Nevin Manimala

OTA Int. 2026 Jan 7;9(1):e461. doi: 10.1097/OI9.0000000000000461. eCollection 2026 Mar.

ABSTRACT

OBJECTIVES: The burden of orthopaedic trauma has continued to increase with a disproportionate impact on low- and middle-income countries (LMICs), in part due to inadequacy of resources for operative fracture fixation. The objective of this study was to evaluate the available literature regarding the availability of equipment and implants for operative fracture care in LMICs and the barriers to accessing these resources.

DATA SOURCES: A comprehensive literature search was conducted in the PUBMED, SCOPUS, EMBASE, and WEB OF SCIENCE databases for the period January 2003 to December 2023 using search terms including “implants,” “hardware,” “availability,” “accessibility,” and “access” to identify relevant records published in English.

STUDY SELECTION: All studies that assessed the availability of implants for operative fracture fixation in LMICs were included.

DATA EXTRACTION: Articles were critically appraised for their methodological quality using the JBI critical appraisal checklist for qualitative research. Data were manually extracted into a predesigned data extraction template.

DATA SYNTHESIS: Data were synthesized through basic pooling and summarized using descriptive statistics, including percentages and proportions.

RESULTS: Seven hundred twenty-two records were identified, and 11 articles comprising 488 health care facilities from 8 LMICs met the inclusion criteria for analysis. The included studies were all observational, including 8 cross-sectional surveys and 3 qualitative case studies. Findings included little to no capability of performing internal or external fixation at small, community hospitals. Resources were still generally inadequate for treating orthopaedic injuries at larger, tertiary hospitals. Private hospitals and tertiary hospitals with medical schools are the best equipped. Barriers identified included the high cost of implants and reliance on imported implants, lack of government funding and trauma system organization, patients needing to procure their own implants, and even corruption and poor leadership. Solutions proposed included improved funding for trauma care, prioritizing orthopaedic services and providing continuing trauma education, defining essential equipment necessary for orthopaedic care, strengthening resource monitoring and organization, and encouraging local implant manufacturing.

CONCLUSIONS: Inadequate availability of fracture fixation implants and equipment is a major challenge in LMICs. There is little known about the availability of specific orthopaedic equipment and implants at the specialist level of fracture care. A future study aimed at evaluating the availability of specific orthopaedic equipment and implants necessary for specialized fracture care in these countries is recommended to identify key areas for improvement. Ideally, orthopaedic surgeons working in these settings could be surveyed to determine which resources are most critically lacking and should be prioritized to enhance the delivery of adequate care.

LEVEL OF EVIDENCE: IV.

PMID:41510526 | PMC:PMC12778074 | DOI:10.1097/OI9.0000000000000461

Methodology (Gott). 2025 Jun;21(2):144-160. doi: 10.5964/meth.14733. Epub 2025 Jun 30.

ABSTRACT

Dose-response relationships between continuous risk factors and disease outcomes are necessary for understanding the risks related to different levels of exposure. Dose-response risk curves can lead to more targeted public health messaging, prevention efforts, and policy implementation. Meta-analyses are often used to combine statistical results from different studies and can be used to model dose-response relationships. However, several challenges are encountered when performing dose-response meta-analysis, such as having heterogeneous reference categories, inconsistent measures of risk, and determining the most accurate shape of the curve. In this paper, we propose a three-step process for estimating dose-response relationships via meta-analysis, which involves: 1) harmonizing the measures of risk, 2) homogenizing the reference category, and 3) selecting meta-regression models. We use data obtained from a systematic review on the dose-response relationship between alcohol consumption and the risk of chronic liver disease to provide an example of the proposed process.

PMID:41510522 | PMC:PMC12779110 | DOI:10.5964/meth.14733

SAGE Open Nurs. 2026 Jan 6;12:23779608251409854. doi: 10.1177/23779608251409854. eCollection 2026 Jan-Dec.

ABSTRACT

INTRODUCTION: Migration from Albanian healthcare professionals to Western countries has been widespread since Albania emerged from communism in 1991. The migration of Albanian physicians and nurses has significant impacts on the country’s healthcare system.

OBJECTIVE: The manuscript addresses the migration intentions of Albanian healthcare professionals, including physicians and nurses focusing on their inclination to emigrate to Western countries.

METHODS: This cross-sectional study included 315 participants from two municipalities, Fier and Vlore, examining various factors that impact their desire to seek employment abroad. A structured, culturally adapted questionnaire (18 items; four subscales: migration intention, social worth, teamwork climate, financial dissatisfaction) adapted from Goštautaitė et al. was used; internal consistency was high (Cronbach’s α = 0.885).

RESULTS: Results indicate a moderate-to-high level of migration intention, particularly pronounced among younger healthcare workers, those with fewer years of professional experience, and individuals working in high-stress departments such as emergency medicine and intensive care. Statistically significant associations were found between migration intention and key variables, including age (p < .01), ward of employment (p < .05), and self-reported financial dissatisfaction (p < .01). Participants citing greater dissatisfaction with income and professional growth opportunities were more likely to express a desire to emigrate. Additionally, poor teamwork climate and low perceived social worth were moderately associated with higher migration intentions, though not all associations reached statistical significance. These findings highlight a widespread perception of undervaluation and burnout, particularly in public sector facilities and among early-career professionals.

CONCLUSIONS: Financial dissatisfaction and stressful work settings were associated with higher migration intention; policy measures may mitigate these risks. Several systems have piloted targeted retention levers (remuneration, career ladders, dual practice), offering transferable options. Similar interventions could mitigate the brain drain in Albania, improving job satisfaction and financial stability for healthcare workers.

PMID:41510499 | PMC:PMC12775355 | DOI:10.1177/23779608251409854

IJID Reg. 2025 Nov 30;18:100817. doi: 10.1016/j.ijregi.2025.100817. eCollection 2026 Mar.

ABSTRACT

OBJECTIVES: During the COVID-19 pandemic, airport-based measures, such as fever screening and polymerase chain reaction (PCR) testing were implemented in Japan. Okinawa Prefecture introduced a voluntary airport PCR testing program for domestic travelers at Naha Airport (OKA). Their indirect behavioral effects on travelers remain underexplored. This study aims to describe self-reported pre-travel health awareness among participants in this program.

METHODS: In February-March 2021, we conducted a cross-sectional questionnaire survey among Naha Airport PCR test Project (NAPP) participants (n = 4545; March subset n = 1859). The survey assessed demographics, travel purpose, awareness of airport screening (fever screening and PCR testing), pre-travel health awareness, COVID-19 history, and symptoms. Logistic regression evaluated factors associated with self-reported symptoms in the March subset.

RESULTS: Among respondents aware of fever screening and PCR testing, 94.1% and 96.4%, respectively, reported increased attention to their physical condition before travel. Overall, 3.9% reported symptoms, mainly mild respiratory complaints. The proportion symptomatic varied by reason for testing; workplace-mandated testers reported fewer symptoms than family-motivated testers (adjusted odds ratio 0.36, 95% confidence interval 0.15-0.78).

CONCLUSIONS: Awareness of voluntary airport screening measures was associated with greater self-reported pre-travel health awareness among voluntary testers. These findings may inform context-specific behavioral strategies aimed at promoting health-conscious travel during infectious disease outbreaks.

PMID:41510495 | PMC:PMC12774711 | DOI:10.1016/j.ijregi.2025.100817

IJID Reg. 2025 Nov 13;18:100804. doi: 10.1016/j.ijregi.2025.100804. eCollection 2026 Mar.

ABSTRACT

OBJECTIVES: Maternal and neonatal tetanus (MNT) remains a major public health concern in Somalia, where health infrastructure is still recovering. Despite the availability of a safe and effective tetanus toxoid (TT) vaccine, coverage remains low. This study aimed to identify factors influencing TT vaccine uptake among reproductive-age women in Mogadishu, Somalia.

METHODS: A community-based cross-sectional study was conducted from June to August 2025 in Mogadishu, Somalia. A two-stage cluster sampling technique combined with systematic random sampling was used to select 350 households. Data were collected using a structured, interviewer-administered questionnaire, and the primary outcome was adherence to at least two doses of the TT vaccine during pregnancy. Data were analyzed using bivariate and multivariable logistic regression to identify independent predictors of TT vaccine uptake.

RESULTS: A total of 350 women participated in the study. Coverage of the TT vaccine was low, with only 19.7% receiving two or more doses during their last pregnancy. Multivariate analysis showed that women aged 36-49 years were more likely to be protected compared to those aged 15-25 years (AOR = 6.62; 95% confidence interval [CI]: 1.74-25.21; P = 0.006). Planned pregnancy was associated with higher protection (AOR = 8.35; 95% CI: 3.25-21.45; P <0.001). Attendance at health centers for antenatal care (AOR = 0.35; 95% CI: 0.18-0.69; P = 0.002), visits by health extension workers (AOR = 8.13; 95% CI: 4.35-15.22; P <0.001), and good behavior of health workers (AOR = 3.48; 95% CI: 1.15-10.46; P = 0.027) were positively associated with TT protection. Women from households with a monthly income below 57 US$ were significantly less likely to be protected (AOR = 0.04; 95% CI: 0.01-0.22; P <0.001).

CONCLUSIONS: TT vaccination coverage among women was low. Older age, planned pregnancy, antenatal care at health centers, visits by health extension workers, and good behavior of health workers were associated with higher protection, while low household income was linked to lower uptake. Strengthening targeted interventions is needed to improve TT coverage.

PMID:41510494 | PMC:PMC12775988 | DOI:10.1016/j.ijregi.2025.100804

IJID Reg. 2025 Nov 25;18:100810. doi: 10.1016/j.ijregi.2025.100810. eCollection 2026 Mar.

ABSTRACT

OBJECTIVES: Pulmonary tuberculosis (PTB) often leads to impaired health-related quality of life (HRQoL). The study evaluates the impact of a pharmacist-led educational counseling intervention on the HRQOL in individuals with PTB.

METHODS: This single-blind, randomized controlled trial employed a parallel-group design at a tertiary care hospital in Malaysia. A total of 206 adults diagnosed with PTB were randomized (1:1) to receive either standard care under the directly observed therapy (DOT) strategy (control group) or DOT plus structured pharmacist-led counseling (intervention group) for 6 months. HRQoL was assessed at baseline and at treatment completion using the EQ-5D-3L and visual analog scale (VAS). Data analyses were performed using SPSS.

RESULTS: There was a statistically significant difference between the control group and the intervention group on the quality-of-life scores post-intervention. Baseline HRQoL was comparable between groups (P >0.05). At treatment completion, significant improvements were observed in the intervention group compared with the control group for self-care (P = 0.03), mobility (P = 0.05), and pain/discomfort (P = 0.01). Mean VAS scores were also higher in the intervention group (P <0.001).

CONCLUSIONS: Pharmacist-led education and counseling interventions significantly improve the quality of life of patients with PTB.

PMID:41510493 | PMC:PMC12775972 | DOI:10.1016/j.ijregi.2025.100810

J Pediatr Soc North Am. 2025 Oct 21;14:100284. doi: 10.1016/j.jposna.2025.100284. eCollection 2026 Feb.

ABSTRACT

BACKGROUND: Lenke type 5C scoliosis is treated surgically with long-segment (nonselective) or short-segment (selective) level fusion. For Lenke type 5C scoliosis, no standardized criteria exist for selecting proximal and distal fusion levels. Studies report that short-segment level fusion patients with correct patient selection have a direct effect on the result of a well-balanced spine.

PURPOSE: To compare the midterm and long-term radiologic and clinical outcomes of short-segment (selective) vs long-segment (nonselective) fusion in Lenke type 5C scoliosis.

DESIGN: Retrospective cohort study.

PATIENT SAMPLE: This retrospective study evaluated patients who underwent posterior instrumentation for Lenke type 5C adolescent idiopathic scoliosis (AIS) at our institution between 2005 and 2016.

OUTCOME MEASURE: Physiologic measures: radiological evaluations included coronal, sagittal, and spinopelvic balance assessments as well as shoulder balance parameters on X-ray. Functional measures: clinical evaluations were performed using the SF-36 and SRS-22(r) scores.

METHODS: Patients with Lenke type 5C scoliosis who underwent selective (group 1) or nonselective (group 2) instrumentation were retrospectively analyzed. Group 1 included 47 patients (42 females and five males) with a mean age of 16.1 ± 2.4 year (range, 12-22), and group 2 included 58 patients (53 females and five males) with a mean age of 16.3 ± 3.4 yr (range, 12-24; P > .05). Radiological evaluations included coronal, sagittal, and spinopelvic balance assessments, as well as shoulder balance parameters. Clinical evaluations were performed using SF-36 and SRS-22(r) scores; results were compared between the two groups.

RESULTS: Both groups exhibited similar results in terms of coronal, sagittal, and spinopelvic balance as well as shoulder balance in many data after surgery (P > .05). Clinical outcomes, assessed via SF-36 mental health and SRS-22(r) scores, did not show statistically significant differences between groups (P > .05), except fort the physical role difficulty domain of the SF-36, where the selective fusion group (77.1 ± 31.6) showed significantly better scores than nonselective group (58.2 ± 36.1). However, the mean surgical time and transfusion requirement were significantly lower in the selective fusion group.

CONCLUSION: When appropriately applied, selective fusion achieves comparable radiologic and clinical outcomes to nonselective fusion, with the added advantages of shorter surgical time and lower transfusion requirements.

KEY CONCEPTS: (1)Selective fusion, when performed in appropriately selected patients, was found to be as stable as nonselective fusion in terms of shoulder balance, coronal balance, sagittal balance, and spinopelvic parameters.(2)Selective fusion offers several advantages, including shorter operative time, reduced blood loss, shorter hospital stays, and lower patient-based costs.(3)Lenke type 5 selective fusion has high stability within the right patient selection.

LEVEL OF EVIDENCE: Level III Case-control study or retrospective cohort study.

PMID:41510491 | PMC:PMC12774777 | DOI:10.1016/j.jposna.2025.100284

J Pediatr Soc North Am. 2025 Oct 18;14:100285. doi: 10.1016/j.jposna.2025.100285. eCollection 2026 Feb.

ABSTRACT

BACKGROUND: The potential for impaired sleep due to pain or discomfort can be a concern for adherence to nighttime bracing when treating clubfoot. The primary aim of our study was to compare sleep efficiency in young children wearing a nighttime foot abduction orthosis (FAO) to that of a matched control group. Secondary aims included the comparison of total sleep time, number of night wakings, and number of parental interventions between groups.

METHODS: Autovideosomnography using the Nanit infant monitor (Nanit, Inc, New York, NY) was utilized to measure sleep/wake patterns. Clubfoot patients aged 12-36 months at time of enrollment (November 2019 to March 2024, inclusive) undergoing nighttime FAO treatment, with a home Wi-Fi network and who were sleeping alone in a crib, were eligible for inclusion.Sleep metrics from 7 days for 25 children with clubfoot sleeping with nighttime FAO were compared to data from 100 age- and geographically matched controls within Nanit’s database. Shapiro-Wilk tests were performed to assess normality. Mann-Whitney U tests were used to assess differences in all sleep metrics and age between cohorts. Statistical significance was set at P < .05.

RESULTS: There were no significant differences in sleep efficiency, total sleep time, or number of night wakings. There were slightly more nighttime interventions for parents of children with clubfeet compared to controls.

CONCLUSIONS: Sleep metrics of young children undergoing Ponseti-style FAO bracing are not significantly different from those of matched controls.

KEY CONCEPTS: (1)Autovideosomnography using the Nanit infant monitor was utilized to measure sleep/wake patterns in 25 clubfoot patients undergoing Ponseti-style boots and bar treatment and 75 matched controls.(2)Clubfoot patients undergoing Ponseti-style boots and bar treatment did not have any significant differences across sleep efficiency, total sleep time, total time awake or number of night wakings compared to controls.(3)As brace tolerance and consistent adherence to a nighttime bracing regimen are essential to prevent recurrent clubfoot, caregivers and physicians may be reassured that clubfoot bracing will not significantly impact a child’s sleep.

LEVEL OF EVIDENCE: Level II.

PMID:41510489 | PMC:PMC12775981 | DOI:10.1016/j.jposna.2025.100285

Zhongguo Zhong Yao Za Zhi. 2025 Dec;50(23):6666-6676. doi: 10.19540/j.cnki.cjcmm.20250725.703.

ABSTRACT

This study aims to investigate the synergistic protective effects and underlying mechanisms of the combined application of Puerariae Lobatae Radix polysaccharide 1(PLP1) and betaine in alcohol-induced liver and intestinal injuries in mice and AML-12 hepatocytes. An alcoholic liver disease(ALD) mouse model was established according to the NIAAA protocol using chronic ethanol feeding combined with acute ethanol gavage. Mice were randomly divided into six groups: control, model, PLP1 monotherapy, betaine monotherapy, low-dose combination(LD-Comb), and high-dose combination(HD-Comb). Complementary in vitro studies involved ethanol-injured AML-12 mouse hepatocytes, divided into eight groups: control, model, PLP1, betaine, LD-Comb, medium-dose(MD-Comb), HD-Comb, and LD-Comb + lipopolysaccharide(LPS, 1 μg·mL~(-1)). Hepatic and intestinal histopathological changes were evaluated using hematoxylin-eosin(HE) staining, Sirius red staining, and immunohistochemistry. Alanine aminotransferase(ALT), aspartate aminotransferase(AST), alcohol dehydrogenase(ADH), and aldehyde dehydrogenase(ALDH) were quantified by biochemical assays. Enzyme-linked immunosorbent assays(ELISA) measured tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), interleukin-1β(IL-1β), and LPS levels. Protein expressions of cytochrome P450 2E1(CYP2E1), zonula occludens-1(ZO-1), Occludin, mucin-2(MUC-2), Toll-like receptor 4(TLR4), nuclear factor-κB(NF-κB), and myeloid differentiation primary response 88(MyD88) were analyzed using Western blot, immunohistochemistry, and immunofluorescence. The mRNA expression of TLR4, NF-κB, and MyD88 was analyzed by quantitative PCR(qPCR). The results showed that, compared with the model group, PLP1 or betaine monotherapy significantly alleviated hepatic edema and inflammatory infiltration, reduced collagen deposition, increased intestinal mucus thickness, restored goblet cell count, and decreased serum levels of IL-6, TNF-α, IL-1β, LPS, ALT, and AST, while enhancing ADH and ALDH activity. Concurrently, CYP2E1, TLR4, NF-κB, and MyD88 expression levels were downregulated, and the expression of ZO-1, occludin, and MUC-2 in colon tissues was upregulated. The combined treatment of PLP1 and betaine further enhanced these improvements compared with monotherapies, although the difference between the LD-Comb and HD-Comb groups was not statistically significant. In AML-12 cells, PLP1 or betaine monotherapy significantly reduced ALT, AST, IL-6, and TNF-α levels in the culture supernatant and downregulated the expression of TLR4, NF-κB, and MyD88. The combined treatment showed stronger effects than monotherapy, while co-treatment with the TLR4 agonist LPS partially reversed these benefits. In conclusion, the combination of PLP1 and betaine exerts synergistic protective effects by enhancing ethanol metabolism, promoting tight junction protein synthesis, repairing intestinal barrier function, reducing LPS translocation, and suppressing the activation of the TLR4 signaling pathway, thereby lowering inflammatory cytokine levels. This multi-targeted synergy effectively alleviates liver and intestinal injury in ALD mice and ethanol-injured AML-12 hepatocytes.

PMID:41508269 | DOI:10.19540/j.cnki.cjcmm.20250725.703

Zhongguo Zhong Yao Za Zhi. 2025 Oct;50(19):5584-5604. doi: 10.19540/j.cnki.cjcmm.20250516.101.

ABSTRACT

This study was based on the photoreprint of the Ming dynasty’s officially revised Essentials of Materia Medica Distinctions(hereinafter referred to as the Roman version) held in the National Central Library of Rome, Italy. It examined the number of traditional Chinese medicines(TCMs) recorded, TCM adjustment status, the origins of newly added TCMs, and the characteristics of some TCM illustrations in this version. The study aimed to provide reference for the subsequent research and utilization of Essentials of Materia Medica Distinctions. The study employed methods of literature statistics, induction, and herbal textual research to investigate the number of TCMs recorded in the book, the adjustments, the origins of newly added TCMs, and the origins of some TCMs in the illustrations. The Roman version actually recorded 1 808 TCMs. Compared with The Revised Zhenghe Classified Materia Medica from Historical Classics for Emergency, it included 38 newly added TCMs marked as &quot;newly supplemented TCMs&quot;, 23 TCMs marked as &quot;newly separated entries&quot; which were split from existing entries, 31 TCMs that were adjusted, and 422 TCMs with newly added illustrations. The origins of the 38 newly supplemented TCMs and 23 newly separated entries were identified. The rationality of TCM separation and movement was evaluated, and the characteristics of the TCM illustrations in Essentials of Materia Medica Distinctions were summarized. By sorting out the number of TCMs, analyzing the adjustments, examining the newly supplemented TCMs and their origins, and investigating the characteristics of TCM illustrations, this study provides reference for the compilation, structure, versions, TCM collection, reading, and utilization of Essentials of Materia Medica Distinctions.

PMID:41508249 | DOI:10.19540/j.cnki.cjcmm.20250516.101