Category: Nevin Manimala

Ultrasound J. 2025 Jul 31;17(1):37. doi: 10.1186/s13089-025-00441-5.

ABSTRACT

BACKGROUND: The efficacy of bedside chest ultrasonography for the detection and diagnosis of pneumothorax is under debate. We aimed to compare Emergency Healthcare Workers performed chest ultrasonography with chest X-ray in the detection and diagnosis of pneumothorax in the emergency department.

METHODS: We queried PubMed, Cochrane, ScienceDirect, Web of Science and ClinicalTrials.gov databases from 2000 through January 2024. We included all studies (both retrospective and prospective) that compared the diagnostic performance of chest ultrasonography with chest radiography, using chest computed tomography as the gold standard. Participants are patients consulting in the emergency department and physician that performed the chest ultrasound was an Emergency Healthcare Workers. Studies reporting the sensitivity and specificity for both chest ultrasonography and chest X-ray met inclusion criteria. We applied a random effects meta-analysis methodology. We then performed a meta-regression analysis to search for influencing variables such as technical parameters of echograph, patients and pneumothorax.

MAIN RESULTS: 15 studies totaling 3,171 patients were analyzed. 71% of patients were male with a mean age of 40.2 years. The mean prevalence of pneumothorax was 27.6% (95 CI 20.9 to 34.3). Chest ultrasonography had higher sensitivity (79.4%, 68.2 to 90.7) compared to chest X-ray (48.1%, 36.8 to 59.4), and a greater negative predictive value (chest ultrasonography = 94.3%, 91.2 to 97.3, and chest X-ray = 87.9%, 84.1 to 91.6). There was no statistical difference in specificity between the two modalities: chest ultrasonography 99.5%, 99 to 100 and chest X-ray 99.8%, 99.4 to 100) or in positive predictive value (chest ultrasonography 94.2%, 90.5 to 97.9 vs chest X-ray 96.7%,92 to 100). Characteristics of echograph or pneumothorax and patients sociodemographic did not influence results.

CONCLUSION: In this systematic review and meta-analysis, chest ultrasonography performed by Emergency Healthcare Workers, had greater sensitivity and negative predictive value than chest radiography for the diagnosis of pneumothorax in emergency department patients.

PMID:40742513 | DOI:10.1186/s13089-025-00441-5

Child Health Nurs Res. 2025 Jul;31(3):165-175. doi: 10.4094/chnr.2025.014. Epub 2025 Jul 31.

ABSTRACT

PURPOSE: This study aimed to identify the factors affecting the health promotion behavior of school-aged children informed by the Information-Motivation-Behavioral Skills Model.

METHODS: A cross-sectional study was conducted with 209 fifth- and sixth-grade elementary school students from Seoul, selected through convenience sampling. Data were collected from March 13 to 31, 2023, using a self-administered questionnaire. The questionnaire included validated tools that measured health literacy, attitude toward health behaviors, social support, self-efficacy, and health promotion behavior. Data were analyzed using descriptive statistics, Pearson’s correlation, and stepwise multiple regression, using IBM SPSS/WIN ver. 29.0.

RESULTS: The factors influencing the health promotion behavior of school-aged children were social support (β=.43, p<.001), attitude toward health behaviors (β=.27, p<.001), interest in health (high interest group) (β=.14, p=.003), self-efficacy (β=.13, p=.014), and health literacy (β=.10, p=.026). The explanatory power of the model was 63% (F=68.37, p<.001).

CONCLUSION: Based on the results of this study, it is highly recommended to develop and apply health education and health promotion programs that consider health literacy, attitude toward health behaviors, social support, self-efficacy, and interest in health to foster school-aged children’s health promotion behavior.

PMID:40741628 | DOI:10.4094/chnr.2025.014

Tzu Chi Med J. 2025 May 9;37(3):321-327. doi: 10.4103/tcmj.tcmj_249_24. eCollection 2025 Jul-Sep.

ABSTRACT

OBJECTIVES: Transplantation of human umbilical cord blood cells (hUCB) may enhance neuroprotection, and thus, the intravenous (IV) infusion of hUCB in patients with acute ischemic stroke (AIS) is being tested for its safety and efficacy.

MATERIALS AND METHODS: We conducted a 12-month, open-label, and single-center, phase I trial of hUCB treatment in AIS patients at the age of 45-80 years, with magnetic resonance imaging evidence of acute infarction in the internal carotid artery supplied territory and the National Institute of Health Stroke Scale (NIHSS) score between 6 and 18. Eligible participants received a single-dose IV infusion of hUCB followed by the two doses of mannitol infusion within 9 days after the onset of stroke symptoms. The primary endpoint was the incidence of adverse events (AEs) and the secondary endpoints were the changes in NIHSS, Barthel index (BI), and Berg Balance Scale (BBS) scores.

RESULTS: Six patients (Male: Female = 3: 3) were enrolled with a mean age at 65.8 years. A total of 40 AEs occurred in six participants during this study, which included nine serious adverse events. Only transient erythema multiforme and hematuria were probably and possibly related to hUCB infusion, respectively. The mean NIHSS score was 11.5 at baseline and it significantly improved at 1, 3, 6, 9, and 12 months after treatment (mean change from baseline: -4.0, -5.3, -6.8, -7.0, and -7.3). The mean BI score was 22.5 at baseline and it significantly increased at 3 and 6 months after treatment (mean change from baseline: 26.7 and 42.5, respectively). The BBS score increased numerically but did not reach statistical significance. The changes in cytokine levels and spleen size were unremarkable.

CONCLUSION: The IV hUCB was safe and well tolerated in AIS patients, and the preliminary efficacy results demonstrated its therapeutic potential, supporting the conduct of a randomized, placebo controlled, phase II clinical trial in future.

PMID:40741608 | PMC:PMC12306862 | DOI:10.4103/tcmj.tcmj_249_24

Cureus. 2025 Jun 30;17(6):e87035. doi: 10.7759/cureus.87035. eCollection 2025 Jun.

ABSTRACT

INTRODUCTION: Necrotising soft tissue infection (NSTI) is uncommon, and its management is complex due to its diverse clinical presentations, multiple associated comorbidities, and a wide range of potential microbial aetiologies. This study aims to illustrate the clinical profile, microbiological spectrum, and factors affecting mortality among patients with NSTI.

METHODS: This single-centre, hospital-based, prospective observational study included all patients with NSTI aged 18 years or older. The primary outcome was the impact of time to surgery on mortality. Secondary outcomes included identifying the aetiology, microbiological flora, major co-morbidities, and overall outcomes in these patients. Results: During the study period, 87 patients were enrolled. There were 65 (74.7%) male and 22(25.3%) female patients with an age range of 18 years to 88 years. Postoperatively, 18 patients succumbed to death, while 69 survived. Overall, the average timing of the first intervention after admission was six hours, with no significant statistical difference between the survivor and non-survivor group (p-value = 0.575). Our study found types I and II infections in 26 (34.5%) and 45 (65.4%) patients, respectively, and Escherichia coli (E. coli) was the most common isolate in both types. The antibiotic resistance pattern revealed increased resistance to third-generation cephalosporins and fluoroquinolones for the Enterobacteriaceae group and E. coli.

CONCLUSION: High APACHE II and LRINEC scores, anaemia, hypoalbuminemia, and high creatinine are associated with a higher risk of death. Prompt multidisciplinary management of these patients significantly improves outcomes and reduces mortality.

PMID:40741589 | PMC:PMC12309787 | DOI:10.7759/cureus.87035

Cureus. 2025 Jun 30;17(6):e87049. doi: 10.7759/cureus.87049. eCollection 2025 Jun.

ABSTRACT

Real-world data on cardiovascular immune-related adverse events (CV-irAEs) in cancer patients treated with immune checkpoint inhibitors (ICIs) present findings that differ from those reported in meta-analyses of clinical trials. This study aims to estimate the incidence of CV-irAEs from observational studies among patients undergoing ICI therapy for various malignancies and investigate the discrepancy between the results of meta-analyses and observational studies. A systematic literature review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. The PubMed database was searched for observational studies that included cancer patients treated with ICIs. Α single-arm meta-analysis using the metaprop command in Stata Statistical Software: Release 16 (StataCorp LLC, College Station, Texas, United States) was performed for the following outcomes: myocarditis, pericardial disease, arrhythmias, cardiac failure, Takotsubo cardiomyopathy, ischemic heart disease, heart valve disease, venous thromboembolism and artery disease. ICI treatment agents were classified into three major classes: PD-1 inhibitors, PD-L1 inhibitors, CTLA4 inhibitors, or their combinations. Heterogeneity was quantified using the I2 statistic and small study effect, and potential publication bias was assessed by inspecting funnel plots, as well as by Egger’s test. A total of 42 studies were included. The incidence of CV-irAEs within the entire population undergoing treatment with ICIs was assessed as follows: total CV-irAEs: 8% (95% confidence interval (CI): 6%, 10%), arrhythmias: 18% (95%CI: 10%, 27%), myocarditis: 11% (95%CI: 5%, 18%), cardiac failure: 8% (95%CI: 2%, 15%), ischemic heart disease: 6% (95%CI: 3%, 11%), pericardial disease: 5% (95%CI: 1%, 10%), artery disease 5% (95%CI: 1%, 12%), and venous thromboembolism: 3% (95%CI: 0%, 8%); cardiomyopathy and heart valve disease had minimal number of observed episodes, thus the pooled incidence results are referring as zero, 0% (95%CI: 0%, 0%) and total CV deaths: 1% (95%CI: 0%, 3%). Median time to CV-irAEs was estimated at 119 days (interquartile range (IQR) 53-180). The most common CV-irAEs were arrhythmias, myocarditis, and cardiac failure with life-threatening complications. Data derived from meta-analyses of clinical trials in most cases indicated that the total incidence of CV-irAEs varied between 0.05% and 1.30%, while in large pharmacovigilance databases, it ranged from 0.125% to 6.7%. In our meta-analysis of post-market surveillance studies, higher estimates were obtained, which offer an insight into the long-term prevalence and outcomes for patients experiencing CV complications associated with ICIs. Longer follow-up period and different definitions of cardiotoxicity may account for the higher cardiotoxicity rates that seem to reflect an emerging threat.

PMID:40741581 | PMC:PMC12310155 | DOI:10.7759/cureus.87049

Cureus. 2025 Jun 30;17(6):e87033. doi: 10.7759/cureus.87033. eCollection 2025 Jun.

ABSTRACT

The treatment of distal tibial fractures with an articular fracture line remains controversial. Intramedullary nailing allows for the maintenance of good frontal and sagittal alignment, as well as rapid and satisfactory functional recovery. In this retrospective case series, we present our department’s experience with 20 patients presenting with AO 43C1 and 43C2 fractures, treated with intramedullary nailing combined with interfragmentary screw fixation over an eight-year period, with a follow-up of 18 months. Postoperative alignment was assessed using radiographic measurements of the anterior distal tibial angle (ADTA) and lateral distal tibial angle (LDTA), immediately and at follow-up. Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Descriptive statistical analysis was used to report means, standard deviations, and proportions. Acceptable alignment was achieved in 95% of patients. The AOFAS score exceeded 86% in 88% of patients, indicating excellent outcomes. Interfragmentary screw fixation prior to nailing improved construct stability, minimized malalignment risk, and enhanced functional recovery.

PMID:40741563 | PMC:PMC12309624 | DOI:10.7759/cureus.87033

Cureus. 2025 Jun 30;17(6):e87041. doi: 10.7759/cureus.87041. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Hypertension is a prevalent risk factor for coronary artery disease (CAD), and early diagnosis is critical for preventing adverse cardiovascular events. While exercise stress testing (EST) is a common non-invasive tool, its diagnostic performance in hypertensive individuals, especially when combined with beta-blocker therapy, remains under-evaluated. The beta-blocker metoprolol may enhance diagnostic accuracy in this population.

OBJECTIVE: This study aimed to evaluate the diagnostic value of EST combined with metoprolol therapy in hypertensive patients with suspected CAD.

METHODOLOGY: This prospective, hospital-based controlled diagnostic study was conducted at the Department of Cardiology, Abbas Institute of Medical Science (AIMS), Muzaffarabad, Azad Jammu and Kashmir (AJK), from January 2023 to December 2024. A total of 224 hypertensive patients aged between 30 and 70 years with clinical suspicion of CAD (based on anginal symptoms, ECG changes, or physician judgment) were enrolled. Patients with a known history of CAD, contraindications to exercise or beta-blockers, or current beta-blocker use were excluded. All participants received a single oral dose of 50 mg metoprolol tartrate one hour prior to EST, performed using the Bruce protocol. Adverse effects and hemodynamic responses were monitored. A positive EST was defined by ischemic ECG changes, anginal symptoms, or abnormal blood pressure response. All patients underwent confirmatory testing with either coronary angiography or myocardial perfusion imaging (MPI), depending on clinical indication. Diagnostic metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated using confirmed CAD status as the gold standard. Confidence intervals were calculated to assess the precision of diagnostic estimates. Data were analyzed using IBM SPSS Statistics software, version 25.0 (IBM Corp., Armonk, NY), with categorical variables reported as frequencies and percentages, continuous variables as mean ± SD, and diagnostic accuracy of EST with metoprolol evaluated against confirmed CAD using sensitivity, specificity, PPV, NPV, and chi-square test (p < 0.05).

RESULTS: Out of 224 patients, 138 (61.61%) had a negative EST and 86 (38.39%) had a positive result. CAD was confirmed in 94 patients (41.96%). Of the 86 patients with a positive EST, 68 (79.07%) had confirmed CAD. Among the 138 patients with a negative EST, 26 (18.84%) were found to have CAD. The combination of EST and metoprolol demonstrated a diagnostic sensitivity of 72.34%, specificity of 86.15%, PPV of 79.07%, NPV of 81.16%, and an overall diagnostic accuracy of 80.36%.

CONCLUSION: In hypertensive patients with suspected CAD, combining EST with metoprolol provides a viable and non-invasive diagnostic strategy, offering high specificity and PPV despite moderate sensitivity.

PMID:40741561 | PMC:PMC12309863 | DOI:10.7759/cureus.87041

Cureus. 2025 Jun 30;17(6):e87047. doi: 10.7759/cureus.87047. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: The mouse mammary tumor virus (MMTV) has been identified as potentially oncogenic, and its presence in milk was reported and discussed. However, with respect to breast cancer etiology, the transmission routes for these viruses are not known. In this context, the objective of this study is to assess the presence of MMTV-like virus in breast milk and to explore the associated factors of its presence among healthy lactating women in Morocco.

METHODS: In this prospective study, milk samples were collected from 44 lactating women recruited from the Souissi Maternity Hospital of Rabat in Morocco. MMTV-like DNA was identified by polymerase chain reaction amplification using specific primers targeting the env gene.

RESULTS: The prevalence of the MMTV-like virus was 45.5% (20/44). Statistical analysis revealed a significant association with the use of henna. It seems that it increases the risk of the presence of MMTV-like virus in breast milk. The hypothesis could be the possible contamination of henna sold in bulk in local markets by urine and feces of mice during storage.

CONCLUSION: Nevertheless, these results need to be confirmed by multicenter studies to thoroughly investigate the impact of other factors and the potential contamination of henna with the virus through urine and feces of mice during storage.

PMID:40741558 | PMC:PMC12310077 | DOI:10.7759/cureus.87047

Cureus. 2025 Jun 30;17(6):e87059. doi: 10.7759/cureus.87059. eCollection 2025 Jun.

ABSTRACT

Background Medical education is adapting to meet the growing demands of healthcare and patient care complexities. Traditional clinical training often relies on limited patient encounters, which may not fully develop clinical competence. Simulation-based medical education (SBME) offers controlled, immersive environments for practicing clinical skills and decision-making without risking patient safety. While SBME has been well-studied in advanced training, its effectiveness in first- and second-year medical students remains underexplored. This study aims to explore and quantify pre-clerkship medical students’ perspectives on how SBME impacts confidence in clinical decision-making, communication, and clinical skills, compared to traditional learning methods alone. Methods This pre- and post-survey-based study assessed the impact of simulation (SIM) on students’ self-reported confidence in clinical decision-making, communication, and clinical skills. Six simulation scenarios that aligned with the undergraduate medical curriculum of one Canadian institution were conducted from October 2023 to March 2024. Participants completed pre- and post-simulation surveys using 5-point Likert scales. A total of 67 surveys were analyzed. Results All 67 surveys were analyzed (35 pre-, 32 post-simulation) using one-sided Wilcoxon Signed Rank Tests. Pre-simulation responses indicated low baseline confidence, with only one item rated above neutrality. Post-simulation ratings showed statistically significant improvements across all domains (p < 0.01). Students also reported that they perceived simulation as more effective than traditional didactic learning in preparing them for clinical practice. Conclusions This exploratory study suggests that simulation-based education can enhance pre-clerkship students’ confidence in clinical decision-making, communication, and procedural skills, domains often underdeveloped at this stage of training. These findings offer early evidence that high-fidelity simulation may accelerate perceived clinical readiness. However, due to the small, self-selected sample, non-parallel survey design, and reliance on subjective outcomes, results should be treated as exploratory. Further multi-site studies using objective measures are needed to assess long-term impact on knowledge and skill retention as well as clinical performance.

PMID:40741557 | PMC:PMC12310303 | DOI:10.7759/cureus.87059

Cureus. 2025 Jun 30;17(6):e87051. doi: 10.7759/cureus.87051. eCollection 2025 Jun.

ABSTRACT

Background Following an analysis of the National Residency Matching Program statistics, it was found that there is a ratio of 1:1.75 of candidates matching into a neurosurgical residency. The population of students accepted into neurosurgery residency programs appears less diverse compared to other surgical specialties. The objective of this descriptive, observational study is to examine the current trends among students accepted into neurosurgical residency programs and increase exposure to a more diverse demographic within the field of neurosurgery. Methodology A bibliometric analysis of neurosurgical residents across U.S. neurosurgical programs was conducted from 2017 to 2024. Data were collected from the Fellowship and Residency Electronic Interactive Database and residency websites between January and March 2024. Data were further divided into postgraduate years, biological sex, and medical degree. Results A total of 1,608 neurosurgical residents from 116 residency programs were identified. A decreasing trend in osteopathic residents was found from 4.29% of residents graduating in 2025 to 2.12% graduating in 2031. A steady trend was discovered in the percentage of women residents, increasing from 23.33% for residents graduating in 2025 to 30.51% for those graduating in 2031. The highest percentage of osteopathic residents in neurosurgery programs was found in the West Pacific area (8.3%, n = 17), the second highest in the Middle Atlantic (7.8%, n = 26), and the third highest in the West South Central (6.7%, n = 13). The highest percentage of female residents was found in the New England area (37.1%, n = 47), the second highest in the Pacific region (34.1%, n = 68), and the third highest in the South Atlantic (24.7%, n = 80). Conclusions The number of osteopathic residents in neurosurgery programs suggests a potential decline, which could be attributed to geographical, academic, and other factors. The number of female residents suggests a gradual increase; however, future steps toward addressing the gender disparities should be taken.

PMID:40741555 | PMC:PMC12310153 | DOI:10.7759/cureus.87051