Category: Nevin Manimala

Eur J Pediatr. 2026 Jan 3;185(1):49. doi: 10.1007/s00431-025-06704-6.

ABSTRACT

PURPOSE: To describe the sociodemographic and epidemiological characteristics and healthcare utilization patterns-primary healthcare (PHC) use, emergency department (ED) visits, and hospital admissions-of children under 5 years of age born in Portugal between July 1, 2010, and June 30, 2021, and diagnosed with TB during the same period.

METHODS: This is a quantitative, observational cohort study of 58 children diagnosed with TB and reported to the National Epidemiological Surveillance System (SINAVE) before age 5. Data were obtained through linkage of five population-based databases. Descriptive statistics and bivariate analyses were conducted. Incidence rates of PHC, ED visits, and hospital admissions were calculated per 1000 person-days.

RESULTS: Most TB cases (81.0%) were diagnosed between ages 1 and 5; 55.2% were male, and 72.2% resided in metropolitan areas. Over half (58.6%) were unvaccinated with BCG. Unvaccinated children were diagnosed earlier than vaccinated peers (p < 0.01), though no significant differences were found in the clinical presentation of TB, risk factors, or healthcare utilization. Pulmonary TB was most common (51.7%), and 68.4% of children were hospitalized. PHC services were underutilized (32.7%), while ED visits were more frequent, primarily for infectious and respiratory conditions. One child died, with TB diagnosed post-mortem.

CONCLUSIONS: TB in young children remains a public health concern in Portugal, especially in unvaccinated populations. Strengthening PHC access and preventive care is essential to improve early detection and outcomes.

WHAT IS KNOWN: • TB causes substantial morbidity and mortality, particularly in children under 5 years of age. • Pediatric TB remains underdiagnosed and underrepresented in research, surveillance, and national policies.

WHAT IS NEW: • BCG vaccination was associated with later onset of TB. • Children under five with TB represent a particularly vulnerable group; thus, it is critical to promote preventive care to ensure early diagnosis and effective follow-up.

PMID:41483248 | DOI:10.1007/s00431-025-06704-6

Neurol Sci. 2026 Jan 2;47(1):70. doi: 10.1007/s10072-025-08730-6.

ABSTRACT

BACKGROUND: The incidence of acute ischemic stroke (AIS) is increasing among young to middle-aged adults (18-64 years), posing substantial socioeconomic and healthcare challenges. This study aimed to evaluate the diagnostic and predictive value AHR, Klotho, and sdLDL-C in AIS and across different TOAST etiological subtypes in this age group.

METHODS: We retrospectively enrolled young to middle-aged patients with first-ever AIS and age- and sex-matched stroke-free controls. All participants underwent DWI and additional vascular assessments, including MRA, CTA, and/or DSA. Clinical characteristics, imaging findings, and laboratory parameters were statistically analyzed. Patients were classified into TOAST subtypes for etiological analysis.

RESULTS: Multivariate logistic regression identified male sex, DBP, FPG, LDL-C, and DWM as independent risk factors for AIS. The most common TOAST subtype was SAO, followed by SUE and LAA. Compared to controls, AIS patients exhibited significantly higher AHR and sdLDL-C levels and lower Klotho levels (all P < 0.001). ROC analysis demonstrated that the combined use of AHR, Klotho, and sdLDL-C had high diagnostic accuracy for AIS (AUC = 0.971), with the highest predictive value observed for LAA subtype (AUC > 0.9).

CONCLUSION: In young to middle-aged adults, male sex, elevated DBP, FPG, LDL-C, and DWM are independent risk factors for AIS. AHR and sdLDL-C are positively associated with AIS risk, while Klotho is inversely associated. The combined biomarker panel (AHR, Klotho, and sdLDL-C) demonstrates strong diagnostic utility, particularly for identifying the LAA subtype. These findings provide valuable insight into early risk stratification and classification of AIS in younger populations.

PMID:41483236 | DOI:10.1007/s10072-025-08730-6

Int J Biometeorol. 2026 Jan 3;70(1):4. doi: 10.1007/s00484-025-03077-1.

ABSTRACT

The aim of this study was evaluating the effect of peloidotherapy, included in the postoperative rehabilitation, on functional outcomes in patients who have undergone surgical treatment for rotator cuff tears (RCTs) and superior labrum anterior-posterior SLAP tears, and to assess the short-term clinical outcomes of the early rehabilitation protocol. The study was prospective, randomized, controlled, and single-blind. Sixty patients were sequentially enrolled and randomly divided into two groups (30 each) using a computer-generated random number table. Assessments were performed by a blinded researcher, and statistical analysis was conducted by a blinded biostatistician. Group 1 received peloidotherapy(44-45 °C), TENS, and exercise, while Group 2 received a hot pack, TENS, and exercise. Patients were evaluated using VAS, SPADI, and goniometer measurements before treatment and after. Intra-group analyses showed significant decreases in pain-activity/rest VAS, and SPADI scores, increases in all shoulder ROM measures. Between groups, flexion, abduction, and adduction differed significantly, while other shoulder movements and pain-activity/rest VAS, and SPADI scores showed no significant differences. Comparison of difference scores showed no significant changes except for adduction, which differed significantly between groups. A significant between-group difference was observed only in the number of patients achieving MCID for disability SPADI. The addition of peloidotherapy to the rehabilitation program after arthroscopic RCTs and SLAP tear repair has been shown to have similar effects to hot pack application. An early rehabilitation protocol using peloidotherapy and physiotherapy may improve upper extremity performance and quality of life by speeding up functional recovery.

PMID:41483235 | DOI:10.1007/s00484-025-03077-1

Environ Monit Assess. 2026 Jan 3;198(1):78. doi: 10.1007/s10661-025-14929-z.

ABSTRACT

Artificial neural networks (ANNs) are widely applied in air quality modelling because they can capture nonlinear interactions among pollutants and support reliable air pollutant index (API) forecasting. This study aims to identify the pollutants that most strongly influence API variability and to evaluate the performance of two merged hybrid ANN models for forecasting API in the northern region of Peninsular Malaysia. Two hybrid frameworks were developed: an ANN integrated with sensitivity analysis (ANN-SAM) to identify influential pollutants and an ANN combined with principal component analysis (ANN-PCA) to reduce dimensionality while retaining key information. Sensitivity analysis identified O₃, SO₂, PM₁₀, and PM_2.5 as the most influential pollutants, whereas PCA retained all variables except SO₂. These selected inputs were used to develop the MLP-FF-ANN-SAM and MLP-FF-ANN-PCA models. Both models achieved strong predictive performance, with R2 values ranging from 0.821 to 0.826 and RMSE values between 5.922 and 5.982. The slight improvement after removing NO₂ indicates that it contributes limited independent predictive value due to its collinearity with particulate matter. Seasonal increases in PM₁₀ and PM_2.5 during haze periods further highlight the influence of regional transboundary pollution. Using 5 years of multi-station data, this study demonstrates that merged ANN-SAM and ANN-PCA frameworks can provide accurate, efficient, and interpretable API forecasts. These findings support the development of simplified and computationally efficient tools for operational air quality assessment and early-warning applications in Malaysia.

PMID:41483234 | DOI:10.1007/s10661-025-14929-z

Eur J Nutr. 2026 Jan 3;65(1):18. doi: 10.1007/s00394-025-03868-7.

ABSTRACT

PURPOSE: Dietary patterns influence human and environmental health. Shifts toward convenience and ready-to-eat ultra-processed foods have contributed to the rising prevalence of malnutrition, chronic disease, and ecological harm. This study examined the associations between dietary patterns and diet sustainability among Portuguese adults.

METHODS: Data from 2287 individuals aged 18-84 years were obtained from the last National Food, Nutrition, and Physical Activity Survey (2015-2016). Three dietary patterns were identified based on food composition and processing: Traditional, Diet Concerns, and Unhealthy; while four dietary patterns were categorized according to food preparation location: At home by themselves, At home by relatives or friends, By food retail, and By restaurants/canteens. Diet sustainability was assessed using the Diet Sustainability Score (DSS), encompassing health-related nutritional, environmental, economic, and sociocultural dimensions. Linear regression models adjusted for sex, age, education and energy intake were used to estimate associations between dietary patterns and DSS.

RESULTS: Traditional (β = 1.27, p < 0.001) and Diet Concerns (β = 1.60, p < 0.001) patterns were significantly associated with higher DSS compared to the Unhealthy pattern. In terms of food preparation location, only the By restaurants/canteens pattern was significantly associated with lower DSS (β = – 0.76; p < 0.001) compared to the At home by themselves pattern. Younger, urban, and more educated individuals were more likely to follow the Unhealthy or the By restaurants/canteens patterns.

CONCLUSION: These findings underscore the need to consider what people eat, how and where food is prepared. Promoting traditional, minimally processed, and home-prepared meals may be essential to advancing sustainable diets, particularly among younger and urban populations.

PMID:41483233 | DOI:10.1007/s00394-025-03868-7

Int J Biometeorol. 2026 Jan 3;70(1):3. doi: 10.1007/s00484-025-03096-y.

ABSTRACT

Plant spring phenology advancements have been broadly observed, but the change in autumn phenology has varied greatly among different regions and species under global warming. Moreover, how plant phenology responds to climate change in grasslands and deserts is not well understood compared with that in forests. Here, we used long-term (2005 ~ 2020) phenological and climatic in situ observation data from six grassland and desert sites in China to analyze temporal trends in the start (SOS) and end (EOS) of the growing season for 27 herbaceous and shrub species and their responses to climatic factors. The results demonstrated that 70% of the species presented an earlier SOS and that 59% of the species presented an earlier EOS, which resulted in a shortened growing season (LOS) for 41% of the species. The LOS trends were driven by EOS trends, which had greater variation (1.2 days yr^{– 1}) than did the SOS trends (0.5 days yr^{– 1}). The significant changes in EOS were associated mainly with soil moisture in autumn for shrub species. We should be cautious in using the relationship between EOS and SOS to simulate the EOS in models because their correlation is statistically significant only for a small subset of species. This study highlights a greater variability of autumn phenological changes in grassland and desert ecosystems and reveals the critical contributions of spring daytime temperature and autumn soil moisture to phenological changes. We recommend considering the divergent autumn phenological responses to climate factors, especially soil moisture, among plant life forms and species in terrestrial ecosystem models by improving the model structure and involving species-specific parameters.

PMID:41483229 | DOI:10.1007/s00484-025-03096-y

Neurosurg Rev. 2026 Jan 2;49(1):94. doi: 10.1007/s10143-025-03993-1.

ABSTRACT

Cranioplasty (CP) is performed after decompressive craniectomy (DC), with complication rates of 15-40%. Risk factors and ideal timing for CP are unclear. This study investigates risk factors for complications after CP and the best time to perform a CP. This retrospective single-center study includes patients admitted to the neurosurgical department of the University Hospital Zurich between 01.2013 and 05.2023, who underwent a CP following a supratentorial DC. Demographics, comorbidities, indication for the DC, material used, complications, time between DC, CP and onset of complication were collected. The investigated complications are infections, bleeding, bone flap resorption or others requiring surgery. A multivariable logistic regression was performed to identify risk factors for the occurrence of complications. A Classification and Regression Tree (CART) was performed to identify the best time for CP. The result was tested with a Cox regression and a ROC analysis. Overall, 141 patients were included, of whom 39% (n=55) developed a complication. No difference in sex, age, comorbidities, DC-indication, material used was found, except for a trend for CP-time (shorter time for patients with vs without complication, 84±44 vs 102±70 days, p=0.065). In the CART analysis, day 122.5 was the best time cut-off for reducing complications (sensitivity 87%). In our case-series, we could not identify risk factors for complications after CP, except possibly for CP-timing. A longer time between DC and CP seems to be associated with less complications, with day 122.5 as the cut-off time.

PMID:41483213 | DOI:10.1007/s10143-025-03993-1

Inquiry. 2026 Jan-Dec;63:469580251410890. doi: 10.1177/00469580251410890. Epub 2026 Jan 3.

ABSTRACT

Long COVID increases healthcare utilization, yet differences in healthcare spending patterns between individuals with and without long COVID remain poorly characterized, especially at the national level. To evaluate differences in healthcare expenditures among U.S. adults with and without long COVID using nationally representative data. This cross-sectional study analyzed data from the 2022 Medical Expenditure Panel Survey (MEPS), including 16 762 unweighted adults (weighted population: 239 915 159). Healthcare spending outcomes included total expenditures and specific categories including office-based care, outpatient services, emergency room visits, hospital admissions, home healthcare, and prescription medications. A survey-weighted generalized linear model (GLM) with a log link and gamma distribution was used to estimate adjusted differences in expenditures between groups. Individuals with long COVID had significantly higher total healthcare expenditures (mean $11 567; SD $25 334) compared to those without long COVID ($7448; SD $21 734, P < .01). After adjusting for demographic characteristics, insurance status, chronic conditions, and other potential confounders, individuals with long COVID incurred 40% higher total expenditures (β = 1.40, P = .01). Expenditures were significantly elevated for office-based visits (35% higher; β = 1.35, P = .02) and outpatient services (118% higher; β = 2.18, P < .01). No significant differences were found in emergency room, hospital admissions, or dental care expenditures. Long COVID imposes a substantial financial burden on individuals and healthcare systems, primarily through increased outpatient and office-based service utilization. Understanding these spending patterns can help inform policy decisions, optimize healthcare resource allocation, and guide targeted interventions to manage long COVID more effectively.

PMID:41482843 | DOI:10.1177/00469580251410890

Echocardiography. 2026 Jan;43(1):e70385. doi: 10.1111/echo.70385.

ABSTRACT

OBJECTIVES: A novel index, termed the right ventricle (RV)-pulmonary artery (PA) index, was established by integrating the longitudinal strain of the right ventricular free wall (RVFWLS) and the right ventricular ejection fraction (RVEF), both evaluated using three-dimensional speckle-tracking echocardiography (3D-STE), with the stiffness of the pulmonary artery (PAS). This approach aims to enhance our understanding of the underlying mechanisms associated with heart failure with preserved ejection fraction (HFpEF).

METHODS: The study comprised 80 patients diagnosed with HFpEF, 60 high-risk patients without clinical heart failure (HF), and 50 healthy controls. Clinical data and pulmonary stiffness measurements were collected, and right ventricular function was evaluated using 3D-STE. Furthermore, the corresponding RV-PA coupling parameters were established. Statistical analyses were conducted using SPSS version 26.0 and R software, employing one-way ANOVA, the Kruskal-Wallis H test, Pearson and Spearman correlation coefficients, multivariable linear regression, and receiver operating characteristic (ROC) curve analysis.

RESULTS: Patients with HFpEF exhibited elevated levels of PAS, dilated right heart structures, and impaired right ventricular (RV) function when compared to both high-risk and control groups. PAS was identified as an independent risk factor for RV dysfunction. Stratified diagnostic analysis revealed that the novel coupling index, RVEF/PAS, demonstrated exceptional diagnostic performance during the initial screening phase (AUC = 0.813) and maintained robust discriminatory power during the differentiation stage of the high-risk population (AUC = 0.757). Both newly developed indices, RVEF/PAS and RVFWLS/PAS, exhibited significant positive correlations with tricuspid annular plane systolic excursion (TAPSE)/PASP (r = 0.536, p = 0.004; r = 0.449, p = 0.019). The proposed stratified diagnostic model, characterized by a “primary screening-refined discrimination” approach based on parameter characteristics, offers a novel strategy for the early detection of HFpEF.

CONCLUSIONS: The 3D-STE method reliably assesses right ventricular function in patients with HFpEF, while pulmonary arterial compliance is effectively evaluated through PAS. The novel RV-PA coupling indices, namely RVEF/PAS and RVFWLS/PAS, are developed by integrating these techniques, providing a stratified diagnostic strategy for the early detection of HFpEF. PAS is appropriate for initial screening in primary care settings, whereas RVEF/PAS offers precise diagnostic support in medical centers. Collectively, these methods establish a novel non-invasive tool system for evaluating interactions between the right heart and pulmonary vasculature.

PMID:41482835 | DOI:10.1111/echo.70385

JMIR Nurs. 2026 Jan 3. doi: 10.2196/90714. Online ahead of print.

ABSTRACT

BACKGROUND: Hospital-acquired pressure injuries (HAPIs) remain a largely preventable cause of patient injury and are often utilized as nursing-sensitive quality metrics. At a tertiary military hospital in XXXXXX, rising HAPI rates necessitated implementing a comprehensive quality improvement program in accordance with the National Database of Nursing Quality Indicators (NDNQI) guidelines. On the basis of Donabedian’s Structure-Process-Outcome model, we hypothesized that the implementation of a standardized, evidence-based pressure injury prevention bundle, accompanied by structured staff education (structure), will enhance adherence to prevention practices (process) and markedly decrease HAPI incidence and prevalence (outcomes) among hospitalized adult inpatients.

OBJECTIVE: To assess the effect of introducing a standardized, evidence-based pressure injury prevention bundle and corresponding staff education on HAPI incidence and prevalence.

METHODS: We implemented a comprehensive hospital-wide quality improvement project utilizing a pre-post methodology underpinned by Plan-Do-Study-Act (PDSA) cycles, statistical process control monitoring, and the FOCUS-PDSA framework. The strategy established a standardized preventive package for high-risk patients; it included routine risk and skin assessments, scheduled repositioning, pressure redistribution support surfaces, nutrition optimization with dietitian input, and moisture control. The primary outcomes were monthly HAPI incidence (per 1,000 patient-days), measured using wound care census and unit reporting, and quarterly HAPI prevalence, evaluated using NDNQI surveys by trained NDNQI link nurses, with >90% interrater reliability for staging.

RESULTS: In the initial deployment phase (July-December 2023), the HAPI incidence rate was 2.32 per 1,000 patient-days (267 cases/115,314 patient-days). The incidence declined to 1.44 per 1,000 patient-days (330 cases/229,647 patient-days) in 2024 (38% reduction from the baseline) and to 0.88 per 1,000 patient-days (98 cases/111,589 patient-days) by June 2025, (62% reduction from the baseline). The prevalence decreased from 5.12% in Q3 2023 to 1.38% in Q3 2024 and remained low at 1.43% in Q2 2025.

CONCLUSIONS: Implementation of a standardized prevention bundle, supported by systematic staff education, interdisciplinary collaboration, and periodic incidence and prevalence surveillance was associated with sustained reductions in HAPI incidence and prevalence over 2 years. These findings support a bundle-based approach to prevention, combined with real-time feedback and competency-driven teaching, as a scalable means of enhancing patient safety.

CLINICALTRIAL: none.

PMID:41482822 | DOI:10.2196/90714