Tag: nevin manimala

Pediatr Neonatol. 2026 Mar 21:S1875-9572(26)00029-X. doi: 10.1016/j.pedneo.2025.04.010. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric drug poisoning poses significant risks, with some cases resulting in life-threatening outcomes. This study analyzes drug poisoning of children under 18 years of age in Taiwan, utilizing a comprehensive 30-year database to identify factors associated with severe to fatal outcomes.

METHODS: We conducted a retrospective analysis of cases from the Taiwan Poison Control Center (PCC-Taiwan) database (1991-2020), focusing on various drugs, including pharmaceuticals, pesticides, environmental agents, and herbal medicines. Demographic data, poisoning characteristics, involved substances, and clinical outcomes were extracted. Cases were classified by severity: asymptomatic to moderate versus severe to fatal (life-threatening). Statistical analyses were performed to compare demographic data and identify factors associated with severe to fatal outcomes.

RESULTS: Of 17,274 cases, 99.0% were asymptomatic to moderate, while 1.0% (175 cases) were severe to fatal, resulting in an overall mortality rate of 0.26% (n = 45). Significant differences in demographics and specific management were observed between severity groups (p < 0.001). Among severe to fatal cases, peak incidence occurred in early childhood (0-5 years: 49.7%) and late adolescence (12-17 years: 42.3%).The most common toxic substances identified were organophosphates, anticonvulsants, and amphetamines. Intentional exposures accounted for 38.9% of severe to fatal cases, of which 55.9% were suicide attempts and 25.0% involved drug abuse. Significant factors associated with severe to fatal outcomes included prolonged exposure, intentionality, injection route, pesticide/herbal medicine use, and the requirement for specific management (p < 0.001). Pesticide use and requirement for specific management are risk factors for death in life-threatening cases (p < 0.01).

CONCLUSION: Between 1991 and 2020, life-threatening outcomes occurred in 1.0% of pediatric drug poisoning cases, primarily affecting young children and adolescents. Intentional exposures, especially suicide attempts and drug abuse, were significant contributors to these cases, while pesticides use was associated with higher mortality rates. Further studies on targeted prevention strategies and effective interventions are essential to improving outcomes for this vulnerable population.

PMID:41935946 | DOI:10.1016/j.pedneo.2025.04.010

Chin J Traumatol. 2026 Mar 31:S1008-1275(26)00067-2. doi: 10.1016/j.cjtee.2026.03.001. Online ahead of print.

ABSTRACT

PURPOSE: Anterior-column acetabular fractures extending posteriorly toward the sacroiliac (SI) region without SI joint disruption represent a rare and under-recognized fracture pattern. It remains unclear whether these fractures behave as atypical anterior-column fractures or as combined pelvic-acetabular injuries that necessitate sacroiliac fixation. This study addresses the lack of systematic data on this morphology and provides a biomechanical insight that the continuity of the SI ligamentous complex preserves pelvic stability despite posterior extension. This study aims to evaluate clinical, radiological, and functional outcomes of this fracture type and to clarify whether posterior fixation is necessary.

METHODS: A retrospective case series was conducted, including 19 adult patients with anterior-column acetabular fractures that extended posteriorly toward the SI region, while the posterior ligamentous complex remained intact between January 2015 and January 2022. Inclusion criteria were: (1) adults aged ≥ 18 years, (2) patients diagnosed with acute anterior column acetabular fractures confirmed on CT, (3) fractures demonstrating posterior extension toward the SI region without evidence of diastasis or ligamentous injury. Fractures associated with SI dissociation or pelvic-ring instability, both-column fractures with complete posterior involvement, pathological fractures secondary to tumor or infection, prior ipsilateral hip or pelvic surgery, and inadequate imaging or follow-up shorter than 24 months were all excluded. Preoperative evaluation included thin-slice CT with 3-dimensional reconstruction to confirm SI integrity. All patients underwent anterior fixation via either the ilioinguinal (n = 11) or modified Stoppa approach (n = 8). Reduction quality, fracture union, SI stability, and functional outcomes (Harris hip score, modified Merle d’Aubigné-Postel, and Western Ontario and McMaster Universities Osteoarthritis Index scores) were assessed over a mean follow-up of (39.8 ± 13.5) months. Statistical analyses were performed with SPSS (version 27). Mean ± standard deviation was used to describe continuous variables, while categorical variables were presented as frequency and percentage. Comparisons between subgroups were carried out using Student’s t-test or Mann-Whitney U test for continuous variables, and Chi-square or Fisher’s exact test for categorical variables. A p < 0.05 was considered statistically significant.

RESULTS: The mean age of the included patients was (45.7 ± 11.8) years. The mean union time of all fractures was (4.8 ± 0.7) months. Anatomical reduction was achieved in 16 patients (84.2%) and imperfect reduction in 3 (15.8%). No patient required SI fixation, and SI joint congruity was maintained in all cases. Functional outcomes were favorable. The mean Harris hip score at final follow-up was 88.9 ± 6.8. According to the Western Ontario and McMaster Universities Osteoarthritis Index score, 14 patients (73.7%) had excellent outcomes, 4 patients (21.1%) had good outcomes, 1 patient (5.3%) had a fair outcome, and no poor outcomes were recorded. All patients were evaluated using the modified Merle d’Aubigné-Postel score: 15 (78.9%) achieved an excellent rating, 3 (15.8%) a good rating, 1 (5.3%) a fair rating, and none were rated as poor. Complications were minimal, including 1 superficial wound infection and 1 transient lateral femoral cutaneous nerve neuropraxia.

CONCLUSION: Posterior extension of anterior-column fractures without SI ligamentous disruption behaves biomechanically as an isolated acetabular injury, obviating the need for posterior fixation. Accurate preoperative CT assessment and intraoperative verification enable safe anterior fixation, ensuring union, stable SI articulation, and excellent function. These findings highlight a distinct morphologic variant overlooked by current classification systems, warranting refinement to integrate functional stability criteria.

PMID:41935945 | DOI:10.1016/j.cjtee.2026.03.001

J Clin Lipidol. 2026 Mar 15:S1933-2874(26)00073-5. doi: 10.1016/j.jacl.2026.03.009. Online ahead of print.

ABSTRACT

BACKGROUND: Atherosclerotic cardiovascular disease develops in adulthood, but its metabolic precursors, such as dyslipidemia, often emerge during childhood.

OBJECTIVE: This study aimed to evaluate the associations of parental LDL-C levels with their offspring’s LDL-C levels and dyslipidemia risk.

METHODS: This study examined the intergenerational association between parental dyslipidemia (low-density lipoprotein cholesterol [LDL-C]-defined) and offspring LDL-C levels using nationally representative data from the Korea National Health and Nutrition Examination Survey (2017-2023).

RESULTS: A total of 2702 first-born children aged 7 to 18 years with available parental lipid data were included. Offspring hypercholesterolemia was defined as LDL-C ≥130 mg/dL, and parental dyslipidemia as a diagnosis of dyslipidemia (i.e. total cholesterol ≥240 mg/dL, LDL-C ≥160 mg/dL, or use of lipid-lowering medication). Linear regression was used to assess associations between parental and offspring LDL-C, and logistic regression to estimate odds ratios (ORs) for offspring hypercholesterolemia (high LDL-C levels) according to parental dyslipidemia (LDL-C-defined). Statistical interaction terms between maternal LDL-C and offspring biological sex or age group (7-12 vs 13-18 years) were tested. Both maternal and paternal LDL-C were significantly associated with offspring LDL-C (β = 0.214 and 0.113, respectively; both P < .001). Offspring hypercholesterolemia (high LDL-C levels) risk increased with parental dyslipidemia (LDL-C-defined) (OR = 2.12 for father only, 4.03 for mother only, and 3.83 for both parents; all P < .01).

CONCLUSION: These findings highlight maternal LDL-C as a predominant determinant of offspring lipid levels and emphasize the importance of family-based early screening and preventive strategies.

PMID:41935911 | DOI:10.1016/j.jacl.2026.03.009

J Surg Res. 2026 Apr 3:S0022-4804(26)00157-5. doi: 10.1016/j.jss.2026.01.034. Online ahead of print.

NO ABSTRACT

PMID:41935891 | DOI:10.1016/j.jss.2026.01.034

J Voice. 2026 Apr 3:S0892-1997(26)00119-0. doi: 10.1016/j.jvoice.2026.03.002. Online ahead of print.

ABSTRACT

PURPOSE: Vocal folds (VF) are key structures for phonation, and their length varies between individuals depending on sex and anthropometric characteristics. The aim of this study was to measure VF length in healthy adults using videolaryngoscopy and to investigate its relationship with sex, age, height, and weight.

METHODS: This prospective study was approved by the Ethics Committee of Kayseri City Hospital (September 9, 2025, no: 563). A total of 215 patients (107 males, 108 females; aged 18-88 years) who underwent general anesthesia for various surgical procedures and had no history of laryngeal disease or dysphonia were included. After induction of anesthesia and neuromuscular blockade, videolaryngoscopic images of the glottis were obtained using a HugeMed-VL3R videolaryngoscope (image size 640 × 480 pixels). Calibration of pixel-to-millimeter conversion was performed on three cadaveric larynges by placing a ruler at the level of the VF; 10 mm corresponded to 118 pixels. Intraoperative images were analyzed in ImageJ. Right and left VF lengths were measured at the glottic level by three independent observers, each performing three repeated measurements (nine measurements per VF), and mean values were used for analysis. Statistical analyses were performed using IBM SPSS v23.

RESULTS: The mean age of the participants was 47.1 ± 16.1 years, mean height 167.8 ± 9.1 cm, and mean weight 74.2 ± 14.2 kg. The mean right VF length was 21.95 ± 3.89 mm (range: 10.7-31.5 mm) and the mean left VF length was 22.15 ± 3.92 mm (range: 11.3-31.3 mm). Both right and left VF lengths were significantly longer in males than in females (P < 0.001 for both). Height showed a strong positive correlation with right (r = 0.61, P < 0.001) and left (r = 0.63, P < 0.001) VF length, while weight showed a moderate positive correlation (r ≈ 0.32-0.34, P < 0.001). Age was not significantly correlated with VF length. Multiple regression analysis demonstrated that sex, height, weight, and age together explained 68% of the variance in right VF length and 66% in left VF length.

CONCLUSION: VF length is strongly associated with sex and height, and to a lesser degree with weight, whereas age has no significant effect on VF length in healthy adults. These findings may provide reference values for laryngeal assessment, preoperative planning, and voice-related clinical decision-making.

PMID:41935887 | DOI:10.1016/j.jvoice.2026.03.002

J Microbiol Immunol Infect. 2026 Mar 30:S1684-1182(26)00042-3. doi: 10.1016/j.jmii.2026.03.009. Online ahead of print.

ABSTRACT

BACKGROUND: Epidural analgesia (EA) is widely used during labor and frequently associated with maternal intrapartum fever, often prompting neonatal sepsis evaluations. Data from East Asia is scarce; we evaluated whether EA is associated with increased neonatal infection risk and related complications in a Taiwanese cohort.

METHODS: This retrospective cohort study included 2375 full-term, singleton vaginal deliveries at a tertiary medical center in Northern Taiwan from 2018 to 2021. Neonatal outcomes were compared between mothers who received EA and those who did not. Neonatal infection was operationalized as admission to the NICU for suspected infection, and prolonged antibiotic therapy (>48 h) was evaluated as a secondary outcome.

RESULTS: Neonates in the EA group had a slightly higher rate of NICU admission for suspected infection than non-EA infants (4.04% vs 2.81%; p = 0.157), but this difference was not statistically significant. Maternal intrapartum fever occurred significantly more often with EA (28.3% vs 11.4%; p < 0.001), whereas neonatal fever was rare and similar between groups (1.79% vs 1.58%), and only one infant had culture-confirmed infection. In the NICU subgroup (EA N = 63; non-EA N = 23), low Apgar scores and meconium aspiration occurred only in EA-exposed infants, but these rare events and neonatal fever were not independently associated with EA in exploratory Firth logistic regression. Stratified analyses instead suggested that maternal intrapartum fever, rather than EA exposure, was more closely linked to neonatal fever.

CONCLUSIONS: In this cohort, EA was associated with frequent precautionary neonatal sepsis evaluation without an increase in culture-confirmed infection. Potential residual confounding suggests that these findings should be interpreted as exploratory rather than causal. These findings highlight the need for cautious evaluation to prevent unnecessary antibiotic use in neonates.

PMID:41935873 | DOI:10.1016/j.jmii.2026.03.009

Acad Radiol. 2026 Apr 3:S1076-6332(26)00124-8. doi: 10.1016/j.acra.2026.02.033. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: This study aimed to comprehensively compare the diagnostic performance, technical efficacy, and safety profiles of four different approaches for core needle biopsy (CNB) of oropharyngeal and adjacent space lesions: transoral versus percutaneous approaches, each guided by either conventional ultrasound (US) or contrast-enhanced ultrasound (CEUS).

MATERIALS AND METHODS: This retrospective cohort study consecutively enrolled eligible adults who underwent imaging studies showing suspected oropharyngeal, parapharyngeal, retropharyngeal space, and adjacent space tumors from October 2015 to December 2024. From 388 eligible patients (initial cohort: 416), 240 patients were selected using a 1:1:1:1 matched design with percutaneous US-guided CNB as the reference group to form four balanced groups: transoral or percutaneous CNB guided by either conventional US or CEUS (60 patients per group). Matching by age and maximum tumor diameter was performed to balance baseline characteristics among groups. All procedures used 18-G automated cutting needles. The primary outcome was diagnostic concordance between US/CEUS-guided CNB histopathology and the reference standard. The secondary outcomes included imaging concordance (US/CEUS concordance with histopathological reference standard); procedure efficacy (first-puncture success; total number of needle punctures; and overall procedure duration); safety profile, including infection and hemorrhagic complications; and pain assessment. Statistical analyses accounted for the matched design by applying linear models, conditional logistic regression, and generalized estimating equations for continuous, binary, and repeated-measures outcomes, respectively.

RESULTS: Among 240 patients, transoral CEUS guidance demonstrated favorable perioperative outcomes across multiple domains. For procedural precision, first-attempt puncture success was significantly higher with transoral versus transcutaneous approaches (adjusted OR = 2.35, 95% CI: 1.18-4.68, P = 0.015). CEUS significantly reduced puncture attempts compared with conventional US (β = -0.69, 95% CI: -0.84 to -0.53, P < 0.001), with transoral CEUS achieving a notably greater reduction versus transcutaneous conventional US (β = -0.82, 95% CI: -1.04 to -0.60, P < 0.001). Intraoperative blood loss was statistically significantly lower with CEUS guidance overall (β = -0.30, 95% CI: -0.36 to -0.24, P < 0.001), with transoral CEUS showing a relatively greater effect (β = -0.34, 95% CI: -0.43 to -0.25, P < 0.001 vs transcutaneous conventional US). CEUS guidance was associated with a statistically significant prolongation of procedure time compared with US (β = 1.6 min; 95% CI: 1.3-1.9; P< 0.001). For transoral CEUS relative to percutaneous guidance, the prolongation was β = 1.7 min (95% CI: 1.4-2.0; P< 0.001). And transoral CEUS yielded a relatively more favorable pain profile, with significantly lower scores immediately postoperatively (β = -0.72, P < 0.001) and at 24 h (β = -0.40, P < 0.001). Diagnostic accuracy remained uniformly high across all groups (95.0-98.3%), with no significant differences by approach (P = 0.712) or guidance technique (P = 0.295). Complications were rare (1.25% overall: two hematomas, one infection), with no significant intergroup differences (P > 0.05); all resolved with conservative management.

CONCLUSIONS: CEUS-guided transoral biopsy achieved superior technical success with fewer puncture attempts and improved pain control for oropharyngeal lesions, despite modest procedural time extension. This approach demonstrates notable advantages over conventional methods and represents a valuable diagnostic technique for oropharyngeal space lesions.

PMID:41935848 | DOI:10.1016/j.acra.2026.02.033

J Nurs Scholarsh. 2026 May;58(3):e70087. doi: 10.1111/jnu.70087.

ABSTRACT

INTRODUCTION: In Taiwan, engagement in professional help-seeking among persons living with schizophrenia remains limited despite increasing demands on mental healthcare systems. Clarifying the factors that shape professional help-seeking attitudes is essential for promoting recovery-oriented care. This study examined the correlates of professional help-seeking attitudes in persons with schizophrenia in Taiwan.

DESIGN: A cross-sectional correlational study.

METHODS: A total of 144 persons receiving psychiatric rehabilitation care at three hospitals in Taiwan were recruited. Data were collected using structured self-report measures assessing sociodemographic and clinical characteristics, schizophrenia literacy, internalized stigma, and professional help-seeking attitudes. Descriptive statistics, bivariate analyses, and hierarchical multiple regression analyses were conducted.

RESULTS: Participants generally reported unfavorable attitudes toward professional help-seeking. More favorable attitudes were associated with higher educational attainment, shorter illness duration, greater schizophrenia literacy, and lower internalized stigma. Schizophrenia literacy and internalized stigma showed the most robust relationships with professional help-seeking attitudes.

CONCLUSION: Within Taiwanese mental healthcare settings, schizophrenia literacy and internalized stigma appear to be central to attitudes toward professional help-seeking among persons living with schizophrenia.

CLINICAL RELEVANCE: Routine assessment of schizophrenia literacy and internalized stigma, together with culturally sensitive and recovery-oriented nursing interventions, may enhance treatment engagement among persons living with schizophrenia. The findings may also inform mental health nursing practice in other cultural and healthcare contexts where limited schizophrenia literacy, stigma, and long-term inpatient care pose barriers to recovery-oriented care delivery.

PMID:41935843 | DOI:10.1111/jnu.70087

J Dent. 2026 Apr 2:106670. doi: 10.1016/j.jdent.2026.106670. Online ahead of print.

ABSTRACT

OBJECTIVES: This study examined the impact of the COVID-19 pandemic on presentation, referrals, diagnoses, stage distribution, primary treatment, and survival for Head and Neck Cancer (HNC) patients in Northern Ireland (NI) by analysing population-based patient level data collected during 2016-2023.

METHODS: Individual-level data for all patients diagnosed with HNC available on the regional Cancer Patient Pathway System (CaPPs) during the period 2016-2023 was accessed to examine the number of cancers diagnosed, referrals, diagnosis, stage at diagnosis, and first treatment. Northern Ireland Cancer Registry (NICR) data up to 2021 was used to estimate the proportion of patients managed by the regional Multidisciplinary Team (MDT) and provide additional key characteristics and survival information. Data on activity in primary dental care (2016-2023) was accessed from the Northern Ireland Statistics and Research Agency (NISRA). Four time-periods were compared: pre-pandemic (PP: January 2016-March 2020), initial pandemic (IP: April 2020-March 2021), initial recovery (IR: April 2021-March 2022) and pandemic recovery (PR: April 2022-May 2023).

RESULTS: Adult dental examinations in primary care dental services decreased by 78%, from a yearly average of 965,000 during the PP period to 218,000 during the IP period. The number of HNC patients assessed at the MDT did not change significantly over the period 2016-2023 (P>0.05) from an annual average of 322 in the PP period; 302 in the IP period; 315 in the IR period and 342 in RP. Although there was an increased proportion of late-stage HNCs (III and IV) in the IP period, this was only significant for the oral cancer subsite (51.7% PP versus 67.1% IP), with recovery in the following periods. There was a decrease in the number of HNC patients receiving surgery as first treatment, and conversely an increase in radiotherapy, across the four time periods. The number of patients undergoing surgery as first treatment type decreased from PP (136) to IP periods (119) and failed to recover to pre-pandemic levels (117 in PR). Short-term (2-year) observed and net survival was not significantly different for HNC patients diagnosed pre-pandemic compared to periods thereafter (IP, IR, RP). The largest decrease in 2-year net survival was found for oral cancer, from 64.7% (PP) to 57.3% (IR), which approached significance (P=0.06).

CONCLUSION: The COVID-19 pandemic had wide-ranging impacts on HNC in Northern Ireland with substantially fewer examinations provided in primary dental care; reduced HNC incidence in the IP period; higher proportions of late-stage disease (statistically significant in oral cavity only); fewer surgical treatments and lower survival. These patterns approached statistical significance for oral cancers, the site most likely to be detected through dental screening.

CLINICAL SIGNIFICANCE: The COVID-19 pandemic severely impacted patient access to primary care dental services throughout NI, where clinical screening for HNC is undertaken by General Dental Practitioners (GDPs) as part of a dental check-up. This study demonstrates the importance of primary dental care services in the identification and early diagnosis of HNCs.

PMID:41935818 | DOI:10.1016/j.jdent.2026.106670

Environ Pollut. 2026 Apr 2:128058. doi: 10.1016/j.envpol.2026.128058. Online ahead of print.

ABSTRACT

Microplastics (MPs; 1-5000 μm) have been detected in various locations, and numerous surveys have been conducted in rivers to identify their sources and characterize the extent of MP pollution. However, standardized observation and analytical methods for small MPs have not yet been established, and the relationship between MP abundance and size-distribution characteristics remains poorly understood. This study aimed to characterize the size spectra of MP number and mass concentrations over a broad size range in river water and evaluate the applicability of a power-law model to these size spectra. To achieve this, we applied three different sampling methods to surface water in the Tsurumi River, Japan, yielding seven MP samples. The results demonstrated the statistical significance of the power-law approximation for the size spectra of the number and mass concentrations of MPs across all samples. The estimated power-law slopes were -3.27±0.19 and -1.05±0.20 for number and mass concentrations, respectively, which are close to the assumed values of -3 and -1, respectively. Additionally, MP mass concentrations were calculated from the measured values within a limited size range using the power-law model of the MP size spectrum. The results indicated that MP mass concentrations can be accurately estimated by extrapolating across unmeasured size ranges using a power-law relationship. This approach addresses a key limitation that has hindered inter-study comparisons owing to differences in the MP size ranges considered and provides an important step toward harmonizing MP datasets and improving the quantitative understanding of MP pollution in riverine environments.

PMID:41935770 | DOI:10.1016/j.envpol.2026.128058