Category: Nevin Manimala

BMC Pharmacol Toxicol. 2026 Jun 26. doi: 10.1186/s40360-026-01177-1. Online ahead of print.

ABSTRACT

BACKGROUND: Methylphenidate is widely prescribed for attention-deficit/hyperactivity disorder, and its use has increased substantially in recent years. Although generally considered safe within therapeutic ranges, supratherapeutic ingestion may result in various systemic adverse effects. This study aimed to evaluate the demographic and clinical characteristics of children presenting with overdose ingestion and to identify potential factors associated with symptom development.

METHODS: We conducted a retrospective review of patients younger than 18 years who presented to a tertiary pediatric emergency department between January 1, 2020, and December 31, 2024, due to overdose ingestion. Demographic characteristics, psychiatric history, ingested dose, mode of exposure, clinical findings, emergency department course, and factors potentially associated with adverse effects were analyzed.

RESULTS: Thirty-two patients were included; 72% were female, and ingestion was intentional in 84%. The mean ingested dose was 5.7 mg/kg. Clinical symptoms developed in 41% of patients. The most frequent findings were tachycardia (38%), mild hypertension (34%), agitation (22%), and seizures (16%). Although most cases were mild and resolved within 12 h of observation, one toddler developed neuropsychiatric manifestations requiring close monitoring with full recovery within 48 h. No statistically significant association was observed between age, sex, gastrointestinal decontamination status, or reported ingested dose and the development of clinical symptoms (p > 0.05).

CONCLUSIONS: Pediatric methylphenidate intoxication is generally mild, but severe neuropsychiatric and cardiovascular effects may occur. Careful clinical monitoring remains essential.

TRIAL REGISTRATION: Not applicable.

PMID:42363304 | DOI:10.1186/s40360-026-01177-1

J Neuroeng Rehabil. 2026 Jun 26. doi: 10.1186/s12984-026-02060-0. Online ahead of print.

ABSTRACT

BACKGROUND: Functional constipation (FCon) involves central nervous system dysregulation, particularly in brain regions responsible for visceral sensation, emotional processing, and autonomic control. Using functional near-infrared spectroscopy (fNIRS), we examined brain activity alterations in FCon patients to elucidate brain-gut interactions.

METHOD: Patients with constipation meeting Rome IV criteria were recruited from Sir Run Run Shaw Hospital, while healthy controls were enrolled from the local community. The cortical regions of interest (ROIs) included the prefrontal cortex (PFC), dorsolateral prefrontal cortex (DLPFC), broca’s area, primary motor cortex (M1), supplementary motor area (SMA)/premotor cortex (PMC), and primary somatosensory cortex (S1). Participants were monitored during resting state and three defecation-related tasks: imagined defecation, simulated defecation and anal sphincter contraction. Functional connectivity (FC) strength and regional brain activation (HbO concentration changes) were compared between groups and across tasks.

RESULT: 64 patients and 64 healthy controls (50% females each) were included. There was no significant difference in average FC between groups (P = 0.757). In both groups, simulated defecation and anal sphincter contraction activated most ROIs more strongly than imagined defecation (P < 0.05). In healthy controls, anal sphincter contraction elicited significantly lower HbO than simulated defecation in the left Broca’s area (P < 0.05); no significant differences between these two tasks were found in the FCon group. No significant between-group differences in HbO were found during any task. During imagined defecation, FCon patients showed a trend toward lower HbO across most ROIs, most notably in the right M1, with comparable levels in the right PFC. During simulated defecation, a similar trend of lower HbO in sensorimotor ROIs was observed alongside numerically higher HbO in the right PFC/DLPFC. During anal sphincter contraction, they showed numerically higher HbO across all ROIs. Progression curves further revealed a linear increasing pattern in FCon patients across tasks, contrasting with task-appropriate modulation in healthy controls.

CONCLUSION: This first fNIRS study reveals task-specific cortical dysregulation in FCon. Although between-group differences were not statistically significant, these trends and dynamic patterns identify sensorimotor and prefrontal cortical targets for future neuromodulation therapies. Trial registration ChiCTR2500104882.

PMID:42363274 | DOI:10.1186/s12984-026-02060-0

Health Qual Life Outcomes. 2026 Jun 26. doi: 10.1186/s12955-026-02573-1. Online ahead of print.

ABSTRACT

PURPOSE: Quality of life (QOL) research in diabetes has long been a concern with many specific instruments being developed, but no scale for diabetes has been developed based on the modular approach. This study aimed to develop and validate the Diabetes Mellitus Scale of the System of Quality of Life Instruments for Chronic Diseases QLICD-DM (V2.0) by a modular approach and mixed methods.

METHODS: The Scale was developed based on procedural decision-making methods and by combining the general module and the specific module. The instrument was used to assess the quality of life of 242 diabetic patients both before and after treatments. Under Classical Test Theory (CTT), the psychometric properties of the scale were assessed with regard to validity, reliability and responsiveness by correlation analyses, structural equation modeling, as well as t-tests. In addition, G-study and D-study in Generalizability Theory (GT) were used to validate the scale further.

RESULTS: The QLICD-DM (V2.0) was developed with a 14-item specific module and a 28-item general module in the final scale. For all domains, Cronbach’s α values were greater than 0.70 with the exception of physical function (0.68), the test-retest reliability correlations r and ICCs were greater than 0.80 with the exception of physical and social function (0.65,0.64). The theoretical construct was supported by correlation analyses and confirmatory factor analysis using structural equation modeling, which demonstrated good construct validity. There were significant differences (P < 0.05) in the domains of physical function, specific module and the total scale before and after treatments. The standardized response means (SRMs) of the physical, psychological, social, and the specific module were 0.36, 0.14, 0.11 and 0.28 respectively. All G-coefficients were all greater than 0.70 with the exception of the physical domain (0.683), further confirming the reliability of the scale further. The overall error was found to be small in the G-study and in the D-study, indicating a high level of accuracy.

CONCLUSION: The QLICD-DM (V2.0) not only integrated characteristics of generic and disease-specific instruments but also demonstrated good reliability, validity, and moderate responsiveness, and it could serve as a quality of life assessment tool for diabetes patients.

PMID:42363272 | DOI:10.1186/s12955-026-02573-1

Thyroid Res. 2026 Jun 26. doi: 10.1186/s13044-026-00308-4. Online ahead of print.

ABSTRACT

AIM AND OBJECTIVES: Tumour stroma is acknowledged as a fundamental constituent of the tumour microenvironment, which drives cancer progression. Cancer-associated fibroblasts are an integral part of the cancer stroma. However, their role in thyroid cancer is not fully elucidated. The aim of this study is to determine the relationship between the expression of stromal cancer-associated fibroblasts’ immunohistochemical biomarkers in thyroid cancer and clinicopathological features of the disease.

METHODS: Eighty-five formalin-fixed paraffin-embedded tissue sections of different thyroid cancer cases were stained with Masson’s trichrome, α-smooth muscle actin (α-SMA) and fibroblast activation protein (FAP) and scored based on the extent of the stained area and staining intensity. Statistical analysis was performed to assess any correlation with clinicopathological features.

RESULTS: α-SMA showed a positive correlation with male gender (p = 0.02), tumour size greater than 1 cm (p = 0.0014) and histopathologic features of aggressiveness (p = 0.023). FAP was positively correlated with extent of desmoplasia (p = 0.024). Additionally, stromal desmoplasia was negatively correlated with tumour size greater than 1 cm (p = 0.0082).

CONCLUSION: Cancer-associated fibroblasts are associated with increased tumour progression and desmoplasia in thyroid cancer.

PMID:42363240 | DOI:10.1186/s13044-026-00308-4

BMC Oral Health. 2026 Jun 26. doi: 10.1186/s12903-026-08893-4. Online ahead of print.

ABSTRACT

OBJECTIVE: Obesity has become one of the leading health concerns in the world. There has been limited data on the effect of obesity on oral health in children and no research has specifically examined the impact of obesity on halitosis in this population. The aim of this study was to evaluate the potential effects of obesity on oral health parameters including dental caries, periodontal health, and halitosis in children.

MATERIALS AND METHODS: A total of 295 children aged 10-13 years were included in the study. Height, body weight, and waist circumference were measured, and body mass index (BMI), z-scores, and percentile values were calculated using the WHO AnthroPlus 2007 program. Participants were classified into obese and non-obese groups. The obese group consisted of overweight/obese children, whereas the non-obese group comprised underweight/normal weight children. Oral health status, including the presence of halitosis, was assessed. In addition, a questionnaire was administered to the parents. The collected data were statistically analyzed using the chi-square test, Fisher’s exact test, Mann-Whitney U test, and multivariable logistic regression analysis (p < 0.05).

RESULTS: The obese group consisted of 111 children (37.6%), whereas the non-obese group comprised 184 children (62.4%). No statistically significant differences were observed between the obese and non-obese groups regarding DMFT/DMFS, dmft/dmfs, ICDAS II, plaque index, or gingival index scores. However, a statistically significant difference was found in the prevalence of halitosis between the groups. The frequency of halitosis was significantly higher in the obese group (24.3%) than in the non-obese group (14.7%) (p = 0.038). Furthermore, the association between tongue coating and halitosis was statistically significant in the non-obese group (p = 0.049), but not in the obese group (p = 0.790). Multivariable logistic regression analysis also identified overweight and obesity as potential risk factors for halitosis (OR = 1.847, 95% CI: 1.006-3.389).

CONCLUSIONS: In addition to the well-known causes of halitosis, overweight and obesity may also be considered potential risk factors in children. Parents should be informed that overweight and obesity may be associated with bad breath, which can lead to embarrassment and anxiety in children.

PMID:42363236 | DOI:10.1186/s12903-026-08893-4

AIDS Res Ther. 2026 Jun 26. doi: 10.1186/s12981-026-00902-4. Online ahead of print.

ABSTRACT

PURPOSE: Caribbean countries are among the most heavily burdened by both human immunodeficiency virus (HIV) and cancer, with prevalent stigmatization of both illnesses. This novel pilot study responds to the need to examine and understand both cancer- and HIV-related stigma among cancer survivors living with HIV (CSLWH).

METHODS: Data were collected via quantitative surveys and administered in person in Trinidad and Tobago. The survey used in this pilot study included an HIV stigma scale and a cancer stigma scale. Descriptive analyses were conducted using IBM SPSS Statistics 29.0.0.

RESULTS: For most stigma items, HIV stigma is higher than cancer stigma, especially for personal and relational self-stigma: 95% vs 28% of participants reported that they feel telling someone is risky for their HIV status and cancer status, respectively. HIV-related societal/community stigma is also higher than cancer-related stigma: 87% of participants reported that they feel most people believe a person who has HIV is dirty, vs 18% reported the same stigma for cancer. Most CSLWH believed HIV is more stigmatized than cancer by the community/society (90.6% vs 9.4%) and family/friends (93.8% vs 6.3%). However, cancer-related stigma exists in health outcome beliefs: 57% of CSLWH believed that once having cancer, a person will never be ‘normal’ again, while 45% of CSLWH felt the same for HIV.

CONCLUSIONS: Our preliminary findings suggest greater HIV-related personal and relational self-stigma and societal/community stigma compared to cancer-related stigma among CSLWH. However, more cancer-related health outcome beliefs are stigmatizing compared to HIV-related stigma among CSLWH.

PMID:42363228 | DOI:10.1186/s12981-026-00902-4

BMC Res Notes. 2026 Jun 26. doi: 10.1186/s13104-026-07923-2. Online ahead of print.

ABSTRACT

OBJECTIVES: Identifying children at highest risk for deterioration during evaluation for septic shock in emergency department (ED) settings remains challenging. Soluble CD25 (sCD25), a hemophagocytic lymphohistiocytosis (HLH) diagnostic criterion, has been associated with sepsis mortality in ICU settings. This study aimed to determine whether sCD25 is associated with adverse outcomes in children undergoing initial septic shock evaluation in a pediatric ED. We also sought to compare sCD25 in patients with septic shock, infection without sepsis, and HLH.

RESULTS: Children with HLH demonstrated significantly higher sCD25 levels [25,800 pg/mL (IQR: 1620-42,300)] compared with those with septic shock [5200 pg/mL (IQR: 2500-20,600)] or infection [5500 pg/mL (IQR: 2200-12,500)]. No statistical differences were observed between septic shock and infection groups; however, a subset of septic shock patients exhibited sCD25 elevations comparable to HLH patients. These patients experienced severe outcomes, including 100% PICU admission, 50% vasoactive support requirement, and prolonged hospitalization (16 days). Bloodstream infections were associated with the highest sCD25 levels. These findings suggest sCD25 elevation may be associated with adverse outcomes in children with septic shock. Larger studies are warranted to validate sCD25 as a prognostic marker for children with septic shock.

PMID:42363221 | DOI:10.1186/s13104-026-07923-2

BMC Med Educ. 2026 Jun 26. doi: 10.1186/s12909-026-09776-6. Online ahead of print.

ABSTRACT

BACKGROUND: Widening participation in medicine is a key societal priority. To improve representation of non-traditional applicants, UK medical schools use contextual admissions, although definitions of under-represented groups vary across institutions. This study examined the educational and training trajectories of one such group-mature non-graduates. We aimed to determine whether their progression was comparable to that of school-leavers and graduate entrants, whether they progressed through medical school non-inferiorly, and whether they were equally likely to secure postgraduate training posts.

METHODS: Data on UK medical students and resident doctors (2007-2015) were extracted from the UK Medical Education Database (UKMED). Undergraduate performance (Educational Performance Measure (EPM), Prescribing Safety Assessment (PSA), Foundation Programme Situational Judgement Test (FP-SJT) and postgraduate performance (Membership of the Royal College of Physicians, MRCP and MRCGP Applied Knowledge Test, MRCGP AKT), Annual Review of Competency Progression (ARCP), and obtaining an offer for a Level 1 training post) were compared across the three groups using multivariate statistical analyses, including Kruskal-Wallis tests where appropriate.

RESULTS: Across all measures of undergraduate academic attainment (EPM, PSA and FP-SJT) and postgraduate examination performance (MRCP Part 1, Part 2 and PACES), mature non-graduates performed less well than school-leavers or graduates. They were more frequently released from training (ARCP Outcome 4) and received higher numbers of Developmental ARCP outcomes. Mature non-graduates were also less likely to receive an offer for competitive specialty training on their first application; however, the likelihood of them applying exclusively to General Practice did not differ from that of school-leavers or graduates.

CONCLUSIONS: Although performance differences persist for a subset of widening-participation candidates named here as mature non-graduates, they still progress through training, obtain Certificates of Completion of Training, and contribute to the medical workforce. Further research is needed to examine how their life experience and non-traditional educational trajectories influence their long-term practice.

PMID:42363203 | DOI:10.1186/s12909-026-09776-6

BMC Ophthalmol. 2026 Jun 26. doi: 10.1186/s12886-026-05035-w. Online ahead of print.

ABSTRACT

BACKGROUND: Age-related macular degeneration (AMD) is a leading cause of blindness in developed countries. Smoking is the only modifiable risk factor and is associated with faster AMD progression. While Age-Related Eye Disease Study (AREDS) supplements are recommended for intermediate AMD, their impact on visual acuity over time remains unclear.

OBJECTIVE: To describe baseline disparities and visual acuity trajectories in patients with intermediate dry AMD stratified by AREDS use and smoking status.

DESIGN: Retrospective observational study of patients with intermediate dry AMD conducted under IRB protocol 22-0267. Data collected from January 1, 2014 to January 1, 2024.

SETTING: Single academic medical center.

PARTICIPANTS: A total of 450 patients (759 eligible eyes) with intermediate dry AMD (ICD code H35.3192) were included. Patients were stratified by smoking status and AREDS use. Participants with fewer than three ophthalmology visits during the 10-year study period were excluded.

EXPOSURE: AREDS supplementation (AREDS1 or AREDS2) and smoking status (current/former vs. never).

MAIN OUTCOMES AND MEASURES: Visual acuity measured in Logarithm of the Minimum Angle of Resolution (LogMAR) at first and final clinic visits. ANOVA, Chi-square tests, and mixed effect regression models were used for analysis. Changes in LogMAR over time were calculated descriptively.

RESULTS: Among 450 patients (mean age, 82.32 years), 255 were smokers (423 eyes) and 195 were non-smokers (336 eyes). Baseline vision was better in non-smokers (mean LogMAR 0.28; SD 0.28) and smokers (mean LogMAR 0.30; SD 0.33) taking AREDS compared to non-smokers (mean LogMAR 0.48; SD 0.44) and smokers (mean LogMAR 0.45; SD 0.47) not taking AREDS (P < 0.0001). All groups experienced visual acuity decline from baseline with no significant differences in final visual acuity among the groups in a mean follow up period of 3.62 years. In a sub-analysis of greater than 5 years follow up mean years of 6.93 ± 1.55 years), a statistically significant difference in final LogMAR values across groups was observed (p = 0.033). The Smokers & AREDS group demonstrated the best final visual acuity (mean 0.39, SD 0.40), followed by Smokers & No-AREDS (mean 0.44, SD 0.43), Non-smokers & AREDS (mean 0.46, SD 0.47), and Non-smokers & No-AREDS (mean 0.72, SD 0.60).

CONCLUSIONS AND RELEVANCE: These results suggest that less than 5 years AREDS users had larger decline in vision from baseline, protective associations of AREDS supplementation may become more discernible over longer follow-up horizons. Real-world observational findings should be interpreted cautiously and do not contradict AREDS efficacy shown in randomized trials.

PMID:42363196 | DOI:10.1186/s12886-026-05035-w

BMC Pediatr. 2026 Jun 26. doi: 10.1186/s12887-026-07212-8. Online ahead of print.

ABSTRACT

BACKGROUND: Non-invasive ventilation (NIV) is widely used in preterm infants to reduce ventilator-associated lung injury. However, nasopharyngeal suctioning during NIV is an invasive procedure that may cause pain, stress and physiological instability in preterm infants. This study aimed to compare the effects of less invasive suction protocol and conventional nasopharyngeal suctioning on pain and physiological stability in preterm infants receiving non-invasive ventilation.

METHODS: This randomized controlled trial was conducted in a tertiary neonatal intensive care unit. Preterm infants with a gestational age of 32^0/7 to 36^6/7 weeks who required NIV were eligible. A total of 100 infants were randomly assigned to either the less invasive suction protocol group (n = 50) or the conventional suction group (n = 50). Pain was assessed using the Neonatal Pain, Agitation and Sedation Scale (N-PASS). Heart rate (HR), respiratory rate (RR), oxygen saturation (SpO₂), and skin color were recorded before suctioning, during the procedure, and 10 min after completion. Between-group comparisons were performed using appropriate parametric or non-parametric statistical tests, with p < 0.05 considered statistically significant.

RESULTS: Baseline demographic and clinical characteristics were comparable between groups. During suctioning, infants in the less invasive suction protocol group had significantly lower HR and higher SpO₂ levels compared to the conventional group (p < 0.05). The proportion of infants with pink skin color was significantly higher in the less invasive suction protocol group. N-PASS pain scores during the procedure were significantly lower in the less invasive suction protocol group (p < 0.05). No significant differences were observed between groups in RR measurements at any time point.

CONCLUSIONS: The less invasive suction protocol reduced procedural pain and supported physiological stability in preterm infants receiving NIV. Minimizing airway manipulation may contribute to safer and more developmentally supportive care in neonatal intensive care units.

TRIAL REGISTRATION: ClinicalTrials.gov (NCT07111611), registered on 08 August 2025 (retrospectively registered).

PMID:42363180 | DOI:10.1186/s12887-026-07212-8