Nevin Manimala

Infect Dis Poverty. 2026 Feb 15;15(1):24. doi: 10.1186/s40249-026-01423-y.

ABSTRACT

BACKGROUND: Treating drug-resistant tuberculosis (DR-TB) is clinically complex and economically burdensome compared to drug-susceptible tuberculosis (DS-TB). China’s diagnosis-intervention packet payment system initially omitted risk adjustment for drug resistance. In 2022, a diagnosis-intervention packet (DIP)-pilot city implemented such adjustment, establishing distinct reimbursement standards for DR-TB and DS-TB. This study aimed to assess the impact of this DR-type risk adjustment on medical expenditures, treatment efficiency, and care quality for TB patients.

METHODS: A quasi-experimental difference-in-differences design was employed, involving 8465 TB patients from June 2021 to December 2023. Linear regression was performed with time and treat fixed effects and the interaction term between time and treat. Subgroup analyses for DR-TB and DS-TB patients were conducted.

RESULTS: Under the DIP system, risk adjustment led to marginally significant reductions in inpatient expenditure per hospitalization [β = – 151.14, P = 0.065; 95% confidence interval (CI) for difference in proportions: – 311.66, 9.38] and in annual total inpatient expenditure per patient (β = – 200.58, P = 0.078, 95% CI – 423.26, 22.10) for all TB patients. It also resulted in significant reductions in inpatient out-of-pocket per hospitalization (β = – 257.51, P < 0.001, 95% CI – 316.20, – 198.81), annual total inpatient out-of-pocket per patient (β = – 266.78, P < 0.001, 95% CI – 342.02, – 191.53), inpatient length of stay per hospitalization (β = – 3.58, P < 0.001, 95% CI – 4.53, – 2.62), and annual total length of stay per patient (β = – 3.21, P < 0.001, 95% CI – 4.50, – 1.92). For DR-TB patients, all outcome measures in expenditures, efficiency, or care quality showed P > 0.1, indicating no significant changes. For DS-TB patients, measures of expenditures and efficiency showed P < 0.1, supporting significant or marginally significant reductions.

CONCLUSIONS: The DR-type risk adjustment policy under China’s diagnosis-intervention packet system proved effective in optimizing resource use and enhancing efficiency, particularly for DS-TB patients, while preserving care quality for DR-TB patients. These findings demonstrate the value of tailored risk adjustment within payment frameworks for heterogeneous diseases like tuberculosis, providing crucial evidence for optimizing TB care and implementing effective payment reforms in China and similar settings.

PMID:41691353 | DOI:10.1186/s40249-026-01423-y

Genome Biol. 2026 Feb 14. doi: 10.1186/s13059-026-04003-3. Online ahead of print.

ABSTRACT

BACKGROUND: Epigenetic modifications play a vital role in the pathogenesis of human diseases, particularly neurodegenerative disorders such as Alzheimer’s disease, where dysregulated histone modifications are strongly implicated in disease mechanisms. While recent advances underscore the importance of accurately identifying these modifications to elucidate their contribution to Alzheimer’s disease pathology, existing computational methods remain limited by their generic approaches that overlook disease-specific epigenetic signatures.

RESULTS: To bridge this gap, we develop a novel large language model-based deep learning framework tailored for disease-contextual prediction of histone modifications and variant effects. Focusing on Alzheimer’s disease as a case study, we integrate epigenomic data from multiple patient samples to construct a comprehensive, disease-specific histone modification dataset, enabling our model to learn Alzheimer’s disease -associated molecular signatures. A key innovation of our approach is the incorporation of a Mixture of Experts architecture, which effectively distinguishes between disease and healthy epigenetic states, allowing for precise identification of Alzheimer’s disease -relevant epigenetic modification patterns. Our model demonstrates robust performance in disease-specific histone modification prediction, significantly outperforming existing state-of-the-art methods that lack disease context. Beyond accurate modification site prediction, our framework provides important biological insights by successfully prioritizing Alzheimer’s disease-associated genetic variants, which show significant enrichment in disease-relevant pathways.

CONCLUSIONS: Our framework establishes a powerful new paradigm for epigenetic research that can be extended to other complex diseases, offering both a valuable tool for variant effect interpretation and a promising strategy for uncovering novel disease mechanisms through epigenetic profiling.

PMID:41691336 | DOI:10.1186/s13059-026-04003-3

Eur J Med Res. 2026 Feb 14. doi: 10.1186/s40001-026-04053-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Idiopathic Granulomatous Mastitis (IGM) is a chronic inflammatory disease that affects women of childbearing age and is prone to recurrence. The M-score can be used to measure the severity of symptoms and assess the response to treatment in IGM patients. The aim of this study is to investigate the effect of the initial M-score on the recurrence of the disease in IGM patients.

MATERIAL AND METHODS: A total of 90 patients who were clinically and histopathologically diagnosed with IGM were included in the present study. The patient data were analyzed retrospectively. The M-score, which provides more objective data, was used to evaluate the severity of symptoms. Disease recurrence rates were compared with the initial M-score.

RESULTS: The recurrence rate in patients with abscesses was higher (93.18%) than in patients without abscesses (60.87%) (p < 0.001). No statistically significant differences were found when analysing the recurrence rates in patients who underwent surgery (p = 0.518). When analysing recurrence rates according to initial M-score values, patients with an initial M-score of ≥ 5 had a significantly higher recurrence rate (98.4%) than patients with an initial M-score < 5 (24%) (p < 0.001).

CONCLUSION: The treatment of IGM patients depends on the patient’s symptoms. For this reason, a scoring system is needed to define the symptoms and interpret the response to treatment more objectively. The M-score is at a level that can meet this need. In the present study, the recurrence rate was found to be higher in patients with an initial M-score ≥ 5 than in patients with an M-score < 5, which leads us to the idea of initiating more aggressive treatment than observation or mono-treatment in patients with high M-scores at the time of presentation.

PMID:41691333 | DOI:10.1186/s40001-026-04053-0

Child Adolesc Psychiatry Ment Health. 2026 Feb 14. doi: 10.1186/s13034-026-01042-3. Online ahead of print.

ABSTRACT

BACKGROUND: Depression and anxiety symptoms in adolescents and young adults represent a significant global public health challenge. Digital health interventions (DHIs) offer potential solutions to supplement traditional mental health services, though the relative efficacy of different types of interventions remains unclear.

OBJECTIVE: This study aims to systematically compare the treatment effects of digital health interventions driven by different mechanisms on depression and anxiety symptoms in this population through a Bayesian network meta-analysis.

METHODS: A systematic search was conducted in major databases such as PubMed, Embase, and PsycINFO (up to September 2025), including randomized controlled trials (RCTs) targeting depression or anxiety symptoms in individuals aged 12-25 years. Interventions were categorized based on treatment mechanisms into four types: cognitive behavioral therapy-based digital interventions (CBT-DI), third-wave digital therapies (TWDT), general digital mental health support (GDMHS), and technology-enhanced innovative interventions (TEII). The primary outcome measure was the standardized mean difference (SMD), with the cumulative ranking probability assessed using the surface under the cumulative ranking curve (SUCRA).

RESULTS: A total of 18 RCTs involving 5, 821 participants were included. Network meta-analysis indicated that CBT-DI achieved the highest surface under the cumulative ranking curve (SUCRA) values for both depression (79.3%) and anxiety (83.4%). In pairwise comparisons with no intervention controls, CBT-DI demonstrated a statistically significant improvement in anxiety symptoms (SMD = 0.33, 95% CrI: 0.05 to 0.69). However, for depression, the improvement associated with CBT-DI did not reach statistical significance (SMD = 0.44, 95% CrI: -0.02 to 0.91), suggesting that the high ranking probability reflects a potential trend rather than confirmatory evidence of superiority. TWDT and GDMHS demonstrated moderate efficacy for both symptoms, ranking above usual care and no intervention controls. The evidence quality assessment (GRADE) indicated that the primary outcomes were of low to moderate quality.

CONCLUSION: Digital health interventions, particularly CBT-based interventions (CBT-DI), were associated with statistically significant improvements in anxiety symptoms. For depression, while CBT-DI ranked highest in probability, it did not demonstrate statistical superiority over controls. Given the imprecision in effect estimates, CBT-DI may be considered a potential complementary measure within a stepped-care mental health system. Results should be interpreted with caution due to wide credible intervals, and further high-quality studies are required to confirm these findings.

PMID:41691290 | DOI:10.1186/s13034-026-01042-3

J Orthop Surg Res. 2026 Feb 14. doi: 10.1186/s13018-026-06717-3. Online ahead of print.

ABSTRACT

BACKGROUND: The present study aimed to investigate the effects of the glycogen synthase kinase-3 (GSK-3) inhibitor tideglusib on bone-tendon interface healing in a rabbit model of rotator cuff injury, based on biomechanical and histological assessments.

METHODS: Fourteen New Zealand rabbits underwent supraspinatus tendon detachment to establish a chronic rotator cuff tear model. After six weeks, surgical repair was performed. In the right shoulders, tideglusib was administered at the bone-tendon junction prior to performing the primary repair (drug group), whereas the left shoulders underwent primary repair without biological augmentation (control group). Seven animals were included in the group subjected to biomechanical tension testing, and six for histological evaluation.

RESULTS: Biomechanical evaluation demonstrated that the tideglusib group showed significantly higher load-to-failure values compared with the control group the control group (p < 0.05), whereas elongation at failure showed no statistically significant difference. Histological scoring demonstrated significantly improved cellular organization and tissue healing in the tideglusib group (p < 0.05).

CONCLUSION: Local application of tideglusib positively enhances tendon-bone healing both biomechanically and histologically. Further studies are warranted to explore its potential clinical applications.

PMID:41691285 | DOI:10.1186/s13018-026-06717-3

Eur J Med Res. 2026 Feb 14. doi: 10.1186/s40001-026-04037-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Cardiovascular-Kidney-Metabolic (CKM) syndrome reflects the convergence of cardiovascular, renal, and metabolic disorders. Metabolic dysfunction-associated steatotic liver disease (MASLD), as the hepatic phenotype of metabolic impairment, provides a critical link within this continuum. However, the association between CKM syndrome staging, MASLD prevalence, and liver fibrosis severity remains unclear.

METHODS: This study included 3084 individuals with CKM stages 1-4 from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). Hepatic steatosis and fibrosis were assessed through vibration-controlled transient elastography, providing both controlled attenuation and stiffness indices. To explore the links between CKM staging, MASLD prevalence, and fibrosis severity, weighted multivariable logistic regression was performed. Furthermore, predictive machine learning models were constructed, and SHapley Additive exPlanations (SHAP) were applied to clarify the relative impact of CKM components on MASLD prevalence.

RESULTS: Advancing CKM stages were associated with higher prevalence of MASLD, advanced fibrosis, and cirrhosis, whereas no significant association was observed with significant fibrosis. Among machine learning models, the random forest model showed the best predictive performance (AUC = 0.809). SHAP analysis identified waist circumference, HbA1c, metabolic syndrome, triglycerides, diabetes, HDL-C, and age as key predictors.

CONCLUSION: CKM stage was significantly associated with MASLD prevalence, advanced liver fibrosis, and cirrhosis. Machine learning interpretation highlighted adiposity, glycemic control, and lipid metabolism as the principal contributors, suggesting that these CKM-related metabolic domains may contribute to MASLD and fibrotic burden.

PMID:41691268 | DOI:10.1186/s40001-026-04037-0

BMC Oral Health. 2026 Feb 14. doi: 10.1186/s12903-026-07871-0. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the feasibility and effectiveness of mixed reality combined with surgical navigation for resection of oral and maxillofacial tumors.

METHODS: Patients with maxillary or mandibular tumors in the oral and maxillofacial region who underwent surgical treatment at Peking University School and Hospital of Stomatology between January 2020 and June 2023 were enrolled in this study. During the preoperative phase, patients in the mixed reality-surgical navigation group (MRSN group) underwent additional image data processing using mixed reality-surgical navigation technology, which enabled intraoperative tumor localization and resection under navigation guidance. The control group underwent conventional virtual surgical planning (VSP) incorporating computer-aided design (CAD) and computer-aided manufacturing (CAM). Tumor resection in the control group was also performed under surgical navigation guidance. Baseline patient characteristics were recorded for both groups. Using a normal vector-based selection method, osteotomy planes were extracted from the preoperative virtual surgical plan and from postoperative computed tomography reconstruction models using digital software for chromatographic analysis. Deviations between planned and actual osteotomy planes were compared between the two groups. All analyses were performed using SPSS 26.0 software (IBM Corp, Armonk, NY, USA), with statistical significance set at P < 0.05.

RESULTS: A total of 38 patients were included, with 19 patients in each group. The mean osteotomy deviation was significantly smaller in the MRSN group than in the control group (1.84 mm vs. 3.07 mm, P < 0.001). Chromatographic analysis showed that 74.84% of osteotomy points in the MRSN group deviated by less than 3 mm, compared with 64.81% in the control group. Subgroup analyses by tumor location (maxillary vs. mandibular) and pathology (benign vs. malignant) demonstrated consistently smaller deviations in the MRSN group. No significant differences in osteotomy accuracy were observed between maxillary and mandibular tumors or between benign and malignant tumors within either group (P > 0.05). During a mean follow-up of 27 months in the MRSN group, five patients experienced complications, including facial paralysis, skin numbness, and titanium mesh exposure; no tumor recurrence or distant metastasis was observed. In the control group, with a mean follow-up of 18.8 months, two patients developed complications (infection and titanium mesh exposure), and three patients experienced tumor recurrence.

CONCLUSION: The clinical application of mixed reality combined with surgical navigation is feasible for the resection of oral and maxillofacial tumors. Compared with conventional navigation systems, this approach allows more precise localization of osteotomy planes and improves the accuracy of tumor resection.

PMID:41691248 | DOI:10.1186/s12903-026-07871-0

BMC Psychiatry. 2026 Feb 14. doi: 10.1186/s12888-026-07884-7. Online ahead of print.

ABSTRACT

BACKGROUND: Suicide represents a major public health challenge globally, with depression, anxiety, and stress constituting well-established risk factors. Spiritual health has emerged as a potentially protective factor against psychological distress, yet its relationship with mental health outcomes in suicide attempters remains inadequately characterized, particularly in Middle Eastern populations where spiritual and religious frameworks play central roles in cultural identity.

OBJECTIVE: This study aimed to investigate the relationship between spiritual health and depression, anxiety, and stress among individuals who attempted suicide in Yasuj, Southwest Iran.

METHODS: This cross-sectional study was conducted on 136 individuals who attempted suicide and were admitted to Imam Sajjad Hospital in Yasuj, Iran, during 2023-2024. Participants were selected using convenience sampling. Data were collected through face-to-face interviews using a demographic questionnaire, the Depression Anxiety Stress Scale-21 (DASS-21), and the Paloutzian and Ellison Spiritual Health Questionnaire. Data analysis was performed using SPSS version 26, employing descriptive statistics and Spearman correlation coefficients to examine relationships between spiritual health and psychological distress variables across urban and rural subgroups.

RESULTS: The sample consisted predominantly of young adults aged 16-30 years (70.6%), females (55.9%), single individuals (64.0%), and urban residents (76.5%). Drug ingestion was the most common suicide method (94.9%), and 34.5% reported prior suicide attempts. Severe to extremely severe depression was present in 80.9% of participants, with 81.6% experiencing severe to extremely severe stress, and 38.9% reporting severe to extremely severe anxiety. Spiritual health demonstrated significant negative correlations with depression (urban: r = -0.591, p < 0.01; rural: r = -0.544, p = 0.001) and stress (urban: r = -0.602, p < 0.01; rural: r = -0.499, p = 0.004). However, correlations between spiritual health and anxiety were weak and non-significant in both urban (r = -0.186, p = 0.059) and rural areas (r = -0.100, p = 0.585). Strong positive intercorrelations were observed among depression, anxiety, and stress (r = 0.430-0.663, all p < 0.01).

CONCLUSION: Spiritual health is significantly and inversely associated with depression and stress, but not with anxiety, among suicide attempters in Southwest Iran. These findings suggest that spiritual health may serve as a protective factor against specific dimensions of psychological distress in this high-risk population. The integration of spiritual health assessment and spiritually-informed interventions into comprehensive suicide prevention and post-attempt care protocols may enhance treatment outcomes, particularly for individuals whose cultural and personal identities incorporate spiritual dimensions. Future longitudinal research is needed to establish causal relationships and evaluate the efficacy of spiritually-integrated therapeutic interventions for reducing psychological distress and preventing suicide reattempts.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41691222 | DOI:10.1186/s12888-026-07884-7

BMC Pregnancy Childbirth. 2026 Feb 14. doi: 10.1186/s12884-026-08824-9. Online ahead of print.

ABSTRACT

OBJECTIVE: The management of symptomatic hydronephrosis during pregnancy requires balancing maternal and fetal health. This exploratory retrospective study evaluated outcomes of conservative versus invasive intervention approaches in pregnant patients with symptomatic hydronephrosis.

METHODS: We conducted a retrospective analysis of pregnant patients with symptomatic hydronephrosis who underwent conservative management or invasive interventions. Groups were compared regarding demographics, gestational age at diagnosis, fetal birth weight, maternal renal function, and pregnancy-related complications.

RESULTS: The conservative (n = 52) and invasive intervention (n = 29) groups had comparable baseline characteristics, including maternal age (25.8 ± 4.7 vs. 27.0 ± 4.9 years, p = 0.290) and gestational age at diagnosis (24.1 ± 5.9 vs. 24.8 ± 5.8 weeks, p = 0.610). Birth weight was significantly higher with conservative management (3,289 ± 531 g vs. 3,045 ± 337 g, p = 0.029). Multivariable regression analysis adjusting for maternal age, gestational week, and gravidity showed no significant independent association with birth weight (β = 167.5 g, 95% CI: -55.5-390.5 g, p = 0.139), with the most significant difference observed in Grade 3 hydronephrosis (654 g, p = 0.055). Serum BUN levels were lower with invasive intervention (6.9 ± 1.0 vs. 7.5 ± 1.1 mg/dL, p = 0.020), though serum creatinine, a more specific renal function marker, showed no significant difference (p = 0.836). Rates of gestational hypertension and preeclampsia were comparable between groups.

CONCLUSION: Both conservative and invasive management strategies appear feasible and clinically acceptable for symptomatic hydronephrosis during pregnancy, with no clinically significant differences in maternal or neonatal outcomes. Although a statistically significant difference in birth weight was observed, neonatal outcomes, including Apgar scores, were comparable between groups, and birth weights did not fall into categories of small for gestational age or fetal growth restriction. Invasive procedures may be necessary in severe cases with refractory symptoms, infection, or deteriorating renal function. Treatment selection should be individualized based on clinical severity rather than expected outcome differences.

PMID:41691207 | DOI:10.1186/s12884-026-08824-9

BMC Gastroenterol. 2026 Feb 14. doi: 10.1186/s12876-026-04687-8. Online ahead of print.

ABSTRACT

BACKGROUND: The variability of pancreatic vasculature, especially the dorsal pancreatic artery (DPA), increase surgical difficulty and may elevate the risk of intra- and postoperative bleeding. This study aimed to establish a precise preoperative vascular assessment protocol for pancreatic surgery, summarize DPA variant patterns, and evaluate their impact on pancreatic surgery-related bleeding.

METHODS: In this prospective study, 206 patients undergoing pancreatic surgery were included and evaluated preoperatively using computed tomography (CT) imaging and Preoperative Accurate Assessment Form for Pancreatic Vascular Variations (PAAF-PVV). 50 historical controls who underwent pancreatic surgery without PAAF-PVV were retrospectively included. DPA variants were systematically classified. The impact of PAAF-PVV-based vascular assessment and DPA variants on bleeding outcomes was analyzed.

RESULTS: Among patients who underwent precise preoperative vascular assessment for the pancreas (n = 148) versus those who did not (n = 32), no significant differences were observed in intraoperative blood loss, PPH incidence and postoperative hemoglobin decline (ΔHb). However, in the distal pancreatectomy group, the hemoglobin decline on POD2 differed significantly (ΔHb_POD2-POD1, -5.11 vs. -10.69 g/L, 95% CI 1.45-9.71, P = 0.010). Then, DPA origins were classified into five types and no significant association was found with intraoperative blood loss or PPH incidence. However, type IIB DPA may increase the risk of early postoperative hemoglobin decline, whereas type IC DPA appeared to be associated with a lower risk, as reflected by ΔHb_POD2-POD1 values (-12.45 ± 11.605 vs. -1.15 ± 6.902 g/L, P = 0.046). DPA branching patterns were also documented. Patients with DPA head-side branch (HB) showed more postoperative hemoglobin decline than those without HB in distal pancreatic surgery, as reflected by ΔHb_POD3-POD1 values (-11.65 ± 6.434 vs. -7.45 ± 8.667 g/L, P = 0.049). Interestingly, we also found that centro-inferior pancreatic vein (CIPV) drainage type was associated with ΔHb_POD3-POD1, with inferior mesenteric vein (IMV) drainage type linked to greater hemoglobin decline (-12.52±11.422 vs. -7.27±9.508 g/L, P=0.009). Besides, the minimally invasive surgical approach, distal pancreatic resection, and benign pancreatic disease appeared to be associated with fewer intra-operative blood loss.

CONCLUSION: Variations in the pancreatic vasculature, including both arterial and venous systems, may influence surgery-related bleeding. Robust statistical evidence for bleeding reduction is not established in the overall study. Although the clinical outcome related measures presented in this study are merely associative and exploratory findings, a precise preoperative vascular assessment could help enhance anatomical understanding and optimize preoperative procedural planning, which is particularly valuable for surgeons during their learning phase.

PMID:41691178 | DOI:10.1186/s12876-026-04687-8