Nevin Manimala

NeuroRehabilitation. 2025 Jun 9:10538135251344930. doi: 10.1177/10538135251344930. Online ahead of print.

ABSTRACT

BackgroundPrimary intracerebral hemorrhage (ICH) carries high mortality and disability risks. Although early mobilization is beneficial, concerns about physiological instability often delay mobilization.ObjectiveTo evaluate whether a structured early mobilization protocol improves functional mobility and reduces adverse events in critically ill ICH patients.MethodThis retrospective pre-post study included 192 patients with ICH (ICH score 0-4) admitted to a dedicated stroke center. In the pre-implementation phase in 2022, patients received standard care. In the post-implementation phase in 2023, a standardized mobility protocol, incorporating time-based stratification, neurological thresholds, and safety criteria to guide activity progression, was introduced. Primary outcomes included the Modified ICU Mobility Scale (MIMS) score at intensive care unit (ICU) discharge and the occurrence of adverse events.ResultsThe post-implementation group (99 patients) showed higher MIMS scores at ICU discharge, with a greater proportion achieving out-of-bed sitting during their ICU stay compared to the pre-implementation group (93 patients). Non-serious adverse events in the former decreased significantly; ICU and hospital lengths of stay were shorter but not statistically significant.ConclusionThe structured pathway enabled safer, earlier mobilization and improved ICU functional outcomes. While mobility benefits were observed, caution is warranted in interpreting non-significant trends in length of stay.

PMID:40485320 | DOI:10.1177/10538135251344930

Malar J. 2025 Jun 8;24(1):182. doi: 10.1186/s12936-025-05434-2.

ABSTRACT

BACKGROUND: Installing insecticidal netting on open eaves, windows, and holes in walls of unimproved houses is a potential malaria control tool. It prevents mosquito house-entry, induces lethal and sub-lethal effects on malaria vectors, and may reduce malaria transmission. Therefore, a household epidemiological trial was conducted to assess the efficacy of insecticide-treated screening (ITS) on malaria infection and indoor vectors in Tanzania.

METHODS: In Chalinze district, Tanzania, 421 households were randomized into two arms. In June-July 2021, one group of households’ houses was fitted with ITS (incorporated with deltamethrin and piperonyl butoxide) on eaves, windows, and wall holes, while the second group did not receive screening. After installation, consenting household members (aged ≥ 6 months) were tested for malaria infection using quantitative polymerase chain reaction after the long rainy season (June/July 2022, primary outcome) and the short rainy season (January/February 2022, secondary outcome). Secondary outcomes included indoor total mosquito per trap/night (June-July 2022), adverse effects after one month of ITS installation (August 2021), and chemical bioavailability and retention of ITS samples after one year of field use (June/July 2022). At the end of the trial, the control group received ITS.

RESULTS: Malaria prevalence among residents in the ITS arm was 19.9% (50/251) and 28.3% (65/230) in the control arm after the long rains, however, this difference was not significant [adjusted odds ratio (OR) 0.67 (95% CI 0.35-1.28), p = 0.227]. Similarly, no protection was seen for ITS after the short rains, [OR 1.27 (95% CI 0.68-2.38), p = 0.452]. However, school-age children in the ITS arm had lower malaria after the long rains [OR 0.11 (95% CI 0.02-0.73), p = 0.022]. No serious adverse effects were reported. The mean number of female Anopheles mosquitoes caught per trap/night was not significantly different between arms [1.7 vs 2.4, crude relative risk: 0.71 (95% CI 0.16-3.09), p = 0.650]. ITS showed reduced chemical bioavailability and retention post-field use. The trial reported high household refusals (17-30%) in both arms in both surveys.

CONCLUSION: The trial was inconclusive because households’ refusal resulted in low power. A large cluster randomized trial of the intervention, preferably with screens treated with longer-lasting insecticides installed in houses, is needed.

TRIAL REGISTRY: The trial was registered at ClinicalTrials.gov (NCT05125133) on October 2021.

PMID:40484966 | DOI:10.1186/s12936-025-05434-2

Harm Reduct J. 2025 Jun 8;22(1):100. doi: 10.1186/s12954-025-01242-8.

ABSTRACT

BACKGROUND: The use of anabolic androgenic steroids (AAS) among male recreational gym users has become a global substance use concern. A substantial black market for these substances exists with possibly extensive counterfeiting. Drug checking services (DCS) are established harm reduction services for people who consume illicit substances. To evaluate the feasibility of implementing a novel specialized DCS for AAS, a pilot study was conducted within a pre-existing DCS in Zurich (Switzerland).

METHODS: The reporting of this pilot study follows an adapted CONSORT statement. Further aims were to characterize AAS use as well as the chemical properties of customer-provided substance samples analysed through the DCS in a Swiss context. Customers could access DCS in Zurich from August 2023 onwards by providing a voluntary user questionnaire and dispense samples of AAS. Primary feasibility outcomes for this study were customer satisfaction metrics with the DCS received (i.e., customer satisfaction score (CSAT); net promoter score (NPS)). The chemical analytical method utilized was gas chromatography-mass spectrometry (GC-MS). Descriptive statistics were used.

RESULTS: Overall, 52 clients accessed DCS over the pilot period and 71 samples were chemically assessed. Excellent results regarding customer satisfaction metrics towards DCS for AAS were achieved (NPS: 97 (integer); CSAT: 93%). The typical clients were males partaking in recreational sports, between 22 and 40 years old, working, and with a higher education. The main motivation for using AAS was for aesthetic purposes. Patterns of AAS use were complex with frequent extensive concomitant substances use. Most AAS in this sample were acquired from non-medical sources. The sample analysis revealed that over half (52%) of the user-provided samples of AAS were fake.

CONCLUSIONS: We demonstrate that the implementation of DCS for AAS was feasible with high acceptance among clients. Those clients may engage in many high-risk behaviors and the use of substances with low chemical properties may expose them to additional unexpected health risks. As a harm reduction tool, DCS for these clients and substances appears to be feasible and it may further serve as monitoring tool for public health purposes. Upon the initial study results, DCS for AAS were continued with close monitoring.

PMID:40484965 | DOI:10.1186/s12954-025-01242-8

Cancer Imaging. 2025 Jun 8;25(1):69. doi: 10.1186/s40644-025-00890-0.

ABSTRACT

BACKGROUND: The aim of this study was to investigate the prediction value of metabolic response using gallium 68 (⁶⁸Ga) labeled fibroblast-activation protein inhibitor (⁶⁸Ga-FAPI) positron emission tomography-computed tomography (PET/CT) in Non-Hodgkin lymphoma (NHL) patients receiving (cyclophosphamide-doxorubicin HCl-vincristine[Oncovin]- prednisone) CHOP-like chemotherapy.

METHOD: This single-center prospective study was conducted in our hospital and enrolled participants who was initially diagnosed with NHL and received CHOP-like chemotherapy. ⁶⁸Ga-FAPI PET/CT was performed before chemotherapy. Metabolic response was assessed by fluorine 18 (¹⁸F) labeled fluorodeoxyglucose (¹⁸F-FDG) PET/CT. Quantitative analysis included measurement of the maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), peak standardized uptake value (SUVpeak), metabolic tumor volume (MTV) and total lesion FAP (TLF). The SUVmax value of the lesion is divided by SUVmean of normal tissue to calculate the target-to-background ratio (TBRblood and TBRmuscle). Depending on the response, participants were categorized as responders and non-responders. Mann-Whitney U-test was used to compare the ⁶⁸Ga-FAPI PET/CT parameters of responders with that of non-responders. Logistic regression analyses were performed to determine the relationship between clinical characteristics, ⁶⁸Ga-FAPI PET/CT parameters, and efficacy of chemotherapy. Receiver operating characteristic curve analysis was used to identify the accuracy of ⁶⁸Ga-FAPI PET/CT parameters for response prediction.

RESULTS: From October 2022 to May 2023, 18 participants (10 men and 8 women; median age: 56 years [interquartile range: 47-67 years]) with pathologically confirmed diagnosis of non-Hodgkin’s lymphoma were recruited in our hospital and enrolled in this study. The mean values of SUVmax, TBRblood, and TBRmuscle were significantly higher in responders than those in non-responders (8.41[Formula: see text]3.90 vs. 3.98[Formula: see text]2.81 P=0.025; 7.93[Formula: see text]3.31 vs. 3.69[Formula: see text]2.36 P=0.035; 7.04[Formula: see text]3.22 vs. 3.09[Formula: see text]1.73 P = 0.025; respectively). The area under the curve (AUC) of SUVmax, TBRblood, and TBRmuscle were statistically significant (0.875, P = 0.025; 0.857, P=0.034; 0.875, P = 0.026, respectively). SUVmax (OR=0.592, P = 0.041) is a significant factor in the prognosis of these participants.

CONCLUSION: Low radiotracer uptake on ⁶⁸Ga-FAPI PET/CT indicated poor metabolic response of NHL patients received CHOP-like therapy. SUVmax could be used to screen sensitive patients.

PMID:40484962 | DOI:10.1186/s40644-025-00890-0

BMC Health Serv Res. 2025 Jun 8;25(1):813. doi: 10.1186/s12913-025-12846-y.

ABSTRACT

OBJECTIVE: The aim of the study is to measure the readiness levels of medical artificial intelligence and the perception of openness to organizational change of healthcare professionals working in a university hospital in Istanbul. Additionally, the study seeks to identify the relationships between medical AI readiness and perceptions of organizational change openness, as well as to examine differences based on demographic variables.

METHOD: The research was conducted with 195 healthcare workers. The research is a cross-sectional descriptive quantitative research. The construct validity of the scales was checked using statistical analysis.

RESULT: As a result of the research, it was determined that healthcare workers’ are prepared for the use of medical artificial intelligence in healthcare institutions and perceive organizational change positively. A significant but low-level positive relationship was found between healthcare workers’ level of readiness for medical artificial intelligence and their perception of openness to organizational change. The level of readiness for medical artificial intelligence among healthcare workers’ was found to be high among males, doctors and internal sciences, while the perception of openness to organizational change was found to be high among postgraduate/doctoral graduates, surgical sciences, nurses.

CONCLUSION: The study determined that healthcare workers’ are ready to use medical artificial intelligence and perceive organizational change positively. The study contributes to the formation of the institution’s healthcare policies and practices and to the development, well-being and change of healthcare workers’. It is recommended that employees be made aware of the benefits of using artificial intelligence in healthcare institutions and that necessary training activities be planned.

PMID:40484945 | DOI:10.1186/s12913-025-12846-y

BMC Med. 2025 Jun 9;23(1):338. doi: 10.1186/s12916-025-04162-3.

ABSTRACT

BACKGROUND: Adenomyosis is associated with lower implantation and higher miscarriage rates. Studies on recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF) have shown that endometrial immune cell populations play a crucial role during implantation and early pregnancy. In women with adenomyosis, improved pregnancy outcomes following assisted reproductive technologies (ART) and pre-treatment with GnRH-agonists (GnRH-a) prior to frozen embryo transfer (FET) have been reported. We aimed to compare the endometrial immune cell populations of women with adenomyosis to those of women with RPL and RIF, and to characterise endometrial leucocyte subpopulations within the adenomyosis group before and after GnRH-a.

METHODS: We conducted a prospective study between 2021 and 2024. Women with infertility and adenomyosis undergoing ART underwent one endometrial biopsy 6-9 days after oocyte retrieval and a second biopsy after 3 months of GnRH-a prior to FET. Women in the RPL and RIF groups underwent one endometrial biopsy in the midluteal phase. We performed flow cytometry (FC) to characterise immune cell populations and immunohistochemistry (IHC) to analyse uterine natural killer cells (uNKs) and plasma cells (PC). The Kruskal-Wallis test was used for comparisons between the study groups, and the Wilcoxon signed rank tests were used for paired samples before and after GnRH-a.

RESULTS: Endometrial leucocyte subpopulations at baseline showed no significant differences between the adenomyosis (n = 20), the RPL (n = 40) and RIF (n = 15) group. In the adenomyosis group, following GnRH-a, we observed a significant decrease in the percentage of monocytes, from 77% (IQR 71, 82) to 71% (IQR 65, 75) (adj. p = 0.030). Baseline IHC showed elevated plasma cell concentrations (≥ 5/mm²) in 1/20 adenomyosis patients (5%), 4/40 RPL patients (10%) and 1/15 RIF patients (6.7%) while uNK cells were elevated (≥ 300/mm²) in 8/20 adenomyosis patients (40%), 11/40 RPL patients (27.5%) and 1/15 RIF patients (6.7%).

CONCLUSIONS: Women with infertility and adenomyosis showed a similar endometrial immune profile as women with RPL and RIF. The beneficial effect of GnRH-a prior to FET in women with adenomyosis may be mediated through effects on monocyte subpopulations. Based on the high prevalence of elevated uNK cells in patients with adenomyosis, we suggest testing women with adenomyosis undergoing ART before FET.

PMID:40484943 | DOI:10.1186/s12916-025-04162-3

Malar J. 2025 Jun 8;24(1):181. doi: 10.1186/s12936-025-05288-8.

ABSTRACT

BACKGROUND: It remains unclear how household structure and practices can contribute to Uganda’s goal of becoming a malaria-free nation by 2040. Effective malaria prevention and control require the implementation of measures such as long-lasting insecticidal nets, indoor residual spraying (IRS), treatment with artemisinin-based combination therapy (ACT), maintaining suitable housing structures, and practicing environmental management at the household level. This study examines household structure and practices related to malaria prevalence in children under five years old, as well as prevention and control efforts across five districts in Northern Uganda.

METHODS: A cross-sectional survey was conducted in five districts (Gulu, Omoro, Amuru, Pader, and Lamwo) from November 2022 to March 2023 to assess malaria prevalence, prevention practices, and health-seeking behaviours. Data were collected using rapid diagnostic tests for Plasmodium falciparum, observational checklists, and pre-tested questionnaires, with analysis performed using IBM SPSS Statistics.

RESULTS: The survey included 597 households and 4524 individuals, with 25.6% being children under five years of age. Of 1157 children under five, 597 (51.6%) were tested, revealing RDT positive prevalence of 44.1%. Most households had over seven members, with an average of 3.69 people per bed net. While 77.6% of households owned mosquito nets, visual inspection revealed 70.2% were torn, and only 48.7% of individuals slept under a net the night before the survey. IRS coverage was low, with 97.7% of households not sprayed in the last three months. Health-seeking behaviour predominantly involved government health centers. Housing structures, particularly mud/clay walls and grass-thatched roofs, were significantly associated with higher malaria prevalence (p < 0.001). Were their enough untreated nets?

CONCLUSION: A high prevalence of malaria was observed in children under five years old. This was closely linked to the poor use of bed nets, low coverage of IRS, and inadequate housing structures, which primarily consisted of grass-thatched roofs and mud or clay walls. The study highlights the urgent need for improved housing, IRS, and consistent use of insecticide-treated nets to reduce malaria prevalence.

PMID:40484941 | DOI:10.1186/s12936-025-05288-8

Infect Dis Poverty. 2025 Jun 9;14(1):44. doi: 10.1186/s40249-025-01317-5.

ABSTRACT

BACKGROUND: Dengue is a major global health threat with varied clinical manifestations across age groups, countries, and regions. This study aims to estimate global dengue disability weights (DWs) based on clinical manifestations data and examine variations across different demographics and geographical areas. These findings will inform public health strategies and interventions to reduce the global burden of dengue.

METHODS: We conducted a systematic search across six databases (Scopus, Web of Science, PubMed, China National Knowledge Infrastructure, Wanfang Data, and Database of Chinese sci-tech periodicals) for studies on human dengue clinical manifestations or infection from the establishment of each database through December 31, 2023. DWs were estimated by combining clinical manifestations frequencies with corresponding DW values derived from the Global Burden of Disease (GBD) study, using Monte Carlo simulations to generate uncertainty intervals. Odds ratios (ORs) with 95% confidence intervals (CI) and Chi-square tests were performed to compare clinical manifestations between adults and children.

RESULTS: A total of 35 adult studies (7109 cases) and 17 pediatric studies (2996 cases) were analysed. Adults had higher rates of muscle pain (OR = 9.18; 95% CI: 8.17-10.33) and weak (OR = 4.95; 95% CI 4.12-5.98). Children showed higher frequencies of decreased appetite (OR = 0.12; 95% CI: 0.11-0.14) and lymphadenectasis (OR = 0.04; 95% CI: 0.03-0.06). Severe dengue was more prevalent in children (8.2%) than adults (4.6%). The global DW for universal dengue was 0.3258 in adults and 0.4022 in children, with Indian children showing the highest DW for severe dengue (0.6991) and Chinese adult showing the highest DW for severe dengue (0.7214). Regionally, most studies were from South and Southeast Asia, with India contributing the largest number of publications (80 articles). Additionally, India had the highest dengue disease burden in 2021 (352,468.54 person-years).

CONCLUSIONS: These findings reveal important age and regional differences in dengue disease burden. There is a relative lack of research on dengue clinical manifestations in several high-burden countries in the Americas, and these gaps may affect the comprehensiveness and accuracy of global dengue disability weight estimates. These highlight the urgent need for targeted interventions and optimized resource allocation to mitigate its global impact.

PMID:40484939 | DOI:10.1186/s40249-025-01317-5

BMC Womens Health. 2025 Jun 8;25(1):285. doi: 10.1186/s12905-025-03841-w.

ABSTRACT

SYNOPSIS: Health inequalities intensified, burden shifting to low-resource regions despite preventive advancements. HPV and screening rates diverged by SDI, highlighting coverage gaps. Screening and vaccination inversely linked to disease burden, underscoring critical efficacy. Innovative modeling exposed disparities, advocating SDI-stratified interventions.

OBJECTIVE: This study analyzes global and regional cervical cancer trends (1990-2021) across different Socio-Demographic Index (SDI) levels, highlighting health inequalities, assessing the impact of HPV vaccination and screening, and modeling future trends. The findings aim to inform targeted prevention policies, reduce regional disparities, and promote global health equity.

METHODS: Data were sourced from the Global Burden of Disease study 2021(GBD 2021), OECD, and WHO. The focus was on incidence and disability-adjusted life years (DALYs) of cervical cancer. Time trends were analyzed by SDI regions, alongside health inequality assessments. Correlation analyses examined links between screening rates, HPV vaccination coverage, and disease burden.

RESULTS: From 1990 to 2021, global age-standardized incidence rate and age-standardized DALYs rates declined significantly, with estimated annual percentage changes (EAPC) of -0.54% (95% CI: -0.63 to -0.44) and – 1.27% (95% CI: -1.36 to -1.18). However, significant differences exist in specific patterns of change across SDI regions: exhibited an upward incidence trajectory. From 1990 to 2021, the burden of cervical cancer disease shifted from developed to less developed regions. Correlation analysis showed negative associations between screening rates and DALYs (r = -0.56, p < 0.01) and between vaccination coverage and incidence (r = -0.35, p < 0.01).

CONCLUSION: Although the global cervical cancer burden has decreased, significant regional disparities remain. Future policies should focus on tailored interventions, with low-resource regions strengthening healthcare infrastructure and implementing minimum effective preventive measures, while high-SDI regions shift to precision public health approaches. Policymakers must also incorporate culturally sensitive health education to address social barriers, challenge misconceptions, and empower communities, ultimately reducing preventable cervical cancer morbidity.

PMID:40484937 | DOI:10.1186/s12905-025-03841-w

BMC Med. 2025 Jun 9;23(1):344. doi: 10.1186/s12916-025-04187-8.

ABSTRACT

BACKGROUND: Dietary guidelines recommend replacing saturated fatty acid with unsaturated fats, particularly polyunsaturated fatty acids. Cohort studies do not suggest a clear benefit of higher intake of polyunsaturated fatty acids but, in contrast, higher circulating linoleic acid (LA) levels-reflective of dietary LA intake, are associated with a reduced risk of type 2 diabetes. However, genetic variants in the fatty acid desaturase 1 gene (FADS1) may influence individual responses to plant-based fats. We explored whether FADS1 variants influence the relationships of LA and α-linolenic acid (ALA) intakes and nut consumption with plasma phospholipid fatty acid profiles and type 2 diabetes risk in a large-scale cohort study and a randomized controlled trial.

METHODS: In the EPIC-InterAct case-cohort (7,498 type 2 diabetes cases, 10,087 subcohort participants), we investigated interactions of dietary and plasma phospholipid fatty acids and nut consumption with FADS1 rs174547 in relation to incident type 2 diabetes using weighted Cox regression. In PREDIMED (492 participants in the Mediterranean Diet + Nuts intervention group, 436 participants in the control group), we compared changes in plasma phospholipid FAs from baseline to year 1.

RESULTS: In EPIC-InterAct and PREDIMED, nut consumption was positively associated with LA plasma levels and inversely with arachidonic acid, the latter becoming stronger with increasing number of the minor rs174547 C allele (p interaction EPIC-InterAct: 0.030, PREDIMED: 0.003). Although the inverse association of nut consumption with diabetes seemed stronger in participants with rs174547 CC-genotype (HR: 0.73, 95% CI: 0.54-1.00) compared with CT (0.94, 0.81-1.10) or TT (0.90, 0.78-1.05) in EPIC-InterAct, this interaction was not statistically significant.

CONCLUSIONS: FADS1 variation modified the effect of nut consumption on circulating FAs. We did not observe clear evidence that it modified the association between nut consumption and type 2 diabetes risk.

PMID:40484934 | DOI:10.1186/s12916-025-04187-8