Nevin Manimala

Ital J Pediatr. 2025 Apr 17;51(1):121. doi: 10.1186/s13052-025-01956-2.

ABSTRACT

BACKGROUND: Helicobacter pylori (H. pylori) causes chronic infection in more than half of the population worldwide. Accumulating body of evidence indicates the possible role of H. Pylori infection in extra-intestinal health problems, including epilepsy. This study aims to investigate the efficacy of treating H. pylori infection on seizure frequency among children with drug-resistant idiopathic generalized epilepsy (IGE).

METHODS: A parallel, two-arm, open-label, randomized controlled trial was conducted on 126 children with drug-resistant IGE and positive H. pylori stool antigen test who were randomly assigned to study and comparison groups in 1.2:1 ratio. Only the study group received H. pylori eradication therapy (esomeprazole, amoxicillin, and clarithromycin) for two weeks. The primary outcome was seizure improvement (≥ 50% seizure frequency reduction compared with baseline) after 2.5 months. Secondary outcomes were occurrence of status epilepticus, escalation of antiseizure medication (ASMs), and adverse effects. Outcomes between the two groups were compared using Chi-square/Fisher exact tests on an intention-to-treat principle. Logistic regression analysis was performed to investigate possible effects of baseline variables on primary outcome.

RESULTS: Seizure improvement occurred in 23 (33%) children in the study group compared with seven (12%) children in the comparison group (Risk ratio [RR] 2.7, 95% confidence interval [CI]: 1.3-5.9; p 0.006). The study group had lower occurrence of status epilepticus (2.9% vs. 14%; RR 0.21, 95%CI: 0.05-0.93; p 0.042) and lesser need for ASMs escalation (4.4% vs. 19.3%; RR 0.23, 95%CI: 0.07-0.77; p 0.010). Adverse effects were more frequent among subjects in the study group, including nausea (15.9% vs. 10.5%) vomiting (8.7% vs. 3.5%), diarrhea (11.6% vs. 5.3%), and skin rash (4.4% vs. 1.8%), but the differences were not statistically significant (p > 0.05). None of baseline participants’ variables was significantly associated with the primary outcome.

CONCLUSION: Treating H. pylori infection may improve seizure control in children with drug-resistant IGE, but further studies are warranted to confirm our findings and explore mechanisms behind seizure improvement following H. pylori eradication therapy.

TRIAL REGISTRATION: Registered on www.

CLINICALTRIALS: gov (identifier: NCT05297695) on 17 March 2022. https://clinicaltrials.gov/study/NCT05297695 .

PMID:40247384 | DOI:10.1186/s13052-025-01956-2

Eur J Med Res. 2025 Apr 17;30(1):305. doi: 10.1186/s40001-025-02563-x.

ABSTRACT

BACKGROUND: While previous studies have indicated comparable outcomes for redo surgical valve replacement (SVR) and primary SVR, there is limited information regarding the long-term follow-up of these patients. Providing prognostic data on redo SVR is crucial for enhancing decision-making and medical care, as well as for identifying low-risk subsets of patients eligible for redo SVR. This study aimed to evaluate the short- and mid-term outcomes of patients who underwent their first and second redo SVR of a previously replaced valve.

METHODS: We included 118 consecutive patients with a history of first or second redo SVR. The participants had a mean age of 57.5 ± 14.4 years, with 71 (60%) being female. The median follow-up period was 69 months. Clinical, intraoperative, and laboratory data were analyzed to assess all-cause mortality, major adverse events (MAE), and a composite of prosthetic valve thrombosis, embolic events, and major hemorrhage (TEH), along with their predictors. Bayesian model averaging was used for statistical analysis.

RESULTS: The 30-day mortality rate was 11 patients (9.3%). Chronic kidney disease was identified as an independent predictor of 30-day mortality. The overall survival rates at one and five years were 86% (95% CI 80% to 93%) and 76% (95% CI 68% to 85%), respectively. Dyslipidemia, a history of major bleeding, chronic kidney disease, stroke, and transvalvular leakage in biological prostheses were all associated with all-cause mortality as independent predictors. The TEH-free survival rates at one and five years were 91% (95% CI 86% to 97%) and 79% (95% CI 71% to 88%), respectively. Diabetes, sex, a history of percutaneous coronary intervention, and baseline functional capacity were identified as independent predictors for the occurrence of TEH. The MAE-free survival rates at one and five years were 82% (95% CI 73% to 92%) and 61% (95% CI 49% to 75%), respectively. Hypertension and baseline functional class were independent predictors of MAE occurrence. The type and anatomical position of the valve were not predictors of mortality, THE, and MAE.

CONCLUSIONS: Our study demonstrated acceptable short- and mid-term outcomes for redo SVR, especially in patients without significant risk factors. Several potential predictors of adverse outcomes were identified.

PMID:40247382 | DOI:10.1186/s40001-025-02563-x

J Orthop Surg Res. 2025 Apr 17;20(1):385. doi: 10.1186/s13018-025-05769-1.

ABSTRACT

PURPOSE: To evaluate the functional outcomes of arthroscopic onlay dynamic anterior stabilization (DAS) using the long head of the biceps (LHB) tendon for treatment of anterior glenohumeral instability (AGI) with limited to subcritical glenoid bone loss (GBL).

METHODS: Twenty-five patients underwent arthroscopic DAS using LHB tendon between March 2022 and October 2022 for treatment of anterior glenohumeral instability (AGI) with limited to subcritical glenoid bone loss (GBL) were included in a prospective study with a minimum follow-up period of 2 years. The shoulder functional outcomes were assessed using the Rowe and the Quick Disabilities of Arm, Shoulder and Hand (Quick DASH) scores both preoperative and at 2 years follow-up. Magnetic resonance imaging (MRI) was done 6 months after surgery to evaluate LHB tendon healing to the anterior glenoid.

RESULTS: The study included 25 patients complaining of recurrent AGI. Twenty-one patients were males and four patients were females. The mean age of the patients at surgery was 22.75 ± 3.24 years. The mean duration between the first shoulder dislocation episode and surgery was 5.5 ± 2.13 months. The right shoulder was injured in 15 patients while the left shoulder was involved in 10 patients. The mean follow-up period was 24.25 ± 0.82 months. DAS using the long head of the biceps tendon resulted in a statistically significant improvement of the mean Rowe and the Quick DASH scores between preoperative and 2 years postoperative. Recurrent dislocation was reported in two (8%) patients during the follow-up period.

CONCLUSION: Arthroscopic onlay dynamic anterior stabilization using the long head of the biceps tendon is a safe and effective method for the treatment of recurrent anterior shoulder instability with GBL up to 25%.

LEVEL OF EVIDENCE: Level IV, case series study.

PMID:40247377 | DOI:10.1186/s13018-025-05769-1

BMC Health Serv Res. 2025 Apr 17;25(1):562. doi: 10.1186/s12913-025-12732-7.

ABSTRACT

BACKGROUND: Adverse childhood experiences (ACEs) are common and can negatively affect the physical, mental, emotional, and developmental health of a child acutely and for a lifetime. Trauma-informed care (TIC) in the pediatric medical home helps counteract these effects by fostering supportive relationships and building skills that promote resilience. As key figures in the medical home, pediatric clinicians must understand adverse childhood experiences (ACEs) and TIC principles to effectively recognize, assess and intervene early in cases of childhood adversity, which ultimately promotes long-term health and well-being.

METHODS: Pediatric clinicians who attended a virtual symposium were surveyed before and after eight one-hour educational sessions on TIC topics. To assess their knowledge of fundamental TIC principles, they were asked about their familiarity with the ACE study, the affiliative response, and the strength-based approach in pediatrics. Participants rated each sessions’ value using a 4-point Likert scale. In the post survey, they also shared how they would apply the knowledge gained clinically and suggestions to improve future education.

RESULTS: Seventy-five out of the 82 participants (91%) who were pediatric clinicians completed a pre survey and of those pediatric clinicians who completed the pre survey, 47 (63%) also completed the post-education survey. Prior to the educational sessions, 81% of participants were familiar with the ACE Study but only 37.1% were familiar with the affiliate response and only 50.6% with strength-based care approaches to pediatrics. Of those who completed the post survey, 95.7% rated the education as “Useful” or “Very useful.” Statistically significant improvements were detected in scores relating to each of the three fundamental TIC principles: associations between childhood stressors and later life health and well-being (p = < 0.0001), familiarity with the affiliate response (p = < 0.0001), and familiarity with the concept of a strength-based approach to pediatrics (p = < 0.005). After the training sessions, a majority, 34/47 (72%), of participants stated they would apply concepts from the training in clinical care.

CONCLUSIONS: This study was able to demonstrate existing gaps in pediatric clinicians’ knowledge of TIC, the usefulness of pediatric TIC education, and practical steps in providing TIC education for pediatric clinicians and healthcare providers.

PMID:40247357 | DOI:10.1186/s12913-025-12732-7

BMC Health Serv Res. 2025 Apr 17;25(1):566. doi: 10.1186/s12913-025-12644-6.

ABSTRACT

BACKGROUND: Healthcare professionals often face substantial work-related burdens. A large body of evidence has shown that poor working conditions can lead to low levels of job satisfaction, increased emotional stress and burnout. While symptom targeted interventions take effect after symptoms become manifest, preventive interventions are required to reduce the risk of work-related diseases. Therefore, the UPGRADE-trial aimed to evaluate the effectiveness of Creative Strengthening Groups as a potential intervention to enhance job satisfaction and work-related health. The German Innovation Fund (Innovationsfonds) funded the project.

METHODS: We conducted a randomized controlled trial and randomly assigned healthcare professionals to either the intervention or the control group. The intervention – Creative Strengthening Groups – consisted of two one-day classes. We evaluated the primary outcome job satisfaction and further work-related outcomes using standardized questionnaires. We collected data at baseline as well as after three and six months. The study was conducted between October 2019 to March 2023, including the pandemic period.

RESULTS: We enrolled 196 participants (intervention n = 88, control n = 108) with a mean age of 46.2 ± 12.1 years (84.5% female). 43.7% were nursing professionals. Job satisfaction in the intervention group increased from 55.47 ± 10.23 to 57.07 ± 11.65 after three months and decreased in the control group from 56.29 ± 19.69 to 53.47 ± 20.09. The difference between groups did not reach statistical significance. Additionally, change in patient-related stress significantly differed between groups (intervention: -3.9 ± 12.16 vs. control: 5.17 ± 17.43; p =.027) as well as personal burnout (intervention: -5.25 ± 13.1 vs. control: 4.35 ± 16.24; p =.011). Within the intervention group, we observed a greater improvement concerning work-related burnout in nursing staff in geriatric care than in hospitals (-15.27 ± 13.5 vs. +3.28 ± 13.7; p =.003).

CONCLUSION: Though the Covid-19 pandemic worsened working conditions for healthcare professionals, our results indicate that intervention has the potential to enhance job satisfaction and work related health. Notably, due to the overall workload and the pandemic restrictions, a high number of participants did not continually participate in both classes of the intervention and some did not return all questionnaires. As long as healthcare professionals in Germany are facing exceedingly bad working conditions, it is very difficult to support their resources such as self-efficacy, self-esteem, and optimism by health promotion interventions.

TRIAL REGISTRATION: The trial has been registered at the German Clinical Trials Register (DRKS; ID: DRKS00020908). Date of Registration: 2020-03-16.

PMID:40247351 | DOI:10.1186/s12913-025-12644-6

BMC Psychol. 2025 Apr 17;13(1):395. doi: 10.1186/s40359-025-02691-3.

ABSTRACT

BACKGROUND: Aging has become a global trend, and depression, as an accompanying issue, poses a significant threat to the health of middle-aged and older adults. Existing studies primarily rely on statistical methods such as logistic regression for small-scale data analysis, while research on the application of machine learning in large-scale data remains limited. Therefore, this study employs machine learning methods to explore the risk factors for depression among middle-aged and older adults in China.

METHODS: Using a two-step hybrid model combining long short-term memory (LSTM) and machine learning (ML), we compared 20 depression risk/protective factors in a balanced panel dataset of middle-aged and elderly Chinese adults (N = 3706; aged 45-94; 64.65% female; 41.20% middle-aged) from the China Health and Retirement Longitudinal Study (CHARLS). Data were collected across five waves (2011, 2013, 2015, 2018, and 2020). The LSTM model predicted risk factors for the fifth wave via data from the preceding four waves. Five ML models were then used to classify depression (yes/no) based on these factors, which included demographic, lifestyle, health, and socioeconomic variables.

RESULTS: The LSTM model effectively predicted depression-related variables (mean square error = 0.067). The average AUC of the five ML models ranged from 0.78 to 0.82. The key predictive factors were disability, life satisfaction, activities of daily living (ADL) impairment, chronic diseases, and self-reported memory. For the middle-aged group, the top three factors were disability, life satisfaction, and chronic diseases; for the Older people group, they were life satisfaction, chronic diseases, and ADL impairment.

CONCLUSION: The two-step hybrid model (“LSTM + ML”) effectively predicted depression over 2 years via demographic and health data, aiding early diagnosis and intervention.

PMID:40247342 | DOI:10.1186/s40359-025-02691-3

J Orthop Surg Res. 2025 Apr 17;20(1):384. doi: 10.1186/s13018-025-05682-7.

ABSTRACT

INTRODUCTION: Knee osteoarthritis (KOA) is a prevalent chronic joint disease. Due to the risks of opioid use and limited pharmacological effectiveness, mind-body exercise (MBE) therapy and other non-pharmacological interventions have emerged as first-line treatments for this condition. However, the optimal MBE modes for KOA remain undetermined. This systematic review and network meta-analysis (NMA) aims to compare the efficacy of different MBE modes, including Pilates, Tai Chi, Yoga, and Qigong, in managing KOA.

METHODS: We searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Database from inception to 25 April 2024. Randomized clinical trials comparing MBE interventions for pain, physical function and quality of life (QoL) in KOA patients were eligible. The Cochrane Risk-of-Bias Tool 2.0 and Grading of Recommendations, Assessment, Development & Evaluation (GRADE) approach were used to assess literature quality and evidence certainty for each outcome.

RESULT: A total of 38 studies (N = 2561) were included, with 38 for pain, 36 for physical function, and 12 for QoL in the NMA. With moderate-certainty, both Pilates and TC showed significant improvements in pain reduction [Pilates: standardized mean difference (SMD) = – 1.19, 95% confidence intervals (95% CI): – 1.92 to – 0.46; TC: SMD = – 0.78, 95% CI – 0.97 to – 0.59] and physical function (Pilates: SMD = – 1.37, 95% CI – 2.13 to – 0.50; TC: SMD = – 0.85, 95% CI – 1.08 to – 0.63) compared to the usual care group, while TC [SMD = – 0.57, 95% CI = (- 1.07 to – 0.06)] showed statistically significant efficacy in improving QoL compared to the usual care group.

CONCLUSION: There is moderate-certainty evidence that Pilates and Tai Chi may be the most effective mind-body exercises for improving pain and physical function in knee osteoarthritis, while Tai Chi may be the best for improving quality of life. These findings may help clinicians guide their prescription of exercise types with respect to treatment outcomes. The limited number of large sample studies and the few studies with low bias risk are limitations. Trial registration The protocol for NMA has been registered with PROSPERO (CRD42024531878).

PMID:40247321 | DOI:10.1186/s13018-025-05682-7

BMC Med Educ. 2025 Apr 17;25(1):570. doi: 10.1186/s12909-025-07084-z.

ABSTRACT

BACKGROUND: With the integration of Artificial Intelligence (AI) into educational systems, its potential to revolutionize learning, particularly in content personalization and assessment support, is significant. Personalized learning, supported by AI tools, can adapt to individual learning styles and needs, thus transforming how medical students approach their studies. This study aims to explore the relationship between the use of AI for self-directed learning among undergraduate medical students in the UK and variables such as year of study, gender, and age.

METHODS: This cross-sectional study involved a sample of 230 undergraduate medical students from UK universities, collected through an online survey. The survey assessed AI usage in self-directed learning, including students’ attitudes towards AI accuracy, perceived benefits, and willingness to mitigate misinformation. Data were analyzed using descriptive statistics and linear logistic regression to examine associations between AI usage and demographics.

RESULTS: The analysis revealed that age significantly influenced students’ willingness to pay for AI tools (p = 0.012) and gender was linked to concerns about AI inaccuracies (p = 0.017). Female students were more likely to take steps to mitigate risks of misinformation (p = 0.045). The study also found variability in AI usage based on the year of study, with first-year students showing a higher reliance on AI tools.

CONCLUSION: AI has the potential to greatly enhance personalized learning for medical students. However, issues surrounding accuracy, misinformation, and equitable access need to be addressed to optimize AI integration in medical education. Further research is recommended to explore the longitudinal effects of AI usage on learning outcomes.

PMID:40247306 | DOI:10.1186/s12909-025-07084-z

BMC Public Health. 2025 Apr 17;25(1):1442. doi: 10.1186/s12889-025-22567-w.

ABSTRACT

BACKGROUND: Strengthening health systems and ensuring equity and access to human resources can significantly reduce maternal and child mortality and improve maternal and child health outcomes. This mixed-methods study aimed at the quantity, quality, and equity of the allocation of human resources for health (HRH) in Chinese maternal and child healthcare institutions from 2002 to 2021 while providing a reference for optimally allocating HRH in the new era.

METHODS: Relying on health-related data obtained from statistical yearbooks in 2003-2022, the study analysed the allocation status using descriptive statistics, examined the allocation equity with the Gini coefficient and the Health resource agglomeration degree/Health resource population agglomeration degree (HRAD/HRPAD). Finally, the study predicted the future allocation trend by compiling a grey prediction model GM (1,1).

RESULTS: HRH quantity in Chinese maternal and child healthcare institutions experienced steady growth. However, the composition of educational background and professional titles was unreasonable. The quality structure needs to be further optimized. The equity of demographic allocation (Gini < 0.2) was superior to the geographic allocation (Gini = 0.631-0.678), with significant regional differences. The HRAD values of HRH in different regions were as follows: eastern region (3.50-3.70) > central region (1.69-1.92) > western region (0.36-0.44); HRPAD (2021): western region (1.150) > central region (0.991) > eastern region (0.912). The equity of sparsely populated regions was superior to that of densely populated regions. The HRH future allocation trend is positive.

CONCLUSIONS: Emphasis should be placed on the status quo of unreasonable allocation and unbalanced distribution. Careful consideration must be given to factors like service population, service radius, economic development, and population mobility while considering demographic and geographic equity to promote the reasonable allocation and full utilisation of HRH.

PMID:40247304 | DOI:10.1186/s12889-025-22567-w

BMC Med Genomics. 2025 Apr 17;18(1):74. doi: 10.1186/s12920-025-02143-2.

ABSTRACT

BACKGROUND: Recent observational studies have revealed an inconclusive correlation between inflammatory bowel disease (IBD) and sepsis, accompanied by an uncertain understanding of the causal relationship between the two. To investigate the causality between IBD and sepsis, we employed a two-sample Mendelian randomization (MR) approach.

METHODS: A genome-wide significant threshold (P < 5 × 10^-8) was achieved in order to identify single nucleotide polymorphisms (SNPs) as instrumental variables (IVs) for two types of IBD, such as Crohn’s disease (CD) and ulcerative colitis (UC). Subsequently, the selected SNPs were assessed in relation to three categories of sepsis, namely sepsis, sepsis (critical care), and sepsis (28-day death in critical care). An inverse-variance weighted (IVW) estimation of MR was conducted, followed by sensitivity analysis on multiple dimensions.

RESULTS: There was a significant association between genetic liability to CD (IVW: OR, 1.246; 95% CI, 1.090-1.423; P = 0.0012) with sepsis (28-day death in critical care), but not with sepsis (critical care) and sepsis. Whereas UC showed slightly, yet statistically insignificant, higher risk for sepsis (IVW: OR, 1.031; 95% CI, 0.988-1.064; P = 0.064).

CONCLUSION: Our study offers genetic evidence that supports a substantial causal relationship between CD and sepsis (28-day death in critical care). To enhance the specificity and objectivity of future research findings, it is recommended to specify the types of IBD and the severity of sepsis. Furthermore, the genetic risk loci related may become potential drug development targets.

PMID:40247302 | DOI:10.1186/s12920-025-02143-2