Nevin Manimala

BMC Palliat Care. 2026 May 4. doi: 10.1186/s12904-026-02132-x. Online ahead of print.

ABSTRACT

BACKGROUND: Early integration of pediatric palliative care (PPC) improves symptom control, communication, and goal-concordant decision-making. Despite these benefits, PPC remains underutilized in many Asian healthcare systems, where referrals are often delayed and most children die in intensive care units (ICUs).

METHODS: This retrospective cohort study included children aged 0-18 years who died between 2008 and 2017 at two medical centers in southern Taiwan (n = 294). A shared PPC program was implemented in 2011, embedding palliative specialists within primary care teams. Documentation of do-not-resuscitate (DNR) orders, family meetings, PPC consultations, cardiopulmonary resuscitation (CPR), and place of death were compared across pre-implementation, early post-implementation, and late post-implementation phases.

RESULTS: Following implementation, DNR documentation increased from 59.2% to 73.9% (p = .03). Documented family meetings rose from 4.1% to 18.2% (p < .001), and PPC consultations increased from 7.1% to 23.9% (p < .001), suggesting potential improvements in interdisciplinary communication and advance care planning. ICU deaths remained high (87.8%-89.8%), and CPR rates declined but did not reach statistical significance (p = .09). Cancer diagnosis (OR = 7.97, 95% CI 2.71-23.42) and increasing age at diagnosis (OR = 1.12 per year, 95% CI 1.06-1.18) were independently associated with PPC consultation.

CONCLUSIONS: Integration of a shared PPC model was associated with improvements in advance care planning and interdisciplinary collaboration. Earlier referral triggers, clinician education, and expansion of community-based PPC services may be important to help reduce high-intensity end-of-life care and better align care delivery with family preferences.

PMID:42082973 | DOI:10.1186/s12904-026-02132-x

J Exp Clin Cancer Res. 2026 May 4. doi: 10.1186/s13046-026-03716-4. Online ahead of print.

ABSTRACT

BACKGROUND: Immunotherapy has emerged as a promising strategy for multiple myeloma (MM), yet relapse remains frequent due to the immunosuppressive bone marrow (BM) microenvironment, characterized by T cell dysfunction and accumulation of immunosuppressive myeloid cells. The co-stimulatory receptor 4-1BB (CD137, TNFRSF9) can enhance T and NK cell effector functions, but its therapeutic utility in MM is not well established. Tasquinimod (TQ), a clinical-stage S100A9 inhibitor, offers a complementary approach by limiting the recruitment and activity of suppressive myeloid cells.

METHODS: 4-1BB expression was assessed during disease progression in MM mice and in newly diagnosed MM patients using single-cell RNA sequencing and flow cytometry. Therapeutic potential was evaluated in 5TGM1 tumor-bearing mice treated with two 4-1BB agonists, LOB12.3 (IgG1κ) and 3H3 (IgG2a), using isotype controls. The lead agonist was subsequently combined with TQ to investigate dual targeting of the immunosuppressive tumor microenvironment. Tumor burden was quantified via BM and spleen plasmacytosis and serum M-protein levels. Immune modulation was analyzed using multi-parameter flow cytometry. Statistical significance was determined using the Mann-Whitney U test or one-way ANOVA (p < 0.05).

RESULTS: 4-1BB expression progressively increased on T and NK cells during tumor development in mice. In primary MM patient BM samples, ex vivo 4-1BB stimulation with urelumab enhanced effector responses, increasing IFN-γ⁺ and Granzyme B⁺ CD3⁺ T cells, alongside trends toward increased CD56⁺ NK cells and elevated IFN-γ⁺ NK cell activity. In vivo, 4-1BB agonist treatment promoted expansion of T cell subsets, with clone-specific effects: the IgG2a clone 3H3 significantly reduced M-protein levels and BM plasmacytosis, whereas the IgG1 clone LOB12.3 induced NK cell depletion and demonstrated limited anti-tumor activity. Combining 3H3 with TQ provided superior anti-myeloma efficacy, reducing BM plasmacytosis from 62.5% in controls to 14.1% under combination treatment. Mechanistically, the combination enhanced Granzyme B expression, effector T cell differentiation, and dendritic cell maturation (CD86 upregulation), collectively overcoming BM immunosuppression.

CONCLUSIONS: These findings establish the isotype-specific efficacy of 4-1BB agonists and support 4-1BB stimulation combined with TQ as a promising strategy to enhance durable immunotherapeutic responses in MM.

PMID:42082972 | DOI:10.1186/s13046-026-03716-4

BMC Med Educ. 2026 May 5. doi: 10.1186/s12909-026-09354-w. Online ahead of print.

ABSTRACT

BACKGROUND: Medical emergencies during dental procedures are not uncommon. Given the high-risk nature of dentistry and the necessity for immediate patient management, this study aimed to evaluate the effectiveness of a targeted educational intervention by expanding assessment parameters for knowledge and performance, including follow-up evaluations.

METHODS: This educational interventional study was conducted in 2023 with 60 senior dental students recruited via an open call. Participants were randomly assigned to intervention and control groups using a random number table. All participants underwent a theoretical and practical assessment based on the American Heart Association (AHA) standardized examination. The intervention group participated in a hands-on emergency medicine and resuscitation workshop, followed by theoretical and practical assessments at one- and three-months post-intervention. Data were analyzed using SPSS version 26. Independent t-tests and ANCOVA were used for between-group comparisons, while repeated measures ANOVA and LSD post hoc tests were applied for within-group analyses. A significance level of 0.05 was adopted.

RESULTS: The mean scores from the workshop questionnaire at baseline, immediately post-intervention, and at one- and three-month follow-ups showed a statistically significant improvement over time in the intervention group (p < 0.001), while no significant change was observed in the control group (p = 0.808). Similarly, practical exam scores demonstrated a significant time-dependent improvement in the intervention group (p < 0.001), with no meaningful change in the control group (p = 0.999).

CONCLUSION: The emergency medicine workshop-covering both basic and advanced resuscitation-significantly enhanced the theoretical knowledge and practical skills of senior dental students. Moreover, the sustained impact observed over time underscores the long-term value of such educational interventions.

PMID:42082971 | DOI:10.1186/s12909-026-09354-w

BMC Pulm Med. 2026 May 4. doi: 10.1186/s12890-026-04319-7. Online ahead of print.

ABSTRACT

BACKGROUND: Asthma is a heterogeneous disease, underscoring the urgent need for reliable diagnostic biomarkers. Vanin-1, a well-recognized sensor of oxidative stress, has been implicated in various inflammatory disorders; however, its diagnostic value in asthma remains to be fully elucidated. This study aimed to evaluate serum Vanin-1 levels in asthmatic patients and explore their correlations with systemic oxidative stress biomarkers-malondialdehyde (MDA) and glutathione (GSH)-as well as inflammatory cytokines, pulmonary function parameters, and to assess its diagnostic potential.

METHODS: A case-control study was conducted, enrolling 169 participants: 129 asthmatic patients and 40 age- and sex-matched healthy controls. Serum concentrations of Vanin-1, MDA, GSH, cytokines (IL-4, IL-13, IL-17, IFN-γ), and total IgE were measured. Pulmonary function tests were also performed. Statistical correlations were analyzed using Spearman’s rank test, and diagnostic efficacy was evaluated using receiver operating characteristic (ROC) curves.

RESULTS: Compared with healthy controls, asthmatic patients exhibited significantly elevated serum levels of Vanin-1 (7.54 ± 1.62 ng/mL vs. 4.59 ± 1.30 ng/mL, P < 0.001) and MDA [0.11 (0.09, 0.12) nmol/mg protein vs. 0.08 (0.06, 0.10) nmol/mg protein, P < 0.001], but markedly reduced GSH [1.44 (1.16, 1.57) nmol/mg protein vs. 2.06 (1.65, 2.37) nmol/mg protein, P < 0.001]. Vanin-1 level was positively correlated with MDA (ρ = 0.342, P < 0.001) and negatively correlated with GSH (ρ = – 0.329, P < 0.001). No significant correlations were observed between Vanin-1 and IL-4, IL-13, IL-17, IFN-γ, eosinophil counts, or pulmonary function indices. ROC analysis demonstrated that Vanin-1 had robust diagnostic utility, with an area under the curve (AUC) of 0.884 (95% CI: 0.832-0.936, P < 0.001). At an optimal cutoff of 6.12 ng/mL, the sensitivity and specificity were 69.0% and 92.5%, respectively.

CONCLUSION: Serum Vanin-1 is significantly elevated in asthmatic patients and is closely associated with an oxidative stress imbalance. It may serve as a potential biomarker for distinguishing asthma patients from healthy individuals.

PMID:42082969 | DOI:10.1186/s12890-026-04319-7

BMC Musculoskelet Disord. 2026 May 4. doi: 10.1186/s12891-026-09838-2. Online ahead of print.

ABSTRACT

BACKGROUND: Differentiating between spinal tuberculosis, pyogenic (bacterial) spondylitis and spinal metastasis remains a major diagnostic challenge because their radiological features often overlap. Delayed or incorrect diagnosis may lead to inappropriate treatment, permanent disability or death.

OBJECTIVE: To develop and evaluate deep learning models for automated classification of spinal tuberculosis, pyogenic infection, and spinal metastasis using magnetic resonance imaging (MRI).

METHODS: T2-weighted sagittal MRI scans from 120 patients (40 per disease group) with pathologically or microbiologically confirmed diagnoses between 2014 and 2019 were retrospectively analyzed. Lesion regions were manually annotated by radiologists, and data were split into 80% training and 20% testing sets at the patient level. Extensive data augmentation (rotation ± 5°, zoom 1.1-1.2×, shearing ± 5°, grid distortion 2 × 2) was applied to mitigate overfitting. Three models were trained and compared: (1) a single-layer perceptron baseline, (2) a custom dense neural network (2 × 1024 neurons), and (3) pre-trained convolutional neural networks (ResNet50, VGG16, InceptionV3). Model performance was evaluated using accuracy, precision, recall, and F1-score on both whole and segmented images.

RESULTS: After augmentation, 1,000 synthetic samples were generated per class. The baseline model achieved 27-33% accuracy, whereas the dense and pre-trained models achieved 98-100% accuracy on the test set. Although pre-trained networks demonstrated marginally higher performance, the difference compared with the dense model was not statistically significant. Activation heatmaps revealed inconsistent localization of attention regions, suggesting potential overfitting and limitations in visualization interpretability.

CONCLUSION: Deep learning models demonstrated strong potential in distinguishing between spinal tuberculosis, bacterial spondylitis, and spinal metastasis on MRI. However, the near-perfect performance likely reflects dataset homogeneity and augmentation effects rather than full generalization. External, multi-center validation and improved interpretability methods (e.g., Grad-CAM) are warranted to confirm clinical applicability and ensure reliable decision support for radiologists.

PMID:42082966 | DOI:10.1186/s12891-026-09838-2

BMC Psychiatry. 2026 May 4. doi: 10.1186/s12888-026-08136-4. Online ahead of print.

ABSTRACT

Alzheimer’s disease (AD) is a prevalent degenerative neurological disorder with limited treatment options. Prior studies reported specific metabolites and inflammatory proteins to be related to AD risk. However, the intricate relationship between inflammatory proteins, blood metabolites, and AD risk in European population remains unclear. Genetic instruments for 1,091 metabolites and 736 inflammatory proteins were derived from two recent comprehensive genome-wide association studies. Univariable Mendelian Randomization was employed to assess potential causal effects of metabolites on AD risk, potential effects of inflammatory proteins on metabolites, and effects of inflammatory proteins on AD risk. Multivariable MR (MVMR) was further applied to disentangle direct effects of proteins and metabolites on AD. Twelve metabolites were identified to be associated with AD risk, and 226 inflammatory proteins demonstrated likely to be causal effects on these 12 metabolites. Further examining the associations between such inflammatory proteins and AD risk revealed 22 associations for which the effect directions from inflammatory proteins to metabolites, from metabolites to AD risk, and from inflammatory proteins to AD risk were aligned, suggesting inflammatory protein – metabolite – AD risk pathway. MVMR further highlighted four trios in which the effect directions were consistent with the UVMR results, supporting a metabolite‑mediated pattern. This large‑scale genetic analysis highlights specific metabolites as direct contributors to AD risk and suggests that certain inflammatory proteins may influence AD primarily through downstream metabolic pathways. Our findings offer potential novel therapeutic targets for AD intervention.

PMID:42082960 | DOI:10.1186/s12888-026-08136-4

BMC Public Health. 2026 May 4. doi: 10.1186/s12889-026-27512-z. Online ahead of print.

ABSTRACT

BACKGROUND: The main aim of this study is to investigate the connection between a high workload and health-related quality of life among in-home care workers in northern Sweden during the COVID-19 pandemic. We also investigate whether social support and control at work can prevent poor health due to high workload.

METHODS: A cross-sectional survey was conducted during the pandemic, with 629 (response rate 33 per cent) of an estimated 1,900 in-home care workers responding. Results were compared with a nearly identical survey conducted prior to the pandemic in which 1,154 (response rate 58 per cent) of an estimated 2000 in-home care workers responded. Psychosocial factors were measured using QPSNordic and health-related quality of life using EuroQol 5 Dimensions (EQ-5D). EQ-5D responses were translated into quality-adjusted life year (QALY) scores. Propensity scores were used with absolute risk differences.

RESULTS: During the pandemic, staff with high workload had a statistically significantly (6.2%) lower QALY score (confidence interval 2.2%-10.3%) compared to staff with a normal workload. This was also the case for the usual activities and the anxiety/depression dimensions of EQ-5D. These risk differences were greater, but not statistically significant, during the pandemic than before. The combination of a normal workload and a high degree of control over one’s work appeared to protect against a low QALY score, while social support at work did not seem to be protective.

CONCLUSIONS: High workload is related to poorer health-related quality of life. This is mainly attributable to anxiety/depression. In-home care organisations need to manage workload better to prevent poor health among staff during strained situations such as a pandemic. The results of our study indicate that in-home care organisations should increase their readiness to promote opportunities for staff to maintain a high degree of control over their work, in order to counteract variations in workload that ultimately appear to have a negative impact on HRQoL.

PMID:42082951 | DOI:10.1186/s12889-026-27512-z

BMC Nurs. 2026 May 4. doi: 10.1186/s12912-026-04714-9. Online ahead of print.

ABSTRACT

BACKGROUND: Nursing is intrinsically demanding, exposing practitioners to substantial workloads, emotional labour, and systemic healthcare challenges that contribute to significant psychological distress. In Ghana, the compounding effects of structural deficiencies within the healthcare system make nurses particularly vulnerable. However, research on culturally informed coping strategies within this population remains limited. This study examined the association between psychological distress and Africentric coping strategies among 248 nurses in public healthcare facilities in the Central and Greater Accra regions of Ghana.

METHODS: Data were collected using the Hospital Anxiety and Depression Scale (HADS) and the Africultural Coping Systems Inventory (ACSI). Psychological distress was operationalised as the summed HADS total score (range: 0-42). Descriptive statistics, Pearson correlation analysis, and multiple linear regression models were used to examine associations.

RESULTS: The mean HADS anxiety score was 12.22 (SD = 3.14) and mean depression score was 11.27 (SD = 3.06), indicating elevated anxiety and moderate depressive symptoms. Mean ACSI subscale scores were: Cognitive/Emotional Debriefing M = 2.11 (SD = 0.61), Spiritual-Centred Coping M = 2.18 (SD = 0.73), Collective Coping M = 1.96 (SD = 0.58), and Ritual-Centred Coping M = 0.75 (SD = 0.34). Spiritual (r = – .268, p < .05) and collective coping (r = – .587, p < .05) were significantly and negatively associated with psychological distress; cognitive and ritual coping were not. In regression models, only spiritual (β = -2.681) and collective (β = -0.811) coping demonstrated significant negative associations with distress. Demographic factors including gender, marital status, and professional rank were significant predictors of distress.

CONCLUSION: These findings highlight the importance of culturally and contextually tailored mental health support that incorporates spiritual resources and peer support networks. The study provides empirical evidence to guide healthcare policy, workplace mental health programming, and culturally responsive nursing practice in sub-Saharan Africa.

CLINICAL TRIAL: Not applicable.

PMID:42082950 | DOI:10.1186/s12912-026-04714-9

BMC Infect Dis. 2026 May 4. doi: 10.1186/s12879-026-13454-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Hepatitis B virus (HBV) coinfection worsens HIV care outcomes and liver disease risk, but genotype-specific data in the World Health Organization (WHO) Africa Region is limited. To address this gap, we assessed HBV genotype distribution and genotype-specific clinical features in a cohort of people living with HIV (PLHIV) in Maputo City, Mozambique.

METHODS: This was a sub-analysis of a prospective cohort study that included newly diagnosed, HIV/HBV coinfected patients who were enrolled from May 2021 to November 2023. DNA extraction and partial-genome nested PCR with Sanger sequencing was performed on plasma samples. HBV genotypes were assigned by BLASTn, Geno2pheno, HBVdb, and NCBI-HBV, and phylogeny was inferred with MAFFT-based alignments and maximum likelihood-based phylogenetics. Clinical/laboratory data (Hepatitis B e antigen, HBV viral load, aspartate aminotransferase, alanine aminotransferase, CD4⁺ T cell count, HIV viral load) were recorded. Fibrosis was estimated using the AST-Platelet Ratio Index (APRI) score and WHO thresholds. R was applied for statistical analyses. Group comparisons used Pearson’s chi-squared or Fisher’s exact and Wilcoxon rank sum tests (complete-case analysis).

RESULTS: Of 1,106 newly diagnosed ART-naïve PLHIV, 81 (7.3%) were hepatitis B surface antigen (HBsAg)-positive and genotyping was successful in 55 (68%). Among HBV genotyped patients, the median age was 33.0 years (IQR 30.0, 39.0), 37 (67.3%) were male, 46 (83.6%) had HBV genotype A (subgenotype A1) and 9 (16.4%) genotype E. Median AST, ALT, and APRI scores tended to be higher in genotype E than subgenotype A1 cases, although differences were not statistically significant (AST 71.9 vs. 37.9 U/L; IQR 26.0-118.0 vs. 29.0-98.1; ALT 36.5 vs. 32.6 U/L; IQR 20.4-63.0 vs. 20.2-57.7; APRI 1.3 vs. 0.5; IQR 0.3-1.8 vs. 0.3-1.3). HBV DNA > 2,000 IU/mL occurred in 52.2% of subgenotype A1 and 55.6% of genotype E cases. Most cases were HBeAg-negative (A1: 36/46, 78.3%; E: 6/9, 66.7%).

CONCLUSION: HBV subgenotype A1 and genotype E are prevalent among HIV/HBV coinfected patients in Maputo, often with high HBV DNA levels and evidence of liver injury. Routine HBV screening, simple fibrosis assessment and further research are recommended.

PMID:42082949 | DOI:10.1186/s12879-026-13454-9

BMC Infect Dis. 2026 May 4. doi: 10.1186/s12879-026-13500-6. Online ahead of print.

ABSTRACT

INTRODUCTION: The Prevention of Mother-To-Child Transmission (PMTCT) of Hepatitis B Virus (HBV) infection is a crucial strategy for achieving global HBV elimination by 2030. As HBV testing forms the foundation of effective PMTCT programs, empowering women of reproductive age to accept HBV testing and screening services is essential. This study applied the Theory of Planned Behaviour to investigate the impact of psychosocial factors, including attitude, subjective norm, perceived behavioural control, and risk perception, on HBV testing intentions among women of reproductive age.

METHODS: A hospital-based cross-sectional study was conducted among 400 non-pregnant women aged 18-49 years attending child welfare and family planning clinics in rural northern Ghana. Participants were selected using simple random sampling and completed a structured, pretested questionnaire based on constructs from the Theory of Planned Behaviour. Composite sum scores were computed for each construct, and internal consistency was assessed using Cronbach’s alpha. Spearman’s correlation and hierarchical multiple regression analyses were performed using SPSS version 26, with statistical significance set at p < .05.

RESULTS: The mean age of participants was 27.12 years (SD = 5.8). In the main-effects regression model, attitude (β = 0.650, p < .001), perceived behavioural control (β = 0.275, p < .001), and risk perception (β = 0.061, p = .022) were significant predictors of HBV testing intention, while subjective norms were not statistically significant. The model explained 75.3% of the variance in testing intention (R² = 0.753). When the interaction between attitude and subjective norms was added, the interaction term was statistically significant (β = -0.108, p < .001), accounting for an additional 1.1% of variance (ΔR² = 0.011).

CONCLUSION: Attitude and perceived behavioural control were the primary predictors of HBV testing intention among women of reproductive age in rural northern Ghana. Risk perception showed a smaller association with intention, while subjective norms did not independently predict intention but moderated the relationship between attitude and intention. Interventions aimed at increasing HBV testing intention should prioritise strengthening positive attitudes and enhancing women’s perceived ability to access testing services.

CLINICAL TRIAL REGISTRATION: The study is a cross-sectional study and hence did not involve any experimentation or trial; clinical trial registration was not applicable in this case.

PMID:42082944 | DOI:10.1186/s12879-026-13500-6