Nevin Manimala

Int J Retina Vitreous. 2025 Jul 17;11(1):81. doi: 10.1186/s40942-025-00707-z.

ABSTRACT

BACKGROUND: A macular hole (MH) is a retinal condition affecting the central macula, leading to progressive visual impairment. Pars plana vitrectomy with internal limiting membrane (ILM) peeling is the standard surgical treatment, while the inverted ILM flap technique has emerged as a promising alternative. However, the effectiveness of this technique was still debated.

METHODS: Randomized controlled trials (RCTs) comparing ILM peeling and inverted ILM flap for MH were identified through searches in PubMed, ScienceDirect, Cochrane Library, and ClinicalTrials.gov in the last 15 years that compared ILM peeling and inverted ILM flap procedure. The primary outcome was anatomical closure, and the secondary outcome was visual acuity (VA) post-procedure. Data synthesis was performed using Review Manager (RevMan) 5.4.1 with odds ratio (OR) for anatomical closure and mean difference (MD) for VA with 95% confidence interval (CI). Statistical significance is achieved when the p-value is below 0.05.

RESULTS: Twelve RCTs involving 719 patients were included. The inverted ILM flap showed superior anatomical closure (OR 0.28; 95% CI: 0.15-0.52; p < 0.0001). VA post-procedure, based on follow-up time (3-, 6-, and 12-month), revealed no statistically significant difference in visual outcomes. Sensitivity analyses confirmed anatomical and visual benefits of the inverted flap in large MHs (≥ 400 μm).

CONCLUSION: The inverted ILM flap technique offers better anatomical outcomes than ILM peeling, especially for larger MHs. Visual improvement is variable and may depend on MH chronicity and retinal recovery. Further high-quality studies are needed to confirm these findings.

PMID:40676682 | DOI:10.1186/s40942-025-00707-z

Crit Care. 2025 Jul 17;29(1):310. doi: 10.1186/s13054-025-05528-y.

ABSTRACT

BACKGROUND: Admissions of immunocompromised patients to intensive care units (ICUs) are on the increase. The main reason for admission is acute respiratory failure, predominantly of infectious origin. In such circumstances, early and appropriate antibiotic therapy guarantees a better prognosis. Rapid diagnostic techniques such as multiplex polymerase chain reaction (PCR) have shown their value in both diagnosis and treatment in immunocompetent patients. To date, little data are available on immunocompromised patients.

METHODS: In this retrospective, single-center study, we analyzed data from critically ill immunocompromised patients admitted for acute respiratory failure requiring invasive ventilation, in whom a respiratory specimen was taken and processed simultaneously by BioFire FilmArray Pneumonia Panel multiplex PCR (BFPPm PCR) and conventional culture (CC). Samples had to be taken from deep respiratory tracts less than 48 h after mechanical ventilation. The primary endpoint was the evaluation of the diagnostic performance of BFPP mPCR compared with CC. The secondary endpoint was the therapeutic impact of the results of BFPP mPCR.

RESULTS: One hundred and fourteen patients were included, with immunosuppression mainly of a hematological (35.1%) and oncological (35.1%) nature. The mPCR positivity rate was 36.8%, with the majority identifying enterobacteria (51%) and a median turnaround time of between 2h30 and 4 h. Comparison of rapid techniques with CC showed sensitivity of 89%, specificity of 83%, predictive positive value of 52% and negative predictive value of 98%. Concordance between the two techniques was complete in 84.2% of cases. mPCR enabled antibiotic therapy to be modified in 17.5% of cases, mainly de-escalation.

CONCLUSION: The use of mPCR in the diagnosis of pneumonia in immunocompromised patients shortens the time required to obtain results, and is particularly effective in eliminating the presence of multi-resistant germs. Bacteria detected in culture and not included in the mPCR spectrum were mostly bacteria of low pathogenicity or sensitive to the antibiotics usually prescribed. The mPCR technique could reduce exposure to broad-spectrum antibiotics in this population.

PMID:40676679 | DOI:10.1186/s13054-025-05528-y

Diagn Pathol. 2025 Jul 17;20(1):85. doi: 10.1186/s13000-025-01691-6.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the value of cancer-associated fibroblasts (CAFs) that positively express α-smooth muscle actin (α-SMA) and fibroblast activation protein (FAP) as survival indicators for patients with extrahepatic cholangiocarcinoma (eCCA).

METHODS: The clinicopathological data of eCCA patients who underwent surgical treatment in Tianjin Nankai Hospital from January 1, 2019, to December 31, 2022, were retrospectively analysed. A total of 79 patients were included, 49 were male and 30 were female, with an age of (64.3 ± 8.3) years. Clinicopathological data such as age, gender, tumour location, lymph node metastasis, tumour differentiation degree, and TNM stage of the patients were recorded. The expressions of α-SMA and FAP, the markers of CAFs, in eCCA were detected by immunohistochemistry. The relationships between the expressions of the two proteins and the clinicopathological data and prognosis of the patients were analysed.

RESULTS: The positive expressions of α-SMA and FAP in CAFs were observed in 78.5% (62/79) and 35.4% (28/79) of the patients, respectively. There was a highly positive correlation between the expression of α-SMA and that of FAP (r = 0.992, P < 0.001). Univariate analysis showed that CAFs with positive FAP expression and tumour location were statistically significant in terms of overall survival time and recurrence-free survival time. Multivariate analysis indicated that positive FAP expression and tumour location might be independent factors affecting overall survival time and recurrence-free survival time.

CONCLUSIONS: CAFs with positive FAP expression may be a prognostic indicator of poor postoperative survival in eCCA patients and may serve as an independent predictor of poor postoperative survival rate in these patients.

PMID:40676676 | DOI:10.1186/s13000-025-01691-6

J Orthop Surg Res. 2025 Jul 17;20(1):670. doi: 10.1186/s13018-025-06102-6.

ABSTRACT

BACKGROUND: Rotator cuff repair in patients with osteoporosis (OP) is often hindered by poor tendon-to-bone healing and a high rate of retears, largely due to compromised bone remodeling at the repair site. However, few studies have investigated the relationship between computed tomography (CT)-based quantitative analysis of bone microarchitecture and the prognosis of rotator cuff healing.

METHODS: An OP rat model was established via bilateral ovariectomy combined with dexamethasone administration. A full-thickness supraspinatus tear was surgically induced, followed by an 8-week intervention with either alendronate (ALN) or saline. Non-osteoporotic rats served as control group. Histological analysis and biomechanical testing were performed to evaluate tendon-to-bone healing. Additionally, quantitative micro-CT analysis of the humeral greater tuberosity was conducted, and correlations with tendon healing outcomes were assessed.

RESULTS: Histological analysis at 8 weeks revealed disorganized structure and poor fibrovascular tissue in the OP group, while the OP + ALN group exhibited improved tendon-bone healing with better collagen fiber alignment and higher histological scores. A decreased RANKL/OPG ratio suggested that ALN treatment modulated regional bone metabolism in the humeral greater tuberosity. The Young’s modulus was reduced in both osteoporotic groups compared to the Control group. Although the difference between the OP and OP + ALN groups was not statistically significant, a trend was observed: 50% of specimens in the OP group failed at the tendon-bone interface, compared to 33.3% in the OP + ALN group. CT analysis demonstrated that ALN treatment improved bone microarchitecture. Notably, bone microarchitectural parameters significantly correlated with histological scores of tendon healing.

CONCLUSION: Tendon-bone healing is impaired in the presence of OP but can be partially restored by ALN treatment. Furthermore, CT-based quantitative analysis of bone microarchitecture at the humeral greater tuberosity shows a significant correlation with rotator cuff healing. These results imply that such analysis might serve as a potential indicator of postoperative prognosis.

PMID:40676668 | DOI:10.1186/s13018-025-06102-6

Genome Biol. 2025 Jul 17;26(1):208. doi: 10.1186/s13059-025-03686-4.

ABSTRACT

Droplet-based profiling techniques such as CITE-seq are often contaminated by technical noise. Current computational denoising methods have serious limitations, including a strong reliance on often-unavailable empty droplets or null controls and insufficient efficiency due to ignoring protein-protein interactions. Here, we introduce scPDA, a probabilistic model that employs a variational autoencoder to achieve high computational efficiency. scPDA eliminates the use of empty droplets and shares information across proteins to increase denoising efficiency. Compared to currently available methods, scPDA substantially improves the efficiency of gating-strategy-based cell-type identification, marking a clear advancement in computational denoising of the protein modality.

PMID:40676645 | DOI:10.1186/s13059-025-03686-4

BMC Public Health. 2025 Jul 17;25(1):2488. doi: 10.1186/s12889-025-23683-3.

ABSTRACT

INTRODUCTION: Infant mortality, defined as the death of a baby within its first year of life, remains a critical public health issue, particularly in Sub-Saharan Africa (SSA). Health equity is a fundamental right, yet significant disparities persist, with poorer populations experiencing disproportionately higher mortality rates. This study aims to assess whether these inequalities in infant mortality continue despite governmental efforts and the pursuit of Sustainable Development Goals (SDGs) in SSA countries.

METHODS: We analyzed a comprehensive dataset comprising 30,109 weighted samples from Demographic and Health Surveys across 14 SSA countries. Data cleaning was performed using Microsoft Excel, and statistical analyses were conducted with STATA Version 17 software. To evaluate wealth-related inequalities in infant mortality, we employed the concentration index and curve, alongside Wag staff decomposition analysis. A p-value of < 0.05 was considered statistically significant.

RESULT: The pooled estimate of the infant mortality rate in Sub-Saharan Africa was found to be 34.14% (95% CI: 28.74, 39.54%), with substantial heterogeneity (I² = 83.6%), indicates wide variation across the country. Rates varied significantly across countries, ranging from 18.75% in Gabon to 52.8% in Côte d’Ivoire. The weighted concentration index for infant mortality based on women’s education was – 0.0072 (95% CI; -0.00134, -0.0012), while the wealth index concentration index was – 0.0093 (95% CI: -0.00154, -0.0032), both with p-values < 0.0001.

CONCLUSION AND RECOMMENDATION: Our analysis reveals that wealth-related disparities in infant mortality disproportionately impact poorer populations in Sub-Saharan Africa, with children of mothers who possess lower socioeconomic status and less education facing higher risks. Factors contributing to these disparities include family size, media exposure, and birth order. The persistence of social injustice is largely due to the inadequate response to these health inequalities. Policymakers must prioritize equitable access to healthcare and consider the socioeconomic distribution of infant mortality in their strategies. To combat these disparities and improve infant survival rates, it is vital to enhance child-rearing practices through targeted health policies, promote equitable economic development, engage communities in health initiatives, and establish monitoring systems. By focusing on these strategies, we can make significant progress toward reducing infant mortality and addressing the underlying social injustices affecting vulnerable populations in line with the goals of Countdown to 2030 and 2063.

PMID:40676638 | DOI:10.1186/s12889-025-23683-3

BMC Nurs. 2025 Jul 17;24(1):934. doi: 10.1186/s12912-025-03492-0.

ABSTRACT

BACKGROUND: This study compared scenario-based generative artificial intelligence (GenAI) patient simulation with immersive 360° virtual reality (VR) simulation in terms of perceived clinical competence, cultural awareness, AI readiness, and simulation effectiveness among nursing students.

METHODS: This cross-over randomised controlled study design was conducted from June 2024 to August 2024. Forty-four undergraduate nursing students from years 1-3 were randomised to receive either GenAI patient simulation (Group B) or 360° VR simulation (Group A) with a one-week washout period. Five self-reported questionnaires were used to measure clinical competency: the Clinical Competence Questionnaire (CCQ), Cultural Awareness Scale (CAS), Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS), Simulation Effectiveness Tool – Modified Questionnaire (SET-M), and a demographic questionnaire.

RESULTS: Both interventions significantly improved clinical competence, cultural awareness, and AI readiness. When administered first, GenAI patient simulation demonstrated greater initial effects on clinical competence and AI readiness compared to the 360° VR simulation, though both groups achieved similar improvements by study completion. At T1, Group B (receiving GenAI) demonstrated significantly larger improvements in CCQ total score [47.68 (95% CI: 36.68, 58.68), p < 0.001] compared to Group A (receiving 360° VR) [24.95 (95% CI: 13.96, 35.95), p < 0.001], with significant between-group difference [16.59 (95% CI: 2.77, 30.41), p = 0.020]. At T2 (post-crossover), both groups maintained significant improvements. For MAIRS-MS (measured at baseline and following each group’s GenAI exposure), Group B showed improvement from baseline to T1 [30.18 (95% CI: 23.35, 37.01), p < 0.001] while Group A showed improvement from baseline to T2 [16.64 (95% CI: 9.80, 23.47), p < 0.001], with significant between-group difference [12.09 (95% CI: 4.43, 19.75), p = 0.003]. Both groups experienced changes in CAS scores, though between-group differences were not statistically significant. For SET-M, most participants (75%) felt debriefing contributed to their learning, and 68.2% reported increased confidence in nursing assessment skills.

CONCLUSIONS: The findings provide preliminary evidence of its effectiveness in enhancing perceived clinical outcomes among nursing students. Both 360° VR simulation and GenAI patient simulation may serve as effective teaching tools; however, GenAI patient simulation appeared to demonstrate a greater initial effect on clinical competence and AI readiness, although both interventions proved effective across all measured domains.

CLINICAL TRIAL REGISTRATION/NUMBER: Not applicable.

PMID:40676632 | DOI:10.1186/s12912-025-03492-0

Int J Health Geogr. 2025 Jul 17;24(1):15. doi: 10.1186/s12942-025-00402-0.

ABSTRACT

Green spaces provide diverse health benefits, and provision of green spaces is often linked to lower incidences of adiposity. Undergraduates, who are at a transitional stage of development, represent a critical population for obesity prevention. However, recent studies suggest that the health effects of green space may vary by type. Furthermore, inferring any causal relationship between green spaces and adiposity using a cross-sectional research design remains challenging. To address these issues, this study utilized a large, representative sample of 21,990 undergraduates from 89 universities across 29 provinces in China, and employed a quasi-experimental approach to explore the impacts of specific green space types on body mass index (BMI). Propensity score matching was used to make the students who were influenced by green spaces comparable to those who were not. A difference-in-differences model was applied to estimate the causal effects of three types of green spaces (trees, bushes, and grass) on BMI. To further explore the underlying mechanisms, we examined two potential mediators: energy expenditure (physical activity) and energy intake (unhealthy food consumption). The results revealed that trees had a negative impact on BMI, whereas bushes and grass had no significant effect. Physical activity serves as a significant mediator linking tree exposure to adiposity changes, while unhealthy food intake showed no statistically significant mediation effect. In the stratified analysis, trees had significantly negative effects only on males. These findings highlight the importance of distinguishing green space types and provide causal evidence linking tree exposure to reduced BMI among undergraduates.

PMID:40676630 | DOI:10.1186/s12942-025-00402-0

BMC Public Health. 2025 Jul 17;25(1):2479. doi: 10.1186/s12889-025-23676-2.

ABSTRACT

BACKGROUND: The Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome (HIV/AIDS) infection continues to cause enormous damage in the world despite the multiple strategies developed for the response. That’s why the Joint United Nations Programme on HIV/AIDS (UNAIDS) has adopted an acceleration strategy for this response with a view to eliminating HIV/AIDS by the year 2030. Nevertheless, access to screening, which remains underserved in Cameroon, is the first pillar on which actions must be taken to achieve this objective. This study aimed to identify factors associated with low HIV testing in Maroua 1 Health District (MHD1).

METHODS: A cross-sectional study was conducted among 808 participants aged 15 to 65 years living in the Maroua 1 Health District between September and December 2022. Data were collected by means of a non-probabilistic survey using a structured questionnaire sutured into socio-demographic characteristics, socio-cultural factors, and factors linked to the healthcare system. These factors were assessed by multiple logistic regression analysis, and associations were established by calculating Odds ratios, confidence intervals, and P-values. Statistical significance was declared at P < 0.05.

RESULTS: The results showed that the study participants had a mean age of 32.7 years (SD ± 11) and males (57.18%) outnumbered females (42.82%). A total number of 383 (47.40%) participants had already taken a screening test, and 97 (12%) had done so in the last 12 months. Furthermore, it was noted that being a man (AOR = 2.79; CI = 1.83-4.31; P-value < 0.001), young (AOR = 7.95; CI = 4.02-16.2; p -p-value < 0.001), single (AOR = 1.97; CI = 1.19-3.27; p-value = 0.02), informal education (AOR = 5.25; CI = 2.26-12.45; p-value < 0.001 ), having low knowledge about HIV (AOR = 8.77; CI = 4.60-17.24; p-value < 0.001), having a stigmatizing opinion (AOR = 2.46; CI = 1.36-4.38; p-value < 0.001), not being in a relationship with a partner (AOR = 1.70; CI = 1.04-2.79; p-value = 0.03), never been sensitized by a health worker (AOR = 1.82; CI = 1.21-2.75; p-value = 0.001), and not visiting a health facility during the last 12 months (AOR = 1.75; CI = 1.06-2.75; p-value = 0.02) were associated with low screening.

CONCLUSIONS: This study identified several factors associated with low HIV testing rates in the Maroua 1 health district in Cameroon, including male gender, young age, celibacy, lack of education, low HIV knowledge, stigmatizing attitudes, absence of a stable partner, lack of awareness by health care workers and low use of health services. Addressing these factors in HIV testing interventions is essential to achieving the UNAIDS 95-95-95 targets and eliminating HIV by 2030. Targeted public health policies and improved access to testing services are needed to combat the epidemic in this region.

PMID:40676626 | DOI:10.1186/s12889-025-23676-2

BMC Med Educ. 2025 Jul 17;25(1):1067. doi: 10.1186/s12909-025-07575-z.

ABSTRACT

BACKGROUND: The development of Pharmacovigilance (P.V) systems in Palestine remains in its early stages, with limited national infrastructure and underreporting of Adverse Drug Reactions (ADRs) posing ongoing challenges. Despite the growing global recognition of P.V as essential to ensuring the safety and efficacy of medications, its integration into pharmacy education in Palestine is still insufficient. Bachelor’s Degree of Pharmacy (BS Pharm) and Doctor of Pharmacy (Pharm D) students in Palestine as future pharmacists involved in health care profession, play a pivotal role in P.V activities. However, current curricula often lack structured and comprehensive P.V training, leading to significant gaps in students’ knowledge and preparedness. Also, researches concerning their knowledge and perceptions of P.V are still limited in Palestine.

OBJECTIVES: To assess the knowledge and perceptions regarding P.V activities among BS Pharm and Pharm D students in Palestine, and to evaluate influencing factors.

METHODS: Study design was cross-sectional; it was conducted from September to December 2024 across seven Palestinian universities. A structured, validated online questionnaire was administered among 412 final-year BS Pharm and Pharm D students. The questionnaire encompassed demographic data, assessment of knowledge regarding P.V and ADRs reporting, as well as perceptions of ADRs monitoring and reporting using a 5-point Likert scale. Data were analyzed using Statistical Package for Social Sciences (SPSS V. 28). Thus, descriptive statistics, binary logistic regression, and multiple logistic regression analysis were performed using odds ratios (ORs) with corresponding 95% confidence intervals (CIs) to assess knowledge, perceptions, and associated demographic factors. A P. value < 0.05 was considered statistically significant.

RESULTS: Two thirds (67.5%) exhibited poor knowledge regarding P.V, with a mean knowledge score of 4.0 ± 1.3. Female students (OR = 1.698; 95% CI: 1.096-2.629), those aged 21-24 years (OR = 2.874; 95% CI: 1.767-4.675), and students who had prior exposure to P.V concepts (OR = 1.984; 95% CI: 1.182-3.332) demonstrated significantly better knowledge (p < 0.05). While majority of students (80.8%) recognized the importance of ADRs reporting, substantial gaps were noted in understanding specific practices, such as reporting ADRs from herbal medicines and knowledge of national P.V guidelines.

CONCLUSION: The study highlights the need for structured integration of P.V education into BS Pharm and Pharm D curricula in Palestine. Addressing identified knowledge gaps and demographic disparities through targeted training programs can enhance students’ perceptions and professionalism in P.V activities, thus, improving medication efficacy, safety, and health outcomes.

PMID:40676624 | DOI:10.1186/s12909-025-07575-z