Nevin Manimala

Spine (Phila Pa 1976). 2025 May 5. doi: 10.1097/BRS.0000000000005384. Online ahead of print.

ABSTRACT

STUDY DESIGN: Biomechanical cadaveric study.

OBJECTIVE: To evaluate whether pre-tapping reduces the risk of pedicle fractures following pedicle screw instrumentation.

SUMMARY OF BACKGROUND DATA: Pedicle screw instrumentation is the standard for rigid fixation of the thoracolumbar spine. While complications such as screw loosening and misplacement are well-documented, pedicle fractures are rare and poorly understood. Pre-tapping, a technique used during screw insertion, has been proposed to enhance fixation strength and potentially reduce the risk of fractures. However, its biomechanical effects on pedicle integrity remain unclear.

METHODS: Twenty lumbar vertebrae (L1-L5) were harvested from four cadavers. Preoperative CT scans were used to plan screw trajectories and assess bone mineral density (BMD). Each vertebra was alternately instrumented with screws using pre-tapping and non-pre-tapping techniques. Biomechanical testing measured maximum bending force to failure under a flexion moment. Pedicle fractures were classified based on CT imaging, and statistical analysis was performed to evaluate factors influencing fracture risk.

RESULTS: The maximum bending force to failure showed no significant difference between pre-tapping (103.9±47.5 Nm) and non-pre-tapping (98.1±43.4 Nm) groups (P=0.321). Pre-tapping significantly reduced maximum insertion torque (1.30±1.05 Nm vs. 2.91±2.65 Nm, P=0.025). Pedicle fill was a significant predictor of bending force (β=222.29 Nm, P=0.035), while BMD and pedicle diameter were not. Fracture patterns did not differ significantly between groups (P=0.384).

CONCLUSION: Pre-tapping does not significantly influence the biomechanical stability of pedicle screws or the risk of pedicle fractures under flexion moments. However, pedicle fill is a critical factor in screw fixation strength. These findings suggest that optimizing pedicle fill is more relevant than pre-tapping in enhancing construct stability.

PMID:40325503 | DOI:10.1097/BRS.0000000000005384

Spec Care Dentist. 2025 Apr;45(3):e70038. doi: 10.1111/scd.70038.

ABSTRACT

INTRODUCTION: Children with special health care needs (CSHCN) rely heavily on their caregivers. Therefore, caregivers must possess adequate oral health knowledge, attitudes, and practices (KAP) to maintain the oral health of CSHCN.

OBJECTIVES: To assess caregivers’ oral health KAP toward CSHCN.

METHODS: A cross-sectional study using convenience sampling was conducted. Data from 295 caregivers attending support group meetings in Harare Province were analyzed using STATA, with p < 0.05 considered statistically significant.

RESULTS: Most caregivers were aged 31-40, with cerebral palsy being the most common disability. Caregivers’ oral health knowledge and practices were satisfactory, while their attitudes were good. Significant associations were found between caregivers’ oral health knowledge and educational level (p = 0.001), and between oral health attitude and both educational level and employment status (p = 0.001, p = 0.003, respectively).

CONCLUSIONS: Caregivers generally had a positive attitude. However, their knowledge about oral health and their practical application of this knowledge was fair. This could be due to a lack of sufficient information or skills to effectively implement good oral health practices.

PMID:40325495 | DOI:10.1111/scd.70038

Trop Med Health. 2025 May 6;53(1):65. doi: 10.1186/s41182-025-00743-3.

ABSTRACT

BACKGROUND: Hypertension (HPT) and diabetes mellitus (DM) are major contributors to morbidity and mortality in Ghana. A key challenge in managing these conditions is non-adherence to follow-up visits, commonly referred to as “lost- to- follow-up” (LTFU). Data from the National Health Insurance Authority (NHIA) between 2017 and 2019 revealed that 37% (232,442/634,981) of patients were LTFU at NHIA-accredited health facilities. This study aimed to investigate the factors driving this high LTFU rate in Ghana.

METHODS: A total of 480 hypertensive and diabetic patients, randomly selected from the NHIA electronic claims database from facilities in the Greater Accra and Ashanti regions between 2019 and 2020, were interviewed. Participants were divided into two groups: LTFU, which consisted of only one visit (351, 73%), and follow-up (FU), which consisted of more than one visit (129, 27%). The sample included patients diagnosed with hypertension only (308, 64%), diabetes only (45, 9%), and both hypertension and diabetes (127, 26%).

RESULTS: No statistically significant socioeconomic differences were observed between the LTFU and FU groups, except in their adherence to follow-up visits. The likelihood of LTFU was higher among patients without follow-up awareness (OR = 2.5, 95% CI: 1.05-4.83), those who felt stigmatized (OR = 15.51, 95% CI: 1.01-238.90), those who attended facilities where physicians were available only some of the time (OR = 7.37, 95% CI: 1.07-50.61), those attending facilities without the necessary diagnostic equipment, those who described the NHIS coverage for DM diagnostic tests as inadequate, and those receiving traditional or herbal treatments (OR = 16.90, 95% CI: 3.12-91.45). Conversely, patients from the Ashanti Region (OR = 0.58, 95% CI: 0.35-0.96), those educated on diagnostic procedures (OR = 0.28, 95% CI: 0.08-0.98), and those whose treatment was not under control (OR = 0.04, 95% CI: 0.00-0.69) were less likely to be LTFU. Additionally, patients diagnosed more than ten years ago (OR = 0.44, 95% CI: 0.24-0.79) and those who were neutral about establishing support groups were less likely to be LTFU.

CONCLUSIONS: The study found that lack of follow-up awareness, stigmatization, and preference for traditional or herbal treatments are key drivers of lost-to-follow-up behavior among hypertension and diabetes patients. Thus, remedial policies should include increasing patient education on the importance of follow-up visits, ensuring the availability of essential medications, diagnostic equipment, and physicians, expanding the NHIA financial coverage, and integrating traditional medicine into standard healthcare to improve treatment adherence and reduce LTFU rates.

PMID:40325488 | DOI:10.1186/s41182-025-00743-3

Malar J. 2025 May 5;24(1):142. doi: 10.1186/s12936-025-05383-w.

ABSTRACT

BACKGROUND: Malaria is a major public health problem in Nigeria. This study set out to ascertain Nigerian nurses’ knowledge and willingness to recommend malaria vaccination to caregivers of under-5 children.

METHODS: This was a cross-sectional study carried out among nurses from all six geopolitical zones of Nigeria. A pretested semi-structured questionnaire was used to collect data on participants’ demographics, their knowledge of the RTS S/AS01 and R21 Matrix M malaria vaccines, how they obtain malaria vaccine-related information, and the factors that the nurses consider when recommending any malaria vaccine. Univariate association between each of the demographics characteristics and the key research variables: knowledge of the vaccine and willingness to recommend was used. This was examined using the Chi-Square test and multiple logistic regression.

RESULTS: The study found that nearly two out of every three nurses had poor knowledge and perception of the vaccines (p < 0.05). Awareness of the malaria vaccine was the only factor that was found to be associated with their knowledge (p <0.05). The odds of willingness to promote the vaccine were about 21 times higher among nurses with high perceptions of efficacy than their counterparts who have low perceptions.

CONCLUSIONS: The findings highlight major gaps in Nigerian nursing’s knowledge and awareness of malaria vaccinations, as well as their willingness to recommend the vaccine to parents. Addressing these gaps will enable nurses to play a critical role in the successful implementation of malaria immunization campaigns, lowering the illness burden among vulnerable populations.

PMID:40325474 | DOI:10.1186/s12936-025-05383-w

BMC Public Health. 2025 May 5;25(1):1652. doi: 10.1186/s12889-025-22684-6.

ABSTRACT

BACKGROUND: School bullying has negative impacts on the overall health of children and adolescents, but the association between bullying and oral health-related quality of life (OHRQoL) is still unclear.

METHODS: In this study, a two-wave prospective design was used to collect data in Yunnan Province, southwest China. A total of 5,346 children and adolescents aged 10-17 years were included in the study through two-stage randomized cluster sampling. Univariate and multivariate logistic regression models were employed to assess the sequential associations between baseline bullying and the subsequent OHRQoL. Stratified analyses were further performed to evaluate the effect modification by important demographic variables.

RESULTS: The prevalence of school bullying was 16.40%. After adjustment, bullying involvement at baseline was associated with increased odds of subsequent poor OHRQoL (odds ratio, OR: 1.77, 95% CI: 1.50-2.11). Victims and bully-victims were seen significantly deteriorated OHRQoL, with ORs of 1.81 (95% CI: 1.50-2.19) and 2.10 (95% CI: 1.35-3.33). For different types of bullying victimization, only verbal victimization displayed a significant association with OHRQoL (OR: 2.07; 95% CI: 1.63-2.65). Bullying involvement was significantly associated with all four subdomains of OHRQoL, particularly for social well-being (OR: 1.91, 95% CI: 1.60-2.27). Stratified analyses revealed prominent effect modification by age, sex, ethnicity, and left-behind status in bullying-OHRQoL association.

CONCLUSION: Our findings suggest that children and adolescents who experienced school bullying had a significantly higher risk of subsequently poor OHRQoL, particularly for verbal victims. Targeted interventions should be designed and implemented.

PMID:40325468 | DOI:10.1186/s12889-025-22684-6

Int J Health Geogr. 2025 May 5;24(1):11. doi: 10.1186/s12942-025-00396-9.

ABSTRACT

BACKGROUND: Accessibility to community pharmacies is crucial for ensuring timely access to medications and essential health services. While accessibility to community pharmacies is critical, disparities driven by temporal and spatial factors persist, resulting in inequities in healthcare access. This study aims to comprehensively assess spatiotemporal and multimodal accessibility to community pharmacies in Lisbon, highlighting the influence of transport modes and time of day on accessibility disparities.

DATA AND METHODS: The study employed a methodology that considered five daily time slots and two modes of transport-walking and public transport-to evaluate accessibility to community pharmacies. Data was sourced from road and pedestrian networks, Google API, and GTFS data. Descriptive statistics and spatial analysis were utilized to assess travel time and accessibility disparities across different regions of Lisbon. The analysis focused on both the percentage of residents able to access pharmacies within 10 min and the total number of pharmacies accessible.

RESULTS: ndings reveal significant temporal variations in accessibility, with public transport consistently improving access compared to walking. Accessibility peaks in the evening (6-7 PM), when 83.3% of residential buildings are within a 10-min walking distance of a pharmacy, and 92.7% are reachable by public transport. In contrast, early morning hours (4-5 AM) show the lowest accessibility, with only 8.9% of buildings accessible by walking and 16.1% by public transport. During the daytime (8-9 AM), notable disparities emerge across the city: public transport enhances access in the southwest, northwest, and central areas, while limited pharmacy opening hours constrain accessibility in the north and southeast, where only 108 of 258 pharmacies are operational. Finally, travel time to pharmacy services for city residents highlight significant spatial and temporal disparities in pharmacy accessibility, emphasizing the role of transport modes and service hours in shaping urban healthcare access.

CONCLUSIONS: This study underscores the importance of addressing both temporal and spatial factors to ensure equitable accessibility to community pharmacies. The findings suggest the need for targeted policies to improve public transport services during off-peak hours and to extend pharmacy operating hours. Future research should focus on comparative studies across different urban contexts and incorporate more granular data to better understand accessibility to urban services.

PMID:40325464 | DOI:10.1186/s12942-025-00396-9

Clin Epigenetics. 2025 May 5;17(1):75. doi: 10.1186/s13148-025-01875-3.

ABSTRACT

BACKGROUND: Thromboembolism is one of the most prevalent cardiovascular conditions affecting the elder population. The associations between epigenetic aging and thromboembolism risks remain incompletely elucidated. Through Mendelian randomization (MR), this research seeks to assess the causal links between genetically determined epigenetic aging factors and thromboembolism.

RESULTS: Genetic variants were extracted from genome-wide association studies (GWAS) under stringent threshold as instrumental variables (IVs). Bi-directional two-sample MR analyses were conducted to determine the direction of causal associations. We employed the inverse variance weighted (IVW), weighted median, weighted mode and MR Egger to estimate the causal effect, with sensitivity analyses such as Cochran’s Q tests, MR-PRESSO and leave-one-out performed to avoid potential heterogeneity and pleiotropy. Our MR analysis revealed a causal association between intrinsic epigenetic age acceleration and deep vein thrombosis of lower extremities (IVW: OR 0.963, 95% CI 0.934-0.992, P = 0.014), and between the genetically determined levels of plasminogen activator inhibitor-1 and other arterial embolism and thrombosis (IVW: OR 1.000, 95% CI 1.000-1.0005, P = 0.029). Causality was also identified between the genetically predicted levels of FGF23 and other arterial embolism and thrombosis (IVW: OR: 1.661, 95% CI 1.051-2.624, P = 0.029) and arterial embolism and thrombosis of lower extremity artery (IVW: OR 1.68, 95% CI 1.031-2.725, P = 0.037). Moreover, bi-directional MR showed reverse effects between portal vein thrombosis and PhenoAge (IVW: OR 0.871, 95% CI 0.765-0.992, P = 0.037) and between venous thromboembolism and GrimAge (IVW: OR 1.186, 95% CI 1.048-1.341, P = 0.007). Sensitivity analysis using Cochran’s Q tests, MR-PRESSO and leave-one-out excluded the influence of heterogeneity, horizontal pleiotropy, and outliers.

CONCLUSION: Our results identified a causal association between genetically predicted epigenetic aging factors and thromboembolism. The findings highlight the necessity for further exploration into the underlying etiology of thromboembolism.

PMID:40325450 | DOI:10.1186/s13148-025-01875-3

BMC Med Educ. 2025 May 5;25(1):652. doi: 10.1186/s12909-025-07224-5.

ABSTRACT

INTRODUCTION: Pharmaceutical care (PC) is a pharmacist’s responsibility, and its provision of medication-related care is meant to improve patients’ quality of life. The future of PC is in the hands of graduating pharmacy students (GPS). Good knowledge and a positive attitude toward providing PC is essential among pharmacy students. In addition, identifying and resolving perceived barriers is crucial for PC.

METHOD: A Cross-sectional study was conducted among GPS using a single-stage cluster sampling technique in North West, Ethiopia. A self-administered questionnaire was used to measure knowledge, attitude, and perceived barriers of GPS toward PC provision. The data that passed the quality check were entered and analyzed using Statically Package for Social Science version 27.0. Kruskal-Wallis H test and Mann-Whitney U test were performed to assess the difference in PC knowledge and attitude, and P-value < 0.05 was used to declare statistically significant difference.

RESULT: Overall, 140 GPS participated, giving a response rate of 90.3%, and the mean (± SD) age was 23.72 ± 2.87 years. Overall, 122 (87.1%) and 54 (38.6%) GPS have good PC knowledge and positive attitudes toward provision of PC, respectively. Half of the GPS perceived that lack of therapeutics knowledge prevents them from providing PC. Statistically significant differences were observed in PC knowledge and attitude based on institution, education level before joining the program, source of motivation, previous incomplete grades, and participation in extracurricular activities.

CONCLUSION: Graduating pharmacy students’ knowledge on PC is adequate. But only less than half of the GPS have a positive attitude toward the provision of PC. Identifying barriers and tackling them is crucial to improve practitioners’ attitude and the PC provision service. Promoting inclusive health policies on PC can improve the PC provision.

PMID:40325444 | DOI:10.1186/s12909-025-07224-5

Microb Cell Fact. 2025 May 5;24(1):98. doi: 10.1186/s12934-025-02706-z.

ABSTRACT

BACKGROUND: Alkaline proteases are useful enzymes for various industrial applications as bio-additives in detergents and in the recovery of silver from used X-ray films. Therefore, many strategies were used to increase enzyme production and reduce production costs by using microbial cultures, using agro-industrial waste, and improving growth conditions via statistical methods. The enzyme kinetics and thermodynamics were studied as well as its ability to recover silver was also evaluated.

RESULTS: An alkaline protease suitable for industrial applications was produced by Bacillus licheniformis strain-MA1. The ability of B. licheniformis strain-MA1 to produce protease was optimized using multi-factorial designs (Plackett-Burman and Box-Behnken). Optimization process improved enzyme production by 9.6-fold over that obtained from the original medium. Highest alkaline protease production was reached after 72 h at pH 7.0, 35 °C, and 150 rpm. The protease was maximally active at 50 °C and pH 9.0 with high thermal and pH stability. The protease showed high catalytic efficiency and high affinity toward substrate with low activation energy (Ea). In addition, the thermodynamic parameters of protease enzyme (enthalpy, free energy, and entropy) were also investigated and showed its superior thermal stability. At 70 °C the thermal deactivation constant (kd) was 4.75-fold higher than that at 50 °C. The higher t_0.5, D-values, and activation energy for thermal denaturation (Ed) of the protease indicated its higher thermal stability and thus its potential application in industrial processes. The compatibility of the protease with laundry detergents at 40 °C was higher than at 50 °C. In the presence of EDTA, the protease enzyme retained 93.6% of its activity. Furthermore, the crude enzyme successfully hydrolyzed the gelatin layer from X-ray films waste after 1 h enabling recycling and reuse.

CONCLUSIONS: Stable alkaline protease from B. licheniformis strain-MA1 was suitable for some industrial aspects as a bio-additive in detergents and capable of recovering silver from used X-ray.

PMID:40325442 | DOI:10.1186/s12934-025-02706-z

BMC Complement Med Ther. 2025 May 5;25(1):163. doi: 10.1186/s12906-025-04899-7.

ABSTRACT

BACKGROUND: Cerebral ischemia-reperfusion injury (CIRI) is a complex pathological process, which can further aggravate the damage of ischemic tissues. Traditional Chinese medicine (TCM) monomers, bioactive compounds extracted from Chinese herbal medicines, have been demonstrated to have various protective effects against reperfusion injury. This network meta-analysis (NMA) aimed to investigate the optimal treatment strategy of TCM monomers for CIRI in animal models.

METHODS: Four databases including PubMed, Embase, Web of Science, and Cochrane were searched up to January 06, 2024. First, prospective registration was done at PROSPERO (ID: CRD42024496289), the quality of the included studies was evaluated with SYRCLE’s risk of bias tool, and statistical analysis was conducted with Stata Version 18.0 and RStudio.

RESULTS: In total, 26 studies were included, involving 506 animals and 12 TCM monomers. The results of a meta-analysis demonstrated that, compared to the control group, puerarin, paeoniflorin, hydroxysafflor yellow A, sinomenine, and salvianolic acid significantly reduced mNSS scores. Furthermore, ginsenoside, scutellarin, and baicalein significantly reduced Longa scores. In addition, salvianolic acid treatment significantly decreased brain water content. Regarding infarct volume, bilobalide, baicalein and puerarin all demonstrated remarkable effects. The network meta-analysis suggested that paeoniflorin might be the most effective intervention in terms of mNSS score, with a surface under the cumulative ranking curve (SUCRA) value of 92.8%; Scutellarin might be the most effective intervention to reduce Longa score (SUCRA = 87.6%); And salvianolic acid might be the most effective intervention to reduce brain water content (SUCRA = 98.2%); For infarct volume specifically, bilobalide may be the most effective intervention (SUCRA = 95.5%). In our meta-regression, we found that dose and duration of treatment may contribute to heterogeneity among mNSS studies.

CONCLUSION: TCM monomers could provide a favorable neuroprotection on CIRI, with heterogeneous protective effects. Given the small number and the differences in quality of included studies, more high-quality, programmatic animal studies were needed to validate our findings.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40325432 | DOI:10.1186/s12906-025-04899-7