Nevin Manimala

Ital J Pediatr. 2025 Jun 20;51(1):196. doi: 10.1186/s13052-025-01988-8.

ABSTRACT

BACKGROUND: We aimed to compare endotracheal intubation through a laryngeal mask vs. using a direct laryngoscope in a manikin simulating a term infant.

METHODS: A randomized, controlled, crossover (AB/BA) trial of intubation through a laryngeal mask vs. a direct laryngoscope in a manikin simulating a term infant. Thirty-four tertiary neonatal intensive care unit consultants and pediatric residents who had previous experience with intubating laryngeal airway and direct laryngoscopy participated. The primary outcome measure was the success of the procedure at the first attempt. The secondary outcome measures included the total time of endotracheal tube positioning and participant’s opinion on insertion difficulty and overall difficulty.

RESULTS: Success at first attempt was 34/34 with the laryngeal mask (100%) and 26/34 with the direct laryngoscope (76%) (difference in percentage 24%, 95% confidence interval 5-41%; p = 0.008). Median time of endotracheal tube positioning was 24 s (IQR 19-30) with both devices (p = 0.86). Insertion difficulty (p = 0.96) and overall difficulty (p = 0.99) were not statistically different between the devices.

CONCLUSIONS: In a term infant manikin model, positioning the endotracheal tube through the laryngeal mask increased the success at the first attempt compared to direct laryngoscopy, without extending the duration of the procedure or affecting the perceived difficulty.

REGISTRATION: clinicaltrial.gov NCT06263790. Registered 16 February 2024, https://clinicaltrials.gov/study/NCT06263790 .

PMID:40542416 | DOI:10.1186/s13052-025-01988-8

Eur J Med Res. 2025 Jun 20;30(1):498. doi: 10.1186/s40001-025-02798-8.

ABSTRACT

BACKGROUND: Endotracheal intubation may be performed using deep anesthesia, neuromuscular blocks, or the topical application of anesthetics on the vocal cords. The null hypothesis in this study was that there is no difference in hoarseness one hour after extubation between patients receiving neuromuscular blocks versus lidocaine sprayed on the glottis for endotracheal intubation.

METHODS: A randomized, controlled, double-blinded study was conducted. A total of 114 patients were included. Group I (n = 58) received rocuronium 0.6 mg/kg. Group II (n = 56) received lidocaine spray 4 ml (20 mg/ml) on the vocal cords. The primary outcome measure was hoarseness one hour after extubation. Secondary outcomes were hoarseness at 24 and 48 h after extubation, sore throat at 1, 24, and 48 h after extubation, and intubation and extubation conditions.

RESULTS: There was no statistically significant difference between groups in hoarseness one hour after extubation. At 24 h, Group I had significantly more reported hoarseness (27.6%) and observed hoarseness (1.7%) than Group II (12.5% reported) (p = 0.03). Group II had a significantly sorer throat (21.4%) than Group I (1.7%) (p < 0.001) at one hour. Beyond this, there were no differences between groups.

CONCLUSION: Even though some differences were observed in hoarseness and sore throat 24 h after extubation, there were few differences between topical lidocaine spray and the use of neuromuscular blocks before intubation for patient-reported and observed outcomes. Consequently, clinicians should choose an approach based on considerations other than those included in this study, such as the need for muscle relaxation or minimizing the number of laryngoscopies. THE STUDY WAS PROSPECTIVELY REGISTERED AT CLINICALTRIALS.GOV : NCT05614609.

PMID:40542414 | DOI:10.1186/s40001-025-02798-8

Lipids Health Dis. 2025 Jun 20;24(1):219. doi: 10.1186/s12944-025-02640-4.

ABSTRACT

BACKGROUND: Pentadecanoic acid (C15:0) and heptadecanoic acid (C17:0) are considered to have protective effects on cardiovascular health. However, research on the relationship between C15:0 and C17:0 levels and hypertension remains limited. This cross-sectional study aims to investigate the association between serum levels of odd-chain fatty acids (C15:0 and C17:0) and prevalent hypertension.

METHODS: Data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) were used for this study. Multiple logistic regression models, restricted cubic spline (RCS) analysis, saturation threshold effect analysis, and interaction effect tests were employed to analyze the relationship between serum C15:0 and C17:0 levels and prevalent hypertension.

RESULTS: A total of 4,775 participants (C15:0 analysis group) and 4,718 participants (C17:0 analysis group) were included in this study. The prevalence of hypertension in the two groups is 46.99% and 46.82%, respectively. To improve the distribution and comparability of the data, the primary analysis used the per mille of total fatty acids (C15:0‰ and C17:0‰). After adjusting for multiple confounders, both C15:0‰ and C17:0‰ levels were significantly inversely associated with the odds of prevalent hypertension. In the fully adjusted model, an increase in C15:0‰ and C17:0‰ levels was associated with a lower odds of prevalent hypertension (C15:0‰: OR = 0.78, 95% CI: 0.66-0.93, P = 0.0063; C17:0‰: OR = 0.77, 95% CI: 0.64-0.93, P = 0.0074). Further restricted cubic splines analysis showed a significant nonlinear relationship between C15:0‰ level and prevalent hypertension. Saturation threshold effect analysis revealed that when C15:0‰ level was below 1.5‰, the inverse association with the odds of prevalent hypertension was stronger (OR = 0.42, 95% CI: 0.23-0.77, P = 0.0052), while the relationship weakened when C15:0‰ level was above 1.5‰ (OR = 0.89, 95% CI: 0.74-1.07, P = 0.2158). Interaction effect tests indicated that, in the subgroup with C15:0‰ level ≥ 1.5‰, age modified the relationship between C15:0‰ level and prevalent hypertension. In the population aged ≥ 65 years, C15:0‰ level was inversely associated with the odds of prevalent hypertension (OR = 0.54, 95% CI: 0.36-0.79, P = 0.0384), while no significant association was observed in the population aged < 65 years (OR = 0.83, 95% CI: 0.68-1.02, P = 0.1032).

CONCLUSIONS: Serum C15:0 and C17:0 levels are significantly inversely associated with the odds of prevalent hypertension, suggesting that serum C15:0 and C17:0 levels may serve as potential biomarkers for hypertension monitoring.

PMID:40542410 | DOI:10.1186/s12944-025-02640-4

Orphanet J Rare Dis. 2025 Jun 21;20(1):316. doi: 10.1186/s13023-025-03786-1.

ABSTRACT

BACKGROUND: Ataxia-telangiectasia (A-T) is an inherited multiorgan disorder with onset in childhood. Liver involvement, with steatosis and subsequent fibrosis, is increasingly recognized in children and young people with A-T.

PURPOSE: To evaluate feasibility of T1-weighted two-point mDixon MRI for identification of liver steatosis in children with A-T and conduct exploratory analysis of relationships between MRI-quantified liver fat fraction and clinical and laboratory measures.

STUDY TYPE: Post hoc analysis of prospectively collected research data.

POPULATION: 16 participants (8 female) with A-T aged 4.8-16.6 years.

FIELD STRENGTH/SEQUENCE: 3.0-T, two-point T1-weighted mDixon.

ASSESSMENT: Participants underwent whole-body MRI including T1-weighted mDixon. Water/fat signal percentage images were generated. Hepatic T1 fat fraction (T1-FF) was calculated from regions-of-interest placed in the right anterior, right posterior and left hepatic lobes. T1-FF > 5.56% was used as the diagnostic criterion for hepatic steatosis.

STATISTICAL TESTS: Group comparisons of variables between participants with and without previous diagnosis of liver steatosis were made using independent sample Mann-Whitney U. Associations between T1-FF and age, neurological severity and of liver function tests were tested with Spearman correlation. Statistical significance was pre-specified as p < 0.05.

RESULTS: Analyzable T1-weighted mDixon data was available for 11 participants. Five MRI datasets were discarded due to motion artefact (n = 3) or incorrect archiving of the original water image (n = 2). Median liver T1-FF was 11.3% (4.7-49.7%), and 10/11 (91%) of participants had evidence of steatosis. Participants with previous diagnosis of steatosis had higher T1-FF than those without (median 32.7% [9.7-49.7%], versus 10.3% [4.7-11.3%], p = 0.030). T1-FF correlated most strongly with alanine transaminase (r = 0.76, p = 0.007) and γ-glutamyltransferase (r = 0.76, p = 0.006).

CONCLUSION: T1-weighted mDixon MRI is feasible for detecting steatosis in children with A-T, although motion artefacts reduced data completeness. MRI-quantified liver T1-FF correlates with markers of liver health. We found higher prevalence of liver steatosis using T1-weighted mDIXON than previously reported in pediatric A-T cohorts.

PMID:40542396 | DOI:10.1186/s13023-025-03786-1

J Neurodev Disord. 2025 Jun 20;17(1):34. doi: 10.1186/s11689-025-09626-4.

ABSTRACT

OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder with a significant genetic component. The latest genome-wide association study (GWAS) meta-analysis of ADHD identified 27 whole-genome significant risk loci in the European population. However, genetic risk factors for ADHD are less well-characterized in the Asian population, especially for low-frequency / rare variants.

METHODS: In this study, we aimed to investigate the contributions of both common and low-frequency / rare variants to ADHD in a Hong Kong sample. Our sample comprised 279 cases and 432 controls who underwent genotyping using the Illumina Infinium Global Screening Array. We employed various analytical methods at different levels, while also leveraging multi-omics data and large-scale summary statistics to comprehensively analyze the genetic basis of ADHD.

RESULTS: We identified 41 potential genomic risk loci with a suggestive association (p < 1e^-4), pointing to 111 candidate risk genes, which were enriched for genes differentially expressed during late infancy brain development. Furthermore, tissue enrichment analysis implicated the involvement of the cerebellum. At the polygenic level, we also discovered a strong genetic correlation with resting-state functional MRI connectivity of the cerebellum involved in the attention/central executive and subcortical-cerebellum networks. In addition, an accumulation of ADHD common-variant risks found in European ancestry samples was found to be significantly associated with ADHD in the current study. In low-frequency / rare variant analyses, we discovered the correlations between ADHD and collapsing effects of rare damaging variants in TEP1, MTMR10, DBH, TBCC, and ANO1. Based on biological and functional profiles of the potential risk genes and gene sets, both common and low-frequency / rare variant analyses demonstrated that ADHD genetic risk was associated with immune processes.

CONCLUSIONS: These findings re-validate the abnormal development of the neural system in ADHD and extend the existing neuro-dysfunction hypothesis to a multi-system perspective. The current study identified convergent risk factors from common and low-frequency / rare variants, which implicates vulnerability in late-infancy brain development, affecting especially the cerebellum, and the involvement of immune processes.

PMID:40542392 | DOI:10.1186/s11689-025-09626-4

Popul Health Metr. 2025 Jun 20;23(Suppl 2):28. doi: 10.1186/s12963-025-00387-9.

ABSTRACT

BACKGROUND: Before COVID-19, knowledge on pandemic vulnerability and mortality in South Africa was largely limited to the context of HIV/AIDS. We evaluated mortality rates and risk of death, prior to and during the COVID-19 pandemic, in relation to an individual’s COVID-19 vulnerability, based on a scoring algorithm developed in South Africa.

METHODS: The analysis was undertaken using data from a health and demographic surveillance system (HDSS) in Soweto and Thembelihle, Gauteng, South Africa. Health and demographic population-based data have been collected from the HDSS area since 2018. Using indicators included in a COVID-19 Vulnerability Index, previously developed in South Africa, the current study established a composite COVID-19 vulnerability index, stratified into tertiles. The risk of death pre-COVID-19 (1 January 2018-28 February 2020) and during the COVID-19 period (1 March 2020-31 December 2021) was analysed. A Cox proportional hazard model was used to compare the risk of death between the two time periods. Statistical analyses were conducted using Stata software version 17.

RESULTS: Before COVID-19, overall mortality rates were 8.1 (95% CI 7.6-8.8), 7.0 (95% CI 6.4-7.7) and 6.1 (95% CI 5.5-6.7) per 1000 person-years in the lowest, middle, and highest tertile of vulnerability index, respectively. All cause-mortality across all tertiles more than doubled during the COVID-19 period compared to pre-COVID-19 (15.5 against 7.2). The mortality rates during the COVID-19 era were 17.1 (95% CI 16.3-18.0), 14.5 (95% CI 13.4-15. 7) and 13.7 (95% CI 12.8-14.7) per 1000 person-years in the lowest, middle, and highest tertiles, respectively. Overall, individuals in the highest tertile of COVID-19 vulnerability were at a significantly lower risk of death relative to those in the lowest tertile (aHR 0.9, 95% CI 0.8-1.0, p < 0.05). The risk of dying during the COVID-19 period for vulnerable individuals was at least double compared to the pre-COVID-19 period for each of the individual vulnerability indicators.

CONCLUSIONS: All-cause mortality during the COVID-19 era was significantly higher than the pre- COVID-19 period, with the increase observed across all vulnerability tertiles. It is important to identify vulnerable individuals and communities during the early stages of a pandemic to inform prioritisation of public health intervention.

PMID:40542376 | DOI:10.1186/s12963-025-00387-9

BMC Nurs. 2025 Jun 20;24(1):662. doi: 10.1186/s12912-025-03301-8.

ABSTRACT

BACKGROUND: Nurses’ intention to leave harms healthcare organizations and the nursing profession. Organizational productivity level that cannot be achieved without their attention to improving nurses’ loyalty with quiet firing management and nurses’ quiet quitting.

PURPOSE: This study aims to examine the relationships between nurses’ loyalty, intention to leave, quiet quitting, and quiet firing. Also, investigate the role of quiet quitting in the relation between nurses’ quiet firing, loyalty, and intention to leave.

METHODS: The study employed a cross-sectional design. Data were collected from nurses in Sohag University Hospital, Egypt. It was conducted with 482 nurses who had worked at their employing facility. Researcher used three scales; intention to leave scale, loyalty scale and quiet quitting and quiet firing scale.

RESULTS: Shows that there was a high statistically significant (P < 0.001) positive correlation between quiet quitting intention and perceived quiet firing (r = 0.460**), quiet quitting intentions and intention to leave scale (r = 0.464^**), perceived quiet firing and intention to leave scale (r = 0.450^**), while there was a statistically significant negative correlation between nurses’ loyalty and quiet quitting and quiet firing scale at (r = -0.300^**) and nurses’ loyalty and intention to leave scale at (r =-0.186^**).

CONCLUSION: The research findings concluded that there was a highly statistically significant relation between quiet quitting intentions, perceived quiet firing, nurse loyalty, and intention to leave. Also, there was a statistically significant indirect effect of perceived quiet firing on nurses’ intention to leave and perceived quiet firing on nurses’ loyalty when the perceived quiet firing acted as a mediator variable.

IMPLICATIONS FOR NURSING AND HEALTH POLICY: Policy implications to increase nurses’ loyalty by increasing nursing participation in hospital committees, promotion opportunities, implementation of professional practice models, and use of mentorship programs, to competitive compensation and career development opportunities.

PMID:40542367 | DOI:10.1186/s12912-025-03301-8

BMC Nurs. 2025 Jun 20;24(1):663. doi: 10.1186/s12912-025-03307-2.

ABSTRACT

BACKGROUND: Parenting practices are relevant in shaping children’s psychological development, and positive parenting tends to be associated with positive outcomes. These practices significantly affect adolescents’ mental health by influencing depression, suicidal behaviours, and attitudes towards suicide.

AIM: To examine the predictive role of parenting styles and depression in vulnerability to suicidal ideation among university students.

METHODS: A descriptive correlational study was conducted with 480 university students recruited using stratified multistage cluster sampling from the Faculty of Health Sciences (Medicine and Nursing), Mathematical Sciences (Engineering and Computer Science), and Human Sciences (Arts and Commerce) at Port-Said University. The instruments used for data collection included the Parenting Styles and Dimensions Questionnaire (PSDQ), Beck Depression Inventory, Morey Suicidal Ideation Scale (SUI), and a sociodemographic data sheet. Statistical analysis included Spearman correlation, non-parametric tests, and mediation analysis to explore the direct and indirect relationships.

RESULTS: Participants’ ratings ranged from moderate levels of depression (13.85 ± 7.68) to suicidal ideation (10.20 ± 5.32). In this regard, participants provided higher ratings for the scores of authoritative parenting reported by both mothers and fathers, with mean scores of 48.61 ± 10.59 and 45.96 ± 10.34, respectively. Suicidal ideation was somewhat negatively related to parenting style (p < 0.001), and there was a negative relationship between depression and the maternal parenting style (p < 0.0001). In contrast, depression was positively correlated with suicidal ideation (p < 0.01).

CONCLUSION: The study concluded that Parenting styles significantly influence university students’ mental health. Warmth combined with structure in parenting, which is authoritative parenting, is associated with lower levels of depression and suicidal ideation. These findings suggest that promoting positive parenting practices may foster students’ mental well-being.

CLINICAL TRIAL: No clinical trial.

PMID:40542345 | DOI:10.1186/s12912-025-03307-2

BMC Nurs. 2025 Jun 20;24(1):661. doi: 10.1186/s12912-025-03306-3.

ABSTRACT

BACKGROUND: As artificial intelligence (AI) becomes an integral part of healthcare, nursing practice is rapidly evolving, requiring a deeper understanding of how nurses’ attitudes toward AI influence essential competencies such as creative self-efficacy and clinical reasoning competency, both of which are crucial for delivering safe and effective patient care.

AIM: This study aimed to explore the relationship between nurses’ AI-related attitudes, creative self-efficacy, and clinical reasoning competency.

METHODS: A cross-sectional descriptive-correlational design was employed, involving a convenience sample of 380 nurses working in critical care units at a university-affiliated hospital in Egypt. Data were collected using three validated instruments: the Nurses’ Artificial Intelligence Attitudes Scale, the Creative Self-Efficacy Scale, and the Clinical Reasoning Competency Scale. Data analysis included both descriptive and inferential statistics.

RESULTS: The majority of nurses demonstrated high levels of AI-related attitudes and clinical reasoning competency, while moderate levels of creative self-efficacy were observed. A strong positive correlation was found between AI attitudes and both creative self-efficacy and clinical reasoning competency (r = 0.559 and r = 0.728, p < 0.001, respectively). Regression analysis confirmed that AI attitudes were significant predictors of both creative self-efficacy and clinical reasoning competency, explaining 37.4% and 56.5% of their variance, respectively. Additionally, educational qualifications and years of nursing experience were identified as significant factors influencing these competencies.

CONCLUSION AND IMPLICATIONS: Positive attitudes toward artificial intelligence (AI) play a crucial role in enhancing nurses’ creative self-efficacy and clinical reasoning competency. Therefore, fostering positive perceptions of AI and providing targeted training are vital to prepare nurses for AI-integrated clinical environments. Integrating AI-focused content into nursing education and promoting continuous professional development are key strategies to strengthen nurses’ readiness to engage with AI-driven healthcare. Additionally, healthcare organizations and nursing leaders should create supportive environments that encourage AI adoption while preserving the principles of patient-centered care.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40542340 | DOI:10.1186/s12912-025-03306-3

BMC Infect Dis. 2025 Jun 20;25(1):806. doi: 10.1186/s12879-025-11220-x.

ABSTRACT

BACKGROUND: There is a gap between tuberculosis (TB) infection and the onset of clinical TB disease, which makes identifying TB transmission dynamics a prominent challenge. Different reports were made on the concordance of drug-resistance profiles between the household contact and the purported index case. This study investigated the drug-resistance pattern concordance of the index-household contact pair in central Ethiopia.

METHOD: A laboratory-based cross-sectional study was conducted on Mycobacterium tuberculosis isolates identified from bacteriologically confirmed pulmonary TB patients and their household contacts (HHCs) in central Ethiopia from January to December 2023. Sputum specimens were collected from index cases and presumptive HHCs and examined using the Xpert Ultra assay, Xpert XDR assay, and Mycobacterium tuberculosis culture. Descriptive statistics were used to summarize the data.

RESULT: Among 902 TB symptoms screened HHCs of 303 index cases, 20.17% (182/902) had Presumptive TB, and 7.14% (13/182) developed active tuberculosis. In index cases, 23.52% (64 /272) showed resistance to at least one of the five first-line anti-TB drugs. The prevalence of mono-resistant to STR, INH, RIF, and PZA was: 2.20% (6 /272), 2.20% (6/272), 6.25% (17/272), and 1.47% (4/272), respectively. Any first-line anti-TB drug resistance was higher among relapse cases than new cases, at 41.67% (10/24) and 21.77% (54/248), respectively. Among the RR/MDR-TB cases tested with the Xpert MTB/XDR assay, 56.81% (25/44) cases showed resistance to INH. Among these 25 INH resistance samples, 5 had no melting point on the wild ahpc gene as well as on the ahpc gene mutant. In HHCs with positive cultures, 23.07% (3/13) displayed resistance to any first-line anti-TB medication. Only 69.23% (9/13) of HHCs had isolates that aligned with the pDST pattern of the index case for all five first-line anti-TB drugs.

CONCLUSION: Nearly one-third of the household contacts have discordant drug-resistance profiles from the index patients. This study offers compelling proof that it is not advisable to treat close contacts without DST results based on the DST results of the supposed source case. The low drug resistance rate to new oral second-line drugs in this study did not guarantee the absence of resistance to each drug.

PMID:40542339 | DOI:10.1186/s12879-025-11220-x