Tag: pubmed

BMC Oral Health. 2026 May 30. doi: 10.1186/s12903-026-08723-7. Online ahead of print.

ABSTRACT

BACKGROUND: Bisphosphonates are widely prescribed for osteoporosis, Paget’s disease, and malignancy-related bone disease. While effective in reducing skeletal complications, they are associated with medication-related osteonecrosis of the jaw (MRONJ), a serious but preventable condition. Medical practitioners play a central role in initiating therapy, educating patients, and coordinating referrals, yet data on awareness and practices in Malaysia remain limited.

OBJECTIVE: This study assessed the awareness, prescribing practices, and perceived roles of medical practitioners at a university hospital concerning oral health risks associated with bisphosphonate therapy.

METHODS: A cross-sectional survey was conducted among 130 medical practitioners at a university hospital using a validated questionnaire. Participants included medical officers, Clinical Master’s trainees, and specialists in medicine, orthopaedics, and primary care. The questionnaire assessed demographics, awareness of oral complications, prescribing patterns, referral behaviours, and perceived roles. Data were analysed using descriptive statistics and chi-square tests.

RESULTS: Most respondents (96.2%) were aware that bisphosphonates may cause oral complications, and 94.6% identified MRONJ. However, only 58.5% reported awareness of clinical guidelines, and 23.8% felt adequately informed to manage affected patients. Oral bisphosphonates were the most frequently prescribed (77.7%), primarily for osteoporosis (95.4%), while intravenous forms were less common; at osteoporosis dosing, the risk of MRONJ with intravenous zoledronate remains very low compared to oncology regimens. Alternative therapies were considered by 67.7% of practitioners, most often denosumab and teriparatide. Preventive practices were inconsistent: 73.8% educated patients about MRONJ, 49.2% advised pretreatment dental evaluation, and 52.3% referred patients for dental screening. Awareness was significantly associated with prescribing frequency, while referral behaviours varied by department, position, and age.

CONCLUSION: Medical practitioners demonstrated high recognition awareness of MRONJ but notable gaps in guideline literacy, preventive practices, and interprofessional collaboration. These findings highlight the need for structured education, clearer referral protocols, and stronger integration between medical and dental teams to ensure early prevention and optimal patient care.

PMID:42216162 | DOI:10.1186/s12903-026-08723-7

BMC Endocr Disord. 2026 May 29. doi: 10.1186/s12902-026-02329-4. Online ahead of print.

ABSTRACT

BACKGROUND: Diabetic ketoacidosis (DKA) is one of the most serious acute complications of diabetes mellitus in children, often leading to severe dehydration, altered consciousness, and death if not promptly managed. The burden of DKA is increasing globally and in Ethiopia, placing substantial strain on pediatric emergency and inpatient care services. Despite its clinical and public health importance, evidence on time to resolution of DKA and its predictors remains limited in Ethiopia, particularly in the northeastern region. This study aimed to assess the time to resolution of DKA and its predictors in children with type 1 diabetes.

METHODS: A retrospective follow-up study was conducted using 494 medical records of children with type 1 diabetes mellitus treated at Dessie Comprehensive Specialized Hospital between January 1, 2020, and December 31, 2024. Patient charts were selected using a simple random sampling technique. Data were extracted through a structured checklist based on registry and medical chart reviews. Kaplan-Meier survival analysis was employed to estimate time to resolution from DKA, and differences in survival distributions across categories of explanatory variables were assessed using the log-rank test. Cox proportional hazards regression was applied to identify predictors of time to resolution of DKA. Variables with a p-value < 0.25 in the bivariable analysis were included in the multivariable Cox regression model, adjusted hazard ratio (AHR) with its 95% confidence interval and p-value ≤ 0.05 in the multivariable analysis were considered statistically significant.

RESULTS: A total of 487 children were followed for 12,279 person-hours of observation. Of these, 406 children recovered, yielding a resolution proportion of 83.37% (95% CI: 80.06-86.67), while 81 (16.63%) were censored during the follow-up period. The overall incidence rate of resolution from DKA was 3.30 per 100 person-hours (95% CI: 2.99-3.64), with a median time to resolution of 22 h (95% CI: 18.32-25.67). In the multivariable Cox regression analysis, baseline random blood sugar (RBS) levels > 500 mg/dL (AHR = 0.77; 95% CI: 0.62-0.96), presence of infection (AHR = 0.65; 95% CI: 0.47-0.90), newly diagnosed diabetes mellitus (AHR = 0.79; 95% CI: 0.63-0.99 and DKA duration ≥ 24 h (AHR = 0.08; inverse of < 24 h) were associated with a longer time to resolution of DKA. Conversely, mild DKA (AHR = 1.37; 95% CI: 1.01-1.84) and DKA duration < 24 h (AHR = 11.96; 95% CI: 7.71-18.55) were significantly associated with a shorter time to resolution of DKA.

CONCLUSION AND RECOMMENDATIONS: The study identified a relatively prolonged resolution time of DKA among children in the study area. Baseline random blood sugar level > 500 mg/dL, presence of infection and newly diagnosed diabetes had negative relationship (delayed resolution) while mild DKA severity, and duration of DKA < 24 h had positive relationship (faster resolution). These findings highlight the need for healthcare providers and caregivers to address these factors to accelerate resolution and improve clinical outcomes.

TRIAL REGISTRATION: Clinical trial number: Not applicable.

PMID:42216154 | DOI:10.1186/s12902-026-02329-4

BMC Anesthesiol. 2026 May 30. doi: 10.1186/s12871-026-03954-1. Online ahead of print.

ABSTRACT

BACKGROUND: Inadequate postoperative pain management predisposes patients to delayed recovery, impairs mother-infant interaction, prolongs hospital stay, and increases the risk of chronic pain development. In resource-limited settings, postoperative pain management remains challenging because of inadequate administration of analgesics and a high patient-to-nurse ratio, which limits adequate pain assessment and timely management.

OBJECTIVE: To assess the incidence and predictors of moderate to severe postoperative pain after cesarean delivery among parturients receiving spinal anesthesia at two Southern Governmental teaching Hospitals between March1 and May 30, 2023.

METHODS: A multicenter prospective cohort study involving 205 parturients was conducted after ethical approval was obtained from the institutional review board. Participants were selected using a systematic sampling technique. Postoperative pain severity was assessed using the Numeric Rating Scale within the first 24 h after surgery. Binary logistic regression was used to identify independent risk factors for postoperative pain. A p value of 0.05 was considered the cutoff point to test for statistical significance in multivariate logistic regression analysis.

RESULTS: In our study, the incidence of moderate to severe postoperative pain after cesarean delivery was 71.2% within the first 24 h. On the basis of the multivariable analysis, preoperative anxiety (AOR: 2.849, 95% CI: 1.276, 6.359), previous cesarean delivery (AOR: 3.571, 95% CI: 1.536, 8.300) and transverse incision (AOR: 6.965, 95% CI: 2.469, 19.652) were significantly associated with moderate to severe postoperative pain after cesarean delivery. Abdominal field blocks were associated with a reduced likelihood of postoperative pain (AOR = 0.035, 95% CI: 0.009-0.139).

CONCLUSION: A high proportion of parturients experienced moderate to severe postoperative pain after cesarean delivery. Preoperative anxiety, previous cesarean delivery, and transverse incision were significant predictors of postoperative pain, whereas abdominal field blocks had a protective effect. Routine postoperative pain assessment and the implementation of multimodal analgesic strategies, including regional analgesic techniques, are recommended to improve post-cesarean pain management.

PMID:42216146 | DOI:10.1186/s12871-026-03954-1

BMC Nephrol. 2026 May 29. doi: 10.1186/s12882-026-05092-9. Online ahead of print.

ABSTRACT

BACKGROUND: Whether IgA nephropathy (IgAN) in patients with systemic lupus erythematosus (SLE) represents a coincidental comorbidity or a distinct clinico-pathological entity remains unclear. This study aimed to characterise the demographic, clinical, pathological, and prognostic features of this rare association.

METHODS: We conducted a systematic review of the PubMed and Embase databases to 31 May 2025 were conducted to identify all reported cases of biopsy-proven IgAN in patients with SLE, excluding cases with concomitant thrombotic microangiopathy, negative Gd-IgA1 immunostaining, prior IgA vasculitis, or ANA-negative disease. Study quality was assessed using the JBI checklist. Individual patient data were pooled; descriptive statistics summarized clinical features, and group comparisons were performed using Mann-Whitney U and Fisher’s exact tests. Individual patient data were extracted and analyzed as a single cohort. Renal outcomes were defined as either a ≥ 40% decline in estimated glomerular filtration rate (eGFR) from baseline or progression to end-stage renal disease.

RESULTS: Thirty-one patients (25.8% male; mean age 40.8 ± 15.8 years; 67.7% Asian) were included. Median proteinuria was 1.10 g/24 h, and 12.9% presented with nephrotic syndrome. Microscopic haematuria was observed in 93.5% of patients. Mean eGFR at biopsy was 84.0 ± 53.4 mL/min/1.73 m², with 12.9% exhibiting acute kidney injury (AKI). All patients were antinuclear antibody-positive, 64.5% were anti-dsDNA-positive, and 55.2% had hypocomplementaemia. Renal biopsy revealed dominant mesangial IgA and complement C3 deposition, with electron-dense deposits confined to the mesangium in all but one case. Immunosuppression (glucocorticoids 87.1%; cyclophosphamide 22.6%) yielded complete remission in 54.8% of patients. Over a median follow-up of 16.5 months, 27.8% of patients reached the renal endpoint, including three of four patients with AKI.

CONCLUSIONS: Limited by retrospective case report methodology, this largest cohort to date suggests IgAN complicating SLE manifests a distinctive phenotype that bridges features of primary IgAN and lupus nephritis. Although immunosuppression is effective, long-term renal risk remains non-negligible. Early recognition and targeted therapy may improve outcomes.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42216130 | DOI:10.1186/s12882-026-05092-9

BMC Nephrol. 2026 May 29. doi: 10.1186/s12882-026-05040-7. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiorenal metabolic (CRM) disease, is identified by the co-location of multiple disorders including obesity, diabetes, hypertension, cardiovascular disease and chronic kidney disease (CKD). Early intervention is essential to slow CKD progression, reduce cardiovascular risk, and improve quality of life. The Harrow CRM Hub project established a personalised, multidisciplinary pathway to identify high-risk patients, optimise clinical management, and provide access to lifestyle and psychosocial support. This paper reports on the clinical outcomes achieved within the first year of implementation.

METHODS: A comprehensive logic model was co-developed to guide the design, delivery, and evaluation of the Harrow CRM programme. Two EHR-identified cohorts were invited: (1) adults aged 20-80 years with BMI >27.5-30 kg/m² (ethnicity-dependent) and non-diabetic hyperglycaemia ± hypertension (CRM Stage 2); and (2) adults with diabetes ± CKD or CVD (CRM Stage 4). Pre visit health questionnaire – using digital tools enabled detailed pre visit updates and tests. Protected consultations (lasting 30 to 45 minutes) followed a structured EHR template incorporating guideline-based optimisation of pharmacotherapy, risk calculators, and co-created lifestyle care plans. Data were extracted for paired analysis of systolic BP, HbA1c, and weight. A qualitative evaluation was undertaken to explore patient and staff experiences of the CRM pathway.

RESULTS: Thus far, between November 2024 and September 2025, 2,641 patients were reviewed, with 2,300 included in paired analysis. Across the full cohort, mean changes were -3.65 mmHg in systolic BP (median -2.0 mmHg), -1.03 mmol/mol in HbA1c (median 0.0 mmol/mol), and -0.46 kg in weight (median 0.0 kg) (all p<0.001). For those with an improvement only – an average improvement of -14.12 mmHg (n=1,279) and an average deterioration of +10.61 mmHg among those whose readings worsened (n=895). HbA1c values showed a mean cohort wide reduction of -1.03 mmol/mol (median 0.0 mmol/mol), with mean changes of -8.08 mmol/mol among improvers (n=785) and +5.22 mmol/mol among those with deterioration (n=762). Weight trends showed a mean overall reduction of -0.46 kg (median 0.0 kg), comprising an average improvement of -3.63 kg among improvers (n=1,124) and deterioration of +3.93 kg among those with deterioration (n=761). Among those with paired readings, 33.4% achieved ≥5% BP reduction and 19.7% achieved ≥10%; 19.8% achieved ≥5% HbA1c improvement and 12.7% ≥10%; and 9.6% achieved ≥5% weight loss and 2.7% ≥10%. Overall, 73.9% improved in ≥1 parameter, while 10.4% improved across BP, HbA1c, and weight simultaneously. This real world review identified patients with improvements and deterioration in their health parameters. Qualitative findings showed patients valued extended consultations and holistic discussions, with vast majority of patients reporting greater understanding of their health and feeling more confident to manage it. A staff survey (n=14) provided supportive but preliminary quantitative evidence of having greater confidence in delivering CRM clinics and increased ability to access multidisciplinary expertise.

CONCLUSION: A personalised, multidisciplinary CRM model embedded within primary care was associated with statistically and clinically significant improvements in blood pressure, glycaemic control, and weight in a large, ethnically diverse population. Patients and clinicians both reported greater engagement, confidence, and satisfaction. The approach combining structured identification, extended consultations, co-produced care plans, and workforce education demonstrates a scalable, sustainable pathway to slow CKD progression, reduce CVD risk, and enhance patient wellbeing across diverse communities.

PMID:42216129 | DOI:10.1186/s12882-026-05040-7

BMC Psychiatry. 2026 May 29. doi: 10.1186/s12888-026-08241-4. Online ahead of print.

ABSTRACT

BACKGROUND: Syrian refugees across diverse host countries, including high-income European countries, face increased mental health needs. Digital interventions can scale support, but global scalability limits human guidance and contextual adaptations. We evaluated the effectiveness of a potentially scalable digital intervention (Step-by-Step; SbS) with minimal contact-on-demand (COD) in reducing psychological distress and functional impairment among Syrian refugees in Germany and Sweden. These trials were conducted in parallel with SbS studies in Egypt and Lebanon, using the same content to test broader contextual applicability without further adaptations.

METHODS: Separate two-arm pragmatic RCTs were conducted in Germany (N = 559) and Sweden (N = 184) with Syrians screening positive for elevated distress (K10 > 15) and impaired functioning (WHODAS 2.0 > 16). Participants were randomized to SbS (five sessions) + care-as-usual (CAU) or CAU-only. Primary outcomes were psychological distress (HSCL-25) and functioning (WHODAS 2.0) at 3-month follow-up. Secondary outcomes were PTSD symptoms (PCL-5 short) and self-defined problems (PSYCHLOPS). Intention-to-treat (ITT) analyses were run separately by trial. Exploratory per-protocol analyses combined datasets.

RESULTS: ITT analyses showed no statistically significant time × condition effects for any primary or secondary outcome in both trials. Dropout was high (Germany: 86.3%; Sweden: 82.1%). In per-protocol analyses (participants completing ≥ 4 of 5 sessions), the SbS + CAU arm showed significantly lower standardized mean scores at 3 months for psychological distress (HSCL-25; Hedges’ g = 0.31; p = .03) and PTSD symptoms (PCL-5 short; Hedges’ g = 0.27; p < .05). COD use was low (Germany: 15.1%; Sweden: 8.4%), leaving the intervention effectively unguided for most participants.

CONCLUSIONS: While limiting guidance and contextual tailoring can enhance scalability across borders, digital interventions may struggle with engagement, adherence, and contextual relevance. In high-income settings, an unguided approach for refugees may not work, showing that prioritizing scalability could potentially compromise clinical impact in this population. Some level of human guidance may be necessary to balance scalability and effectiveness, and it remains unclear how minimal that guidance can be without compromising outcomes.

TRIAL REGISTRATION: German Register for Clinical Studies (Germany: DRKS00022143-registered June 29th, 2020, and Sweden: DRKS00022144-registered July 1st, 2020).

PMID:42216127 | DOI:10.1186/s12888-026-08241-4

J Neurosurg Spine. 2026 May 29:1-6. doi: 10.3171/2025.8.SPINE25389. Online ahead of print.

ABSTRACT

OBJECTIVE: With the advent of artificial intelligence (AI), scientific research and writing has benefitted from large language models to generate hypotheses, evaluate data, and draft manuscripts. However, this brings into question the prevalence, impact, and ethics of AI writing assistance on published literature. The purpose of this study was to quantify the extent of AI involvement in published spine articles and establish a statistical threshold for scientific integrity.

METHODS: Spine-focused clinical journals were selected for their impact factor and comprehensive representation of the specialty. All full-length research articles published in 2005 and 2023-2024 in these journals were extracted. ZeroGPT was used to assess AI content in each article. Baseline AI utilization was evaluated on the 2005 data, with 2 standard deviations above the mean serving as the threshold for significant AI usage. Based on pre-AI era articles, a threshold ZeroGPT score of 48.8% was established. Articles exceeding this threshold in the 2023-2024 data were assessed across spine journals and years of publication.

RESULTS: In total, 2790 post-AI articles published across 6 spine journals in 2023-2024 were examined. Among these spine journal articles, 25.7% were considered to have significant AI involvement. AI involvement varied significantly across spine journals, ranging from 20.2% for Spine (Phila Pa 1976) to 31.1% for Journal of Neurosurgery: Spine (p < 0.01). Likewise, AI involvement varied significantly across the years, with peak utilization at 32.0% at the start of 2023 and plateau in utilization at 20.7% by the second quarter of 2024 (p < 0.01).

CONCLUSIONS: AI involvement in drafting manuscripts was observed in 25% of articles in recent spine literature. Although the use of AI has plateaued since mid-2024, likely due to the implementation of clear ethical guidelines and utilization of improved detection tools, continued efforts should be made with the evolving AI landscape to the ensure quality, authenticity, and integrity of spine research.

PMID:42214108 | DOI:10.3171/2025.8.SPINE25389

J Neurosurg Pediatr. 2026 May 29:1-7. doi: 10.3171/2026.1.PEDS25230. Online ahead of print.

ABSTRACT

OBJECTIVE: In shunted pediatric hydrocephalus patients, the potential for shunt failure is a frequent cause of emergency department (ED) presentation. The assessment of papilledema through ophthalmological fundoscopic examination (OFE) is an often-utilized adjunct evaluation in clinical workup to rule out shunt failure in patients. However, its utility in this setting has not been established in the literature. The objective of the present study was to investigate the association of papilledema with eventual shunt revision in ED encounters to rule out shunt failure.

METHODS: The authors conducted a retrospective, single-institution, cohort study of ED encounters with concern for shunt failure prompting neurosurgical evaluation in patients who underwent OFE from January 1, 2014, to December 31, 2021. Chart encounters were reviewed for baseline demographic characteristics, clinical characteristics, presence of papilledema, and interventions. The primary endpoint was need for shunt revision and intraoperative evidence of shunt failure.

RESULTS: A total of 594 ED encounters with concern for shunt failure were identified, and 98 encounters were included. Overall, 6 cases of papilledema were identified (6.1%), of whom only 3 were new or worsened (3.1%) compared to prior examinations. Twenty-six (26.5%) encounters resulted in shunt revision, while 72 (73.4%) encounters resulted in no revision. There was no statistically significant difference in baseline patient demographic characteristics, etiology of hydrocephalus, or clinical symptoms between encounters resulting in shunt revision or no revision. No significant difference was identified in the comparison of patients who underwent shunt revision versus those without revision with regard to the presence of papilledema (3 [12%] patients with papilledema vs 3 [4%] without, p = 0.19), performance of shunt tap (6 [23%] vs 9 [12.5%], p = 0.21), or prior shunt revisions (3.2 ± 3.9 vs 2.9 ± 3.3, p = 0.77).

CONCLUSIONS: Among pediatric ED encounters with concern for shunt failure, ophthalmological consultation for fundoscopic examination and the presence of papilledema did not demonstrate a significant association with shunt revision. Additional prospective studies are warranted to assess the clinical utility of using OFE as part of the armamentarium of triage in acute shunt failure evaluation.

PMID:42214105 | DOI:10.3171/2026.1.PEDS25230

J Neurosurg. 2026 May 29:1-11. doi: 10.3171/2025.12.JNS251651. Online ahead of print.

ABSTRACT

OBJECTIVE: The rates of thromboembolic events are highest within the first few days of intracranial stent placement and before complete endothelialization has occurred. Accelerating the rate of neointima formation may be a strategy to reduce thromboembolic events. This study was performed to evaluate the efficacy of vascular endothelial growth factor (VEGF) embedded in a poly(lactic-co-glycolic acid) (PLGA) coating in conjunction with mesenchymal stem cells (MSCs) to improve neointima formation after stent placement.

METHODS: Endovascular stents were coated with VEGF/PLGA or PLGA alone (control 1) or left uncoated (control 2), and protein quantification was performed both before and after a mock endovascular deployment process. A total of 23 New Zealand White rabbits then underwent endovascular implantation of stents coated with VEGF/PLGA, followed by an intra-arterial microcatheter injection of MSCs; stents coated with VEGF/PLGA without MSC injection (vehicle alone); stents coated with PLGA alone without MSC injection (vehicle alone); or uncoated stents without MSC injection (vehicle alone). After stent deployment on day 0 and prior to euthanasia on day 3, animals underwent optical coherence tomography (OCT), so that the degree of neointima formation over the stent struts as well as thrombus formation could be evaluated. Scanning electron microscopy (SEM) was also performed after euthanasia. OCT and SEM images were both scored by observers blinded to treatment group.

RESULTS: Stents coated with VEGF/PLGA contained a significantly larger amount of protein than the stents coated with PLGA alone or uncoated stents, and there was no significant loss of protein after the mock delivery process. In vivo, VEGF/PLGA-coated stents with MSC injection demonstrated superior measurements of the neointimal area, neointimal ratio, stent-strut neointimal coverage ratio, and maximum neointimal thickness on OCT compared to those for the uncoated stent at 3 days. VEGF/PLGA-coated stents with MSCs also showed significantly improved scores on SEM and a large, though not statistically significant, reduction in the variability of thrombus formation compared to that with uncoated stents at 3 days (p = 0.06).

CONCLUSIONS: This short-term study demonstrates that coating stents with VEGF embedded in PLGA, along with an intra-arterial injection of MSCs, improves neointimal coverage and may reduce thrombus formation. Follow-up studies are required to assess the long-term consequences of VEGF and MSC administration, as well as to elucidate the potential mechanism of their effect.

PMID:42214099 | DOI:10.3171/2025.12.JNS251651

J Neurosurg. 2026 May 29:1-12. doi: 10.3171/2025.11.JNS251462. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the respiratory consequences of phrenic nerve transfer (PNT) by analyzing clinical and paraclinical data across published studies.

METHODS: The authors conducted a systematic review and meta-analysis of studies reporting respiratory outcomes after PNT. Only cases with documented postoperative follow-up and perioperative respiratory outcome were included. Data on patient demographics, diaphragm imaging, and pulmonary function test (PFT) values were extracted. Paired analyses were conducted in cases in which pre- and postoperative PFT data were available.

RESULTS: Among 617 patients with postoperative follow-up, 4.9% reported respiratory symptoms, and 67.4% of those assessed showed unilateral diaphragm paralysis. A meta-analysis of paired PFT data demonstrated a significant reduction in forced expiratory volume in 1 second and a nonsignificant reduction in forced vital capacity postoperatively. Fifteen (2.4%) of 617 patients reported mild but persistent respiratory symptoms.

CONCLUSIONS: Although PNT is effective for motor restoration, postoperative respiratory impairment, although typically mild, was observed in a subset of patients with follow-up data. These findings emphasize the need for long-term monitoring and careful patient selection in PNT, particularly in individuals with reduced pulmonary reserve.

PMID:42214098 | DOI:10.3171/2025.11.JNS251462