Nevin Manimala

Acta Paediatr. 2026 Feb 13. doi: 10.1111/apa.70456. Online ahead of print.

ABSTRACT

AIM: Tuberculosis (TB) among refugee minors in low-incidence countries remains underexplored. We estimated the incidence of TB disease among refugee minors compared to Danish-born minors.

METHODS: This nationwide prospective historical cohort study included 31 172 refugee minors (< 18 years) granted residency in Denmark from 1993 to 2015. Each was matched 1:6 with a Danish-born control on age and sex. Follow-up extended from the date of residency until the earliest of: TB diagnosis, the age of 21 years, or study-end (31.12.2015). Data were obtained from Statistics Denmark and the International Reference Laboratory of Mycobacteriology. We conducted descriptive analyses and estimated incidence rates (IRs) using Poisson regression.

RESULTS: Refugee minors had a 48 times higher TB IR compared to their Danish-born peers. Notably, refugee minors from sub-Saharan Africa had an IR of 203 per 100 000 person-years. For both refugee minors and their Danish-born peers, pulmonary TB was the most common form, but still more than a third had extrapulmonary manifestations. Among refugee minors, most TB cases were diagnosed more than 2 years after arrival.

CONCLUSION: Our findings underscore the need for national policies and clinical guidelines for TB screening of all refugee minors upon arrival to reduce morbidity and advance TB elimination efforts.

PMID:41689350 | DOI:10.1111/apa.70456

Nurs Health Sci. 2026 Mar;28(1):e70310. doi: 10.1111/nhs.70310.

ABSTRACT

Clinical education plays a crucial role in nursing students’ learning process, where they apply theoretical knowledge and develop their professional identities. However, experiences of incivility encountered during this process can negatively impact students’ psychological well-being, academic performance, and professional motivation. This study explored incivility among Turkish nursing students and examined the potential consequences. A descriptive qualitative study design was used. This descriptive qualitative study was conducted between 11.03.2025 and 30.03.2025, involving 19 nursing students from the nursing program at a state university in Turkey. Data were collected through face-to-face interviews, and thematic analysis was employed to analyze the data. The data analysis yielded four primary themes and five subthemes: (I) Types of Incivility, (II) Effects of Incivility, (III) Coping Strategies, and (IV) Solutions and Suggestions. The experience of uncivil behavior during clinical practice significantly affected students’ academic performance and professional career development. Beyond documenting experiences of incivility, the findings demonstrate how repeated low-intensity uncivil behaviors cumulatively undermine nursing students’ professional identity development, learning engagement, and willingness to provide holistic patient care.

PMID:41689345 | DOI:10.1111/nhs.70310

J Clin Ultrasound. 2026 Feb 13. doi: 10.1002/jcu.70198. Online ahead of print.

ABSTRACT

BACKGROUND: Hepatocellular carcinoma (HCC) at the early stage frequently evades detection. Aberrant expression of miR-1233 has been reported in various malignancies, yet its level and potential clinical value in HCC remain unknown.

OBJECTIVE: This study evaluated miR-1233 expression and potential diagnostic performance in HCC patients.

MATERIALS AND METHODS: This prospective study enrolled 100 individuals with benign hepatic tumors and 120 cases with HCC. They all underwent dual-source CT imaging and were confirmed pathologically. The miR-1233 level was quantified by qRT-PCR. The multivariate logistic regression analysis was employed to identify the underlying risk factors of HCC. Pearson correlation analysis was carried out to assess the association of miR-1233 with alpha fetoprotein (AFP) or des-gamma-carboxy prothrombin (DCP). After statistical analysis in SPSS, ROC curves were generated for significantly different miR-1233, dual-CT parameters, and the combination to compare their diagnostic performance in distinguishing HCC patients.

RESULTS: Serum miR-1233 was up-regulated in HCC patients. The expression pattern of miR-1233 showed positive correlation to AFP and DCP indicators. In ROC curve of miR-1233, AUC reached 0.821, with a sensitivity of 73.33% and specificity of 76.67%. Combined with the differential dual-CT parameters, the AUC reached 0.944, with both sensitivity and specificity exceeding 90%.

CONCLUSION: Serum miR-1233 was significantly up-regulated in HCC patients. The diagnostic efficacy of miR-1233 combined with dual-source CT was superior to that of the single one in recognizing HCC individuals.

PMID:41689344 | DOI:10.1002/jcu.70198

J Coll Physicians Surg Pak. 2026 Feb;36(2):277-279. doi: 10.29271/jcpsp.2026.02.277.

ABSTRACT

Suicide among medical students is a serious issue. To understand the pattern and risk factors associated with medical students’ deaths by suicide, a Google search was conducted for news reports in the last 10 years (2013-2023) using the keywords: medical students, suicide, death by suicide, medical student suicide, and Pakistan. Over this decade, 12 medical student suicides were reported, of which two were excluded. Among the remaining 10 suicide cases, eight were males, and two were females (male-to-female ratio was 4:1). Most of the victims (n = 7, 70%) were in their clinical years of study. The most frequently used method of suicide was hanging (n = 3, 30%), followed by firearms (n = 2, 20%), jumping in front of trains (n = 2, 20%), and drug overdose (n = 1,10%). Academic failure was reported as the most common precipitating factor. Suicide among medical students is an urgent issue that requires a multi-layered preventive strategy, including improved mental health support to medical students. Key Words: Medical students, Pakistan, Suicide, Mental health.

PMID:41689334 | DOI:10.29271/jcpsp.2026.02.277

J Coll Physicians Surg Pak. 2026 Feb;36(2):271-273. doi: 10.29271/jcpsp.2026.02.271.

ABSTRACT

This study aimed to investigate the potential educational applications of teacher-made mind maps for students. This quasi-experimental study employed a single-group pre-test, post-test design and was conducted from September 2022 to April 2024. Fifty-five medical students studying symptomatology, who were willing to participate, were recruited. The effectiveness of teacher-made mind maps was assessed based on changes in two test scores, and students’ perceptions were evaluated using questionnaires. The difference between pre-test and post-test scores in two tests was statistically significant (p <0.001), and the majority of students provided favourable feedback. Teacher-made mind maps were effective in improving students’ academic performance, were well received by students, and are recommended for use in student teaching. Key Words: Mind map, Perception, Motivation, Academic performance, Medical education.

PMID:41689332 | DOI:10.29271/jcpsp.2026.02.271

J Coll Physicians Surg Pak. 2026 Feb;36(2):253-257. doi: 10.29271/jcpsp.2026.02.253.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness and safety of duodenum suspension in the laparoscopic treatment of congenital duodenal obstruction (CDO).

STUDY DESIGN: A descriptive study. Place and Duration of the Study: Department of Paediatric Surgery, Ganzhou Maternal and Child Healthcare Hospital, Ganzhou, China, from January 2015 to December 2024.

METHODOLOGY: Patients who underwent surgery for duodenal obstruction were categorised into three groups: open repair (OP), laparoscopic repair (LA), and laparoscopy with duodenal suspension (Sus-LA). Patients with severe malformations or age >1 month were excluded. Demographics, comorbidities, intraoperative and postoperative data, and outcome parameters were evaluated. Descriptive statistics were employed to summarise the distribution of continuous variables, with normally distributed data presented as mean ± standard deviation and skewed data as median (interquartile range). ANOVA, Welch’s t-test, Bonferroni post hoc comparison, and Fisher’s exact test were used for pairwise comparisons.

RESULTS: Thirty-eight patients were included, with no significant differences in gender, age, weight, gestational weeks, obstruction aetiologies, and comorbidities among the groups (p >0.05). Operating time was shorter in the Sus-LA group [120.0, (48) minutes] compared to the LA group [(176.5, (75) minutes, p = 0.001)], but did not differ from the OP group [85.0, (31) minutes; p = 0.055]. Time to feed initiation was shorter in the Sus-LA group [4.0, (3) days] than the OP group [7.5, (4) days; p = 0.033], with no difference between the OP and LA groups [p >0.99]. The length of hospital stay differed significantly among the groups [23.0 (8), 24.0 (15), and 18.0 (8) days, respectively, (p = 0.036)]. Complications occurred in 13 (34.2%) patients, with lower frequencies in the Sus-LA group (7.7%) than the OP group (55.6%; p = 0.024).

CONCLUSION: Duodenal suspension in the laparoscopic treatment of neonatal duodenal obstruction is a manoeuvre that facilitates the surgical procedure and is associated with reduced surgical difficulty, shorter operative time, and decreased postoperative complications.

KEY WORDS: Neonate, Duodenal obstruction, Duodenum suspension, Laparoscopy, Complications.

PMID:41689328 | DOI:10.29271/jcpsp.2026.02.253

J Coll Physicians Surg Pak. 2026 Feb;36(2):248-252. doi: 10.29271/jcpsp.2026.02.248.

ABSTRACT

OBJECTIVE: To compare the effects of intermittent classical blood cardioplegia and single-dose modified Del Nido cardioplegia on postoperative serum lactate levels and extubation time in patients undergoing coronary artery bypass grafts (CABG).

STUDY DESIGN: An observational study. Place and Duration of the Study: Department of Cardiovascular Surgery, Faculty of Medicine, Kastamonu University, Kastamonu, Turkiye, from 2020 to September 2023.

METHODOLOGY: Forty patients who underwent CABG between 2020 and 2023 were randomly divided into two groups. Group 1 formed 20 patients who received intermittent classical blood cardioplegia, and Group 2 formed 20 patients who received single-dose modified Del Nido cardioplegia. Demographic data, bypassed vessels, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, postoperative drainage, inotrope required and extubation time, glomerular filtration rate (GFR), and serum lactate levels were recorded 2 hours after surgery. The Shapiro-Wilk test was utilised to evaluate the normality of data distribution. The Mann-Whitney U test was employed for variables that did not follow a normal distribution, whereas normally distributed variables were analysed using the independent samples t-test. Additionally, the chi-square test was applied to compare categorical variables across groups.

RESULTS: No statistically significant differences were detected between the groups with respect to demographic data, ACC time, CPB time, bypassed vessels, postoperative drainage, inotrope requirement, or GFR. Postoperatively, lactate levels were statistically lower in Group 2 than in Group 1, and extubation time was statistically shorter in Group 2 than in Group 1 (p <0.001).

CONCLUSION: Modified Del Nido cardioplegia reduces postoperative lactate levels and extubation time. Therefore, modified Del Nido cardioplegia provides better patient stability and myocardial protection than the classical blood cardioplegia after CABG.

KEY WORDS: Atherosclerosis, Coronary artery bypass grafting, Mortality.

PMID:41689327 | DOI:10.29271/jcpsp.2026.02.248

J Coll Physicians Surg Pak. 2026 Feb;36(2):240-247. doi: 10.29271/jcpsp.2026.02.240.

ABSTRACT

OBJECTIVE: To identify the motivational factors and barriers influencing undergraduate (UG) research in a dental college in Pakistan from students’ perspectives using semi-structured interviews.

STUDY DESIGN: A qualitative phenomenological study. Place and Duration of the Study: Nishtar Institute of Dentistry, Multan, Pakistan, from October 2022 to October 2023.

METHODOLOGY: A validated, modified, and pilot-tested Vodopivec questionnaire was distributed among 67 consenting final-year BDS students as a pre-test to assess their knowledge of research. The pre-test results were calculated manually. Based on these results, a study sample of 20 students was selected: 10 students with the top scores and 10 students with the bottom scores. Semi-structured interviews were conducted with these students until data saturation was achieved. Thematic analysis was performed using NVivo software.

RESULTS: Twelve themes were identified by students, including both research barriers and promoting factors. Each theme comprised several subthemes. The major themes included the poor status of UG research, lack of institutional vision, and insufficient funding. Subthemes included no research-related coursework, favouritism by teachers, and inadequate laboratory infrastructure with untrained research faculty. The incorporation of research projects into the community dentistry subject was suggested in the final year BDS programme.

CONCLUSION: There is a suboptimal status of UG research in public-sector dental colleges in Pakistan, with few motivational factors and numerous barriers.

KEY WORDS: Undergraduate research, Motivational factors, Barriers, Curriculum, Dentistry.

PMID:41689326 | DOI:10.29271/jcpsp.2026.02.240

J Coll Physicians Surg Pak. 2026 Feb;36(2):233-239. doi: 10.29271/jcpsp.2026.02.233.

ABSTRACT

This meta-analysis aimed to compare the efficacy and safety of Diode laser haemorrhoidoplasty (DLH) with conventional haemorrhoidectomy (CH) techniques, namely Milligan-Morgan haemorrhoidectomy (MMH) and Ferguson haemorrhoidectomy (FH), for the treatment of symptomatic haemorrhoids. A search of PubMed, Embase, Cochrane, Web of Science, and Scopus identified 13 eligible studies. Primary outcomes included intraoperative blood loss, postoperative bleeding, pain (measured by VAS), complications (e.g., urinary retention and anal stenosis), recovery time, and recurrence rate. Statistical analysis used both random-effects and fixed-effects models, with results reported as 95% confidence intervals (CIs), and heterogeneity was assessed using the I2 statistic. The results showed that DLH offered significant benefits over MMH and FH, including reduced intraoperative blood loss (MD = -20.19 mL, 95% CI: -28.32 -12.07; p <0.001), lower postoperative bleeding (OR = 0.32, 95% CI: 0.11 – 0.93; p = 0.04), and less postoperative pain, both immediately and one week later. Key Words: Diode laser haemorrhoidoplasty, Milligan-Morgan haemorrhoidectomy, Ferguson haemorrhoidectomy, Haemorrhoids, Meta-analysis.

PMID:41689325 | DOI:10.29271/jcpsp.2026.02.233

J Coll Physicians Surg Pak. 2026 Feb;36(2):217-222. doi: 10.29271/jcpsp.2026.02.217.

ABSTRACT

OBJECTIVE: To compare serum homocysteine, zinc, and copper levels between chronic obstructive pulmonary disease (COPD) patients and healthy controls, and to assess their associations with systemic inflammation.

STUDY DESIGN: A comparative cross-sectional study. Place and Duration of the Study: Department of Pulmonary Diseases, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkiye, from February to April 2025.

METHODOLOGY: This study evaluated homocysteine, folic acid, vitamin B12, zinc, and copper levels in 30 COPD patients and 30 healthy controls (HCs). Pearson’s chi-square test was used to compare categorical variables between groups. The Student’s t-test was employed for comparisons between two groups. Pearson’s correlation analysis was conducted to assess the relationship between continuous variables.

RESULTS: Statistically significant differences were found in leucocyte, platelet, red cell distribution width (RDW), immature granulocyte, and immature granulocyte percentage levels in COPD patients (p <0.001, p = 0.024, p = 0.002, p = 0.035, and p = 0.022, respectively). CRP levels were significantly elevated in the COPD group (p = 0.006). No statistically significant differences were found in homocysteine, folic acid, vitamin B12, zinc, and copper levels between the COPD and Control groups (p >0.05). All measured values in both groups were within the normal reference ranges. However, zinc levels positively correlated with RDW (r = 0.417; p = 0.030), and a negative correlation was observed between copper levels and RDW (r = -0.543; p = 0.009) in the COPD group.

CONCLUSION: Homocysteine, zinc, copper, vitamin B12, and folic acid levels did not differ between COPD patients and HCs, all within normal ranges. Secondary analyses showed significant haematogram and CRP alterations, indicating systemic inflammation. These markers cannot be used as inflammatory parameters in COPD.

KEY WORDS: COPD, Homocysteine, Zinc, Copper, Vitamin B12, Folic acid.

PMID:41689323 | DOI:10.29271/jcpsp.2026.02.217