AEs in DFPP group was lower than in SPE group. The amount of plasma used in DFPP group was significantly less than that in SPE group during hospitalization. Economic cost of hospitalization and remission rate were no significant difference between the two groups. Length of hospital stay and serum creatinine both were the risk factors of ineffective short-term plasma exchange（PE）in the treatment of LN. Conclusions: In summary, both DFPP and SPE were effective and safe procedures for treating LN. However, DFPP did not depend on plasma, and could reduce the incidence of adverse reactions, it should be promoted.

PMID:42250236 | DOI:10.1159/000552429

Ann Med. 2026 Dec;58(1):2682583. doi: 10.1080/07853890.2026.2682583. Epub 2026 Jun 6.

ABSTRACT

BACKGROUND AND AIMS: Metabolic syndrome (MetS) is highly prevalent among perimenopausal and postmenopausal women and poses a major public health challenge because of its association with cardiovascular disease, type 2 diabetes, and premature mortality. However, prediction tools for this population remain limited. Therefore, this study aimed to develop a Body Roundness Index (BRI)-based prediction model for MetS by integrating cross-sectional machine learning and longitudinal assessment.

METHODS AND RESULTS: Cross-sectional models were trained using NHANES 2007-2020 and validated in the Affiliated Hospital of Dalian University (2023-2024). Sixteen predictors were selected via LASSO and Boruta, and eight models were evaluated using AUC, calibration, and decision curve analysis. SHAP ranked high-contribution factors. Longitudinal analysis used a 10-year cohort. Annualized change rates and cumulative exposure metrics of five key predictors were combined with baseline values to build Cox models, compared by C-index and time-dependent ROC.The artificial neural network (ANN) demonstrated optimal cross-sectional performance (internal AUC: 0.854; external AUC: 0.878) with good calibration and clinical benefit. SHAP identified BRI, WBC, ALT, MCV, and AST as top contributors, with BRI showing the strongest impact. Longitudinal analysis revealed that integrating annual change rates and annual cumulative exposure of these five predictors achieved optimal discriminative ability (C-index: 0.847), with time-dependent AUCs of 0.853, 0.859, and 0.847 at 1, 3, and 5 years, respectively.

CONCLUSION: BRI is significantly associated with MetS in perimenopausal and postmenopausal women. The ANN model provides an efficient cross-sectional screening tool, while incorporating longitudinal trajectories of BRI and key laboratory indicators enhances long-term MetS risk prediction.

PMID:42250232 | DOI:10.1080/07853890.2026.2682583