Category: Nevin Manimala

Drug Des Devel Ther. 2026 Jul 14;20:625824. doi: 10.2147/DDDT.S625824. eCollection 2026.

ABSTRACT

PURPOSE: To compare the efficacy and safety of dexamethasone alone versus dexamethasone combined with droperidol for the prevention of postoperative nausea and vomiting (PONV) in patients undergoing gynecological day surgery under ciprofol-alfentanil general anesthesia.

PATIENTS AND METHODS: A total of 268 patients scheduled for gynecological day surgery were randomly assigned to the DD group (dexamethasone-droperidol, n=134) or the DN group (dexamethasone-normal saline, n=134). Before induction of anesthesia, the DD group received 5 mg dexamethasone plus 1 mg droperidol, while the DN group received 5 mg dexamethasone plus normal saline. Anesthesia induction: ciprofol 0.5 mg/kg, alfentanil 20 μg/(kg·h), and mivacurium 0.2 mg/kg. Anesthesia maintenance: ciprofol 1.25 mg/(kg·h), alfentanil 40 μg/(kg·h), with bispectral index (BIS) maintained at 40-60. The primary outcome was the incidence of PONV within 24 h postoperatively. Secondary outcomes included the incidence of adverse events within 24 h postoperatively, patient satisfaction, hemodynamic changes during anesthesia, BIS changes during anesthesia, and the incidence of intraoperative adverse events.

RESULTS: The incidence of PONV within 24 h postoperatively was significantly lower in the DD group than in the DN group (17.2% vs 31.9%), with a statistically significant difference. No significant differences were found between the two groups in the incidence of postoperative adverse events within 24 h, patient satisfaction, hemodynamic changes during anesthesia, BIS changes during anesthesia, or the incidence of intraoperative adverse events. No specific adverse effects of droperidol were observed in the DD group.

CONCLUSION: For patients undergoing gynecological day surgery under ciprofol-alfentanil general anesthesia, the combination of dexamethasone and droperidol is significantly more effective than dexamethasone alone in preventing PONV, with no significant difference in safety between the two regimens.

PMID:42472077 | PMC:PMC13380276 | DOI:10.2147/DDDT.S625824

Ital J Pediatr. 2026 Jul 18. doi: 10.1186/s13052-026-02312-8. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric female dystrophinopathy may be asymptomatic at evaluation or may show skeletal muscle and cardiac manifestations, but childhood presentations are often subtle. We aimed to characterize the clinical spectrum, ascertainment pathways, subclinical muscle involvement, and inheritance patterns in this population.

METHODS: This single-center retrospective case series was conducted between January 2024 and December 2025 and included 35 girls with genetically confirmed DMD gene variants identified from existing clinical records. Primary ascertainment route was recorded separately from cross-sectional clinical status at evaluation and classified as symptom-driven presentation, incidental or unexplained hyperCKemia, family-based cascade screening, or incidental genomic discovery. Clinical status at evaluation was assigned after systematic clinical review with reference to published female dystrophinopathy classifications. Statistical analyses were exploratory.

RESULTS: The median age was 5 years (range, 1-10). Primary ascertainment routes were symptom-driven presentation in 8/35 (22.9%), incidental or unexplained hyperCKemia in 18/35 (51.4%), family-based cascade screening in 8/35 (22.9%), and incidental genomic discovery in 1/35 (2.9%). After systematic clinical review, clinical status at evaluation was classified as asymptomatic in 29 participants, BMD-like in 1, DMD-like in 3, and cardiac-symptom/CMR observations in 2. All 18 girls initially identified through incidental or unexplained hyperCKemia were classified as asymptomatic because no muscle weakness was documented on neurological examination, although some had exercise intolerance, easy fatigue, myalgia, or cramps. EMG abnormalities were identified in 14/34 participants, including definite myopathic findings in 5 and subtle short-duration motor-unit-potential changes in 9. Variants were apparently de novo in 15 cases, maternally inherited in 18, and paternally inherited in 2, including one case inherited from a father with low-level mosaicism in peripheral blood.

CONCLUSIONS: Pediatric female dystrophinopathy shows a broad childhood spectrum and may be recognized before objective muscle weakness is documented. Separating ascertainment route from clinical status highlights recurrent or persistent hyperCKemia and mild exercise-related complaints as practical entry points for targeted neuromuscular assessment and longitudinal follow-up. Earlier recognition in childhood may support timely neuromuscular and cardiac surveillance, parental evaluation when appropriate, family-based genetic counseling, and future reproductive planning.

PMID:42471751 | DOI:10.1186/s13052-026-02312-8

J Cardiothorac Surg. 2026 Jul 18. doi: 10.1186/s13019-026-04541-8. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary complications after coronary artery bypass surgery continue to be a significant problem, affecting 5-20% of patients, prolonging hospital stays and increasing costs. In this study, we investigated whether simple blood tests that measure inflammation, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), could help identify patients at risk before surgery.

METHODS: The records of 1034 patients who underwent elective coronary artery bypass grafting with heart-lung machine support between 2023 and 2024 were retrospectively reviewed. NLR, PLR, and SII values were calculated from routine blood tests performed the day before surgery. Patients who developed pulmonary complications were defined according to the European Perioperative Clinical Outcome (EPCO) definitions.

RESULTS: 114 patients (11%) developed PPC. Preoperative inflammatory markers were significantly higher in patients with complications (NLR: 3.55 ± 1.07 vs. 1.79 ± 0.54, PLR: 156 ± 47 vs. 120 ± 36, SII: 825 ± 248 vs. 548 ± 164; all p < 0.001). ROC analysis demonstrated excellent discrimination for NLR (AUC 0.939), good for SII (AUC 0.818), and fair-to-good for PLR (AUC 0.724). In multivariate analysis, NLR was by far the strongest independent predictor of PPC, together with COPD, diabetes, active smoking, CPB and ACC durations. PLR and SII also reached statistical significance, but with effect sizes very close to unity (adjusted OR 1.02 and 1.01 respectively), indicating that they offered minimal additional discriminatory value once NLR was taken into account.

CONCLUSIONS: In this single-center retrospective cohort, preoperative NLR, PLR and SII were associated with PPC, with NLR accounting for most of the predictive signal. Because they are measured at a single preoperative timepoint, these indices reflect baseline inflammatory tone and cannot capture the acute, surgery-induced inflammatory response that drives postoperative pulmonary complications. In view of the single-center retrospective design, the absence of external validation, and the lack of comparison with validated risk scores such as EuroSCORE II or the STS score, these indices are not yet suitable to guide clinical decision-making on their own. Given their simplicity and ready availability, however, they appear to be promising candidate markers that merit further evaluation in prospective, multicenter studies also incorporating specific inflammatory mediators measured dynamically throughout the perioperative period.

PMID:42471737 | DOI:10.1186/s13019-026-04541-8

J Cardiothorac Surg. 2026 Jul 19. doi: 10.1186/s13019-026-04616-6. Online ahead of print.

ABSTRACT

OBJECTIVES: A systematic review and meta-analysis was performed to observe the incidence of perioperative stroke associated with selective and non-selective carotid ultrasound (CU) screening in the isolated coronary artery bypass grafting (CABG) population.

METHODS: PubMed, Scopus and CENTRAL databases were searched for studies published between January 1995 and October 2025. Inclusion criteria for the review focused on studies reporting primary data related to perioperative stroke in adult patients scheduled to undergo non-emergency isolated CABG who underwent either selective or non-selective preoperative CU screening. The primary outcome was perioperative stroke. Study quality was assessed using the ROBINS-I tool. Data related to the primary outcome was synthesised using an exploratory random-effects model meta-analysis. This review was reported as per PRISMA guidelines.

RESULTS: 2398 studies were identified to undergo title and abstract screening; 63 studies were identified to undergo full-text screening of which 15 studies were eligible for inclusion within the review (Total N = 25,931). For the 13 studies utilising a non-selective screening strategy, the pooled perioperative stroke rate was 1.78% (95% CI: [1.28;2.48]). Independently, the two cohorts utilising a selective screening strategy reported perioperative stroke rates of 1.16% and 1.23%. Due to the structural limitations of the existing literature these findings are presented as independent descriptive cohorts.

CONCLUSIONS: This review provides a descriptive synthesis of perioperative stroke rates across the two previously mentioned screening cohorts and does not establish comparative effectiveness. Although the low absolute event rates observed within the selective screening cohort align with current guideline recommendations, the structural limitations and high disproportion of the available evidence base prevent definitive comparison.

PMID:42471735 | DOI:10.1186/s13019-026-04616-6

Biol Sex Differ. 2026 Jul 18. doi: 10.1186/s13293-026-00954-1. Online ahead of print.

ABSTRACT

Hypoxia research has significantly advanced our understanding of how the human body responds to low-oxygen environments, yet women are still frequently studied without adequate consideration of hormonal status or reproductive life-course stage. This review examines the complex interactions between hormonal status across the female life course and the specific physiological responses of women to acute and chronic hypoxia, focusing on the menstrual cycle, hormonal contraception, pregnancy, menopausal status, hormone replacement therapy, gender-affirming hormone therapy, and reproductive health in high-altitude environments. Estrogen and progesterone significantly modulate ventilatory, cardiovascular, hematological, vascular, and muscular/metabolic responses to hypoxia, with distinct effects across different menstrual cycle phases, contraceptive regimens, and life-course states. Menopause introduces additional complexities, as declining hormone levels alter the body’s ability to acclimatize to low-oxygen conditions. Additionally, we examine how chronic and lifelong hypoxia impacts reproductive health, including fertility and pregnancy outcomes, in women living at high altitudes, highlighting both physiological adaptations and contextual factors. While current research has made progress, further studies are needed to better understand these sex-specific responses. We propose that future research should integrate stratified approaches, accounting for hormonal status (cycle phase, contraceptive use, pregnancy, HRT, GAHT) and reproductive status, to optimize health and performance recommendations for women exposed to hypoxic environments.

PMID:42471728 | DOI:10.1186/s13293-026-00954-1

World J Surg Oncol. 2026 Jul 18;24(1):302. doi: 10.1186/s12957-026-04496-z.

ABSTRACT

INTRODUCTION: Seroma is the most common postoperative complication following mastectomy and may result in additional postoperative interventions and increased treatment burden. However, its etiology and predictive factors remain insufficiently understood. This study aimed to identify predictors of postoperative seroma formation.

MATERIALS AND METHODS: We conducted a retrospective analysis of 245 patients (301 breasts) who underwent conventional mastectomy or skin-/nipple-sparing mastectomy, with or without immediate implant reconstruction and axillary surgery, at the University Hospital Leipzig between 2019 and 2023. Variables analyzed included epidemiological characteristics, neoadjuvant chemotherapy, tumor status, perioperative factors, and wound drainage output. Seroma formation was assessed via drains placed in the breast and axilla. Statistical analyses included univariable and multivariable regression and random forest modeling.

RESULTS: In univariable analyses, higher body mass index (BMI), longer surgical duration, diabetes mellitus, hypertension, advanced tumor stage, and elevated C-reactive protein levels were associated with increased breast seroma formation. Random forest analysis identified BMI, number of resected lymph nodes, surgical duration, hypertension, and diabetes as key predictors, all of which remained significant in multivariable models. For axillary seroma, BMI, number of resected lymph nodes, and tumor stage were significant in univariable analyses, while BMI and number of resected lymph nodes remained significant in multivariable models.

CONCLUSION: Seroma formation is primarily influenced by BMI, extent of lymph node removal, and surgical duration, with hypertension and diabetes as additional risk factors for breast seroma.

PMID:42471711 | DOI:10.1186/s12957-026-04496-z

BMC Med Inform Decis Mak. 2026 Jul 18. doi: 10.1186/s12911-026-03709-5. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop and internally validate an interpretable prognostic model for cumulative clinical pregnancy in women with diminished ovarian reserve (DOR), and to explore, as a hypothesis-generating secondary aim, whether protocol-associated pregnancy rates differ across model-defined baseline-prognosis risk strata.

DESIGN: Retrospective cohort study.

SETTING: A single tertiary reproductive medicine center.

PATIENTS: 1,251 oocyte-retrieval cycles in women with DOR (AMH ≤ 1.1 ng/mL) at a single tertiary centre, January 2019-July 2024. Each record is one retrieval cycle; no patient identifier was available.

METHODS: From 37 candidate predictors, random-forest selection (training set only) retained eight; six algorithms were compared for discrimination (AUC, DeLong), calibration (slope, intercept, Brier) and clinical utility (decision-curve analysis), with SHAP for interpretability. Discrimination was further assessed by out-of-time validation (train ≤2022, test 2023-2024). Within model-defined risk strata, protocols were compared (chi-square/Fisher; bootstrap CIs; FDR and Bonferroni correction), with a pre-treatment-variable-only sensitivity analysis.

RESULTS: A parsimonious logistic regression gave the highest test AUC (0.739, 95% CI 0.688-0.790; Brier 0.200), not significantly better than more complex algorithms (DeLong p>0.10), and held up on out-of-time validation (AUC 0.726). The five most influential predictors (SHAP) were embryo quality, female age, male age, estradiol and AMH. In the exploratory analysis, low-probability cycles showed no protocol differences; among high-probability cycles only one association survived correction (long-acting GnRH-agonist fresh transfer vs HRT frozen transfer; absolute difference +48%, 95% CI 28-67%; FDR p=0.002), persisting in the baseline-only analysis.

CONCLUSIONS: In women with DOR, an interpretable logistic-regression model provided moderate, internally and temporally validated discrimination for cumulative clinical pregnancy at the pre-transfer decision point, though calibration drifted over time and warrants recalibration before use. The single protocol-related association is hypothesis-generating only. The model is best regarded as a pre-transfer prognostic counselling tool, not a basis for protocol selection, and requires prospective external validation.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42471694 | DOI:10.1186/s12911-026-03709-5

BMC Nurs. 2026 Jul 18. doi: 10.1186/s12912-026-05041-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Given the increasing use of artificial intelligence in the field of health and treatment, including nursing, it is necessary to draw students’ attention to this issue from the time of their education. Therefore, this study was conducted with the aim of investigating the relationship between attitudes towards artificial intelligence and moral sensitivity in nursing students.

METHODS: This cross-sectional study was conducted on nursing students from the 2nd to 8th semester of nursing at Kurdistan University of Medical Sciences. Participants were enrolled in the study through a census method. Demographic and ethical sensitivity questionnaires and attitudes towards artificial intelligence were used. Data were analyzed using descriptive and inferential statistical methods in SPSS-24 software.

RESULTS: Out of 155 participants, 61.29% had moderate moral sensitivity based on the Moral Sensitivity Questionnaire (MSQ), and 38.06% had low moral sensitivity. Regarding the Attitude toward Artificial Intelligence Questionnaire, 76.12% held a relatively favorable attitude and 19.36% a favorable one. A weak but statistically significant positive correlation was found between attitudes toward AI and moral sensitivity (*r* = 0.185, *p* = 0.012).

CONCLUSION: Given the weak yet statistically significant relationship between attitudes toward AI and moral sensitivity, integrating AI ethics education and targeted educational workshops into undergraduate nursing curricula may help strengthen students’ preparedness for ethical AI use. However, these findings should be interpreted cautiously because of the study’s cross-sectional design and single-center setting.

PMID:42471693 | DOI:10.1186/s12912-026-05041-9

BMC Nurs. 2026 Jul 18. doi: 10.1186/s12912-026-05053-5. Online ahead of print.

ABSTRACT

INTRODUCTION: As artificial intelligence (AI) becomes more common in healthcare, nursing students need to be both mentally and emotionally ready to use it. But feeling anxious about technology might hold them back. This study looked at whether there is a link between AI Readiness and technology anxiety among nursing students.

METHODS: We carried out a descriptive-correlational study with 297 nursing students at Qom University of Medical Sciences during the 2024-2025 academic year. We used census sampling, meaning we invited all eligible students to take part. Data were collected using a demographic form, the Abbreviated Technology Anxiety Scale (ATAS), and the Medical AI Readiness Scale for Medical Students (MAIRS-MS). Data were analyzed using descriptive statistics, Pearson correlation, independent t-tests, and multiple linear regression to identify predictors of AI Readiness.

RESULTS: The mean scores were 3.76 ± 0.54 for technology anxiety and 3.68 ± 0.61 for AI Readiness, indicating moderate-to-high levels. A strong inverse correlation was found between AI Readiness and technology anxiety (r = – 0.648, p < 0.001). Multiple linear regression showed that AI Readiness was a significant negative predictor of technology anxiety (B = – 0.32, p < 0.001), explaining 42% of the variance (R² = 0.420). No significant differences were observed based on gender, age, or marital status. Students in higher academic years reported lower technology anxiety (r = – 0.121, p = 0.026), and master’s students demonstrated significantly higher AI Readiness compared to bachelor’s students (p = 0.011).

CONCLUSION: These findings show that nursing students who feel more prepared for AI tend to be less anxious about technology. Adding AI training more consistently throughout the nursing curriculum and building digital skills may help reduce fear and make it easier for students to use AI tools in the future. Further longitudinal and interventional studies are needed to better understand causal relationships and to identify effective educational strategies.

PMID:42471688 | DOI:10.1186/s12912-026-05053-5

BMC Nurs. 2026 Jul 19. doi: 10.1186/s12912-026-05070-4. Online ahead of print.

ABSTRACT

BACKGROUND: In Sub-Saharan Africa, nursing professionals operate under intense occupational pressure characterized by high patient loads and an acute deficit of ergonomic support. These systemic constraints amplify the impact of mechanical low back pain (LBP) on work ability, the functional equilibrium between a clinician’s health status and their professional obligations. Guided by the biopsychosocial model, this study investigated the associations of physical activity (PA), pain intensity (PI), and health-related quality of life (HRQoL) with work ability among nurses experiencing mechanical LBP within a Nigerian tertiary clinical setting.

METHODS: A hospital-based, cross-sectional descriptive survey was conducted among 188 clinical nurses at a federal referral hospital in Gombe, Nigeria. Eligible participants were nurses who had experienced a diagnosis of mechanical LBP persisting for at least three months. Validated instruments were deployed: the Work Ability Index (WAI) captured the dependent variable, while the International Physical Activity Questionnaire (IPAQ), Visual Analogue Scale (VAS), and the Physical Component Summary (PCS) of the RAND-36 Health Survey quantified the independent variables. Data were analyzed using descriptive statistics, Pearson’s product-moment correlation, and multiple linear regression analysis (alpha = 0.05).

RESULTS: Bivariate analysis demonstrated significant positive correlations between work ability and both PA (r = 0.435, p = 0.002) and HRQoL (r = 0.388, p = 0.001), alongside a significant inverse correlation with PI (r = -0.312, p = 0.001). The multiple linear regression model was statistically significant, F(3, 184) = 12.525, p = 0.001, accounting for 21.5% of the total variance (R² = 0.215, Adjusted R² = 0.198). Notably, physical activity emerged as the most robust independent indicator in the model (beta = 0.412, t = 3.14, p = 0.002), displaying a substantially greater association with functional work ability than the subjective intensity of clinical pain symptoms.

CONCLUSION: This study demonstrates that physical activity, subjective pain intensity, and health-related quality of life are concurrent factors significantly associated with the work ability of Nigerian clinical nurses managing mechanical low back pain. The empirical findings indicate that higher physical activity levels and lower pain intensities are both independently linked to optimal work ability scores within this cohort. Consequently, occupational health strategies in resource-constrained Nigerian medical environments should consider a comprehensive approach that couples traditional pain management with structured, low-cost institutional physical activity and exercise rehabilitation programs to support the functional capacity of the healthcare workforce.

PMID:42471682 | DOI:10.1186/s12912-026-05070-4