Nevin Manimala

Front Rehabil Sci. 2025 Feb 13;6:1419963. doi: 10.3389/fresc.2025.1419963. eCollection 2025.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has reported significant alarming aftereffects experienced by some individuals following acute sequelae of SARS-CoV-2 infection, commonly referred to as long COVID. Long COVID is a set of symptoms that remain for weeks or months, after the initial phase of COVID-19 infection is ended.

OBJECTIVE: This study protocol outlines the methodology of a systematic review followed by a meta-analysis to comprehensively assess the chronic effects of COVID-19 infection on the Indian population and determine the likely risk factors connected to the development and persistence of long COVID.

METHODOLOGY: This study will employ comprehensive search through a custom-made search strategy across significant databases (PubMed, MEDLINE etc.) and grey literature to identify related literature from January 2020 to December 2023. A systematic review and meta-analysis will be conducted to synthesize data from various studies. The data synthesis will involve a comprehensive narrative and tabular presentation of outcome data from included studies, focusing on long-term effects of COVID-19 infection in Indian population. A meta-analysis will be conducted contingent upon the availability and suitability of data. If sufficient and comparable quantitative data are identified across the included studies, statistical synthesis will be undertaken. Subgroup and sensitivity analyses will manage confounders, while MedCalc software will facilitate a meta-analysis to assess pooled data. Publication bias will be evaluated using statistical tests to ensure the integrity of the findings. In the absence of adequate data, a narrative synthesis will be performed to summarize the findings systematically and transparently.

CONCLUSION: The anticipated findings will contribute to a refined understanding of this condition and its lingering symptoms, guiding healthcare interventions and future research endeavors to mitigate the impact of long COVID in the Indian population.

PMID:40018652 | PMC:PMC11865057 | DOI:10.3389/fresc.2025.1419963

BMJ Public Health. 2024 Nov 2;2(2):e000798. doi: 10.1136/bmjph-2023-000798. eCollection 2024 Dec.

ABSTRACT

INTRODUCTION: Obesity (OB) in children remains a national epidemic. This trial targets children suffering from overweight (OW) and OB living in rural Appalachia. Rural Appalachia is fraught with unhealthy behaviours, high rates of OB, pre-diabetes and type 2 diabetes among children. Diabetes prevalence in Appalachia is nearly double that of other regions. The prevalence of Appalachian children suffering from OB and extreme obesity (EO) increases the severity of diabetes.

METHODS AND ANALYSIS: We will conduct a stratified randomised-controlled trial to evaluate Mentored Planning to be Active+Family (MPBA+F) among seventh grade children with OW/OB/EO from rural Appalachian counties. Based on the Social Cognitive Theory, MPBA+F curriculum is a self-regulation approach to physical activity (PA) developed at The Ohio State University and successfully tested for feasibility in rural Appalachian middle schools. MPBA+F (a) incorporates active skill-building activities; (b) reinforces self-regulating activities; (c) engages in individual and group PA; (d) builds the link between PA, hydration and physical health and (e) actively supports weekly PA goals. Weekly skills are incorporated into reinforcement assignments verified at the beginning the following week. The primary outcome is the average daily minutes of moderate-vigorous PA. We will stratify by sex assigned at birth and conduct intent-to-treat analysis. We use descriptive statistics to summarise cohort and group (MPBA+F or comparison) baseline characteristics and examine variable distributions. Bivariate tests examine the balance of baseline characteristics by intervention groups. Mixed-effects linear modelling will be our more primary regression strategy. A potential problem is loss of curricular integrity. Our process assessment, structured mentor training and Instructor’s Guide reduce this concern. Another concern may be the lack of reliable broadband access. Participating counties exceed 75% broadband access. Those who lose internet access may have materials mailed to their home or accessed on the study website.

ETHICS AND DISSEMINATION: This study was reviewed and approved by the American Diabetes Association Grants Review Committee (Grant number 11-22-ICTSN-30), the host institution’s Social and Behavioral Human Subjects Review Committee (Protocol 2022B0149) and is registered on ClinicalTrials.gov (Protocol NCT05758441). All data that can be shared without compromising human subject protections will be shared to an approved open data repository within six months of publication or 18 months of the conclusion of the funding period (November 2025) if the study remains unpublished. Dissemination to families and stakeholders is by project newsletters. Public presentation of findings will be shared at the Annual Appalachian Translational Research Network and local health department meetings.

TRIAL REGISTRATION NUMBER: NCT05758441.

PMID:40018636 | PMC:PMC11816420 | DOI:10.1136/bmjph-2023-000798

BMJ Public Health. 2024 Oct 13;2(2):e000945. doi: 10.1136/bmjph-2024-000945. eCollection 2024 Dec.

ABSTRACT

INTRODUCTION: Risky sexual behaviour, which puts young people at greater risk of acquiring HIV AIDS and sexually transmitted infection, is a significant public health concern all around the world. In 2020, 15% of ever reported HIV positive cases were youths in Nepal. This study aimed to estimate the prevalence of risky sexual behaviour and its associated factors among youths of Pokhara metropolitan city.

METHODOLOGY: A cross-sectional study was done. The study population was youths aged 15-24 who were currently studying in grades 11/12 or at the bachelor level. The sample size was 850, interviewed in two strata (male and female). A multistage cluster sampling technique was used. A self-administered, structured questionnaire was used to obtain information. Bivariate (χ² test) and multivariate (logistic regression) analyses were performed to assess the statistically significant relationship between the dependent and independent variables.

RESULTS: Overall, nearly a third (31%) respondents ever had sexual intercourse. Similarly, the overall prevalence of risky sexual behaviour was 18.6% (95% CI=16% to 21.2%), while the prevalence among sexually active respondents was 60% (95% CI=53.7% to 65.5%). The prevalence varied greatly among two sexes where 72% male and 31% female were involved in risky sexual behaviour. The logistic regression analysis showed that females were 72% (AOR=0.28, 95% CI=0.12 to 0.69) less likely than males and youths aged 20-24 were 72% (AOR=0.28, 95% CI=0.13 to 0.57) less likely than adolescents aged 15-19 to engage in risky sexual behaviour. Similarly, in regard to caste, Janajatis were almost six times (AOR=5.56, 95% CI=2.47 to 12.5) and Dalits/Madhesi/others were almost two times more likely to involve in risky sexual behaviour than Brahmin/Chhetri.

CONCLUSION: This study shows a significantly higher prevalence of risky sexual behaviour among adolescents, males and Janajatis than their counterparts. Hence, youths should be educated and empowered to practice safe sexual behaviour through appropriate educational and behaviour change interventions with a special focus on adolescents, males and Janajatis.

PMID:40018633 | PMC:PMC11816093 | DOI:10.1136/bmjph-2024-000945

BMJ Public Health. 2024 Aug 21;2(2):e000884. doi: 10.1136/bmjph-2023-000884. eCollection 2024 Dec.

ABSTRACT

INTRODUCTION: Cancer-related fatigue (CRF) continues to be a common problem among most patients with cancer. It is a subjective feeling of tiredness, weakness or lack of energy. CRF has a significant impact on social interactions, everyday activities and the general quality of life of patients with cancer worldwide. However, little is known about CRF in Ethiopia as well as in the current study area. Therefore, the aim of this study was to assess the prevalence and associated factors of CRF among adult patients attending oncology units at the comprehensive specialised hospitals in the Amhara regional state of Ethiopia.

METHODS: An institution-based cross-sectional study was conducted among adult patients with cancer undergoing treatment. A systematic random sampling technique was employed to select the study participants. An interviewer-administered questionnaire and participants’ medical charts were used to collect the data. The questionnaire consisted of eight subsections, including sociodemographic characteristics, behavioural characteristics, Brief Fatigue Inventory, Performance Status Scale, Oslo Social Support Status, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and clinical and medical factors. The data were entered into EpiData V.4.6 and exported into SPSS V.26 for analysis. The participants’ characteristics were compiled using descriptive statics. Bivariable and multivariable logistic regressions were used to identify associations between dependent and independent variables. Variables with a value of p<0.05 were considered statistically significant.

RESULT: A total of 326 randomly selected patients with cancer, undergoing treatment, participated in this study; the response rate was 94%. The prevalence of CRF was found to be 63.93% (95% CI 58.5% to 69.25%). Depression (adjusted OR (AOR) 1.975, 95% CI 1.009 to 3.865), poor sleep quality (AOR 3.309, 95% CI 1.057 to 10.345), poor performance status (AOR 1.983, 95% CI 1.176 to 4.70), cancer stage (AOR 3.242, 95% CI 1.016 to 10.342) and admitted patients with cancer (AOR 2.047, 95% CI 1.122 to 3.734) were associated with CRF.

CONCLUSION AND RECOMMENDATION: The prevalence of CRF was found to be high. Stage of cancer, poor sleep quality, poor performance status, depression and hospital admission were significant factors. The results show that healthcare providers should focus on risk factors as well as CRF through early screening and management.

PMID:40018631 | PMC:PMC11816097 | DOI:10.1136/bmjph-2023-000884

Cytometry B Clin Cytom. 2025 Feb 27. doi: 10.1002/cyto.b.22229. Online ahead of print.

ABSTRACT

Machine-learning (ML) models in flow cytometry have the potential to reduce error rates, increase reproducibility, and boost the efficiency of clinical labs. While numerous ML models for flow cytometry data have been proposed, few studies have described the clinical deployment of such models. Realizing the potential gains of ML models in clinical labs requires not only an accurate model but also infrastructure for automated inference, error detection, analytics and monitoring, and structured data extraction. Here, we describe an ML model for the detection of Acute Myeloid Leukemia (AML), along with the infrastructure supporting clinical implementation. Our infrastructure leverages the resilience and scalability of the cloud for model inference, a Kubernetes-based workflow system that provides model reproducibility and resource management, and a system for extracting structured diagnoses from full-text reports. We also describe our model monitoring and visualization platform, an essential element for ensuring continued model accuracy. Finally, we present a post-deployment analysis of impacts on turn-around time and compare production accuracy to the original validation statistics.

PMID:40016870 | DOI:10.1002/cyto.b.22229

Indian J Dent Res. 2025 Feb 28. doi: 10.4103/ijdr.ijdr_613_22. Online ahead of print.

ABSTRACT

AIM: To evaluate the antibacterial activity of ethanolic extracts and hydroalcoholic extracts of Mangifera indica Linn (mango) plant leaves on Streptococcus Mutans in comparison with the positive control (chlorhexidine 0.12%) and negative control (alcohol 96%).

SETTINGS AND DESIGN: Ethanolic and hydroalcoholic extracts of Mangifera indica Linn leaves were obtained by following the extraction procedure. A disc diffusion test was carried out for each group on Streptococcus Mutans.

MATERIALS AND METHODS: In brain heart infusion agar, Mangifera indica ethanol extract (MEE) and Mangifera indica hydroalcoholic extract (MHE) at 100% and 25% were applied to S. mutans cultures in comparison to the positive (chlorhexidine 0.12%) and negative (alcohol 96%) control groups. For every study group, cultures were produced using the Kirby-Bauer diffusion method, and incubating the cultures at 37°C for 24 hours.

STATISTICAL ANALYSIS USED: The data were analysed using two-way ANOVA followed by a post hoc test.

RESULT: It was found that the MHE 100% and 25% had a higher antibacterial activity of 27.8 ± 1.7 mm and 21.8 ± 1.0mm at 75 mg/ml, respectively compared to other groups. Extracts were found to have statistically significant (P ≤ 0.05) antimicrobial activity against Streptococcus Mutans.

CONCLUSION: All the six groups used in the present study showed antibacterial efficacy and were effective against Streptococcus Mutans. Chlorhexidine continues to remain the gold standard. In comparison with control groups and extracts, MHE 100% showed a maximum zone of inhibition (27.8 ± 1.7 mm at 75 mg/ml) followed by other groups with statistically significant differences. Hence the herbal alternatives proved to be an effective and safe alternative and can be used as conventional modes of treatment.

PMID:40016841 | DOI:10.4103/ijdr.ijdr_613_22

Orphanet J Rare Dis. 2025 Feb 27;20(1):90. doi: 10.1186/s13023-024-03268-w.

ABSTRACT

BACKGROUND: Achondroplasia, a disease characterized by disproportionate short stature and increased morbidity, affects daily function and quality of life over the lifetime of the individual. However, data are limited on its economic impact, especially related to healthcare resource utilization (HCRU) and associated costs. This study aimed to characterize the clinical and economic impact of achondroplasia in the US relative to matched non-achondroplasia controls stratified by pediatric and adult populations.

METHODS: This retrospective study used data from the IQVIA PharMetrics Plus national claims database from January 2008 to December 2021. Individuals diagnosed with achondroplasia (index event) between July 2008 and December 2020 were matched on age and sex (1:2 ratio) to non-achondroplasia controls. General comorbidities were evaluated in the pediatric and adult populations. All-cause HCRU and direct medical costs were determined for the 12-month post-index period; out-of-pocket (OOP) costs were also determined. Study variables were analyzed using descriptive statistics.

RESULTS: A total of 530 individuals with achondroplasia (47.7% pediatric and 52.3% adults) were matched with 1,060 controls. Individuals in the achondroplasia cohort had higher overall comorbidity burdens than controls. HCRU was higher in the achondroplasia cohort relative to controls, with outpatient visits the most frequently used resource. Inpatient visits were the primary driver of mean (SD) total costs, which were 14-fold higher than controls ($28,386 [$259,858] vs $2,031 [$5,418]) in pediatric individuals, and 4-fold higher in adults $21,579 [$58,817] vs $4,951 [$13,020]); prescriptions accounted for 4.7% and 7.4% of total costs in the pediatric and adult achondroplasia cohorts, respectively. The OOP costs were approximately 3-fold higher in both pediatric and adult individuals with achondroplasia relative to controls.

CONCLUSIONS: Individuals with achondroplasia are characterized by a higher comorbidity burden and substantially higher HCRU and related costs relative to matched controls. The results also suggest that despite high HCRU and costs, individuals with achondroplasia likely are not seen by providers early enough nor are they necessarily seen by appropriate specialists, indicating a need for improved care and disease management.

PMID:40016839 | DOI:10.1186/s13023-024-03268-w

Contracept Reprod Med. 2025 Feb 28;10(1):16. doi: 10.1186/s40834-025-00349-4.

ABSTRACT

BACKGROUND: Women with disabilities remain highly vulnerable to sexual and reproductive health problems, particularly in sub-Saharan Africa (SSA), where their sexual and reproductive rights, such as access to sexual health information and contraception, are often neglected. This study investigated the spatial patterns of the shared impact of sexual health knowledge and modern contraceptive use among women with disabilities in Africa.

METHODS: We used the most recent Demographic and Health Survey (DHS) data involving 16,157 women with disabilities from ten African countries for this study. The data were analysed using both spatial and Bayesian inference to account for the shared component model patterns between sexual health knowledge and modern contraceptive use among women with disabilities while accounting for factors unique to each outcome. Bayesian inference via the Integrated Nested Laplace Approximation (INLA) was used for implementation. Priors for shared effects ​were set as log-normal distributions, while Gaussian priors were assigned to fixed effects. Intrinsic Conditional Autoregressive (ICAR) priors modelled spatial dependencies between districts, introducing spatial autocorrelation based on shared boundaries. Penalised Complexity (PC) priors controlled precision parameters to balance model complexity.

RESULTS: The study revealed low sexual health knowledge (ranging from 3% in Nigeria to 27% in Uganda) and modern contraceptive use (ranging from 1% in DR Congo and Chad to 27% in Uganda) among women with disabilities across the countries surveyed. The spatial patterns showed diverse intra-country and inter-country disparities of sexual health knowledge and modern contraceptive use among the women, with lower shared impact observed in Mauritania, Nigeria, Uganda, Chad, and DR Congo relative to Kenya, Malawi, Mali, South Africa, and Rwanda. Factors that influence sexual health knowledge and modern contraceptive use among women with disabilities include education, marital status, place of residence, community literacy level, community socio-economic status, and age.

CONCLUSIONS AND RECOMMENDATIONS: Sexual health knowledge and modern contraceptive use among women with disabilities in Africa remain low, albeit with varied intra-country and inter-country spatial disparities. Therefore, spatial areas with low sexual health knowledge and modern contraceptive use should be given more attention when implementing measures to promote the use of modern contraceptives among women with disabilities. Promoting sexual health knowledge and modern contraceptive use among women with disabilities in Africa could significantly contribute towards the realisation of the 2030 Sustainable Development Goal agenda of “leaving no one behind”.

PMID:40016822 | DOI:10.1186/s40834-025-00349-4

Indian J Dent Res. 2025 Feb 28. doi: 10.4103/ijdr.ijdr_271_24. Online ahead of print.

ABSTRACT

BACKGROUND: Periodontal diseases necessitate adjunctive therapies alongside mechanical debridement. Spirulina platensis, recognized for its antimicrobial properties and minimal side effects, offers promise in periodontal treatment.

AIMS: This study compares the efficacy of subgingivally delivered spirulina gel with chlorhexidine (CHX) gel both clinically and microbiologically in stage III periodontitis patients.

METHODS AND MATERIALS: A randomized, controlled, single-blinded, split-mouth study was conducted with 23 subjects meeting inclusion and exclusion criteria. The participants were randomly assigned to two treatment groups: Group I (control) received scaling and root planing (SRP) followed by 1% CHX gel, and Group II (test) received SRP followed by 4% spirulina gel. Clinical parameters such as Gingival Index (GI), Modified Sulcular Bleeding Index (mSBI), and probing depth were assessed at baseline, 3rd week, and 6th week. Microbial load assessment for Porphyromonas gingivalis (P.g) was conducted using real-time qPCR at baseline and 6th week.

STATISTICAL ANALYSIS USED: Paired t-tests, repeated measures analyses of variance using SPSS software.

RESULTS: Both groups exhibited significant improvements in clinical parameters and reduced P.g load, with no significant difference between the spirulina and CHX groups.

CONCLUSION: The findings suggest that 4% spirulina gel, when delivered subgingivally can be considered a viable adjunct to non-surgical periodontal therapy, offering a natural and potentially cost-effective alternative to traditional antimicrobial agents.

PMID:40016818 | DOI:10.4103/ijdr.ijdr_271_24

Glob Health Res Policy. 2025 Feb 27;10(1):11. doi: 10.1186/s41256-024-00395-6.

ABSTRACT

BACKGROUND: Despite being included in the Millennium Development Goals (MDGs) and now the Sustainable Development Goals (SDGs), stillbirths remain overlooked with limited regional research, highlighting an ongoing gap in addressing this issue. However, a staggering 2 million stillbirths occur each year, equivalent to one every 16 s. Furthermore, approximately 98% of these stillbirths take place in developing countries, particularly in sub-Saharan Africa (SSA). In light of these statistics and the need to address the lack of data, methodological approaches, and population gaps, this study aims to assess the prevalence and determinants of stillbirths in SSA from 2016 to 2023, aligning with the SDGs.

METHODS: This study used data from the Demographic and Health Survey (DHS) conducted in SSA. The analysis included a weighted sample of 212,194 pregnancies of at least 28 weeks’ gestation collected from 2016 to 2023, using R-4.4.0 software. Descriptive data, such as frequencies, were performed. Stillbirth prevalence was visualized using a forest plot. A multilevel modeling analysis was used by considering individual-level factors and community level factors. The multilevel model was employed to account for clustering within countries and allow for the examination of both fixed and random effects that influence stillbirths. For the multivariable analysis, variables with a p value ≤ 0.2 in the bivariate analysis were considered. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) and a p value < 0.05 were reported to indicate the statistical significance and the degree of association in the final model.

RESULTS: The pooled prevalence of stillbirths was found to be 1.54% per 100 [95% CI 1.19-2.01]. Factors positively associated with stillbirths in SSA included maternal age (25-34 years, 35-49 years), marital status (married, divorced or widowed), antenatal care visits, age at first birth (before age 20), short birth intervals, long birth intervals, birth order (second or third), residence in rural areas, country income level (lower middle income), and low literacy rate. Factors negatively associated with stillbirth mortality included maternal education (primary education, secondary or higher education), wealth index (higher economic status), access to mass media, access to improved drinking water, distance to health facilities, and country income level (upper middle income).

CONCLUSIONS: Stillbirth rates fall significantly short of achieving Every Newborn Action Plan target by 2030 in SSA. The analysis of factors that affect stillbirth mortality reveals important connections. It is essential to improve maternal education, economic status, and healthcare infrastructure to decrease stillbirth rates and enhance the health outcomes of mothers and children in the region. To effectively address these risks, efforts should concentrate on increasing access to antenatal care, raising awareness, and improving socio-economic conditions. By improving access to healthcare and education, these disparities could potentially lead to a decrease in stillbirth rates in the region.

PMID:40016816 | DOI:10.1186/s41256-024-00395-6