Nevin Manimala

BMC Pediatr. 2025 Oct 3;25(1):753. doi: 10.1186/s12887-025-06161-y.

ABSTRACT

BACKGROUND: This study aimed to evaluate the efficacy of different treatment modalities in children with cystic fibrosis (CF) and determine the superiority of specific treatment modalities.

METHODS: A comprehensive literature search was conducted using different search strings across multiple databases, including PubMed, Cochrane Library, EMBASE, WOS, Scopus, CINAHL, PsycINFO, and Google Scholar, up to October 2024. Randomized controlled trials (RCTs), case-control studies and cohort studies were included.

RESULTS: The triple therapy indicated a significant reduction in CF-related complications, with an OR of 0.29 and an RR of 0.54, accompanied by low heterogeneity (I² = 0% for both). Physiotherapy and pulmonary exercises also yielded a beneficial effect, with an OR of 0.24 and an RR of 0.49, without heterogeneity. In contrast, nutritional interventions revealed non-significant outcomes (OR = 6.91 and RR = 2.63), suggesting the need to re-evaluate these strategies. Ivacaftor alone did not achieve statistical significance (OR = 0.34 and RR = 0.58), and the confidence intervals were broad, indicating uncertainty in the effect estimates. Azithromycin exhibited a positive effect on CF management, with an OR of 2.37 and an RR of 1.54. The overall pooled OR across all treatments was 0.71, with an RR not computed due to substantial heterogeneity (I²=93%).

CONCLUSION: The study underscores the effectiveness of certain treatments, such as triple therapy and physiotherapy exercises, for CF while highlighting the considerable variability in treatment outcomes. Notably, nutritional interventions need to be carefully reassessed. The findings emphasize integrating physiotherapy and targeted pharmacological interventions into standard CF management tailored to individual needs.

PMID:41044511 | DOI:10.1186/s12887-025-06161-y

BMC Public Health. 2025 Oct 3;25(1):3325. doi: 10.1186/s12889-025-23867-x.

ABSTRACT

BACKGROUND: Studies have indicated that the risk of death on the first day of life (day 0) was higher than risk of death during other periods (days 1 to 6 and 7 to 27). However, little is known about whether the pattern of mortality trends on day 0 differs from those on days 1 to 6 and 7 to 27. We aimed in this study to examine NMRs trends by age at death in Japan, Korea, and Taiwan.

METHODS: In this cross-sectional study, we calculated NMRs (deaths per 1000 live births) by age at death from 2005 to 2021 in Japan, 2005 to 2022 in Korea, and 2005 to 2023 in Taiwan. Joinpoint regression model was used to estimate the annual percent change (APC) for each segment of the trend in NMRs to examine whether the trend changed significantly.

RESULTS: A slowdown of decreasing trend on days 0 to 27 was observed from 2015 to 2021 with APC of – 4.3% to – 1.5% in Japan and from 2008 to 2018 with APC of – 8.5% to – 1.4% in Korea. In contrast, an initial decline followed by an increase pattern of trend was noted in Taiwan with APC of – 2.5% from 2005 to 2014 to 2.1% from 2014 to 2023. In Japan, the slowdown was mainly due to the levelling-off in the decline in NMRs for days 1 to 6. In Korea, the slowdown was mainly attributed to the levelling-off in the decline in NMRs for days 7 to 27. In Taiwan, the prominent change was primarily due to the changes in day 0 NMRs.

CONCLUSIONS: Further analyses are needed to explore potential factors associated with the particular pattern of trends of NMRs at specific age-at-death group. Neonatal mortality on the first day of life is not an appropriate indicator of neonatal care quality, as it may be influenced by artifacts related to birth certification practices.

PMID:41044502 | DOI:10.1186/s12889-025-23867-x

BMC Pediatr. 2025 Oct 3;25(1):756. doi: 10.1186/s12887-025-06175-6.

ABSTRACT

BACKGROUND: Nocturnal Enuresis (NE) is a prevalent childhood condition with a multifactorial pathogenesis comprising genetic, neurological, and connective tissue factors. Recent evidence points toward a possible link between joint hypermobility and NE, but the underlying mechanisms remain unclear, and existing data are limited. The objective of this study is to determine the prevalence of joint hypermobility in patients with primary nocturnal enuresis (PNE) relative to healthy controls and investigate potential correlations between these conditions.

METHODS: This cross-sectional study was conducted in 2024 at Imam Reza Clinic, the largest pediatric outpatient clinic affiliated with Shiraz University of Medical Sciences in Shiraz, Iran. A total of 180 children aged 6-13 years were recruited, including 90 children with primary nocturnal enuresis (study group) and 90 healthy children without nocturnal enuresis (control group). Participants were assessed for generalized joint hypermobility (GJH) using the Beighton score (≥ 6 indicating hypermobility). Demographic and clinical information was gathered on structured checklists. Statistical tests, such as chi-square tests, t-tests, and logistic regression, were carried out using SPSS (version 25) at a significance level of p < 0.05.

RESULTS: The prevalence of joint hypermobility was significantly higher in children with NE (87.8%) than in controls (28.9%) (p < 0.0001). Conversely, NE was present in 75.2% of hypermobile children compared with 14.7% of non-hypermobile children (p < 0.0001). Logistic regression analysis revealed that children with nocturnal enuresis were 19.87 times more likely to have joint hypermobility compared to non-enuretic children following the adjustment for age, gender, and BMI (p < 0.05). Gender-specific analysis indicated that hypermobile girls with nocturnal enuresis at a greater likelihood of suffering from urinary incontinence and frequent urinary tract infections (UTIs), whereas hypermobile boys with nocturnal enuresis had increased rates of constipation and urinary symptoms during the day.

CONCLUSION: This study shows a strong association between GJH and PNE. Further research is needed to determine causal direction and underlying mechanisms.

PMID:41044501 | DOI:10.1186/s12887-025-06175-6

Eur J Surg Oncol. 2025 Sep 11;51(12):110432. doi: 10.1016/j.ejso.2025.110432. Online ahead of print.

ABSTRACT

INTRODUCTION: Women over 70 years of age with operable oestrogen receptor positive (ER positive) breast cancer have worse survival outcomes than younger women. Primary surgery is the optimal treatment with primary endocrine therapy reserved for patients who are unfit or who have multiple co-morbidities. Inferior outcomes in this patient population might be explained by underuse of surgery, the rates of which vary considerably between geographical regions in the UK. We determined the rates of surgery versus primary endocrine therapy in a cohort of women aged over 70 in England, with potentially curable ER positive breast cancer, according to the presence of pre-existing cardiovascular disease (CVD), comorbidities, social deprivation, and by geographical location.

MATERIALS AND METHODS: 33,235 women aged 70 years or older with stage I to III ER positive breast cancer from the 20 regional NHS Cancers Alliances in England were identified from the cancer registry. Linked hospital records were used to identify patient demographics, tumour and treatment characteristics, resection rates, CVD prevalence and other co-morbidities.

RESULTS: 25,800 (77.6 %) patients underwent surgery, 6787 (20.4 %) patients received primary endocrine therapy alone, 648 (2 %) patients received no treatment. Both CVD and surgery prevalence varied by geographical location. After adjustment for case mix the differences between Cancer Alliances attenuated and no longer reached statistical significance.

CONCLUSIONS: We found regional differences in rates of surgery in patients with breast cancer across different centres. After adjustments, the variation is largely attributable to case mix. Under recording of endocrine therapy data in secondary care limits full interpretation.

PMID:41043195 | DOI:10.1016/j.ejso.2025.110432

J Neurosurg. 2025 Oct 3:1-11. doi: 10.3171/2025.5.JNS25705. Online ahead of print.

ABSTRACT

OBJECTIVE: Resection of common peroneal nerve (CPN) schwannomas is generally believed to be associated with a high risk of postoperative deficit, especially the chance for development of a foot drop. The goal of this study was to investigate the surgical results for resection of schwannomas from the CPN around the knee and specifically the chance of developing a postoperative motor deficit.

METHODS: Data from 36 patients with sporadic schwannomas and 8 patients with schwannomatosis (12 schwannomas total) treated at two centers were retrospectively analyzed. For sporadic cases, different locations around the knee were compared (i.e., proximal to the fibular head [FH], at the FH, and distal to the FH), taking into account the preoperative duration of symptoms, size at presentation, and surgical results of resection. The literature was systematically reviewed for reported cases by searching the PubMed and Embase databases.

RESULTS: A total of 24 schwannomas proximal to the FH were surgically treated: 11 at the FH, and 13 distal to the FH. For the entire cohort, the mean size of CPN schwannomas distal to the FH at presentation was smaller (1.4 × 1.8 cm) compared with those proximal to (2.0 × 2.2 cm) and at (2.2 × 2.3 cm) the FH, although these differences were not statistically significant. The mean preoperative duration of symptoms was slightly longer for schwannomas distal to the FH (35 months) than for those proximal to the FH (21 months) and at the FH (27 months); however, this difference was not significant. Postoperative deficits occurred in 3 sporadic cases: 2 patients with temporary weakness (Medical Research Council grade 4) that completely resolved within several months and 1 patient who had previously undergone surgery elsewhere and presented with deficits and in whom weakness increased after resection. Improvement in preoperative deficits was observed in 1 patient with extensor hallucis longus muscle paralysis that completely recovered. One patient with schwannomatosis developed muscle weakness after resection of a plexiform schwannoma. A systematic review of 21 previously reported cases in the literature showed that larger CPN schwannomas (> 5 cm) were more likely to result in permanent motor deficits.

CONCLUSIONS: This retrospective study of 44 patients shows that peroneal nerve schwannomas around the knee can be safely removed with a low risk of deficits. The systematic review of the literature suggests that larger schwannomas are more likely to result in permanent deficit. In the authors’ opinion, CPN schwannomas can best be resected, preferably when the lesion is relatively small.

PMID:41043186 | DOI:10.3171/2025.5.JNS25705

J Neurosurg Pediatr. 2025 Oct 3:1-5. doi: 10.3171/2025.7.PEDS25256. Online ahead of print.

ABSTRACT

OBJECTIVE: Selective dorsal rhizotomy (SDR) is a proven surgical treatment of spastic diplegia to improve function in patients suffering from spasticity compared to physical therapy alone. Few studies have addressed the benefit for those with spastic hemiplegia. The aim of this study was to describe and evaluate the efficacy of SDR in patients with spastic hemiplegia.

METHODS: A retrospective chart review was performed on pediatric patients (< 18 years of age) who underwent SDR at Monroe Carell Jr. Children’s Hospital from July 2013 through January 2024 with a diagnosis of spastic hemiplegic cerebral palsy. Patients underwent pre- and postoperative physical therapy testing at approximately 1 year. Any patients found to have spastic triplegia with asymmetrical hypertonia in the lower extremities, or those without postoperative evaluations, were excluded. Outcome measures included the modified Ashworth Scale (mAS), Gross Motor Function Measure-66 (GMFM-66), timed (10 m) walk test, Gross Motor Function Classification System (GMFCS), and the Pediatric Quality of Life Cerebral Palsy (PedsQL CP) module. Pre- versus postoperative comparisons were performed using a Wilcoxon signed-rank test and the differences were considered statistically significant when p values were < 0.05.

RESULTS: Twenty-one patients underwent SDR for spastic hemiplegic cerebral palsy with pre- and postoperative physical therapy assessments. The patients were 52.4% male, 81.0% White, with a median age of 5 years at the time of surgery. The most common etiology for spastic hemiplegia was stroke (52.4%). All patients had a preoperative GMFCS level of I (85.7%) or II (14.3%). The median percentage of rootlets cut during the procedure was 60% on the affected side. The sum of the mAS extremity score was improved by 5 points (p < 0.001), the GMFM-66 score was improved by a median of 3.1 (p = 0.002), while the PedsQL CP module improved by a median of 12.3 percentage points (p = 0.003). Orthotic use was reduced from 90.5% preoperatively to 66.7% at follow-up.

CONCLUSIONS: SDR is an effective treatment in patients with spastic hemiplegia resulting in significant improvement in motor function, quality of life, and tone.

PMID:41043185 | DOI:10.3171/2025.7.PEDS25256

J Neurosurg. 2025 Oct 3:1-10. doi: 10.3171/2025.5.JNS25596. Online ahead of print.

ABSTRACT

OBJECTIVE: Since 2021, there has been a revolution in the understanding of the mutational landscape of sporadic cerebral cavernous malformations (CCMs), with the key discovery of somatic mutations in the PIK3CA and MAP3K3 genes. These genetic alterations have provided new insights into the pathophysiology of CCMs and opened potential venues for personalized treatments. However, establishing robust clinicoradiological and molecular correlations is essential to guide targeted therapeutic approaches and optimize patient outcomes.

METHODS: This study included a cohort of 89 patients diagnosed with sporadic CCMs. The mutational status of each patient was determined using next-generation sequencing (NGS) targeting known mutations including the PIK3CA, MAP3K3, and CCM genes. NGS findings were confirmed by droplet digital polymerase chain reaction for PIK3CA and MAP3K3 mutations. Clinical and radiological data, including Zabramski classification data, were systematically recorded. Statistical analysis was performed to identify significant clinicoradiological and molecular correlations.

RESULTS: In the cohort, PIK3CA somatic mutations were identified in 43 patients (48%), while MAP3K3 somatic mutations were found in 29 (33%). Clinically, PIK3CA-mutated lesions were less frequently revealed by intracranial hypertension (9.3% vs 19.6%; adjusted OR 0.09, p = 0.006), while for MAP3K3-mutated lesions, seizure as a mode of onset was significantly more frequent (85.7% vs 51.7%, p = 0.002). Radiologically, midline lesions were significantly more frequent in the PIK3CA-mutated group (19.0% vs 2.2%, p = 0.01). Importantly, in univariate analysis, the presence of a brainstem lesion was a significant independent predictor of PIK3CA somatic mutation (14.3% vs 2.2%; unadjusted OR 7.33, p = 0.03).

CONCLUSIONS: This study presents new findings linking genetic mutations with clinicoradiological features in sporadic CCMs. The significant association of PIK3CA somatic mutations with brainstem location highlights a potential avenue for personalized therapeutic strategies targeting this mutation, considering the significantly increased morbidity and surgical challenge associated with brainstem lesions. These findings reinforce the importance of integrating genetic data into clinical practice to improve patient outcomes and develop new therapies for CCMs.

PMID:41043184 | DOI:10.3171/2025.5.JNS25596

J Neurosurg Pediatr. 2025 Oct 3:1-5. doi: 10.3171/2025.5.PEDS24551. Online ahead of print.

ABSTRACT

OBJECTIVE: The relationship between Chiari malformation type I (CMI) and tethered cord syndrome (TCS) is not well understood. The aim of this study was to examine conus position and rates of TCS and tethered cord release (TCR) in pediatric patients with CMI at a tertiary hospital.

METHODS: The medical records of children with a diagnosis of CMI based on MRI of the lumbar spine from 2010 to 2023 were retrospectively reviewed. Conus position on MRI, tonsil position below the foramen magnum, presence of fatty filum or filum terminale lipoma, and rates of CMI decompression and TCR were recorded. Age- and sex-matched controls were randomly selected from a cohort of patients who obtained an MRI of the spine for any reason. Conus position was coded and then compared using the Student t-test. Categorical variables were compared using the chi-square test.

RESULTS: A total of 657 pediatric patients with CMI were included. The mean ± SD tonsil position was 11.7 ± 5.6 mm below the foramen magnum, and 44.7% of patients underwent CMI decompression. The conus terminated at or above the L2-3 disc space in 97% of CMI patients. There was no statistical difference in conus position between CMI patients and controls (p = 0.09). Nine patients (1.4%) in the CMI cohort had symptomatic TCS and underwent TCR. This proportion was not statistically different compared to the control group: 11 patients (1.7%) had symptomatic TCS and underwent TCR (p = 0.1).

CONCLUSIONS: Most patients with CMI had a normal conus position (97%), and conus position was not different between CMI and control patients. The number of patients with symptomatic TCS was not statistically different between CMI and control patients.

PMID:41043181 | DOI:10.3171/2025.5.PEDS24551

Compend Contin Educ Dent. 2025 Jul-Aug;46(7):327-334.

ABSTRACT

PURPOSE: The aim of this retrospective pilot study was to use digital implant planning to assess radiographic outcomes of maxillary sinus augmentation bone grafting procedures (ideal, excess, or insufficient) in reference to the planned implant.

MATERIALS AND METHODS: After ethical approval was received, deidentified data for subjects treated for a maxillary sinus elevation procedure was extracted. Patient-specific variables (age group, gender, race, smoking, diabetes, and cardiovascular disease) and site-specific variables (type of bone graft, type of membrane, membrane perforation, and other complications) were collected, as recorded in the electronic health records. For the records that satisfied the inclusion criteria, preoperative and postoperative cone-beam computed tomography scans for lateral sinus augmentation procedures were retrieved, superimposed, and imported into the implant planning software. An ideal implant was planned digitally in a cross-sectional view by an expert in prosthodontics (KV). The implant measurements in apicocoronal (AC) and buccopalatal (BP) dimensions were kept standard for all cases and were confirmed by two previously calibrated co-investigators (GS, ID). Statistical analysis involved descriptive and bivariate analysis.

RESULTS: A total of 350 electronic health records were reviewed and 26 were included. Descriptive analysis revealed that in the AC dimension, 40.63% of procedures resulted in insufficient amount of bone graft and 37.50% of procedures resulted in excess bone graft; 21.88% of procedures had ideal amount of bone graft in the AC dimension. For the BP dimension, 81.25% of procedures resulted in ideal and 18.75% in insufficient amounts of bone graft.

CONCLUSION: This study revealed that a limited number of maxillary sinus procedures resulted in ideal bone grafting in both the AC and BP dimensions when considering predetermined restorative guidelines for the final implant position. An excess and/or insufficient amount of bone grafting in at least one dimension resulted most of the times. With the use of technology and an interdisciplinary team of experts, future studies should aim to quantify the amount of bone graft needed for an ideal maxillary sinus elevation for upcoming implant placement.

PMID:41043157

J Med Internet Res. 2025 Oct 3;27:e77157. doi: 10.2196/77157.

ABSTRACT

BACKGROUND: Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition, the prevalence of which is increasing in China and worldwide. Digital health technologies offer promising solutions for improving screening, diagnosis, and rehabilitation of children with ASD, particularly in resource-limited settings. However, digital health technologies for ASD have not been adopted in China. Understanding utilization patterns, influencing factors, and user needs is essential to inform equitable, effective digital health strategies.

OBJECTIVE: This study aimed to assess the current use, influencing factors, and perceived needs of digital health services among parents of children with ASD and rehabilitation therapists in 2 distinct provinces in China.

METHODS: A cross-sectional survey was carried out between November 2023 and February 2024 in Heilongjiang and Fujian provinces. Purposive sampling recruited a total of 780 parents and 745 rehabilitation therapists to complete a structured questionnaire. Data were analyzed using descriptive statistics, stepwise multivariable logistic regression, and multiple response analysis.

RESULTS: The use of digital health services was low among parents (46/780, 5.9%) and rehabilitation therapists (161/745, 21.6%), although the demand was substantially higher (621/780, 79.6% and 671/745, 90.0%, respectively). Among parents, higher use was positively associated with younger age (20-29 years), employment, lower income (≤CNY 3000/month [US $421.247/month]), and delayed ASD diagnosis (7-12 years old). Among rehabilitation therapists, male, special education background, and autism-specific training experience predicted higher use (all P<.05). Demand was significantly greater in Fujian than in Heilongjiang and was positively associated with higher education levels in parents and rehabilitation therapists (P<.05). Parents and rehabilitation therapists valued a greater understanding of ASD behaviors and development and easier access to resources as primary benefits. Common barriers to the use of digital health services included high cost, need for additional equipment, and usability challenges. The smartphone-WeChat mini-program was the preferred device and platform, respectively. Parents prioritized access to rehabilitation courses, remote guidance, and policy information, while rehabilitation therapists favored personalized plans and professional skills training.

CONCLUSIONS: Despite a strong demand, digital health services are underused in ASD care across China, with adoption of digital health services influenced by regional disparities and sociodemographic factors. This study, as the first comparative analysis of parents and rehabilitation therapists in 2 Chinese provinces, provides stakeholder-specific insights to guide targeted, locally relevant interventions. Bridging the digital divide through inclusive policies, training, and cross-sector collaboration will be essential for equitable integration into ASD care pathways.

PMID:41043146 | DOI:10.2196/77157