Nevin Manimala

Int J Paediatr Dent. 2025 Oct 8. doi: 10.1111/ipd.70041. Online ahead of print.

ABSTRACT

Probiotics have demonstrated Streptococcus mutans (SM) suppression. This in vitro study compared the SM inhibition capacity of bovine infant formula supplemented with Lacticaseibacillus rhamnosus Gorbach Goldin (LGG) probiotic to a plain formulation.

METHODS: Two bovine-based infant formulas, Similac Advance Optigro (formula non-probiotic, FNP) and Enfamil Nutramigen LGG (formula with probiotic, FWP) were compared. The formulas were reconstituted at different concentrations (0.1×, 0.5×, 1×, and 2×). LGG (ATCC BAA-3227) suspensions were used as positive controls. All assays were inoculated with SM, spiral plated (n = 8) onto selective Mitis Salivarius Agar plates, and incubated at 37°C for 96 h. SM growth was enumerated in colony-forming units (CFU). Multivariate analysis of variance was performed to assess concentration-dependent effects and statistical significance (α = 0.05).

RESULTS: FWP recorded less SM growth than FNP at the 0.5×, 1.0×, and 2.0× concentrations (ANOVA p < 0.001). FWP concentration was negatively correlated to SM growth (p < 0.001, r = -0.864), whereas FNP showed strong positive trends (p < 0.001, r = 0.821). MANOVA tests confirmed that both group and concentration affect SM growth (p < 0.001).

CONCLUSION: Commercial probiotic-enriched infant formula effectively suppresses SM growth in vitro. The observed suppression of SM growth in this study provides evidence for this dietary intervention’s anticariogenic potential.

PMID:41063228 | DOI:10.1111/ipd.70041

BMC Oral Health. 2025 Oct 8;25(1):1559. doi: 10.1186/s12903-025-06871-w.

ABSTRACT

BACKGROUND: The use of sedation in the field of pediatric dentistry is becoming increasingly prevalent. While general anesthesia is perceived as a safer alternative, the appropriate use of sedatives, in conjunction with a well-trained team, can effectively mitigate the risks associated with sedation. Our study aims to identify safe drug combinations for prolonged sedation.

METHODS: This study was conducted in the Operating Room of the Faculty of Dentistry at Akdeniz University. It encompassed 126 patients, classified as ASA 1-2, aged between 3 and 12 years, who underwent dental treatment with sedation support in the Department of Pedodontics from May to December 2022. The patients were categorized into three groups: (1) Ketamine, (2) Propofol-Ketamine (PK), and (3) Dexmedetomidine-Ketamine (DK). During the procedures, vital signs, the requirement for additional doses, complications, and interventions were meticulously documented. Additionally, the Ramsay Sedation Score (RSS), dentist satisfaction during the procedure, recovery time, and Aldrete scores for the postoperative 1st and 2nd hours were also recorded.

RESULTS: There were no statistically significant differences between the groups in terms of age, gender, mean weight, and ASA. The minimum requirement for additional doses was recorded in the DK group. Respiratory depression, apnea, hypoxia, and related maneuvers were most frequently observed in the PK group. DK group had minimum requirement for airway suction event. Hypertension and tachycardia were most frequently observed in the K group, while hypotension and bradycardia were most frequently recorded in the DK group. PONV were most common in the K group in which high ketamine doses were administered. RSS was highest in the DK group. The longest recovery times were observed in the DK group. 1st hour Aldrete scores were lower in the DK group. Dentists reached the highest level of satisfaction in the DK group.

CONCLUSIONS: This retrospective study provides comparative insights into three sedation regimens for pediatric dental procedures. The dexmedetomidine-ketamine combination demonstrated superior intraoperative stability and fewer respiratory complications, though recovery was prolonged. These findings may guide clinicians in selecting appropriate sedation strategies to improve safety and procedural outcomes in cases involving shared airway management.

PMID:41063220 | DOI:10.1186/s12903-025-06871-w

Eur J Pain. 2025 Nov;29(10):e70146. doi: 10.1002/ejp.70146.

ABSTRACT

BACKGROUND AND OBJECTIVE: Chronic pain is a major global health challenge with substantial individual and societal burden. Epidemiological studies are essential for understanding the scale of the problem and identifying approaches to management. However, they reveal wide variation in reported prevalence, largely due to variations in defining and phenotyping of pain, with estimates spanning roughly 10%-50% depending on wording, recall period, severity thresholds, sampling and ascertainment mode. This paper discusses phenotyping approaches in pain epidemiology, highlighting the need for pre-specified, transparent case definitions with harmonisation to improve comparability and reproducibility across studies.

METHODS: We drew from epidemiological literature on chronic pain phenotyping, focusing on methodological approaches. Examples of successful phenotyping strategies from large cohorts and consortia were identified to illustrate scalable and reproducible methods.

RESULTS: We identified ‘broad and shallow’ versus ‘deep and narrow’ approaches to phenotyping, and how they form part of a pyramid model. We explored this further using neuropathic pain as a worked example, with reference to the International Association for the Study of Pain’s Special Interest Group on Neuropathic Pain (NeuPSIG) grading system for neuropathic pain and the Neuropathic Pain Phenotyping by International Consensus (NeuroPPIC) project, which aimed to offer a standardised and scalable phenotype suitable for epidemiological and genetic research. We also briefly reviewed other, modern approaches to phenotyping that have been developed, which combine large population samples, data integration and advanced statistical modelling, with the promise of enhanced comparability, and replication.

CONCLUSIONS: Consensus on phenotyping is needed. We have illustrated a structured, scalable approach to standardised phenotyping, supporting data integration, comparability and replication.

SIGNIFICANCE STATEMENT: This review highlights the critical importance of standardised phenotyping in chronic pain epidemiology. We introduce the pyramid model as a framework addressing key methodological gaps. Enabling scalable and reproducible phenotyping strengthens the foundation for future research and clinical translation, ultimately improving outcomes for people living with pain.

PMID:41063218 | DOI:10.1002/ejp.70146

Acta Neuropathol Commun. 2025 Sep 24;13(1):200. doi: 10.1186/s40478-025-02104-x.

ABSTRACT

Pituitary neuroendocrine tumors (PitNETs) represent the most prevalent category of neuroendocrine neoplasms. Contemporary classification paradigms emphasize transcription factor immunohistochemistry (IHC) as a cornerstone for molecular subtyping and risk stratification. However, the clinical adoption of this approach is hindered by the lack of standardized interpretative thresholds for antibody staining and limited global availability of specialized reagents, particularly in resource-limited settings. To address these challenges, we developed a semi-automated computational framework that predicts PitNET lineages directly from hematoxylin and eosin (H&E)-stained histology slides. The pipeline employs a dynamic confidence threshold: samples below this threshold undergo confirmatory IHC staining and manual pathological review, while those surpassing it are classified automatically. In prospective validation, this approach achieved a 68.9% reduction in diagnostic workload while maintaining 95.9% overall accuracy. Similar efficacy was observed in functional (74.4% workload reduction, 99.0% accuracy) and external (39.3% reduction, 95.1% accuracy) cohorts. Statistical analysis confirmed non-inferiority between semi-automated predictions and fully manual IHC-based evaluations in all the cohorts. Furthermore, we implemented a deep learning-based virtual IHC staining module, generating synthetic transcription factor images demonstrating high morphological concordance with ground-truth IHC slides. Notably, our computational analysis revealed distinct histomorphological correlates of lineages: SF1-lineage tumors exhibited homogeneous cellular architecture characterized by densely packed, compact cells with reduced cytoplasmic volume, whereas PIT1-lineage neoplasms displayed larger cells with expanded intercellular spacing and disorganized spatial arrangements.

PMID:41063205 | DOI:10.1186/s40478-025-02104-x

Trials. 2025 Oct 8;26(1):392. doi: 10.1186/s13063-025-09128-7.

ABSTRACT

BACKGROUND: After a severe acquired brain injury (sABI), individuals might experience mild-to-severe cognitive impairments. In these patients, cognitive rehabilitation is provided as early as possible, to take advantage of and guide brain plasticity. According to a restorative approach, traditional cognitive training (TCT) usually involves repeated paper-and-pencil exercises of increasing difficulty and targeting specific cognitive domains. Recently, some evidence supported the use of virtual reality (VR) for ABI rehabilitation, particularly focusing on stroke cases. Nonetheless, there is limited evidence in sABI and in different etiologies. The present multicenter randomized controlled trial aims at exploring the effectiveness, in terms of clinical-functional, neurophysiological, and biomarker changes, of a cognitive rehabilitation focused on executive functions performed by a non-immersive VR device, compared to TCT, in a cohort of patients with sABI.

METHODS: According to an a priori power analysis, 28 adult patients with sABI will be enrolled by 5 Italian neurorehabilitation units within the Fit for Medical Robotics ( https://www.fit4medrob.it/ ) Consortium. Patients will be randomly assigned to receive either 30 min of VR or TCT sessions each day throughout the trial. At study entry (T0), patients will undergo clinical-functional evaluation, neurophysiological assessments, and serum blood sampling. Thereafter, VR or TCT will be provided daily, five times per week, for 5 weeks (25 total treatment sessions). Clinical-functional and neurophysiological assessments will be repeated at the end of the treatment (T1). A follow-up evaluation will be performed after 1 month from T1 (T2). Statistical analyses will be conducted blindly, according to the intention-to-treat principle.

DISCUSSION: VR has recently been gaining popularity as a cognitive rehabilitation tool. Notwithstanding substantial evidence supporting the use of VR for ABI rehabilitation, there is limited evidence in sABI from traumatic or anoxic etiology. This multicenter pragmatic trial will provide new insights into the effectiveness of VR in sABI cognitive rehabilitation.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06474871. Registered on December 2, 2024.

PMID:41063192 | DOI:10.1186/s13063-025-09128-7

BMC Med. 2025 Oct 8;23(1):542. doi: 10.1186/s12916-025-04285-7.

ABSTRACT

BACKGROUND: A robust insomnia screening and measuring tool is essential for accurately assessing and diagnosing insomnia in research and clinical settings. The Sleep Condition Indicator (SCI) is an initial screening tool designed to assess insomnia complaints according to the DSM-5 criteria. This study aims to systematically evaluate item content, psychometric performance, diagnostic performance, and overall application of the SCI through a methodological quality assessment of original validation studies. These findings offer valuable information for optimizing insomnia diagnosis, assessment, and monitoring.

METHODS: A comprehensive search was conducted for finding studies published from 2012 to 2024, in PubMed, EMBASE, CINAHL, and MEDLINE electronic databases, and citation searching in PubMed, SCOPUS, Web of Science, and Google Scholar. Full-text articles focusing on the translation, validation, and application of the SCI were included. The psychometric studies were assessed regarding their measurement properties and methodological quality, using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. The diagnostic studies were assessed using the Standard for Reporting of Diagnostic Accuracy (STARD) guidelines. Finally, studies in which the SCI was used for assessment or screening purposes provided general information on the application of the scale.

RESULTS: We identified 285 studies with over 720,000 participants that used the SCI, and 13 language versions of the SCI were employed across at least 31 regions. The most commonly assessed measurement properties of the SCI within 19 studies were structural validity, internal consistency, criterion validity, and reliability, with findings supporting a stable two-factor structure and credible overall psychometric properties. The SCI demonstrated adequate sensitivity and specificity in 14 studies evaluating its diagnostic performance, and a cut-off value of 16 was recommended for screening insomnia. Finally, the studies showed that the SCI is widely used across clinical and non-clinical settings and provides valuable information for assessing insomnia risks.

CONCLUSIONS: The SCI includes items that align with the most current diagnostic criteria for insomnia disorder from the DSM-5. This tool demonstrates excellent psychometric performance and strong diagnostic performance. Overall, the SCI provides useful information for screening, diagnosing, and monitoring insomnia, making it a valuable tool in both research and clinical settings.

PMID:41063190 | DOI:10.1186/s12916-025-04285-7

BMC Health Serv Res. 2025 Oct 8;25(1):1324. doi: 10.1186/s12913-025-13119-4.

ABSTRACT

BACKGROUND: Efficiency in healthcare delivery is crucial for maximizing resource utilization and achieving broader health system objectives, particularly in resource-constrained settings like hard-to-reach (HTR) areas in Bangladesh. Despite people facing barriers in these areas in accessing health services, health facilities have not undergone comparative efficiency evaluations with facilities in non-hard-to-reach (non-HTR) areas.

OBJECTIVES: This study aims to comparatively assess the technical efficiency of secondary-level hospitals, as well as identify the factors contributing to inefficiencies in both HTR and non-HTR regions.

METHODS: Data for 62 secondary level hospitals (30 located in HTR and 32 located in non-HTR areas) for the year 2022 were collected from the Local Health Bulletin of the Directorate General of Health Services in Bangladesh. Geographic locations with specific characteristics, such as wetland, coastal, river island, and hilly areas, were categorized as HTR areas, using the Water and Sanitation Program report published by the World Bank in 2012. Initially, data envelopment analysis was employed with output orientation to calculate the efficiency scores using inputs (e.g., number of physicians, nurses and hospital beds) and health service outputs (e.g., maternal care, outpatient visits and inpatient admission) under both constant and variable returns to scale assumptions. Then multiple Tobit regression models were conducted to determine the associations between hospital inefficiency and HTR area characteristics.

RESULTS: The findings revealed that, on average, secondary level hospitals were 73% and 80% efficient in terms of constant returns to scale (CRS) and variable returns to scale (VRS) assumptions, respectively. Hospitals located in HTR regions were relatively less technically efficient (efficiency score = 0.76) than those in non-HTR areas (efficiency score = 0.84), and the differences were statistically significant (p-value < 0.10) when the VRS assumption was used. Similar significant differences in efficiency scores (efficiency score was 0.68 in HTR and 0.77 in non-HTR areas) were observed between these two groups of hospitals when CRS assumption was used (p-value < 0.10). According to multiple Tobit regression, the positive coefficient (Coeff = 0.258, p-value < 0.05) of the association between inefficiency scores and HTR areas implies that hospitals in HTR regions had lower efficiency scores than hospitals in non-HTR regions. Comparable patterns were identified in two additional models using characteristics of geographical locations of the hospitals. Findings revealed that hospitals located in wetland (Coeff = 0.295; p < 0.05), river island (Coeff = 0.372; p < 0.05), and hilly areas (Coeff = 0.422; p < 0.05) exhibited lower technical efficiency compared to those in plain land areas under the CRS assumption. Furthermore, the negative coefficients under CRS (Coeff = -0.004) and VRS (Coeff = -0.003) reflecting a negative association between the bed occupancy ratio (BOR) and inefficiency scores across all models. This suggests that higher BOR levels were associated with greater efficiency (p < 0.01). Results from sensitivity analysis observed no substantial differences in coefficients with the relationship between HTR characteristics and efficiency scores of the hospitals.

CONCLUSION: Hospitals in HTR regions are found to be less technically efficient than non-HTR regions in Bangladesh. Policymakers should address the underlying causes of inefficiencies, implement targeted interventions such as improving healthcare access for vulnerable populations residing in HTR regions, optimize bed occupancy rates and reduce length of stays with proper referral systems and discharge planning in these particular areas. This indicates that further research on health systems in climate-vulnerable areas in Bangladesh should be prioritized to effectively address these challenges.

PMID:41063170 | DOI:10.1186/s12913-025-13119-4

BMC Oral Health. 2025 Oct 8;25(1):1566. doi: 10.1186/s12903-025-06874-7.

ABSTRACT

BACKGROUND: Effective removal of intracanal drugs such as calcium hydroxide is important for the success of endodontic treatment and to prevent possible complications. This study aimed to evaluate the effect of modified salt solution (RISA), a new irrigation solution, in removing calcium hydroxide from artificial grooves in straight root canals.

METHODS: The root canals of 60 human maxillary central incisors were prepared using Reciproc R40 files (VDW) up to size 40/0.04, rinsed with 2 mL of 2.5% NaOCl after each pecking motion, and then the teeth were split longitudinally. A lateral groove in the apical part was prepared in each root half and filled with calcium hydroxide, the root halves were reassembled and samples were placed in Eppendorf tubes. Three groups were established according to the irrigation solutions: group 1, Etilendiamintetraacetic acid (EDTA); group 2, RISA; group 3, Citric acid. After the root canals were irrigated with the irrigation solutions in each group, irrigation activation was performed with the Ultra X ultrasonic device (1 min). The samples were removed from the Eppendorf tubes, divided into two halves, and examined under a 24× magnification microscope by the two evaluators. Statistical analysis was performed using IBM SPSS version 23. Fisher Freeman Halton Test was used to analyze categorical data (p < 0.05).

RESULTS: There is no statistically significant difference between the score values ​​of the groups (p = 0.632).

CONCLUSIONS: RISA solution was similarly effective in removing calcium hydroxide compared to EDTA and citric acid solutions in the apical region.

PMID:41063168 | DOI:10.1186/s12903-025-06874-7

Mol Cancer. 2025 Oct 8;24(1):248. doi: 10.1186/s12943-025-02409-4.

NO ABSTRACT

PMID:41063167 | DOI:10.1186/s12943-025-02409-4

JMIR Hum Factors. 2025 Oct 8;12:e67081. doi: 10.2196/67081.

ABSTRACT

BACKGROUND: The collection of dietary behavior data is crucial in childbearing populations. In addition to observed inequities in perinatal dietary intake and quality, burdensome assessment methods (eg, 24-h dietary recall) may limit research participation for some groups. Ecological momentary assessment (EMA) is associated with reduced recall bias and participant convenience, but there is a dearth of studies with diverse cohorts.

OBJECTIVE: Our aim is to describe participant completion of food intake items in EMA surveys, overall and across individual characteristics (eg, prepregnancy BMI).

METHODS: Using secondary EMA data from participants in a longitudinal study, we report average completion rates of survey items regarding dietary behavior (eg, number of meals eaten in a day) across individual demographic variables (eg, age) and combined strata (eg, race+age) during late pregnancy and throughout 12 months post partum.

RESULTS: In our analytic sample (N=310), the average completion rate was 52.4% (SD 27.8%) during pregnancy, rising to 59.1% (SD 22.0%) after giving birth. Participants who were older (>30 y), overweight before pregnancy, self-identified as White, working, or earning higher annual income (>US $50,000) had higher average completion rates than their counterparts. Examining combined strata, we found some variation in survey completion within racial groups. Black participants using a study phone had higher average completion rates during pregnancy and post partum, but this relationship was reversed for White participants.

CONCLUSIONS: Our secondary analysis showed relatively stable engagement with EMA surveys in a childbearing cohort across 15 months. Increased completion rates among privileged groups (eg, White, higher income) may demonstrate the impact of socioeconomic advantages on individual health behaviors. Investigators should consider how intersections between race and other factors (eg, employment) may impact participation and data collection.

PMID:41061268 | DOI:10.2196/67081