Nevin Manimala

Orphanet J Rare Dis. 2025 Jan 28;20(1):41. doi: 10.1186/s13023-025-03570-1.

ABSTRACT

BACKGROUND: Hepatic glycogen storage diseases (GSD) are inborn errors of metabolism with abnormal storage or utilization of glycogen, a complex disease with significant genetic heterogeneity and similar clinical manifestations. This study aimed to describe the gastrointestinal symptoms and endoscopic features of hepatic GSD, including types Ia, Ib, III, VI, and IX, to provide evidence for etiology and treatment.

METHODS: A national cohort survey questionnaire was distributed to patients diagnosed with GSD type Ia, Ib, III, VI, and IX through genetic testing or their parents in mainland China in May 2022. Expert gastroendoscopists performed endoscopic examinations and evaluations in 10 hospitals. Descriptive statistics were used for analysis.

RESULTS: A total of 315 patients with hepatic GSD were included in the study, including 191 males and 124 females, the median age at diagnosis was 1.42 years (range = 0.08-36.08 years), with a median age of 5.42 years at the time of investigation (range = 0.58-38.08 years). 95% of patients relied on uncooked corn starch (UCCS) for blood glucose maintenance, and the median age of initiation was 18.5 months (range = 4-360 months). The common characteristics of these GSDs were hypoglycemia, lactic acidosis, anemia, liver enlargement, hyperlipidemia, hyperuricemia, and weakness. More than 60% of patients reported gastrointestinal symptom including anorexia, nausea/vomiting, abdominal pain, abdominal bloating, diarrhea, and mucus or bloody stool. The incidence of gastrointestinal symptoms in patients with GSD type Ia, Ib, III, VI and IX were 68%, 68%, 48%, 59% and 48%, respectively. A total of 48 GSD patients underwent gastroenteroscopy, 54% (26/48, 24 patients with type Ib, 1 patient with type Ia and 1 with III) were diagnosed with GSD-associated inflammatory bowel disease (IBD), the endoscopic images showed mucosal edema, erythema, erosions, single or scattered multiple large, deep, round ulcers and strictures, without linear ulcers and cobblestone mucosal lesions.

CONCLUSION: Patients with GSD type Ia, Ib, III, VI and IX had different degrees of gastrointestinal complications, among which patients with type Ia, Ib and III were the most prominent, and the proportion of GSD-Ib patients had a higher proportion of GSD-associated IBD.

PMID:39875987 | DOI:10.1186/s13023-025-03570-1

BMC Oral Health. 2025 Jan 28;25(1):147. doi: 10.1186/s12903-025-05533-1.

ABSTRACT

BACKGROUND: This study aims to investigate the prevalence and morphology of middle mesial canal (MMC) in mandibular first molar (M1M) among a Northwestern Chinese population, and to analyze their relationship with anatomical aspects of the mesial root.

METHODS: Cone beam computed tomography (CBCT) was utilized to evaluate 898 M1Ms and assess the incidence and morphology of MMC. The following parameters for M1M with or without MMC were obtained: the vertical distance between the first appearance of MMC and canal orifices (D), the distance between mesiobuccal (MB) and mesiolingual (ML) canals (D1), the buccolingual width(L1) and mesiodistal width (L2) of mesial roots, and the flatness degree(L1/L2) of mesial roots. The results were statistically analyzed.

RESULTS: The prevalence of MMC was 9.6% when considering the number of teeth and 7.2% when considering individuals. The presence of MMC was not significantly associated with sex (p = 0.993) or age (p = 0.211). Type 1-3-2 emerged as the most prevalent root canal morphology. MMC primarily manifested within 4 mm below the canal orifices. In cases where MMC was present, the MB-ML distance was significantly greater (p = 0.017). Conversely, no significant correlation was found between the presence of MMC and the length, width, or flatness degree of the mesial roots.

CONCLUSIONS: The morphology of MMCs is complex, and most of them exhibit confluent canals. In instances where MMCs are present, the MB-ML distance is significantly larger. For effective detection of MMC, a thorough examination of the area within 4 mm beneath the canal orifice is recommended.

PMID:39875974 | DOI:10.1186/s12903-025-05533-1

J Prosthodont. 2025 Jan 28. doi: 10.1111/jopr.14021. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate and compare the fracture resistance of long-span fixed provisional restorations fabricated using milling, three-dimensional (3D) printing, and conventional methods.

MATERIALS AND METHODS: Sixty specimens were prepared, divided into four groups of 15 each, corresponding to four fabrication methods: computer-aided design and computer-aided manufacturing (CAD-CAM) milled provisional resins, 3D-printed provisional resins, 3D-printed permanent resins, and conventional bis-acryl restorations reinforced with wire. The specimens underwent a three-point bending test using a universal testing machine to measure fracture resistance, quantified as maximum force (in Newtons). Statistical analysis was performed using one-way ANOVA and Tukey’s HSD post-hoc tests to compare the fracture resistance across the four groups.

RESULTS: Significant differences in fracture resistance were observed among the materials tested (p < 0.001). Both the CAD-CAM milled and 3D-printed resins exhibited significantly higher fracture resistance than the conventional bis-acryl method.

CONCLUSION: The results highlight the mechanical advantages of digital fabrication methods for long-span provisional applications in prosthodontics. These techniques may provide improved durability and reliability, addressing the mechanical demands of complex restorations.

PMID:39875969 | DOI:10.1111/jopr.14021

BMC Med Educ. 2025 Jan 28;25(1):138. doi: 10.1186/s12909-025-06706-w.

ABSTRACT

OBJECTIVE: Despite the growth of Emergency Medicine (EM) globally, shortages of EM-trained physicians persist in many countries, disproportionately affecting lower middle/low-income countries (LMIC/LIC). This study examines the career paths of graduates of an Emergency Medicine residency-training program established in Lebanon with the aim of building local capacity in EM.

DESIGN AND PATIENTS: This descriptive study utilizes secondary data sourced from an alumni database that includes nine cohorts of graduates from an Emergency Medicine residency program at the American University of Beirut Medical Center in Lebanon.

MEASUREMENTS AND MAIN RESULTS: Within 12 years since the EM residency program establishment a total of 9 cohorts, including 44 physicians had completed their residency training in EM, with 40.9% being female and 95.5% Lebanese citizens. After graduation, almost half of our graduates (47.7%) enrolled in fellowship training programs and 40.9% joined the workforce. Fellowships in Trauma (19%) and Oncologic Emergencies (19%) were the most commonly pursued. Initial employment destinations predominantly included Lebanon, the United Arab Emirates and the Kingdom of Saudi Arabia, (61.1, 33.3 and 5.6% respectively). However, retention within the local market declined with time, with a median time spent in Lebanon of 1 year and a mean of 3.3 years of practice in Lebanon prior to emigration. Presently, graduates are mostly dispersed across the Gulf Cooperation Council region (38.6%), the USA (25%), and Lebanon (20.5%).

CONCLUSION: Building Emergency Medicine expertise to match the growing population needs for specialized acute care remains a challenge globally, especially in low-middle income and low-income countries. Our study highlights the challenge of retaining specialized medical graduates in LMIC. Understanding and addressing the root-causes of out-migration of highly specialized medical workforce is an essential component of addressing local workforce challenges that needs to be coupled with capacity building initiatives for meaningful impact.

PMID:39875967 | DOI:10.1186/s12909-025-06706-w

BMC Health Serv Res. 2025 Jan 29;25(1):172. doi: 10.1186/s12913-024-12074-w.

ABSTRACT

BACKGROUND: Inadequate medication knowledge and medication nonadherence by patients are considered an issue in healthcare, as they can lead to negative outcomes, such as therapeutic failures and hospitalization. Even though drug dispensing, which has pharmacist counseling as a core element, is a service traditionally performed by pharmacists, there is still no evidence about the influence of this service on these health outcomes.

OBJECTIVE: To evaluate the influence of drug dispensing on patients’ medication knowledge and medication adherence.

METHODS: A systematic review was conducted in which a literature search was performed in the PubMed/Medline, Biblioteca Virtual da Saúde, Web of Science, and Embase databases, as well as in gray literature. Two reviewers read the titles, abstracts and complete texts according to the eligibility criteria and extracted the data from the included articles. Original studies-of any design-evaluating the influence of drug dispensing on patients’ medication knowledge and/or adherence in community pharmacies were included. The methodological quality was assessed through the tools provided by the JBI Institute. The data was analyzed through qualitative synthesis and a meta-analysis was conducted for randomized controlled trials which used the outcome of medication adherence using the RStudio version 4.3.3 program.

RESULTS: A total of 7,590 studies were identified in the initial search, of which 11 articles met the eligibility criteria and were included in this systematic review. The studies were published in Africa, Latin America, Asia, Europe and Australia. Most of the studies were interventional (n = 7). Four studies evaluated the influence of drug dispensing on the patient’s medication knowledge, and all showed that knowledge increased after dispensing. Eight studies evaluated the influence of dispensing on medication adherence. Three studies were included in the meta-analysis, which showed moderate heterogeneity (I² = 44%, p = 0.17). The results indicated that there was no statistically significant difference in medication adherence post-dispensing (RR: 1.19; 95%CI 0.99 to 1.43, p = 0.07). Six studies met more than 70% of the quality assessment criteria.

CONCLUSION: This systematic review demonstrated that patient’s medication knowledge can be increased through drug dispensing. However, the meta-analysis indicated that drug dispensing does not have an impact on medication adherence. Our findings can support evidence-based decisions, guiding the planning and development of public policies and interventions which improve drug dispensing for patients, families, and communities.

PMID:39875964 | DOI:10.1186/s12913-024-12074-w

BMC Nurs. 2025 Jan 28;24(1):104. doi: 10.1186/s12912-025-02754-1.

ABSTRACT

BACKGROUND: Pressure injuries are costly and can lead to mortality and psychosocial consequences if not managed effectively. Proper management of pressure injuries is crucial for quality nursing care. However, there is limited research on nurses’ knowledge and practices in preventing and managing pressure injuries among critically ill patients in Rwanda. In addition, barriers affecting nurses’ practices in this area also need further investigation in order to inform the interventions to improve nursing care of patients with pressure injuries in Rwandan hospitals.

METHODOLOGY: A cross-sectional study involving 129 health nurses was conducted to determine their knowledge and practice levels regarding the prevention of pressure injuries in critically ill patients, and barriers impeding practice in this area. The research modified the Pieper-Zulkowski Pressure Ulcer Knowledge Test to evaluate the knowledge of nurses concerning the prevention of pressure injuries. A 33-item instrument drawn from pressure ulcer risk assessment and prevention toolkits established by the Agency for Healthcare Research and Quality was used to assess nurses’ practices. Additionally, barriers influencing nurses’ knowledge and practices related to the prevention of pressure injuries were evaluated through questions derived from a comparable study conducted in Ethiopia. Descriptive statistics were computed for each variable. Mean scores were computed to categorize nurses’ level of knowledge and practice. Logistic regression analysis was employed to examine the influence of sociodemographic factors and training on the nurses’ knowledge and practice, with a statistical significance set at a p-value less than 0.05.

RESULTS: The study found that 40.0% of nurses had inadequate knowledge towards pressure injury prevention, and 60.0% reported that they inadequately practiced pressure injury prevention among critically ill patients. Nurses who have not been trained in pressure injury prevention have a 52.4% reduction in the odd of having adequate practice compared to those who have been trained (OR 0.476; 95% CI 0.211-0.996). Heavy workload, inadequate staff, shortage of equipments, presence of other priorities than pressure injury prevention, inadequate training coverage of pressure injury prevention were the most prevalent barriers reported.

CONCLUSION: The evaluation of nurses’ knowledge and practices on pressure injury prevention in critically ill patients at the study setting found that while nurses have satisfactory knowledge, their practical application is lacking due to factors like high workloads and insufficient staffing. The study recommends caution in interpreting the results due to a limited sample size, suggesting further research to guide improvements in nursing practices.

PMID:39875962 | DOI:10.1186/s12912-025-02754-1

BMC Health Serv Res. 2025 Jan 28;25(1):166. doi: 10.1186/s12913-024-12139-w.

ABSTRACT

INTRODUCTION: Several adverse drug reactions (ADRs) go unreported within a healthcare setting despite the risks they cause. We therefore decided to conduct this study in order to recognize the obstacles that hinder the healthcare professionals (HCPs) in a tertiary care hospital in Kattankulathur, Tamil Nadu from reporting ADRs and what strategies ought to be implemented.

METHODS: We carried out a cross-sectional study among the HCPs such as doctors, pharmacists and nurses within our institution. A pre-validated questionnaire was used to collect data on the socio-demographics, barriers and facilitators in reporting ADR. A 2 weeks timeline was given to the HCPs to fill the questionnaire forms. Out of the 107 forms distributed, we received 80 of them that were duly filled. Data was analyzed using IBM SPSS version 26.

RESULTS: Out of the 80 HCPs, only 22 of them had reported any ADRs in their career. 52% of our HCPs reported the lack of understanding of ADR reporting mechanism as their main hindrance. Additionally, 25 (31%) of the HCPs stated that reporting ADRs is time consuming. 18 (22%) of them reported a fear of legal liability. 13 (16%) of them stated that the reporting from is complicated and 29 (36%) stated a lack of motivation as the reason for not reporting ADR. Majority of our HCPs 76 (95%) recommended the need for continuous medical education and training as the best strategy to improve ADR reporting.

CONCLUSION: Barriers such as time constraints, workload pressures and competing priorities often hinder HCPs from dedicating adequate attention to ADR reporting. The inclusion of topics related to ADR reporting in the curriculum (i.e. clinical pharmacology) and increased awareness from the ADR monitoring centre were seen to be significant facilitators to enhance ADR reporting among health care practitioners.

PMID:39875957 | DOI:10.1186/s12913-024-12139-w

Syst Rev. 2025 Jan 28;14(1):27. doi: 10.1186/s13643-025-02768-5.

ABSTRACT

INTRODUCTION: Head and neck cancers (HNC) are devastating, thus imposing a negative impact on the appearance of an individual as well as vital activities such as eating, swallowing, speaking, and breathing. Therefore, HNC patients undergo distress, while their caregivers become overburdened. Religion and spirituality can be helpful for patients and their caregivers from diverse cultural backgrounds to cope with cancer. Though well established in palliative care, religion and spirituality are rarely incorporated into usual early oncological care. Despite the availability of heterogeneous literature examining the influence of religion and spirituality on cancer patients, there is notably limited research on this topic across the HNC trajectory. Therefore, this scoping review attempts to answer “What is the influence of religion or spirituality on HNC patients and their caregivers in different contexts?” and will map the evidence on the influence of religion and spirituality on HNC patients and their caregivers in different contexts including geographical areas, cultures, health care systems, and different study settings.

METHODS: This scoping review was formulated using the guidelines of Joanna Briggs Institute (JBI) manual for evidence synthesis: scoping reviews and will be reported confirming to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR checklist). A comprehensive search strategy will include Embase, CINAHL, Scopus, and APA PsycINFO. The OPENGREU.EU and Google Scholar will be used as gray literature sources complimented by manual searches. Our eligibility criteria follow the population, concept, and context (PCC) framework. Patients aged ≥ 18 years diagnosed with HNC and their informal, nonpaid caregivers aged > 18 years will be included. The data will be extracted using piloted data extraction form on sociodemographic, disease-related, and treatment-related factors and outcomes, and the data will be analyzed through descriptive statistics and thematic analysis. The results will be narratively synthesized.

CONCLUSIONS/DISCUSSION: This review will aim to explore existing literature and summarize the findings of studies that examine the influence of religion and spirituality among HNC patients and their caregivers and vice versa over a range of physical, psychological, and social outcomes including quality of life. We also aim to identify existing research gaps. The findings of this review would generate evidence to better inform health care providers in countries and cultures in the management of patients diagnosed with HNC in usual oncological care with due consideration to caregivers.

PMID:39875944 | DOI:10.1186/s13643-025-02768-5

Ital J Pediatr. 2025 Jan 28;51(1):18. doi: 10.1186/s13052-025-01859-2.

ABSTRACT

BACKGROUND: Severe pulmonary infection is the primary cause of death in children aged < 5 years. The early identification of pathogenic bacteria and targeted anti-infective therapies can significantly improve the prognosis of children with severe infections. This study aims to provide a reference for the rational use of antibiotics at an early stage in children with severe pulmonary infections.

METHODS: A retrospective, single-center longitudinal study included children with severe pulmonary infections between January 2017 and December 2022 by obtaining their bacterial culture results of bronchoalveolar lavage fluid.

RESULTS: This study included 4080 samples. The age of onset for severe pulmonary infection increased annually. The proportion of severe pulmonary infections across the different age groups and years was statistically significant (p < 0.001). Among children with severe pulmonary infections, bacilli were the most prevalent, followed by cocci and fungi. The predominant bacilli were Acinetobacter baumannii and Klebsiella pneumoniae. The predominant cocci identified in this study were Streptococcus pneumoniae and Staphylococcus aureus. The primary fungi included Candida albicans and Aspergillus fumigatus, which showed significant differences (p < 0.05). The incidence of drug-resistant bacteria has gradually declined, with infection rates of multidrug-resistant bacteria and extended-spectrum beta-lactamases consistently decreasing annually. For carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, the infection rates peaked in 2018, with statistical significance (p < 0.001).

CONCLUSIONS: Severe pulmonary infections in children are significantly associated with age and types of infectious pathogens. Gram-negative bacteria are the primary cause of severe pulmonary infections in children. Clinicians should rationally use antibiotics according to the local distribution and drug resistance of pathogens, thereby enhancing therapeutic outcomes.

PMID:39875941 | DOI:10.1186/s13052-025-01859-2

BMC Oral Health. 2025 Jan 28;25(1):146. doi: 10.1186/s12903-025-05499-0.

ABSTRACT

OBJECTIVE: The aim of this study was to establish a three-dimensional finite element (FE) hydraulic pressure technique model and compare the biomechanical characteristics of the osteotome technique and the hydraulic pressure technique using three-dimensional finite element analysis (FEA).

METHODS: Three FE models were created: the hydraulic pressure technique (M1), the osteotome technique with a Ø 1.6-mm osteotome (M2), and the osteotome technique with a Ø 3.0-mm osteotome (M3) models. Three models were simulated via computer-aided design software, with the sinus membrane elevated to 1, 3 and 5 mm, after which the required loading force was recorded. Stress distribution, including the equivalent von Mises stress, tensile stress, compressive stress, shear stress, as well as strain (i.e., sinus membrane displacement in horizontal dimensions) of the three models were subsequently examined and statistically compared.

RESULTS: Overall, the required loading force, stress and strain increased as the elevation height increased. The loading force required to elevate the sinus membrane to 1,3 and 5 mm in M1 was 24.9 kPa, 77.1 kPa and 130 kPa, comparing 32.5 kPa, 112. 9 kPa and 200.8 kPa in M2 as well as 54.5 kPa, 160.6 kPa and 273.2 kPa in M3. Under the same elevation height, M1 exhibited the least von Mises stress (P<0.001), as well as the largest horizontal sinus membrane displacement (P<0.001).

CONCLUSIONS: It can be seen from the FEA results that the hydraulic pressure technique enables a greater portion of the sinus membrane to detach from the sinus floor while exerting less stress on the mucosa when the sinus membrane is elevated up to 5 mm. Based on this study, the hydraulic pressure technique was found to be safer and more effective than the osteotome technique under the same elevation height.

PMID:39875935 | DOI:10.1186/s12903-025-05499-0