Tag: pubmed

J Orthop Surg Res. 2026 Jun 7. doi: 10.1186/s13018-026-07017-6. Online ahead of print.

ABSTRACT

BACKGROUND: The atlantoaxial lateral mass joint is a pivotal structure facilitating cervical rotation and flexion-extension. Its morphological characteristics are intrinsically linked to degenerative pathologies and segmental instability. However, comprehensive three-dimensional anatomical data, particularly regarding sex-specific variations, remain insufficient. This study aimed to perform precise three-dimensional measurements of the atlantoaxial lateral mass joint in normal adults to elucidate its normative morphological features and sexual dimorphism, which may serve as a morphological reference for future studies exploring surgical planning, personalized implant design, and biomechanical modeling.

METHODS: A retrospective analysis was conducted on 200 patients (100 males, 100 females; aged 18-50 years) without cervical abnormalities, using cervical three-dimensional spiral CT images obtained between December 2024 and December 2025. Parameters measured on reconstructed images included the anteroposterior diameter (sagittal plane), left-right diameter (coronal plane), medial inclination angle, joint space width, and distance from the transverse foramen to the lateral mass joint midpoint. Statistical analysis employed independent samples t-tests to evaluate sex differences.

RESULTS: All parameters exhibited significant sex differences (P < 0.05). Males consistently demonstrated significantly larger anatomical dimensions than females across all linear and angular metrics. Notably, these sex-related differences remained significant after adjusting for Body Mass Index (BMI) via ANCOVA (P < 0.05), indicating that the observed dimorphism reflects intrinsic biological traits rather than overall body habitus.

CONCLUSION: This study systematically quantifies the three-dimensional anatomy of the atlantoaxial lateral mass joint and confirms significant sexual dimorphism.These findings offer morphological context that may be relevant when investigating atlantoaxial pathologies and provide anatomical baseline data for future research concerning personalized fusion device design, surgical navigation, and finite element simulations.

PMID:42252441 | DOI:10.1186/s13018-026-07017-6

BMC Med Educ. 2026 Jun 8. doi: 10.1186/s12909-026-09574-0. Online ahead of print.

ABSTRACT

BACKGROUND: Specific learning disabilities (SpLDs)-including dyslexia, dysgraphia, dyscalculia, and dyspraxia-affect approximately 5-8% of medical students. The demands of medical education may exacerbate these challenges, while stigma and inconsistent institutional support contribute to ongoing barriers. This mixed-methods systematic review synthesised evidence on prevalence, academic performance, challenges, and support needs to inform more inclusive medical education practices.

METHODS: A mixed-methods systematic review was conducted following Joanna Briggs Institute (JBI) methodology and PRISMA 2020 guidelines. PubMed and EBSCOhost were searched in October 2024. Primary studies on undergraduate medical students with formally diagnosed SpLDs were included. Fifteen studies met the inclusion criteria (eight quantitative, seven qualitative). Quantitative data were synthesised using meta-analysis and narrative approaches, qualitative data using meta-aggregation, and findings were integrated using a convergent segregated approach.

RESULTS: The prevalence of SpLDs among medical students ranged from 2% to 11.5% (mean 5.5%). Meta-analysis of three studies showed no statistically significant difference in multiple-choice assessment performance between students with and without SpLDs when accommodations, most commonly additional examination time, were provided (standardised mean difference d = 0.045; 95% CI: -0.094 to 0.183), although evidence was limited and context-dependent. Evidence for other assessment formats was inconsistent, with some indication of lower performance. Qualitative findings identified persistent academic challenges and psychosocial impacts, alongside unmet support needs, including early identification, flexible assessment design, structured mentoring, and increased staff awareness.

CONCLUSIONS: Limited quantitative evidence suggests that medical students with SpLDs may achieve comparable performance in some accommodated MCQ-based assessments, but findings remain context-dependent. Qualitative findings consistently indicate substantial additional effort, emotional burden, and systemic barriers, suggesting that comparable outcomes may not necessarily reflect equitable learning conditions. More inclusive, flexible, and proactive educational approaches are needed to support equity, inclusion, and wellbeing in medical education.

PMID:42252431 | DOI:10.1186/s12909-026-09574-0

BMC Musculoskelet Disord. 2026 Jun 8. doi: 10.1186/s12891-026-10031-8. Online ahead of print.

ABSTRACT

AIMS: Augmented reality-assisted intraoperative navigation (ARIN) has recently emerged as a novel technology intended to improve intraoperative accuracy and workflow in reverse shoulder arthroplasty (RSA). This study evaluated the impact of ARIN on early complications and revisions, glenoid baseplate inclination and fixation, fluoroscopy time, and surgical duration.

METHODS: Two hundred three primary RSAs were retrospectively analyzed: 72 performed with ARIN and 131 freehand. The primary outcome was 90-day complications and revisions. Secondary outcomes were baseplate inclination (RSA angle on true AP radiographs), number and length of peripheral screws, fluoroscopy time, and surgical duration.

RESULTS: No statistically significant differences were observed between the ARIN and freehand groups regarding complications (3% vs. 9.4%, p = .139), revisions (3% vs. 8.5%, p = .216), or dislocations (1.5% vs. 3.4%, p = .655). Baseplate inclination was significantly closer to neutral in the ARIN group (4.6° ± 7° vs. 11.6° ± 8.1°, p < .001), and superior inclination > 10° was significantly less frequent (18.8% vs. 55.6%, p < .001). Significantly fewer screws were used for baseplate fixation (2.1 ± 0.4 vs. 3.2 ± 0.9, p < .001), which were significantly longer (33.7 ± 6.3 mm vs. 25.6 ± 7.8 mm, p < .001). Fluoroscopy time (19.7 ± 15.4 s vs. 45.9 ± 37.1 s, p < .001) and operative duration (104.1 ± 27.3 min vs. 113.4 ± 35.3 min, p = .038) were also significantly shorter with ARIN.

CONCLUSION: ARIN in RSA was associated with improvements in glenoid baseplate inclination, screw placement, intraoperative fluoroscopy time, and surgical duration, while no statistically significant differences in early complication, dislocation, or revision rates were observed compared with the conventional freehand technique. Larger studies with greater statistical power and longer follow-up are warranted to determine potential long-term clinical benefits.

EVIDENCE LEVEL AND STUDY DESIGN: Level of evidence III; retrospective comparative study.

PMID:42252430 | DOI:10.1186/s12891-026-10031-8

BMC Microbiol. 2026 Jun 8. doi: 10.1186/s12866-026-05257-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Vancomycin-resistant enterococci (VRE) constitute a major global public health concern. These organisms can colonize the gastrointestinal (GI) tract for prolonged periods, ranging from months to years, and efforts to eradicate colonization are often only temporarily effective, with recurrence occurring within days or weeks. In immunocompromised individuals, particularly people living with HIV, VRE colonization may progress to clinically significant infection. Therefore, this study aimed to determine the prevalence of VRE colonization and identify associated risk factors among HIV-positive patients attending Mettu Karl Comprehensive Specialized Hospital.

METHODS: A comparative cross-sectional study was conducted from July to September 2023 among 308 participants. Socio-demographic and clinical data were collected using a pretested structured questionnaire and a standardized checklist. Stool samples were collected for the isolation and identification of Enterococci using standard microbiological methods. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion technique. Data were entered into Epi Data version 3.1 and analyzed using SPSS version 26. Bivariable and multivariable logistic regression analyses were employed to assess the association between presumptive VRE colonization and potential risk factors. Variables with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were used to determine the strength of associations, and a p-value of ≤ 0.05 was considered statistically significant.

RESULTS: Enterococci were found in 56.8% (175 out of 308) of participants, with 9.1% (16 of 175) identified as presumptive VRE. Among HIV-positive individuals, the presumptive VRE colonization rate was 11.2% (11 cases), compared to 6.5% (5 cases) in HIV-negative individuals. Overall, 46.9% of the enterococci isolates showed multidrug resistance (MDR).Being hospitalized within the past six months was significantly associated with presumptive VRE colonization: (AOR = 0.148; 95% CI: 0.031-0.707; p = 0.017).

CONCLUSION: Presumptive VRE colonization rates were 11.2% among HIV-positive individuals and 6.5% among HIV-negative individuals; however, this difference was not statistically significant. Recent hospitalization were significant risk factors. Therefore, stronger antibiotic stewardship and infection control practices are recommended for people living with HIV.

PMID:42252413 | DOI:10.1186/s12866-026-05257-4

BMC Cardiovasc Disord. 2026 Jun 8. doi: 10.1186/s12872-026-06073-4. Online ahead of print.

ABSTRACT

BACKGROUND: Early identification of individuals at risk for hypertension is essential for effective cardiovascular disease. Physiological and activity metrics derived from consumer smartwatches may offer a practical, noninvasive approach to identify individuals at increased risk before the clinical onset of hypertension.

METHODS: In this 12-month prospective observational study, 230 normotensive adults aged 30-60 years were followed using consumer smartwatches. Baseline wearable predictors were calculated as the mean of the first 30 days of valid data after enrollment and included heart rate variability, resting heart rate, and time spent in moderate-to-vigorous physical activity. Incident hypertension was defined according to current European guidelines using standardized office blood pressure measurements obtained at follow-up.

RESULTS: During follow-up, 28 participants (12.2%) developed hypertension. Individuals who developed hypertension exhibited lower baseline heart rate variability and spent less time in moderate-to-vigorous physical activity compared with those who remained normotensive. In multivariable logistic regression analysis, lower heart rate variability, lower levels of physical activity, and higher body mass index were independently associated with incident hypertension. An interaction between autonomic variability and physical activity was observed, indicating that individuals with both reduced autonomic regulation and low physical activity had the highest predicted risk. Machine-learning models showed improved statistical discrimination compared with clinical variables alone and were used as complementary exploratory analyses.

CONCLUSIONS: Smartwatch-derived autonomic and physical activity metrics were independently associated with the development of hypertension over a 12-month period. These findings from an observational study suggest a potential role for wearable-derived physiological parameters as digital biomarkers for early hypertension risk stratification, although further validation in larger and externally replicated cohorts is required.

PMID:42252402 | DOI:10.1186/s12872-026-06073-4

Echo Res Pract. 2026 Jun 8;13(1):21. doi: 10.1186/s44156-026-00118-2.

ABSTRACT

BACKGROUND: To improve standardization, the 2025 American Association of Echocardiography (ASE) guidelines revised the definitions of right ventricular (RV) basal and mid diameters, revising the 2010 ASE and European Society of Cardiology (ESC) definitions.

OBJECTIVES: (1) To quantify differences in right ventricular (RV) diameter measurements between the 2010 and 2025 ASE guidelines, (2) to determine its impact on the diagnosis of RV enlargement (RVE), and (3) to compare these findings with a novel automated non-linear centerline-based approach.

METHODS: We analyzed 208 healthy volunteers and 221 patients with pulmonary arterial hypertension (PAH). Using custom cardiac contour analysis (C2A) software, RV diameters were measured across three definitions. The 2010 ASE/ESC defines diameters as the maximal dimension in the basal and mid segments. In contrast, the 2025 ASE defines the basal diameter just below the tricuspid valve and the mid diameter at ~ 50% of RV inflow, both parallel to the annulus. The C2A method uses a non-linear RV centerline as a reference to standardize measurement locations: the mid-point is taken at 50% along the centerline, and the basal diameter is defined as the maximum perpendicular distance within the proximal third of the RV. We quantified nominal and relative definition differences and compared sex-specific RVE prevalence in healthy controls. Diagnostic performance (ROC) and outcome prediction (Cox models) are presented.

RESULTS: The median age was 63 years in healthy volunteers (52% male) and 48 years in patients with PAH (22% male), with a median pulmonary vascular resistance index (PVRI) of 22 Wood units·m². Compared to ASE/ESC 2010 definitions, ASE 2025 diameters were 15% (basal) and 20% (mid) lower. Using the 2025 definition in healthy controls, basal RVE was observed in 1% of females and 22% of males, while mid-RVE was present in 6% of females and 35.8% of males. The 2010 definition showed slightly better discrimination for PAH (AUC 0.937 vs. 0.898, p < 0.001). However, the prediction of outcomes was similar between the two definitions, with C-statistics of 0.59 (0.53-0.65) and 0.59 (0.53-0.66), respectively.

CONCLUSION: Differences in guideline definitions of RV diameters are important to consider when implementing them in clinical practice.

PMID:42252391 | DOI:10.1186/s44156-026-00118-2

Matern Health Neonatol Perinatol. 2026 Jun 8;12(1):22. doi: 10.1186/s40748-026-00272-9.

ABSTRACT

BACKGROUND: Preterm birth remains a critical global health issue, contributing to approximately one-third of neonatal deaths worldwide. In Rwanda, complications of preterm birth contributed to the second cause on neonatal mortality with specifically two district hospitals (i.e. Kiziguro and Ngarama) located in Gatsibo district reported threefold higher preterm neonatal mortality as compared to national average. We aimed to determine the proportion and determinants of preterm neonatal mortality in two rural hospitals in Gatsibo district, Rwanda.

METHODS: We conducted a retrospective cross-sectional study using records of all preterm neonates admitted to Kiziguro and Ngarama hospital neonatal units, between January 2020 and December 2024. Data were extracted from neonatal files and maternity registers. Descriptive statistics were used to describe the study variables. Bivariate and multivariable logistic regression analyses were conducted to identify the determinants of preterm neonatal mortality. We reported odds ratios, 95% CIs, and p values, and we set the significance at the 95% confidence level.

RESULTS: The majority of preterm deaths occurred at Kiziguro district hospital (21.0%, n = 1217). The determinants of preterm neonatal mortality were early gestational age (aOR = 2.47, 95% CI: 1.30-4.65), neonatal sepsis (aOR = 3.35, 95% CI: 1.98-5.69), hypothermia (aOR = 1.72, 95% CI: 1.12-2.66), need for special care unit services (aOR = 5.32, 95% CI: 2.61-11.96), poor respiratory support (aOR = 7.63; 95% CI: 3.69-15.80), poor bilirubin management (aOR = 2.82, 95% CI: 1.50-5.27), and inadequate kangaroo mother care practices (aOR = 51.82, 95% CI: 31.77-84.51).

CONCLUSION: The proportion of preterm mortality was approximately similar to the national figures. Key determinants associated with preterm neonatal mortality included: early gestational age, maternal infections, inadequate kangaroo mother care (KMC), neonatal sepsis and inadequate respiratory support. Thus, continuous neonatal capacity building, improved KMC practices, appropriate use of neonatal equipment and regular cleanliness are recommended.

PMID:42252389 | DOI:10.1186/s40748-026-00272-9

J Behav Health Serv Res. 2026 Jun 7. doi: 10.1007/s11414-026-10004-8. Online ahead of print.

ABSTRACT

Evidence suggests that 10-30% of youth have co-occurring physical and mental or neurodevelopmental disorders (multimorbidity) and that up to 40% of youth with multimorbidity that require mental health services report unmet mental health care needs. This study examined mental health service use (i.e., perceived need or utilization) and access barriers among youth with multimorbidity (n = 3307) in comparison to youth with mental or neurodevelopmental disorders only (n = 2391). Data come from the 2019 Canadian Health Survey on Children and Youth (youth aged 5-17 years). Physical health conditions and mental and neurodevelopmental disorders were measured using a standard checklist. Participants were asked about the reasons for youth mental health services, professional consults, and among those who endorsed need/use of services if they had experienced barriers to access. Overall, 66.1% of youth in the sample perceived a need for or used services related to focusing/controlling behaviors, mental health, or learning difficulties; of these, 39.5% experienced barriers to accessing services. Compared to youth with mental or neurodevelopmental disorders only, those with multimorbidity were more likely to perceive need for services for mental health (AOR = 1.29 [1.10, 1.48]), and to consult psychiatrists (AOR = 1.32 [1.14, 1.62]). There was no significant difference in the overall difficulty in accessing services (AOR = 1.11 [0.92, 1.28]); however, youth with multimorbidity were more likely to experience barriers due to service unavailability (AOR = 1.48 [1.09, 2.13]). Findings underscore the importance for health systems to adopt models of care that integrate physical and mental health services, and for policies that eliminate mental health service barriers for youth with multimorbidity.

PMID:42252379 | DOI:10.1007/s11414-026-10004-8

Obes Surg. 2026 Jun 8. doi: 10.1007/s11695-026-08762-7. Online ahead of print.

ABSTRACT

BACKGROUND: Recurrent weight gain (RWG) after metabolic and bariatric surgery (MBS) is common, but clinically relevant thresholds remain debated. Health-related quality of life (HRQL) may provide a more patient-centered long-term outcome measure.

OBJECTIVE: To evaluate long-term HRQL trajectories according to eventual RWG phenotype, defined as < 30% versus ≥ 30% RWG after MBS.

METHODS: Prospective multicenter cohort study at two Dutch hospitals. HRQL was assessed using six BODY-Q scales and minimal important differences (MIDs) preoperatively, at 4 months and 1-5 years postoperatively. Patients were retrospectively stratified by eventual RWG phenotype. Analyses were performed separately for laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG).

RESULTS: Overall, 337 patients were included (LRYGB: 206 < 30% vs 19 ≥ 30%; LSG: 81 < 30% vs 31 ≥ 30%). Five-year HRQL data were available for 37-55% of patients across procedures and RWG groups. After LRYGB, longitudinal analyses showed no significant time × RWG interactions, although cross-sectional differences in physical function were observed at multiple time points (p = 0.005-0.033). After LSG, a significant time × RWG interaction was observed for physical function (p = 0.043), whereas differences in body image and psychological well-being at year 4 (p = 0.018) were isolated findings. MID achievement was largely similar between groups.

CONCLUSION: Long-term HRQL improvements and MID-based indicators of patient-perceived benefit were sustained after MBS in both eventual RWG groups. Physical function showed a significant time × RWG interaction after LSG, whereas longitudinal HRQL trajectories after LRYGB were comparable between RWG groups. Findings should be interpreted as associations with eventual RWG phenotype, particularly given the small ≥ 30% RWG subgroup after LRYGB (N = 19).

KEY POINTS: • Both patients who eventually developed < 30% and ≥ 30% RWG sustained HRQL improvements over five years; • Associations between RWG and physical function differed between procedures, with cross-sectional differences after LRYGB and longitudinal interaction effects after LSG; • Absolute BODY-Q scores and MIDs provide complementary insights, underscoring the importance of evaluating both statistical and patient-perceived benefits after MBS.

PMID:42252373 | DOI:10.1007/s11695-026-08762-7

CJEM. 2026 Jun 8. doi: 10.1007/s43678-026-01178-3. Online ahead of print.

ABSTRACT

BACKGROUND: Vertebral compression fractures are a common ED presentation in older adults and often lead to significant pain and functional decline. Oligoanalgesia can worsen morbidity. We aimed to describe pain assessment and management practices for older adults presenting to the ED with fragility vertebral compression fractures.

METHODS: We conducted a retrospective health records review of adults ≥ 65 years presenting to two tertiary EDs with acute thoracic or lumbar fragility vertebral compression fractures between August 2017 and August 2022. Patients with polytrauma, pathologic, or age-indeterminate fractures were excluded. Eligible cases were identified by ICD-10-CA codes, and data were abstracted using a standardized form. Primary outcomes were initial pain assessment, pain reassessment, and analgesic administration. Secondary outcomes included use of consultant and allied health services, discharge prescriptions, disposition, and 30-day return ED visits. Descriptive statistics were used.

RESULTS: Of 646 screened patients, 296 met inclusion criteria. Mean age was 81.4 (SD 8.3) years; 69.0% were female. An initial pain assessment was documented in 65.5%, but only 4.1% had a discharge pain score documented. Of those who had an initial pain assessment, 51.7% had pain reassessments during their ED care. 10.1% of patients received no analgesia. Acetaminophen (68.6%), opioids (54.7%), and NSAIDs (25.7%) were most frequently used. Consultants were contacted for 45.3% of patients. Allied health services were consulted for 23.3% of patients. Nearly one-third (30.4%) were admitted, primarily for pain management (62.2%); 19.3% of discharged patients returned within 30 days.

CONCLUSION: Emergency department care of older adults presenting with acute fragility compression fractures is suboptimal. Nearly one in three older adults did not have a pain assessment and one in ten received no analgesia during their ED visit. Identifying and overcoming barriers to quality care is crucial to ensure effective pain management for this population.

PMID:42252368 | DOI:10.1007/s43678-026-01178-3