Tag: nevin manimala

J Orthop Surg Res. 2026 Mar 3;21(1):169. doi: 10.1186/s13018-025-06209-w.

ABSTRACT

BACKGROUND: Patient comorbidities and medication intake impact on the mortality rate in revision surgery for periprosthetic joint infection (PJI) of the lower limb. The present study collected data from patients who underwent revision surgery for PJI of total hip arthroplasty (THA) or total knee arthroplasty (TKA). Data regarding comorbidities and medication intake for each patient were collected to investigate whether comorbidities and medication intake influence in-hospital mortality in patients who underwent revision surgery for PJI of a THA or TKA.

METHODS: The present study follows the STROBE Statement. Our institutional databases were searched using the OPS (operation and procedure codes) 5-823 and 5-821 in combination with the ICD (International Statistical Classification of Diseases and Related Health Problems) codes T84.5, T84.7 or T84.8. All patients with hip or knee implant infections who underwent revision surgery were retrospectively retrieved and included in the present study.

RESULTS: Data from 346 patients were collected (181 THAs and 165 TKAs). Patients with renal insufficiency demonstrated a statistically significant greater risk of in-hospital mortality (95% CI 0.0131 to 0.1132), as did patients with a history of malignancy (95% CI 0.1478 to 0.7497), and patients with dementia (95% CI 0.0398 to 0.3791). Nicotine and alcohol abuse, diabetes mellitus, arterial hypertension, hereditary thrombophilia, hereditary haemorrhages, cerebrovascular diseases, coronary heart diseases, chronic obstructive pulmonary disease osteoporosis, liver cirrhosis, rheumatoid arthritis, acute dental infection did not influence in the in-hospital mortality rate in patients who underwent revision surgery for PJI of a THA or TKA. Patient medication therapy did not impact the risk of in-hospital mortality in PJI.

CONCLUSION: Patients undergoing revision surgery for PJI after total hip and knee arthroplasty show an increased in-hospital mortality in the presence of the following comorbidities: dementia, renal insufficiency, and history of malignancy. Based on the present results, further infection prevention and geriatric co-management strategies should be evaluated for patients undergoing revision arthroplasty of the hip and knee for PJI.

PMID:41776540 | DOI:10.1186/s13018-025-06209-w

BMC Oral Health. 2026 Mar 3. doi: 10.1186/s12903-026-07743-7. Online ahead of print.

ABSTRACT

STATEMENT OF THE PROBLEM: The clinical performance of ceramic crowns is influenced by overall marginal adaptation. A recently introduced advanced lithium disilicate ceramic requires further evidence compared to conventional lithium disilicate in terms of vertical marginal fit.

PURPOSE OF THE STUDY: To assess the vertical marginal fit of crowns constructed from advanced and conventional lithium disilicate materials.

MATERIALS AND METHODS: Ten (n = 10) ceramic crowns were constructed and randomly assigned to two groups: Group (T) with CEREC Tessera crowns (n = 5) and Group (E) with IPS e.max CAD crowns (n = 5). Vertical marginal fit was evaluated using a stereomicroscope at 10X magnification both before and after cementation, with twenty equidistant measurement points recorded for each crown. Each crown was cemented to its corresponding natural molar tooth using Totalcem resin cement. Mann-Whitney U test was used to compare the two material groups. Wilcoxon signed-rank test was used to compare between vertical marginal fit before and after cementation (P ≤ 0.05).

RESULTS: The overall vertical marginal fit between the two groups showed no significant difference, whether before or after cementation. However, both groups exhibited a statistically significant decrease in vertical marginal fit after cementation.

CONCLUSION: Advanced lithium disilicate shows advantageous properties concerning mean marginal gap values exhibiting comparable performance to IPS e.max CAD.

CLINICAL IMPLICATIONS: CEREC Tessera demonstrated marginal fit values within clinically acceptable limits, supporting its reliability as a novel chairside material suitable for use in restorative dentistry.

PMID:41776528 | DOI:10.1186/s12903-026-07743-7

BMC Nurs. 2026 Mar 3. doi: 10.1186/s12912-026-04508-z. Online ahead of print.

ABSTRACT

AIM: To determine the association between urinary incontinence and primary caregiver burden (ZBI) in individuals aged ≥ 80, and to assess additional clinical and sociodemographic contributors.

METHODS: In this cross-sectional study at Elazığ City Hospital (Oct-Nov 2025), 311 patient-caregiver dyads were evaluated using interviews and chart review. UI was assessed with ICIQ-SF and burden with the ZBI. We used descriptive statistics, Spearman correlation, and multiple linear regression (outcome: total ZBI).

RESULTS: Mean patient age was 84.6 years; UI prevalence was 53.1% (n = 165). Mean caregiver ZBI = 47.08 ± 19.77. ZBI correlated strongly with ICIQ-SF (r = 0.536; p < 0.001). The regression model explained 31.5% of ZBI variance (F = 19.932, p < 0.001; adj R2 = 0.299); UI (B = 14.776; β = 0.374; p < 0.001) and BMI (B = 1.055; β = 0.194; p < 0.001) were the only significant predictors.

CONCLUSIONS: In geriatric patients, UI independently and substantially increases caregiver burden and may adversely affect quality of care. Prioritized strategies to reduce caregiver burden should include effective UI management, psychosocial support for caregivers, and control of modifiable risk factors such as obesity and falls.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41776504 | DOI:10.1186/s12912-026-04508-z

BMC Pregnancy Childbirth. 2026 Mar 3. doi: 10.1186/s12884-026-08866-z. Online ahead of print.

ABSTRACT

BACKGROUND: Burnout in midwifery is widespread globally, influencing workforce attrition and undermining maternity service provision. Large-scale systematic and structural reforms are necessary but time-consuming. Meanwhile, midwives need immediate support for wellbeing to enable them to make sense of their workplace, workload and their practice. This research aimed to examine the impact of Group Clinical Supervision (GCS) on burnout among midwives.

METHODS: This superiority cluster randomised controlled trial studied registered midwives working at public maternity services in metropolitan New South Wales, Australia. Managers, agency staff and midwifery students were excluded. Sites were randomised electronically; midwives at intervention sites received monthly, hour-long, face-to-face GCS sessions. All participating midwives were surveyed six-monthly between June 2022 and November 2024. The primary outcome was burnout, measured with the Copenhagen Burnout Inventory, including sub-dimensions – personal, work-related and client-related burnout – and analysed using a mixed-effects linear regression model adjusted for covariates. Secondary outcomes were perceptions of workplace culture and the GCS sessions. Only the statistician analysing data was blinded to group allocation.

RESULTS: Twelve maternity services were enrolled, with 980 intervention participants and 1009 controls. Burnout rates were similar for both arms, but following adjustment for covariates, the intervention was associated with a small but statistically significant reduction in overall burnout scores: mean 47.3 for midwives at intervention sites (n = 882) and 50.0 for controls (n = 913), β=-2.7, 95% CI: -4.7 to -0.6] (p = 0.013). Specifically, work-related burnout was 3.0% points lower in the intervention group (p = 0.022), although reductions in client-related and personal burnout were not statistically significant. Most participants perceived their workplace culture positively, although the control group rated their overall workplace culture significantly more highly (p < 0.001). No unintended or harmful events occurred.

CONCLUSION: This study showed that regular GCS can lower overall and work-related burnout in midwives. The overall rate of 51.5% was similar to or lower than other studies, with similarly lower rates among older midwives. There is an urgent need for systemic changes in maternity services, encompassing institutional support strategies to mitigate burnout so that staff can better manage their professional demands.

TRIAL REGISTRATION: 10/05/2021 with Australian New Zealand Clinical Trials Registry – ACTRN12621000545864p.

PMID:41776497 | DOI:10.1186/s12884-026-08866-z

BMC Public Health. 2026 Mar 3. doi: 10.1186/s12889-026-26229-3. Online ahead of print.

ABSTRACT

BACKGROUND: The unmitigated spread of novel infectious pathogens, such as SARS-CoV-2, can result in significant disease burdens and widespread societal impacts. The magnitude, severity, and duration of these events are influenced by factors such as contact patterns and the application and effectiveness of public health control measures. Many non-pharmaceutical interventions (NPIs) were implemented to target these heterogeneous drivers and modifiers of wild-type SARS-CoV-2 transmission in Canada; however, determining and understanding their individual and joint effectiveness on different populations is challenging. In this retrospective study, we delineate the impacts of age-specific NPIs in three urban Canadian regions (Calgary, Greater Vancouver, and the Greater Toronto Area) prior to widespread vaccination availability (March 2020-February 2021) and identify relative age-specific NPI effectiveness on mitigating wild-type SARS-CoV-2 transmission.

METHODS: We developed an age-structured Susceptible-Exposed-Infectious-Recovered (SEIR) deterministic model and stratified our population into two age groups: children and youth (0-19 years) and adults (20+ years). The model incorporated contact mixing rates, wild-type SARS-CoV-2 age-specific susceptibility, and NPI strength. Detailed timelines for each region were compiled, capturing the time-dependent implementation of age-specific and population wide NPIs. Using maximum likelihood estimation, we determined regional baseline transmission probabilities in the absence of widespread NPIs, then estimated the subsequent time-dependent and age-specific NPI strength on transmission reduction. Finally, we considered counterfactual NPI scenarios and compared simulated regional age-specific epidemic trajectories with reported SARS-CoV-2 case data.

RESULTS: The age-specific and sequential time-dependent NPI strength on wild-type SARS-CoV-2 transmission reduction was estimated for each region during March 2020-February 2021. We observed that adult-specific contacts play a large role in transmission, and moderately-strengthened adult-specific NPIs were more effective in reducing transmission across all regions compared to a drastic strengthening of NPIs in children and youth (i.e., closing schools). These results held when varying temporal applications of singular and joint counterfactual NPI scenarios; however, regional contexts and data uncertainties caused varied levels of effectiveness.

CONCLUSIONS: By considering population heterogeneity, our retrospective study provides insight into age-specific NPI effectiveness on wild-type SARS-CoV-2 transmission. These findings and associated model can inform decision-making related to targeted NPI implementation and aid in resource planning and preparedness for future emerging disease outbreaks.

PMID:41776444 | DOI:10.1186/s12889-026-26229-3

BMC Nephrol. 2026 Mar 3. doi: 10.1186/s12882-026-04826-z. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic Kidney Disease (CKD) and epilepsy are common comorbidities in children; their clinical interaction in terms of seizure frequency and severity has been poorly explored. This study investigates the influence of CKD stage and kidney function markers on seizure outcomes in pediatric epilepsy patients.

METHODS: A cross-sectional study was conducted among 250 children aged 2-18 years with biopsy-confirmed CKD and a documented diagnosis of epilepsy. Clinical data were extracted from medical records, including seizure frequency, seizure severity (measured using the National Hospital Seizure Severity Scale, NHS3), serum creatinine, Blood Urea Nitrogen (BUN), and CKD stage. Statistical analyses were performed using SPSS version 26, employing Pearson correlation, one-way ANOVA, and independent samples t-tests to evaluate associations between kidney function, epilepsy etiology, seizure subtype, and seizure outcomes.

RESULTS: Significant positive correlations were observed between BUN and both seizure frequency (r = 0.45, p < 0.01) and seizure severity (r = 0.36, p < 0.01). Serum creatinine was similarly correlated with seizure frequency (r = 0.50, p < 0.01) and seizure severity (r = 0.48, p < 0.01). While seizure severity did not differ significantly across CKD stages, ANOVA revealed a significant effect of epilepsy etiology on seizure severity (F(2,247) = 39.45, p < 0.001), with higher severity in metabolic and genetic etiologies compared to structural ones. Additionally, generalized seizures were associated with greater severity than focal seizures (p < 0.001).

CONCLUSION: Although seizure severity remained relatively constant across CKD stages, impaired renal function-reflected by elevated BUN and serum creatinine-was strongly associated with increased seizure frequency and severity. These findings suggest that metabolic dysfunction plays a more prominent role than CKD stage in determining seizure burden. Regular monitoring of kidney function markers, consideration of epilepsy etiology, and individualized management strategies integrating nephrological and neurological care may improve outcomes for children with CKD and epilepsy.

PMID:41776419 | DOI:10.1186/s12882-026-04826-z

Biol Proced Online. 2026 Mar 3. doi: 10.1186/s12575-025-00267-4. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the regularities and clinical features of sintilimab-related autoimmune myocarditis, and to summarize the differential diagnosis key points between sintilimab-related autoimmune myocarditis and acute myocardial infarction.

METHODS: The case reports about sintilimab-related autoimmune myocarditis were searched on databases from the establishment of the database to April 1st 2024. The relevant medical records were searched on the hospital information system of Beijing Hospital of Traditional Chinese Medicine in the past 3 years. The case reports and medical records were collected for statistical analysis.

RESULT: Twenty three cases were collected including 22 case reports and 1 case record. Most of the sintilimab-related autoimmune myocarditis were in elderly men aged 60-75 years old and occurred between the end of the first dose of treatment to the beginning of the second dose. The symptom was nonspecific such as chest tightness and palpitation, sometimes with symptom of myasthenia as muscle weakness or myositisand as muscle soreness. Elevated cardiac biomarkers and changes in electrocardiogram were common, and decreased left ventricular ejection fraction was rarely seen in echocardiography. 9 cases underwent coronary angiography or computed coronary tomography angiography, and 3 cases underwent cardiovascular magnetic resonance.

CONCLUSION: The manifestations of sintilimab-related autoimmune myocarditis are not specific. The medication history and concomitant symptoms are of warning value. Coronary angiography or coronary computed coronary tomography angiography can be helpful when ruling out acute myocardial infarction. Cardiovascular magnetic resonance and myocardial biopsy can confirm the diagnosis. Cardiac biomarkers and the electrocardiogram can assist in diagnosis and prognosis assessment.

PMID:41776397 | DOI:10.1186/s12575-025-00267-4

Clin Trials. 2026 Mar 3:17407745261421842. doi: 10.1177/17407745261421842. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Bayesian designs for clinical trials using assurance to choose the sample size have been proposed in various trial contexts. Assurance allows for the incorporation of uncertainty on both the treatment effect and nuisance parameters into the sample size calculation. In the case of two-arm cluster randomised trials with continuous outcomes, assurance has been proposed with both a frequentist analysis (hybrid designs) and a Bayesian analysis (fully Bayesian designs). A Bayesian analysis in this context ensures a consistent treatment of probability throughout the design and analysis of the trial. In the fully Bayesian design, inference has been achieved via Markov chain Monte Carlo sampling, and since assurance itself is evaluated via simulation, the result is a computationally intensive and often slow-to-run approach. In the case of two-arm cluster randomised trials with binary outcomes, assurance has not yet been explored to specify sample sizes, either in the hybrid or fully Bayesian case.

METHODS: This article considers fully Bayesian designs for two-arm cluster randomised trials with continuous and binary outcomes. For the analysis of the trial, we use a (generalised) linear mixed-effects model. We summarise the inference for the treatment effect based on quantiles of the posterior distribution. We use assurance to choose the sample size. In the continuous case, we investigate Integrated Nested Laplace Approximations for inference to speed up calculation of the assurance and compare Integrated Nested Laplace Approximations in computation time and accuracy to Markov chain Monte Carlo. In the binary case, we develop the first fully Bayesian design for cluster randomised trials and conduct a similar comparison between Integrated Nested Laplace Approximations and Markov chain Monte Carlo. We demonstrate our novel approach using assurance to choose sample sizes for the SPEEDY cluster randomised trial, based on the results of a formal prior elicitation exercise with two clinical experts.

RESULTS: We report comparisons of Integrated Nested Laplace Approximations and Markov chain Monte Carlo for a range of different scenarios for cluster randomised controlled trials (RCTs), to determine when each inference scheme should be used, balancing the computational cost in terms of speed and accuracy. Overall Markov chain Monte Carlo with a very large number of samples produces very accurate inference but does not scale well in terms of computational speed compared to Integrated Nested Laplace Approximations. Based on our simulation study, we recommend that Integrated Nested Laplace Approximations is used for inference in cluster trials with binary outcomes and large (n> 500) cluster trials with continuous outcomes, and that Markov chain Monte Carlo is used in smaller (n≤500) cluster trials with continuous outcomes. Our case study demonstrated how to incorporate the uncertainty of trial clinicians into the sample size calculation to give an overall assessment of the likelihood of success of the trial.

CONCLUSION: A fully Bayesian design can be used for two-arm cluster trials with both continuous and binary outcomes. Integrated Nested Laplace Approximations can allow for more efficient assessment of the assurance for cluster trials with binary outcomes and large cluster trials with continuous outcomes, without loss of accuracy in inference. A fully Bayesian design of a cluster randomised trial provides a coherent design and analysis framework and incorporates uncertainty in model parameters when choosing the sample size.

PMID:41776384 | DOI:10.1177/17407745261421842

Eur J Hum Genet. 2026 Mar 3. doi: 10.1038/s41431-026-02064-3. Online ahead of print.

NO ABSTRACT

PMID:41776349 | DOI:10.1038/s41431-026-02064-3

Sci Rep. 2026 Mar 3. doi: 10.1038/s41598-026-41608-x. Online ahead of print.

ABSTRACT

Ambulatory surgery has become widely used in high-income countries because it is safe, cost-effective, and optimizes hospital resources, yet its development remains limited in many low- and middle-income settings, including Morocco. This study evaluated the feasibility and outcomes of ambulatory digestive surgery in a Moroccan tertiary care hospital and sought to identify factors associated with failure of same-day discharge. Over one year, all adult patients scheduled for elective ambulatory digestive procedures were prospectively included, and their perioperative outcomes were analyzed. Among 595 procedures performed in 2022, 266 were initially planned as ambulatory, but 64 ultimately required unplanned overnight hospitalization, resulting in an effective ambulatory rate of 33.9%. Complication and readmission rates were low, and no 90-day mortality was observed, supporting the overall safety of this approach. However, ambulatory failure was frequently associated with advanced age, comorbidities, prior abdominal surgery, and, importantly, social factors such as illiteracy, lack of caregiver support, and distance from the hospital. These findings indicate that while ambulatory digestive surgery is feasible and safe in this setting, its broader implementation is strongly influenced by non-medical barriers. Strengthening perioperative education, reinforcing family involvement, and adapting organizational infrastructure are essential to expand ambulatory surgery in similar healthcare contexts.

PMID:41776337 | DOI:10.1038/s41598-026-41608-x