Nevin Manimala

BMC Health Serv Res. 2025 Sep 3;25(1):1184. doi: 10.1186/s12913-025-13327-y.

ABSTRACT

BACKGROUND: The World Health Organization (WHO) surgical safety checklist (SSC) is a crucial tool for improving patient safety in surgical settings. This study aimed to assess the knowledge and attitudes towards WHO SSC among healthcare professionals in Mogadishu, Somalia, and identify factors associated with these outcomes.

METHODS: This cross-sectional study was conducted from April to July 2024 among 422 healthcare professionals in Mogadishu. Data were collected using a structured questionnaire adapted from the WHO SSC, consisting of sociodemographic information, knowledge assessment (12 items), and attitude assessment (7 items). Descriptive statistics and binary logistic regression were used for the data analysis.

RESULTS: The study revealed that 81.04% of participants demonstrated good knowledge of SSC (score > 60%), with a mean knowledge score of 9.59 out of 12 (SD 2.92). However, only 13.51% exhibited a positive attitude towards SSC (score > 60%), despite 87.6% agreeing that SSC improves patient safety. Higher knowledge was significantly associated with professional roles in medicine and surgery (p < 0.001), nursing (p < 0.001), and having a master’s degree (p = 0.039). Attitudes were significantly more positive among professionals in medicine and surgery (p < 0.001) and nursing (p = 0.001), but not significantly influenced by education level or years of experience (p > 0.05).

CONCLUSION: While knowledge levels of WHO SSC among healthcare professionals in Mogadishu are generally good, attitudes towards the checklist are mixed, with a low proportion demonstrating positive attitudes. Targeted interventions, including comprehensive training programs and addressing workflow concerns, are recommended to enhance SSC implementation and use in Somali healthcare settings.

PMID:40903723 | DOI:10.1186/s12913-025-13327-y

Eur J Trauma Emerg Surg. 2025 Sep 3;51(1):283. doi: 10.1007/s00068-025-02957-w.

ABSTRACT

BACKGROUND: Craniomaxillofacial (CMF) trauma constitutes a significant proportion of hospital presentations, often resulting from high-energy mechanisms such as interpersonal violence and traffic accidents. The COVID-19 pandemic and associated public health restrictions markedly altered daily life and social behavior, potentially influencing trauma patterns and emergency healthcare utilization.

METHODS: We conducted a retrospective analysis of nationwide anonymized inpatient data from German hospitals, reported to the National Institute for the Hospital Remuneration System (InEK), covering the period from March 18, 2019 to March 17, 2023. CMF trauma cases were identified using ICD-10 codes and stratified across four timeframes: pre-pandemic, pandemic, post-pandemic, and normalization. Statistical analysis included descriptive evaluation and Poisson regression.

RESULTS: A total of 118,620 CMF-related diagnoses were recorded in the pre-pandemic period, which declined significantly during the pandemic (- 14.66%, p < 0.0001). Although case numbers increased in the post-pandemic (+ 4.95%, p < 0.0001) and normalization periods (+ 12.65%, p < 0.0001 compared to pandemic), they did not fully return to pre-pandemic levels. The largest relative declines were observed for mandibular and midfacial fractures. In contrast, general trauma indicators such as distal radius fractures remained relatively stable, suggesting a trauma-mechanism-specific effect.

CONCLUSION: The COVID-19 pandemic significantly reduced the number of CMF emergency cases in Germany, with partial recovery observed in subsequent years. These findings reflect shifts in trauma etiology and healthcare-seeking behavior during and after pandemic-related societal changes.

PMID:40903690 | DOI:10.1007/s00068-025-02957-w

Eur J Pediatr. 2025 Sep 4;184(9):594. doi: 10.1007/s00431-025-06411-2.

ABSTRACT

An increase in severe and invasive infections has been reported since the COVID-19 pandemic. However, most evidence comes from monocentric studies without nationwide representativeness. This multicenter, nationwide, retrospective study, conducted within the network of the Italian Society of Pediatric Infectious Diseases (SITIP), aimed to compare the severity of empyema at presentation in children (aged 1 month to 18 years) admitted to 19 Italian hospitals before, during, and after the pandemic. A severe composite outcome was defined as either fatality, need for respiratory support or thoracic surgery, or admission to the pediatric intensive care unit (PICU). Among the 266 patients included in the study (38.7% females, median age of 4 years [IQR 2-7 years]), 95 (35.8%) were reported during the pre-COVID phase, 32 (12.1%) during the COVID phase, and 138 (52.1%) during the post-pandemic phase. The incidence of empyema significantly increased during the post-pandemic phase (pre-COVID: 95/19,288,639 [0.49]; during COVID pandemic: 32/18,784,272 [0.17]; post-pandemic: 138/18,294,627 [0.75]; p = 0.001). No differences in the demographic characteristics between the three groups were noticed, but a statistically significant difference was detected in the severe composite outcome (p = 0.029), as well as in the clinical (p = 0.006) and laboratory (p = 0.015) disease severity in children admitted during and after the pandemic. An increased odds of severe outcomes was observed during the COVID period (OR: 3.428, 95% CI: 1.21-9.65, p = 0.020) and in patients with complicated effusion observed at lung ultrasound (OR: 3.29, 95% CI: 1.26-8.57, p = 0.015). Each day of persistent fever was associated with a 10% increased risk of severe outcome (OR: 1.10, 95% CI: 1.03-1.18, p = 0.004). Since the onset of the pandemic, we observed an increased use of high flow nasal cannula.

CONCLUSION: Our analysis of children admitted in Italy confirms a surge in the incidence of empyema and an increase in disease severity during and after the pandemic.

WHAT IS KNOWN: • Empyema is a severe complication of pneumonia. • Some studies have suggested increase in empyemas in Europe, but no data available for Italy.

WHAT IS NEW: • The incidence of empyema in Italy significantly increased during the post-pandemic phase. • An increased odds of severe outcomes was observed during the COVID period.

PMID:40903663 | DOI:10.1007/s00431-025-06411-2

Interdiscip Sci. 2025 Sep 3. doi: 10.1007/s12539-025-00757-9. Online ahead of print.

ABSTRACT

Recent advancements in spatial transcriptomics (ST) have revolutionized our ability to simultaneously profile gene expression, spatial location, and tissue morphology, enabling the precise mapping of cell types and signaling pathways within their native tissue context. However, the high cost of sequencing remains a significant barrier to its widespread adoption. Although existing methods often leverage histopathological images to predict transcriptomic profiles and identify cellular heterogeneity, few approaches directly estimate cell-type abundance from these images. To address this gap, we propose HPCell, a deep learning framework for inferring cell-type abundance directly from H&E-stained histology images. HPCell comprises three key modules: a pathology foundation module, a hypergraph module, and a Transformer module. It begins by dividing whole-slide images (WSIs) into patches, which are processed by the pathology foundation module using a teacher-student framework to extract robust morphological features. These features are used to construct a hypergraph, where each patch (node) connects to its spatial neighbors to model complex many-to-many relationships. The Transformer module applies attention to the hypergraph features to capture long-range dependencies. Finally, features from all modules are integrated to estimate cell-type abundance. Extensive experiments show that HPCell consistently outperforms state-of-the-art methods across multiple spatial transcriptomics datasets, offering a scalable and cost-effective approach for investigating tissue structure and cellular interactions.

PMID:40903657 | DOI:10.1007/s12539-025-00757-9

Virchows Arch. 2025 Sep 4. doi: 10.1007/s00428-025-04239-7. Online ahead of print.

ABSTRACT

Ulcerative colitis (UC) is a clinicopathologically challenging diagnosis that greatly impacts patients’ quality of life. The recently developed Inflammatory Bowel Disease-Distribution, Chronicity, Activity (IBD-DCA) scoring system offers histopathologists a consistent template to report colonic biopsies from UC patients in a standardised manner. We reviewed the rate of uptake of the IBD-DCA system within our department since its inception in 2022, and statistically correlated our histological findings with the corresponding UC Endoscopic Index of Severity (UCEIS). Of the 449 cases of IBD biopsies reported, 291 were established UC cases. The uptake of the IBD-DCA reporting format reached beyond 95% across all biopsy sites, with noted variation in applying the scoring system to rectal biopsies. Kendall’s tau correlation of the 116 UC cases reported in the first six months with their UCEIS revealed a moderate positive correlation between histological activity and all components of the UCEIS (all τ > 0.260, p < 0.05). Possible explanations for histological-endoscopic discrepancies include non-representative endoscopic sampling, differences in detection threshold, and the pan-colonic nature of the UCEIS. We call for the application of the IBD-DCA in future clinical trials to predict possible relapses and guide treatment dosages.

PMID:40903633 | DOI:10.1007/s00428-025-04239-7

Eur Radiol. 2025 Sep 3. doi: 10.1007/s00330-025-11930-5. Online ahead of print.

ABSTRACT

OBJECTIVES: Biodegradable biliary stents are used to treat benign biliary strictures in adults. However, there is limited data regarding their use in pediatric patients. This study aims to assess the efficacy and safety of biodegradable biliary stents following pediatric liver transplantation (pLT).

MATERIALS AND METHODS: Consecutive pLT patients with benign biliary strictures were retrospectively evaluated in five tertiary centers between October 2014 and May 2024. All patients underwent percutaneous bilioplasty followed by the placement of self-expanding polydioxanone-based stents. Stricture features and treatment timing were assessed, as well as freedom from stricture recurrence and complications.

RESULTS: A total of 102 patients (52 males, 50 females; median age at treatment = 5 years, interquartile range (IQR) = 2-11 years) were included. At baseline, 58/102 (57%) had a stricture length ≥ 10 mm, and 53/102 (52%) had intrahepatic duct involvement. Stenting was performed a median of 55 days (IQR = 15-128 days) following biliary drainage. Technically successful stent placement was achieved in 101/102 (99%) cases, and low-grade complications occurred in 19/102 (19%). During a median follow-up of 793 days (IQR = 341-1529 days), 24/102 (24%) patients had stricture recurrence with an estimated median time to recurrence of 2915 days. Eight patients were lost to follow-up before recurrence. Logistic regression did not identify any factors that were independent predictors of stricture recurrence, while Cox regression showed that recoil/residual stenosis was independently associated with earlier recurrence (p = 0.005; HR = 5.334; 95% CI = 1.674-17).

CONCLUSION: Biodegradable stents appear safe and effective for treating biliary strictures after pLT. Certain factors may contribute to failure and should inform patient selection and the optimal timing for stenting.

KEY POINTS: Question The management of biliary strictures after pediatric liver transplantation (pLT) poses several challenges due to the frailty of the population and refractoriness of the condition. Findings In this multicenter study self-expanding biodegradable biliary stents made of polydioxanone proved to be safe and effective for the treatment of biliary strictures after pLT. Clinical relevance Biodegradable biliary stents may improve the management of biliary strictures after pLT with a positive impact on outcomes and less invasiveness; some factors may help to predict the outcome and define the best timing for stenting.

PMID:40903624 | DOI:10.1007/s00330-025-11930-5

Eur Radiol. 2025 Sep 3. doi: 10.1007/s00330-025-11940-3. Online ahead of print.

ABSTRACT

Alzheimer disease (AD) is the most common dementing disorder, affecting 55 million people worldwide. Brain MRI plays an integral role in the diagnostic evaluation of patients with cognitive symptoms. When interpreting brain MRI for cognitive impairment, radiologists should assess the following four key features: (1) white matter ischemic burden, (2) structural changes to suggest normal pressure hydrocephalus, (3) locoregional pattern of brain atrophy, and (4) presence of microhemorrhage or superficial siderosis, particularly for determining eligibility for anti-amyloid monoclonal antibody (MAB) treatment when appropriate. The recent approval and clinical adoption of anti-amyloid MAB expanded the role of neuroradiologists in evaluating eligibility and monitoring ARIA (amyloid-related imaging abnormality) among patients receiving anti-amyloid MAB. This advancement underscores the importance of standardized imaging protocols and effective communication between neuroradiologists and cognitive neurologists. Depending on the severity of ARIA and patients’ symptoms, treatment may need to be suspended or discontinued. This review article explores brain MRI and FDG-PET/CT imaging abnormalities in patients with major cognitive and movement disorders associated with dementia. It aims to assist radiologists in providing differential diagnoses within a clinical context. Finally, the article emphasizes the importance of recognizing co-pathologies, since patients may have more than one neurodegenerative disease rather than viewing these neurodegenerative diseases as being mutually exclusive. KEY POINTS: Question Traditional regional patterns of brain atrophy on MRI by neuroradiologists may not be effective given the recent advances in understanding of neurodegenerative disease and recognition of co-pathologies. Findings The locoregional atrophy and the patterns of metabolic abnormality help in the differential diagnosis of neurodegenerative disease. Remember that brain MRI determines eligibility for anti-amyloid immunotherapy. Clinical relevance Understanding clinical history is vital for interpreting brain MRI for patients with cognitive impairment or memory loss. Newly recognized entities such as limbic-predominant age-related TDP43 encephalopathy (LATE) can mimic Alzheimer disease among extremely elderly patients with amnestic symptoms with mesial temporal lobe atrophy.

PMID:40903623 | DOI:10.1007/s00330-025-11940-3

Eur Radiol. 2025 Sep 3. doi: 10.1007/s00330-025-11942-1. Online ahead of print.

ABSTRACT

OBJECTIVES: This study compared three-dimensional myocardial extracellular volume (ECV) quantification among single-phase and dual-phase photon-counting detector computed tomography (PCD-CT) and dual-phase energy-integrating detector computed tomography (EID-CT), using cardiac magnetic resonance (CMR) imaging as the reference.

MATERIALS AND METHODS: This retrospective study included 80 patients who underwent both CMR and cardiac CT (40 patients underwent PCD-CT and 40 underwent EID-CT). Pearson correlation coefficients and intraclass correlation coefficients (ICCs) were used to evaluate the correlation and reliability of CT-ECV with CMR-ECV. Subgroup analysis was performed based on heart rate.

RESULTS: The single-phase and dual-phase ECV measurements on PCD-CT showed excellent correlation and consistency with CMR (correlation coefficient: single-phase, 0.84; dual-phase, 0.91; ICC: single-phase, 0.90; dual-phase, 0.94). Both methods significantly outperformed EID-CT (correlation coefficient: 0.62; ICC: 0.76; all p < 0.05). No significant differences were observed between the two PCD-CT methods (all p > 0.05). PCD-CT demonstrated high consistency across both HR subgroups (ICC: HR ≤ 60 bpm: 0.89 for single-phase, 0.85 for dual-phase; HR > 60 bpm: 0.87 for single-phase, 0.88 for dual-phase), whereas EID-CT exhibited reduced consistency in patients with HR > 60 bpm (ICC: HR ≤ 60 bpm: 0.78; HR > 60 bpm: 0.60).

CONCLUSION: Compared with EID-CT, PCD-CT showed superior correlation and reliability for myocardial ECV quantification, particularly in patients with elevated heart rates. The single-phase PCD-CT method demonstrated performance equivalent to the dual-phase approach.

KEY POINTS: Question How does myocardial ECV quantification using PCD-CT compare with conventional EID-CT? Findings Single-phase and dual-phase methods on PCD-CT significantly outperform EID-CT in myocardial ECV quantification. Clinical relevance These findings suggest PCD-CT significantly outperforms EID-CT as a promising alternative to CMR for myocardial ECV assessment, particularly under challenging conditions such as higher heart rates, offering improved reliability for clinical myocardial tissue characterization.

PMID:40903622 | DOI:10.1007/s00330-025-11942-1

Nurse Educ Today. 2025 Aug 28;155:106857. doi: 10.1016/j.nedt.2025.106857. Online ahead of print.

ABSTRACT

BACKGROUND: Developing interprofessional competencies at the pre-registration level is essential for preparing a collaborative practice-ready workforce committed to patient-centered care and safety.

AIM: (1) To evaluate the impact of a Blended Learning Approach with Simulation-based TeamSTEPPS® (BLAST) training on nursing and medical students’ attitudes, knowledge, and perceived confidence in interprofessional collaboration, and (2) to explore the learning experiences of students and teaching experiences of simulation facilitators.

DESIGN: Mixed-methods design using a one-group pretest-posttest design and focus group discussions.

SETTING: A public tertiary university in Singapore.

METHODS: Final year nursing and medical students participated in the BLAST training, which delivered the TeamSTEPPS® training using multi-user virtual reality simulation followed by high-fidelity simulation. Pre- and post-tests assessed students’ understanding of TeamSTEPPS® key concepts and tools, as well as their attitudes and perceived confidence in interprofessional teamwork. Nine focus group discussions were conducted with students and simulation facilitators. Quantitative and qualitative data were triangulated.

RESULTS: Students demonstrated statistically significant improvements in their understanding of TeamSTEPPS® key concepts, overall attitudes towards interprofessional teamwork, and perceived value of interprofessional training. The virtual reality simulation was reported to improve students’ confidence in participating the high-fidelity simulation. Three themes emerged from the focus group discussions: (1) synergy of interprofessional learning, (2) blended simulation as a learning scaffold, and (3) operationalizing blended simulation. The triangulated data revealed that the integration of virtual reality simulation followed by in-person simulation was a promising pedagogical approach for interprofessional training.

CONCLUSION: This study supports the use of a blended simulation-based learning approach for interprofessional team training, highlighting the benefits of scaffolded learning in enhancing knowledge, collaboration, and communication skills among nursing and medical students. The findings point to the need for innovative approaches to enable sustainable and scalable interprofessional team training.

PMID:40902360 | DOI:10.1016/j.nedt.2025.106857

Curr Opin Neurobiol. 2025 Sep 2;94:103107. doi: 10.1016/j.conb.2025.103107. Online ahead of print.

ABSTRACT

In many brain areas, neurons exhibit continuous changes in their tuning properties over days, even when supporting stable percepts and behaviors-a phenomenon termed representational drift. How do neuronal circuits maintain stable function when their constituent elements are in constant flux? Here, we review recent theoretical and experimental work on interconnected levels, ranging from perpetual changes in synapses driving drifts in tuning of individual neurons to emergent stability at the population level, preserving similarities of activity patterns associated to specific percepts or behaviors. We propose that statistical learning, beyond its well-established roles during development and adaptation to new contexts, is also essential under steady behavioral and environmental conditions to safeguard the stability of representational similarities. We discuss implications for learning, memory, and forgetting. This framework reconciles the apparent paradox between unstable neural activity and stable perception, suggesting that representations are maintained through dynamic processes rather than static neural codes.

PMID:40902357 | DOI:10.1016/j.conb.2025.103107