Nevin Manimala

Neurol Res Pract. 2025 Jun 20;7(1):42. doi: 10.1186/s42466-025-00398-9.

ABSTRACT

BACKGROUND: An analysis of the cerebrospinal fluid (CSF) is essential for diagnosis of meningitis, headache, disturbance of conscience, cranial nerves or autoimmune-related conditions of the CNS. The initial treatment of pleocytosis usually consists of both antiviral therapy and antibiotics until laboratory results enable a more specific approach. Therefore, it is crucial to rapidly and accurately detect pathogens.

METHODS: In this observatory, monocentric study of quality management data, we studied insourcing of ME-PCR, CXCL 13, Antibody-specific Index (AI) for HSV, VZV (G $_1^{}$ ) compared with outsourced laboratory measurements (G $_0^{}$ ) and its benefit for the work-up. Before the implementation of these parameters, data from 150 patients were sampled, followed by 210 after the introduction of ME-PCR, CXCL 13 and AI. Data were collected, anonymized, and analysed afterwards. All were treated in hospital for suspected infections of the Central Nervous System (CNS). The length of hospital stay (LOS), intervals from lumbar puncture, the cumulative dose of anti-infective agents, length of treatment and the potential impact on patients’ safety parameters were examined.

RESULTS: The G $_1^{}$ -group showed a significant decrease of LOS (p<0.001), exposure to antiviral, and antibiotic agents decreased significantly (p < 0.001, each). Insourcing of ME-PCR and CXCL 13 shortened the time-span from admission to diagnosis in patients with suspected inflammatory CNS disease from 13.6 (6.6) to 9.7 (6.7) days in mean (SD).

CONCLUSION: The shortened average LOS after changing the diagnostic pathway increased direct costs for test kits. However, these costs were by far outweighed the economical benefit of being able to treat more patients in the same time. This analysis should be replicated in a different Medical Care System than the one in which this analysis has been calculated.

PMID:40542447 | DOI:10.1186/s42466-025-00398-9

Eur J Med Res. 2025 Jun 20;30(1):502. doi: 10.1186/s40001-025-02698-x.

ABSTRACT

INTRODUCTION: This study investigated the association between the financial performance of workplaces and the incidence of occupational injuries and diseases using the Workplace Panel Survey, a workplace-related national statistical survey in South Korea.

METHODS: The dependent variables were those related to the incidence of occupational injuries and diseases. The independent variables were those related to the financial performance of each workplace. Multilevel Poisson regression (or logistic regression) and linear regression analyses were used.

RESULTS: For the number of victims, the average number of workers, interest income, interest expenses, and value-added per person were associated with a significantly increased relative risk (RR). In contrast, lease expense2, depreciation and amortization, and initial/ending industrial property rights were associated with a significant decrease in RR. For the existence of occupational injuries/diseases, taxes and duties1, and welfare/benefits expenses were associated with a significant increase in the odds ratio (OR). In contrast, severance pay2, depreciation/amortization, and average number of workers were associated with a significant decrease in OR.

DISCUSSION: As the financial status of workplaces worsened, the incidence of occupational injuries and diseases increased. In contrast, as the operating profit and amount of tangible assets (subject to depreciation and amortization) of workplaces increased, the incidence of occupational injuries and diseases decreased. As the number of workers increased, the number of occupational injuries and diseases also increased; however, the odds of occupational injury or disease decreased. The decreasing number of occupationally injured or diseased workers, along with the increasing number of transport devices, might have resulted from special consignment subcontracts between cargo truck owners and shipping companies in South Korea.

PMID:40542441 | DOI:10.1186/s40001-025-02698-x

Eur J Med Res. 2025 Jun 20;30(1):499. doi: 10.1186/s40001-025-02783-1.

ABSTRACT

OBJECTIVES: To explore the latest characteristics and diagnostic methods of renal tuberculosis, and to improve the new recognition and diagnostic level of renal tuberculosis.

METHODS: We collected the medical records and postoperative histopathological slides of 217 patients diagnosed and treated with renal tuberculosis in the Department of Urology of Hebei Provincial Chest Hospital from March 25, 2013 to February 6, 2024, and divided them into the typical group (145 cases) and the atypical group (72 cases) according to their onset characteristics, and analyzed the distribution of onset symptoms and the differences in the positive rates of different examination methods between these two groups.

RESULTS: (1) Frequency, urgency and pain of urination were the main symptoms in the typical group (66.82%), and local or systemic atypical symptoms in the atypical group (33.18%), and the incidence rate of women in the atypical group was higher than that in the typical group (P < 0.05). (2) In both groups, the positive rate of CT diagnosis of renal tuberculosis was higher than that of ultrasound and urography (P < 0.05), and there was no statistically significant difference between the positive rates of T-SPOT.TB and PPD tests (P > 0.05). The CT positivity rate in the typical group was higher than that in the atypical group (P < 0.05). In the typical group GeneXpert MTB/RIF had a higher positive rate than that of PCR TB-DNA, acid-fast staining and tuberculosis culture (P < 0.05). However, in the atypical group and all patients in both groups, there was no statistical difference between the positivity rates of GeneXpert MTB/RIF and PCR TB-DNA (P > 0.05), both of which were higher than those of acid-fast staining and TB culture (P < 0.05). The positivity rate of acid-fast staining and tuberculosis culture was higher in the typical group than that in the atypical group (P < 0.05). In the typical group, the positivity rate of LAM antibody was higher than that of 38KDa and 16KDa (P < 0.05). However, in the atypical group, there was no statistically significant difference between the positivity rates of 38KDa and LAM antibodies (P > 0.05), and both were higher than that of 16KDa antibodies (P < 0.05). (3) There was no significant difference in pathological changes between the two groups, both of which were dominated by granulomas and caseous necrosis, and the positivity of tissue PCR TB-DNA was higher than that of antacid staining (P < 0.05), but there was no statistically significant difference in the positivity of tissue PCR TB-DNA between the two groups (P > 0.05). Cystoscopic biopsy was dominated by granuloma and necrosis in the typical group and chronic inflammation in the atypical group.

CONCLUSIONS: (1) In addition to renal tuberculosis with bladder irritation as the main clinical manifestation, atypical renal tuberculosis is also an important part of renal tuberculosis, which is characterized by systemic or local atypical symptoms, and should be highly concerned. (2) CT, GeneXpert MTB/RIF, T-SPOT.TB (or PPD test) and LAM antibody have higher sensitivity both in typical and atypical renal tuberculosis, which can improve the diagnosis rate of renal tuberculosis. (3) There is no significant difference in the pathologic changes between typical and atypical renal tuberculosis, and PCR TB-DNA of the tissues may help to improve the pathologic diagnosis of renal tuberculosis. In atypical renal tuberculosis, bladder mucosal lesions are characterized by chronic inflammation, and cystoscopic biopsy alone is of low diagnostic value.

PMID:40542434 | DOI:10.1186/s40001-025-02783-1

Orphanet J Rare Dis. 2025 Jun 20;20(1):312. doi: 10.1186/s13023-025-03854-6.

ABSTRACT

BACKGROUND: Ehlers-Danlos Syndrome (EDS) comprises connective tissue disorders associated with increased vascular complication risks. This meta-analysis assesses the prevalence of vascular complications in among patients with EDS.

METHODS: The review was conducted following PRISMA guidelines. A comprehensive literature search was conducted in PubMed, Embase, and Web of Science until November 2024. Observational studies reporting vascular complications in EDS were included. Data extraction included demographics, complication types, and study design, and quality assessment was evaluated using the modified Newcastle-Ottawa Scale (NOS). Random-effects models and I² statistics assessed heterogeneity, while Doi plots evaluated publication bias.

RESULTS: Of the 1,772 articles screened, 12 met the inclusion criteria, reporting various vascular complications in EDS. The overall pooled prevalence of vascular complications was 30.03% (95% CI: 15.00-51.07%). The prevalence for the vEDS subtype was 42.36% (95% CI: 12.63-78.88%), for unspecified EDS was 18.65% (95% CI: 5.38-48.03%), and for hEDS was 19.77% (95% CI: 15.09-25.16%). Sensitivity analyses confirmed the stability of the pooled prevalence estimates, and DOI plots indicated minimal publication bias.

CONCLUSIONS: This review highlights the high risk of vascular complications in vEDS, with moderate involvement in other EDS subtypes. Regular vascular monitoring, especially in vEDS, is crucial for early detection and intervention. Standardized diagnostic protocols and further research into genetic factors are needed to improve management strategies.

PMID:40542421 | DOI:10.1186/s13023-025-03854-6

Ital J Pediatr. 2025 Jun 20;51(1):196. doi: 10.1186/s13052-025-01988-8.

ABSTRACT

BACKGROUND: We aimed to compare endotracheal intubation through a laryngeal mask vs. using a direct laryngoscope in a manikin simulating a term infant.

METHODS: A randomized, controlled, crossover (AB/BA) trial of intubation through a laryngeal mask vs. a direct laryngoscope in a manikin simulating a term infant. Thirty-four tertiary neonatal intensive care unit consultants and pediatric residents who had previous experience with intubating laryngeal airway and direct laryngoscopy participated. The primary outcome measure was the success of the procedure at the first attempt. The secondary outcome measures included the total time of endotracheal tube positioning and participant’s opinion on insertion difficulty and overall difficulty.

RESULTS: Success at first attempt was 34/34 with the laryngeal mask (100%) and 26/34 with the direct laryngoscope (76%) (difference in percentage 24%, 95% confidence interval 5-41%; p = 0.008). Median time of endotracheal tube positioning was 24 s (IQR 19-30) with both devices (p = 0.86). Insertion difficulty (p = 0.96) and overall difficulty (p = 0.99) were not statistically different between the devices.

CONCLUSIONS: In a term infant manikin model, positioning the endotracheal tube through the laryngeal mask increased the success at the first attempt compared to direct laryngoscopy, without extending the duration of the procedure or affecting the perceived difficulty.

REGISTRATION: clinicaltrial.gov NCT06263790. Registered 16 February 2024, https://clinicaltrials.gov/study/NCT06263790 .

PMID:40542416 | DOI:10.1186/s13052-025-01988-8

Eur J Med Res. 2025 Jun 20;30(1):498. doi: 10.1186/s40001-025-02798-8.

ABSTRACT

BACKGROUND: Endotracheal intubation may be performed using deep anesthesia, neuromuscular blocks, or the topical application of anesthetics on the vocal cords. The null hypothesis in this study was that there is no difference in hoarseness one hour after extubation between patients receiving neuromuscular blocks versus lidocaine sprayed on the glottis for endotracheal intubation.

METHODS: A randomized, controlled, double-blinded study was conducted. A total of 114 patients were included. Group I (n = 58) received rocuronium 0.6 mg/kg. Group II (n = 56) received lidocaine spray 4 ml (20 mg/ml) on the vocal cords. The primary outcome measure was hoarseness one hour after extubation. Secondary outcomes were hoarseness at 24 and 48 h after extubation, sore throat at 1, 24, and 48 h after extubation, and intubation and extubation conditions.

RESULTS: There was no statistically significant difference between groups in hoarseness one hour after extubation. At 24 h, Group I had significantly more reported hoarseness (27.6%) and observed hoarseness (1.7%) than Group II (12.5% reported) (p = 0.03). Group II had a significantly sorer throat (21.4%) than Group I (1.7%) (p < 0.001) at one hour. Beyond this, there were no differences between groups.

CONCLUSION: Even though some differences were observed in hoarseness and sore throat 24 h after extubation, there were few differences between topical lidocaine spray and the use of neuromuscular blocks before intubation for patient-reported and observed outcomes. Consequently, clinicians should choose an approach based on considerations other than those included in this study, such as the need for muscle relaxation or minimizing the number of laryngoscopies. THE STUDY WAS PROSPECTIVELY REGISTERED AT CLINICALTRIALS.GOV : NCT05614609.

PMID:40542414 | DOI:10.1186/s40001-025-02798-8

Lipids Health Dis. 2025 Jun 20;24(1):219. doi: 10.1186/s12944-025-02640-4.

ABSTRACT

BACKGROUND: Pentadecanoic acid (C15:0) and heptadecanoic acid (C17:0) are considered to have protective effects on cardiovascular health. However, research on the relationship between C15:0 and C17:0 levels and hypertension remains limited. This cross-sectional study aims to investigate the association between serum levels of odd-chain fatty acids (C15:0 and C17:0) and prevalent hypertension.

METHODS: Data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) were used for this study. Multiple logistic regression models, restricted cubic spline (RCS) analysis, saturation threshold effect analysis, and interaction effect tests were employed to analyze the relationship between serum C15:0 and C17:0 levels and prevalent hypertension.

RESULTS: A total of 4,775 participants (C15:0 analysis group) and 4,718 participants (C17:0 analysis group) were included in this study. The prevalence of hypertension in the two groups is 46.99% and 46.82%, respectively. To improve the distribution and comparability of the data, the primary analysis used the per mille of total fatty acids (C15:0‰ and C17:0‰). After adjusting for multiple confounders, both C15:0‰ and C17:0‰ levels were significantly inversely associated with the odds of prevalent hypertension. In the fully adjusted model, an increase in C15:0‰ and C17:0‰ levels was associated with a lower odds of prevalent hypertension (C15:0‰: OR = 0.78, 95% CI: 0.66-0.93, P = 0.0063; C17:0‰: OR = 0.77, 95% CI: 0.64-0.93, P = 0.0074). Further restricted cubic splines analysis showed a significant nonlinear relationship between C15:0‰ level and prevalent hypertension. Saturation threshold effect analysis revealed that when C15:0‰ level was below 1.5‰, the inverse association with the odds of prevalent hypertension was stronger (OR = 0.42, 95% CI: 0.23-0.77, P = 0.0052), while the relationship weakened when C15:0‰ level was above 1.5‰ (OR = 0.89, 95% CI: 0.74-1.07, P = 0.2158). Interaction effect tests indicated that, in the subgroup with C15:0‰ level ≥ 1.5‰, age modified the relationship between C15:0‰ level and prevalent hypertension. In the population aged ≥ 65 years, C15:0‰ level was inversely associated with the odds of prevalent hypertension (OR = 0.54, 95% CI: 0.36-0.79, P = 0.0384), while no significant association was observed in the population aged < 65 years (OR = 0.83, 95% CI: 0.68-1.02, P = 0.1032).

CONCLUSIONS: Serum C15:0 and C17:0 levels are significantly inversely associated with the odds of prevalent hypertension, suggesting that serum C15:0 and C17:0 levels may serve as potential biomarkers for hypertension monitoring.

PMID:40542410 | DOI:10.1186/s12944-025-02640-4

Orphanet J Rare Dis. 2025 Jun 21;20(1):316. doi: 10.1186/s13023-025-03786-1.

ABSTRACT

BACKGROUND: Ataxia-telangiectasia (A-T) is an inherited multiorgan disorder with onset in childhood. Liver involvement, with steatosis and subsequent fibrosis, is increasingly recognized in children and young people with A-T.

PURPOSE: To evaluate feasibility of T1-weighted two-point mDixon MRI for identification of liver steatosis in children with A-T and conduct exploratory analysis of relationships between MRI-quantified liver fat fraction and clinical and laboratory measures.

STUDY TYPE: Post hoc analysis of prospectively collected research data.

POPULATION: 16 participants (8 female) with A-T aged 4.8-16.6 years.

FIELD STRENGTH/SEQUENCE: 3.0-T, two-point T1-weighted mDixon.

ASSESSMENT: Participants underwent whole-body MRI including T1-weighted mDixon. Water/fat signal percentage images were generated. Hepatic T1 fat fraction (T1-FF) was calculated from regions-of-interest placed in the right anterior, right posterior and left hepatic lobes. T1-FF > 5.56% was used as the diagnostic criterion for hepatic steatosis.

STATISTICAL TESTS: Group comparisons of variables between participants with and without previous diagnosis of liver steatosis were made using independent sample Mann-Whitney U. Associations between T1-FF and age, neurological severity and of liver function tests were tested with Spearman correlation. Statistical significance was pre-specified as p < 0.05.

RESULTS: Analyzable T1-weighted mDixon data was available for 11 participants. Five MRI datasets were discarded due to motion artefact (n = 3) or incorrect archiving of the original water image (n = 2). Median liver T1-FF was 11.3% (4.7-49.7%), and 10/11 (91%) of participants had evidence of steatosis. Participants with previous diagnosis of steatosis had higher T1-FF than those without (median 32.7% [9.7-49.7%], versus 10.3% [4.7-11.3%], p = 0.030). T1-FF correlated most strongly with alanine transaminase (r = 0.76, p = 0.007) and γ-glutamyltransferase (r = 0.76, p = 0.006).

CONCLUSION: T1-weighted mDixon MRI is feasible for detecting steatosis in children with A-T, although motion artefacts reduced data completeness. MRI-quantified liver T1-FF correlates with markers of liver health. We found higher prevalence of liver steatosis using T1-weighted mDIXON than previously reported in pediatric A-T cohorts.

PMID:40542396 | DOI:10.1186/s13023-025-03786-1

J Neurodev Disord. 2025 Jun 20;17(1):34. doi: 10.1186/s11689-025-09626-4.

ABSTRACT

OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder with a significant genetic component. The latest genome-wide association study (GWAS) meta-analysis of ADHD identified 27 whole-genome significant risk loci in the European population. However, genetic risk factors for ADHD are less well-characterized in the Asian population, especially for low-frequency / rare variants.

METHODS: In this study, we aimed to investigate the contributions of both common and low-frequency / rare variants to ADHD in a Hong Kong sample. Our sample comprised 279 cases and 432 controls who underwent genotyping using the Illumina Infinium Global Screening Array. We employed various analytical methods at different levels, while also leveraging multi-omics data and large-scale summary statistics to comprehensively analyze the genetic basis of ADHD.

RESULTS: We identified 41 potential genomic risk loci with a suggestive association (p < 1e^-4), pointing to 111 candidate risk genes, which were enriched for genes differentially expressed during late infancy brain development. Furthermore, tissue enrichment analysis implicated the involvement of the cerebellum. At the polygenic level, we also discovered a strong genetic correlation with resting-state functional MRI connectivity of the cerebellum involved in the attention/central executive and subcortical-cerebellum networks. In addition, an accumulation of ADHD common-variant risks found in European ancestry samples was found to be significantly associated with ADHD in the current study. In low-frequency / rare variant analyses, we discovered the correlations between ADHD and collapsing effects of rare damaging variants in TEP1, MTMR10, DBH, TBCC, and ANO1. Based on biological and functional profiles of the potential risk genes and gene sets, both common and low-frequency / rare variant analyses demonstrated that ADHD genetic risk was associated with immune processes.

CONCLUSIONS: These findings re-validate the abnormal development of the neural system in ADHD and extend the existing neuro-dysfunction hypothesis to a multi-system perspective. The current study identified convergent risk factors from common and low-frequency / rare variants, which implicates vulnerability in late-infancy brain development, affecting especially the cerebellum, and the involvement of immune processes.

PMID:40542392 | DOI:10.1186/s11689-025-09626-4

Popul Health Metr. 2025 Jun 20;23(Suppl 2):28. doi: 10.1186/s12963-025-00387-9.

ABSTRACT

BACKGROUND: Before COVID-19, knowledge on pandemic vulnerability and mortality in South Africa was largely limited to the context of HIV/AIDS. We evaluated mortality rates and risk of death, prior to and during the COVID-19 pandemic, in relation to an individual’s COVID-19 vulnerability, based on a scoring algorithm developed in South Africa.

METHODS: The analysis was undertaken using data from a health and demographic surveillance system (HDSS) in Soweto and Thembelihle, Gauteng, South Africa. Health and demographic population-based data have been collected from the HDSS area since 2018. Using indicators included in a COVID-19 Vulnerability Index, previously developed in South Africa, the current study established a composite COVID-19 vulnerability index, stratified into tertiles. The risk of death pre-COVID-19 (1 January 2018-28 February 2020) and during the COVID-19 period (1 March 2020-31 December 2021) was analysed. A Cox proportional hazard model was used to compare the risk of death between the two time periods. Statistical analyses were conducted using Stata software version 17.

RESULTS: Before COVID-19, overall mortality rates were 8.1 (95% CI 7.6-8.8), 7.0 (95% CI 6.4-7.7) and 6.1 (95% CI 5.5-6.7) per 1000 person-years in the lowest, middle, and highest tertile of vulnerability index, respectively. All cause-mortality across all tertiles more than doubled during the COVID-19 period compared to pre-COVID-19 (15.5 against 7.2). The mortality rates during the COVID-19 era were 17.1 (95% CI 16.3-18.0), 14.5 (95% CI 13.4-15. 7) and 13.7 (95% CI 12.8-14.7) per 1000 person-years in the lowest, middle, and highest tertiles, respectively. Overall, individuals in the highest tertile of COVID-19 vulnerability were at a significantly lower risk of death relative to those in the lowest tertile (aHR 0.9, 95% CI 0.8-1.0, p < 0.05). The risk of dying during the COVID-19 period for vulnerable individuals was at least double compared to the pre-COVID-19 period for each of the individual vulnerability indicators.

CONCLUSIONS: All-cause mortality during the COVID-19 era was significantly higher than the pre- COVID-19 period, with the increase observed across all vulnerability tertiles. It is important to identify vulnerable individuals and communities during the early stages of a pandemic to inform prioritisation of public health intervention.

PMID:40542376 | DOI:10.1186/s12963-025-00387-9