Tag: nevin manimala

BMC Emerg Med. 2026 Jan 13. doi: 10.1186/s12873-025-01462-y. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic pneumothorax is a potentially life-threatening condition requiring timely diagnosis and management, particularly in the prehospital setting where diagnostic tools are limited. This study aimed to evaluate the diagnostic performance of clinical signs used by emergency physicians in the field to identify traumatic pneumothorax requiring early thoracic decompression.

METHODS: We conducted a retrospective observational study in a French level I trauma center from January 2015 to August 2022. All patients with CT-confirmed pneumothorax managed by prehospital emergency physicians were included. The primary endpoint was the diagnostic performance of prehospital clinical assessment to identify pneumothorax requiring early decompression (prehospital or within four hours of admission). Statistical analysis was focused on predictive performance of three clinical signs (asymmetric lung auscultation, thoracic expansion asymmetry, and subcutaneous emphysema) in identifying cases requiring early decompression, using univariable analyses and the construction of a composite predictive score by logistic regression.

RESULTS: Among 280 included patients, 115 (41%) required early thoracic decompression. Clinical suspicion of pneumothorax was present in 63% (95% CI: 54‒71) of these cases. Asymmetric lung auscultation showed the highest sensitivity (74%; 95% CI: 62‒86), while subcutaneous emphysema demonstrated the highest specificity (79%; 95% CI: 68‒89). The overall clinical suspicion rate across the cohort was 46% (95% CI: 41‒52). A composite predictive score using the three clinical signs demonstrated better diagnostic performance (AUC 0.63 (95% CI 0.57‒0.69); score = 1 OR 2.0 [95% CI 1.1‒3.6], score = 2 OR 3.0 [95% CI 1.6‒5.7]; score = 3 OR 11.0 [95% CI 1.3‒96.8]).

CONCLUSION: Prehospital clinical assessment alone had limited diagnostic performance for detecting blunt traumatic pneumothorax requiring early decompression. A simple clinical composite score offers higher specificity but remains insufficiently sensitive to be used as a standalone diagnostic tool; it may support field decision-making as a risk-stratification aid, but prehospital clinical signs alone are not sufficient to rule out a pneumothorax requiring early decompression.

PMID:41530696 | DOI:10.1186/s12873-025-01462-y

BMC Geriatr. 2026 Jan 13. doi: 10.1186/s12877-025-06929-y. Online ahead of print.

ABSTRACT

BACKGROUND: Cognitive Assessment Games (CAGs) represent an emerging area of research. To date, most evidence regarding the efficacy of these games comes from studies conducted in Western, high-income countries. However, evidence from low- and middle-income countries (LMICs), including India, remains limited. Given the ongoing epidemiological and demographic transition in India, and the projected growth in the population aged 60 years and above, it is vital to assess the efficacy of such games in the Indian context. A previous study evaluated such games in healthy young adults; however, it is necessary to examine their use in populations for whom cognitive assessments are most relevant. The proposed study aims to evaluate the validity of the game-derived scores against standard neuropsychological assessments in Indian older adults (aged 60 years and above) with Mild Cognitive Impairment (MCI). Additionally, the study will collect feedback on the usability and acceptability of these games from the older participants.

METHODS: In this prospective, single-centre, 10-months cross-sectional study, we will recruit 70 patients aged over 60 years, diagnosed with MCI according to the Petersen criteria. Each participant will complete three games: a Virtual Reality-based Hand-Eye Coordination Game, and two tablet-based games-one assessing memory and other evaluating shopping ability. Traditional neuropsychological assessments will include the Addenbrooke’s Cognitive Examination III (ACE-III), Trail Making Test A and B, Digit Symbol Substitution Test (DSST), Verbal Learning Test, Line-Bisection Test, and the Instrumental Activities of Daily Living-Elderly (IADL-E). Information Questionnaire for Cognitive Decline in the Elderly (IQ CODE) will be administered to the informant or the caretaker of the patient. Game-related feedback will be collected using standard Cybersickness, System Usability, and Virtual Reality Presence questionnaires. Personal interviews will be conducted to gain contextual insights into each participant’s experience and feedback. All procedures will be completed in a single session, lasting approximately two hours for each participant.

STATISTICAL ANALYSIS: The primary validity endpoint would be the intended correlation of 0.40 between the Shopping game-based Quality-Weighted Efficiency Score (QWES) and Trail Making Test Part (TMT)-B. Six secondary validity endpoints have been pre-specified for assessing the convergent validity of the games, with multiplicity corrected using the False Discovery Rate (FDR) via the Benjamini-Hochberg procedure. Usability of the games will be assessed using the System Usability Scale (SUS), with a mean score exceeding 70 defined as the threshold of acceptable usability. Moderation analysis will be conducted to examine the role of technology proficiency and fatigue in impacting the primary and secondary correlations. Incremental validity analysis will be conducted to examine non-redundancy and ecological validity of the game-based scores. Finally, the inductive thematic analysis approach will be used to analyse the interview transcripts.

DISCUSSION: To our knowledge, this is the first study in India to examine game-based cognitive assessments among participants with MCI. It also offers a unique socio-cultural perspective from India on such games, which is currently absent from the global evidence base. The findings will offer insights into the use of CAGs as an alternative modality for cognitive assessment in the clinical settings, and inform the methodology, planning, and procedures for large-scale, multi-centric studies on games for cognitive assessment, ultimately contributing to the development of generalizable evidence.

STATUS OF THE STUDY AT THE TIME OF PUBLICATION: Ongoing.

TRIAL REGISTRATION: Clinical Trial Registry-India (CTRI Registration number: CTRI/2025/04/085745).

PMID:41530695 | DOI:10.1186/s12877-025-06929-y

BMC Gastroenterol. 2026 Jan 13. doi: 10.1186/s12876-025-04585-5. Online ahead of print.

ABSTRACT

BACKGROUND: Endoscopic ultrasonography (EUS) and enhanced computed tomography (CT) can offer more image features of gastric stromal tumors with higher pathological risk, which is of great significance for determining the pathological risk degree of gastric stromal tumors (GSTs) before surgery.

AIM: To investigate the correlation between EUS and enhanced CT image features and pathological risk of GSTs.

METHODS: Retrospectively collect the cases of primary GSTs. The lesions were divided into four group based on the pathological risk degree. Univariate analysis was used to identify the risk factors for higher pathological risk GSTs. The relatively benign group consisted of the very low-risk group and the low-risk group, while the relatively malignant group consisted of the intermediate-risk group and the high-risk group. Independent risk factors for the relative malignancy of GSTs pathological risk degree were analyzed by multivariate logistic regression.

RESULTS: (1) Statistically significant disparities among groups regarding the presence of ulcer on the lesion surface, length, boundary morphology, internal echo uniformity and cystic change (P < 0.05). Lesion length (P < 0.001) and irregular boundary morphology of the lesion (P = 0.003) were independent risk factors. Receiver operating characteristic (ROC) curve analysis for predicting the relative malignancy of GSTs using EUS revealed that the area under the curve (AUC) was 0.876. (2) Statistically significant differences among groups in the lesion length, shape (round or quasi-round/irregular), boundary clarity, enhancement pattern, and necrosis (P < 0.05). Lesion length (P = 0.031) and the irregular lesion shape (P = 0.019) were independent risk factors. ROC curve analysis for predicting the relative malignancy of GSTs using enhanced CT showed that the AUC was 0.795.

CONCLUSION: The image features of GSTs under EUS and enhanced CT is significantly correlated with the pathological risk of GSTs, which can be used to predict whether the pathological risk of GSTs is relatively malignant.

PMID:41530694 | DOI:10.1186/s12876-025-04585-5

BMC Med Res Methodol. 2026 Jan 13. doi: 10.1186/s12874-025-02754-4. Online ahead of print.

NO ABSTRACT

PMID:41530682 | DOI:10.1186/s12874-025-02754-4

Int J Emerg Med. 2026 Jan 13. doi: 10.1186/s12245-025-01111-y. Online ahead of print.

ABSTRACT

INTRODUCTION: The Republic of Moldova, an upper-middle-income nation in Eastern Europe, has encountered overlapping public health and humanitarian challenges that have tested the resilience of its health system. Following the COVID-19 pandemic and 2022 influx of refugees from neighbouring Ukraine, the Ministry of Health (MoH) identified an urgent need to upskill healthcare providers in emergency care. The World Health Organization-International Committee of the Red Cross Basic Emergency Care (BEC) course was selected as a rapid solution to train a range of providers in managing acute patients. This study assessed BEC’s effects on emergency care knowledge and confidence in Moldova.

METHODS: From February 2023 to December 2024, 15 BEC courses were taught in Moldova. Participants completed pre- and post-course knowledge tests, confidence self-assessments, and feedback forms. Quantitative scores were assessed using descriptive statistics and nonparametric testing, and qualitative responses were analysed thematically.

RESULTS: Of 371 enrolled participants, 312 (84%) completed all course requirements. Post-course knowledge scores were significantly higher than pre-course (mean score: +20.2%, p < 0.001). Self-reports also improved, with mean scores (ranging from 1 – least – to 4 – most) increasing from 1.85 (SD: 0.91) to 2.17 (SD: 0.67) for confidence (p < 0.001) and 1.58 (SD: 0.79) to 2.07 (SD: 0.61) for competence (p < 0.001). Most (89%) found the course highly relevant to their work and rated instructors as excellent (97%). Participants valued the symptom-based approach, hands-on simulations, short course duration, and interactive teaching, while suggesting more time for hands-on skills practice.

CONCLUSION: National BEC implementation in Moldova showed that a standardized short course can generate significant gains in emergency care knowledge and confidence across diverse provider cadres in a matter of days. Participants gained significant emergency care knowledge and confidence, even though the healthcare system was under immense strain at the time of implementation. The rollout’s decentralized delivery and high acceptability underscore its potential for national scalability and integration into existing preparedness frameworks. Moldova’s experience demonstrates how targeted education can strengthen surge capacity and sustainably contribute to resilient health systems, even amid crises.

PMID:41530664 | DOI:10.1186/s12245-025-01111-y

BMC Plant Biol. 2026 Jan 13. doi: 10.1186/s12870-025-08023-2. Online ahead of print.

NO ABSTRACT

PMID:41530659 | DOI:10.1186/s12870-025-08023-2

BMC Microbiol. 2026 Jan 13. doi: 10.1186/s12866-026-04713-5. Online ahead of print.

ABSTRACT

BACKGROUND: Antimicrobial resistance (AMR) has emerged as a critical global health challenge and is currently addressed through a “One Health” approach that investigates its occurrence in humans, animals, and the environment, as well as the transmission pathways linking these reservoirs. In commercial poultry farms, antibiotics are routinely used to treat bacterial infections that are economically significant as well as to promote weight gain. However, data on AMR in Staphylococcus aureus (S. aureus) of poultry origin remain scarce in Nepal. Antimicrobial resistance in S aureus, particularly the emergence of methicillin-resistant (MRSA) and vancomycin-resistant (VRSA) strains in both humans and poultry, poses a significant public health threat worldwide requiring immediate attention. This study aimed to detect the prevalence of multidrug-resistant S. aureus and the distribution of tetA, tetB, ermA, ermB, and ermC genes among S. aureus from litter and soil of poultry farms of Kathmandu Valley.

METHODS: Litter and soil samples were processed using serial dilution and spread plate techniques to isolate S. aureus. Antibiotic susceptibility testing was assessed by a modified Kirby-Bauer disc diffusion method. DNA was extracted from the isolates, and polymerase chain reaction (PCR) was performed to detect resistance genes (tetA, tetB, ermA, ermB, and ermC).

RESULTS: A total of 32 S. aureus were obtained, comprising 20 isolates from litter and 12 isolates from the soil of poultry farms. A total of 59.3% (19/32) of S. aureus isolates were multidrug-resistant (MDR); from which 65% (13/20) were from litter and 50% (6/12) from soil. A Chi-square test revealed no statistically significant association between MDR isolates and the source (litter vs. soil) (p > 0.05). The antibiotic susceptibility results showed high degree of resistance towards erythromycin (68.8%) followed by tetracycline (59.4%). In PCR analysis, the majority of isolates (96.8%) showed the tetA gene, while none of the isolates showed the tetB gene. Only 15 and 11 isolates out of 32 showed the ermB (46.8%) and ermC (34.3%) genes, respectively, while all isolates tested negative for ermA. Additionally, 5 S. aureus isolates carried both ermB and ermC genes. Chi-square analysis showed no significant association between AMR gene occurrence and the source of S. aureus isolates.

CONCLUSION: The high incidence of multidrug-resistant S. aureus and detection of antibiotic resistance genes in poultry litter and soil highlight a significant risk of transmission to farm workers, butchers, and consumers, as well as possible environmental contamination through manure application. These findings underscore the urgent need for strict antimicrobial stewardship, improved biosecurity, and policy measures to prevent the spread of resistant S. aureus from poultry farms to the wider community.

PMID:41530657 | DOI:10.1186/s12866-026-04713-5

J Agromedicine. 2026 Jan 13:1-7. doi: 10.1080/1059924X.2026.2615247. Online ahead of print.

ABSTRACT

INTRODUCTION: Agricultural youth may be at greater risk for poor mental health than their non-farm counterparts. While mental health resources exist for agricultural populations, they are typically adult-focused and not tailored to the needs of youth. Additionally, the preferred sources and modes for mental health information among agricultural youth are not well known. The objective of this pilot study is to identify the sources of mental health information of most interest among agricultural youth and the methods of which they prefer mental health information.

METHODS: A cross-sectional survey using a short questionnaire was administered to youth (ages 14-18) attending the National FFA Convention. A convenience sample of convention attendees completed a paper-based or online survey measuring demographics, preferred mental health information sources, and mental health information delivery modes. Descriptive statistics and independent samples t-tests were used to examine the research question.

RESULTS: Of 386 youth surveyed (mean age = 16.13, SD = 1.15), nearly half (46.89%) reported living on a farm or ranch at least 50% of the time. Compared to their non-farm-residing peers, farm-residing youth were significantly less interested in receiving mental health information from medical doctors (p = .019) and mental health specialists (p < .001). Among farm-residing youth, females showed significantly greater interest than males in receiving information from teachers (p = .040), sport coaches (p = .034), spiritual leaders (p = .039), medical doctors (p = .009), and mental health specialists (p = .005).

DISCUSSION: Results from this study suggest youth who live on farms might be more interested in receiving mental health information from youth leaders and spiritual coaches than individuals in more traditional medical roles. Additional research should examine whether this is due to preferences or barriers to accessing more traditional mental health services in agricultural communities. These findings can inform the development of mental health programming for agricultural youth.

PMID:41530655 | DOI:10.1080/1059924X.2026.2615247

Obes Surg. 2026 Jan 14. doi: 10.1007/s11695-025-08384-5. Online ahead of print.

ABSTRACT

BACKGROUND: Sleeve gastrectomy (SG) is the most common bariatric procedure but requires revision in ~ 30% of cases due to suboptimal response or persistent obesity-related medical problems. Revisional options include re-sleeve gastrectomy, Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD/DS), and single-anastomosis duodenal switch (SADS), though long-term comparative data are limited.

OBJECTIVES: To assess medium- to long-term outcomes of four revisional surgeries after primary SG for suboptimal weight loss or persistent associated medical problems.

SETTING: University hospital.

METHODS: This retrospective study analyzed a prospectively maintained database of patients who underwent revisional bariatric surgery after SG between 2010 and 2021. Indications included suboptimal clinical response (< 50% excess weight loss), ≥ 20% recurrent weight gain, or persistent non-reflux obesity-related medical problems lasting ≥ 1 year. Revisions included re-sleeve, RYGB, BPD/DS, and SADS. Patients with ≥ 3 years of follow-up were evaluated for weight loss, associated medical problems resolution, and major complications.

RESULTS: Of 113 eligible patients, 89 (79%) had ≥ 3 years of follow-up (median 70 [35] months). Median pre-revision BMI was 43.0 (8) kg/m², highest in duodenal switch-type procedures (p = 0.005). Median BMI reduction was 6.0 (7) kg/m². BPD/DS showed the highest median total weight loss (20% [12]) and diabetes resolution, though not statistically significant (p = 0.148 and 0.089). Major complications beyond 6 months were similar across groups (p = 0.248).

CONCLUSIONS: Revisional surgery after primary SG offers modest long-term benefits. Duodenal switch-type procedures show superior trends with comparable safety.

PMID:41530638 | DOI:10.1007/s11695-025-08384-5

Support Care Cancer. 2026 Jan 13;34(2):91. doi: 10.1007/s00520-026-10312-x.

ABSTRACT

PURPOSE: Malnutrition is prevalent in patients undergoing reconstruction surgery for head and neck cancer (HNC), impacting negatively on outcomes. Despite the availability of evidence-based guidelines (EBGs), evidence-practice gaps persist. This study examined the feasibility of implementing a pre-operative, nutrition evidence-based care pathway (EBCP).

METHODS: This mixed-methods, pre-post study included a retrospective audit (Jan-Dec 2023) and prospective pilot implementation of a pre-operative, supportive care-led clinic (Oct 2024-Jan 2025). Nutrition care processes (referrals, malnutrition screening, and nutrition assessment with validated tools) were benchmarked against Clinical Oncology Society of Australia (COSA) EBGs. Secondary analysis examined associations with clinical outcomes (complications, length of stay (LOS), and readmissions). Multidisciplinary team (MDT) engagement informed the EBCP, guided by the Action, Actor, Context, Target, Time (AACTT) Implementation Framework.

RESULTS: Pre- (n = 115, 56% male, mean (SD) age 62 (15) years) and post-implementation (n = 41, 64% male, 62 (14) years) cohorts were included. Pre-operative nutrition care processes all improved following EBCP implementation, including referrals (64% vs. 95%, p < 0.001) and malnutrition screening (91% vs. 98%, p = 0.14). False negative screening reduced (22% vs. 10%, p = 0.13) and median time from screening to surgery increased (0 vs. 5 days, < 0.001). Nutrition assessment with a validated tool increased (13% vs. 80%, p < 0.001). Survey responses pre- (n = 11) and post- (n = 8) implementation indicated improved perception of the service and fewer barriers to screening and assessment following ECBP implementation.

CONCLUSION: Implementation of a pre-operative nutrition EBCP is feasible, improves adherence to evidence-based nutrition care for patients with HNC, and has the potential to improve patient outcomes. This model may be transferrable to other areas of cancer care.

PMID:41530637 | DOI:10.1007/s00520-026-10312-x