Category: Nevin Manimala

Urol J. 2026 May 24. doi: 10.22037/uj.v23i00.8445. Online ahead of print.

ABSTRACT

PURPOSE: To study the effect of Body mass index (BMI) on 24-h urine quantitative analysis in pediatric urolithiasis, and to explore whether obesity and overweight promote the formation of urinary calculi in children.

MATERIALS AND METHODS: A comprehensive search of EMBASE, Pubmed and the Cochrane Library, Web of Science, and Scopus were conducted in March 2024 and updated in October 2025 to find all related studies. BMI was used to specify the body size. And then, a predetermined inclusion and exclusion criteria was used to screen each article. Data from appropriate studies was extracted, a meta-analysis was performed using Stata14.0 software.

RESULTS: Eight studies, including 1033 children with urolithiasis who underwent 24-hour urine collection for chemical analysis, were included in this meta-analysis. The BMI ≥85th percentile group exhibited significantly higher uric acid excretion (SMD = 0.756, 95% CI = 0.092-1.420, P = .026). No statistically significant differences were found in calcium (SMD = -0.320, 95% CI = -0.600 to -0.050, P = .519), 24-h urine volume (SMD = -0.310, 95% CI = -0.790 to 0.160, P = .555), magnesium (SMD = -0.470, 95% CI = -0.820 to -0.120, P = .471), phosphate (SMD = -0.360, 95% CI = -0.610 to -0.110, P = .805), oxalate (SMD = -0.110, 95% CI = -0.390 to 0.170, P = .315), citrate (SMD = -0.190, 95% CI = -0.680 to 0.290, P = .057), or sodium (SMD = 0.200, 95% CI = -0.390 to 0.800, P = .050) excretion between the two groups. Sensitivity analyses confirmed the robustness of these findings.

CONCLUSION: While overweight/obese children with urolithiasis demonstrate higher urinary uric acid excretion, the absence of significant differences in other key urinary risk factors suggests that BMI alone should not be considered a separate and definitive risk factor for pediatric urolithiasis.

PMID:42251510 | DOI:10.22037/uj.v23i00.8445

Urol J. 2026 May 24. doi: 10.22037/uj.v23i00.8514. Online ahead of print.

ABSTRACT

BACKGROUND: Acute kidney injury is a common disease in hospitalized patients, which can have a significant impact on outcomes, including an increase in overall complications and mortality rates, criteria such as serum creatinine level, urinary output, And scoring systems such as KDIGO in acute conditions do not have acceptable specificity and sensitivity to evaluate the kidney function of people; Therefore, this study was conducted with the aim of determining the relationship between plasma uric acid level and mortality rate in patients with sepsis and acute kidney failure.

METHODS: In this descriptive-analytical (cross-sectional) study included 52 children , with the age range of one month to 15 years with sepsis (based on qSOFA criteria) and acute kidney failure (based on serum creatinine level) PICU of Ali Bin Abi Taleb Hospital from October 1401 to October 1402 were admitted and hospitalized, they were studied by census method. Within 48 hours after the admission of patients to the ICU, blood samples should be collected to check serum uric acid levels, electrolytes, albumin, complete blood count (CBC), kidney function tests, arterial blood gases, and chest x-rays. All patients were followed up until discharge or death due to progression of kidney failure. Finally, the findings of the research were analyzed using SPSS version 26 statistical software.

RESULTS: The mean age of patients was 3.66±4.92.The expired number in the hyperuricemia group was significantly higher than in the normal uric acid group (p-value = 0.03), an odds ratio of 3.45 indicates that a high level of uric acid is a risk factor for death. In this study, the duration of hospitalization was longer in those who survived (p-value = 0.02). A particularly strong predictor in our analysis was the QSOFA score (p < 0.001), highlighting its critical role in outcome alive or dead. Serum uric acid level and QSOFA scale showed no significant difference, in totally (p-value = 0.76), subgroup analysis from alive and death patients between uric acid and the QSOFA scale presented the same result (p-value = 0.203, p-value = 0.29, respectively) Conclusion: Finally, it can be stated that the level of uric acid can be considered as a laboratory variable to predict the prognosis of patients.

PMID:42251509 | DOI:10.22037/uj.v23i00.8514

J Int Med Res. 2026 Jun;54(6):3000605261452559. doi: 10.1177/03000605261452559. Epub 2026 Jun 6.

ABSTRACT

ObjectiveThis study aimed to systematically investigate the independent predictive value of the platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio for 28-day all-cause mortality in patients with sepsis and to further evaluate their incremental discriminatory capacity when added to conventional prognostic scoring models.MethodsThis single-center retrospective cohort study involved 287 adult patients diagnosed with sepsis according to the Sepsis-3 criteria. Patients were stratified into high- and low-level groups based on the median values of platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio, and baseline characteristics, and clinical outcomes were compared between groups. Univariate and multivariate Cox proportional hazards regression models were used to assess the independent associations of platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio with 28-day mortality risk. To evaluate predictive performance, multiple models were constructed and compared, including Sequential Organ Failure Assessment score alone, Acute Physiology and Chronic Health Evaluation II score alone, each combined separately with platelet-to-neutrophil ratio or platelet-to-lymphocyte ratio, and a composite model integrating Acute Physiology and Chronic Health Evaluation II, day-3 lactate level, platelet-to-neutrophil ratio, and platelet-to-lymphocyte ratio. Model performance was rigorously assessed using receiver operating characteristic curves, calibration plots, decision curve analysis, integrated discrimination improvement, and net reclassification improvement, enabling a comprehensive evaluation of discrimination, calibration, clinical utility, and the incremental value of novel biomarkers.ResultsMultivariate Cox regression analysis revealed that lower platelet-to-neutrophil ratio (hazard ratio = 0.97, 95% confidence interval: 0.95-0.99, p = 0.012) and higher platelet-to-lymphocyte ratio (hazard ratio = 1.01, 95% confidence interval: 1.01-1.01, p = 0.043) were independently associated with increased 28-day all-cause mortality. Kaplan-Meier survival analysis confirmed significantly higher cumulative mortality in the low-platelet-to-neutrophil ratio and high-platelet-to-lymphocyte ratio groups (log-rank p < 0.05). The composite model incorporating Acute Physiology and Chronic Health Evaluation II, day-3 lactate level, platelet-to-neutrophil ratio, and platelet-to-lymphocyte ratio demonstrated superior predictive accuracy, with an area under the receiver operating characteristic curve (area under the curve) of 0.824 (95% confidence interval: 0.778-0.871), significantly outperforming both the Acute Physiology and Chronic Health Evaluation II only model (area under the curve: 0.746, p < 0.001) and the Sequential Organ Failure Assessment only model (area under the curve: 0.667, p < 0.001). Decision curve analysis showed that this model provided greater clinical net benefit across a broad range of threshold probabilities. Furthermore, both integrated discrimination improvement and net reclassification improvement analyses confirmed statistically significant improvements in discrimination and reclassification accuracy after the inclusion of platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio (both p < 0.001).ConclusionPlatelet-to-neutrophil ratio and platelet-to-lymphocyte ratio are independent predictors of 28-day mortality in patients with sepsis. Incorporating these readily available and cost-effective inflammatory markers into traditional prognostic systems-such as Acute Physiology and Chronic Health Evaluation II-and combining them with dynamic lactate monitoring substantially enhances the discrimination, calibration, and clinical utility of risk prediction models. These findings provide robust evidence supporting the use of platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio for early risk stratification and individualized prognostic assessment in clinical practice.

PMID:42251504 | DOI:10.1177/03000605261452559

Proc Inst Mech Eng H. 2026 Jun 6:9544119261456916. doi: 10.1177/09544119261456916. Online ahead of print.

ABSTRACT

Smash landings in badminton carry high injury risk, worsened by fatigue. Assess how fatigue and task predictability shape lower-limb biomechanics in elite male players and identify fatigue markers via explainable ML. Fourteen elites performed anticipated and unanticipated smash-landings before and after fatigue. Synchronous 3-D kinematics/kinetics were analyzed with a 2 × 2 repeated-measures ANOVA. XGBoost models based on anticipated-task trials were used to classify fatigue status; SHAP ranked feature importance. Fatigue and unpredictability independently affected peak coronal-plane knee moment (fatigue p = 0.033; task p = 0.016). Significant ankle-moment effects were also observed in the transverse plane. Statistical parametric mapping highlighted time-specific effects of fatigue and task on knee/ankle sagittal moments, with an interaction for knee sagittal ROM (p = 0.0395). XGBoost showed high accuracy, identifying peak ankle plantar-flexion moment as the foremost fatigue discriminator. Fatigue and unanticipated tasks were associated with reduced lower-limb control during smash landings. Knee moment and vertical ground-reaction force may serve as biomechanical indicators of fatigue-related movement alterations. Training strategies that combine fatigue exposure with decision-making demands may help improve motor control under high-demand task conditions.

PMID:42251489 | DOI:10.1177/09544119261456916

Trop Med Health. 2026 Jun 6. doi: 10.1186/s41182-026-00994-8. Online ahead of print.

ABSTRACT

BACKGROUND: The potential re-emergence of Mpox poses an increasing public health concern in the Horn of Africa, particularly in Ethiopia. This study examined perceptions of preparedness among surveyed surveillance professionals in Ethiopia regarding the disease surveillance system’s ability to detect and respond to a potential Mpox outbreak.

METHODS: A descriptive cross-sectional survey design was employed, utilizing a structured 58-item questionnaire that assessed preparedness across five domains: general awareness and understanding, surveillance infrastructure and resources, coordination and communication, preparedness and response, and policy, training, and equity. The survey was distributed to disease surveillance professionals at both federal and regional levels through purposive sampling. The data were analyzed using descriptive statistics, Mann-Whitney U tests, Cramér’s V, and content analysis.

RESULTS: Among the 42 surveyed surveillance professionals, 45.3% believed that the surveillance system could effectively respond to an Mpox outbreak, while 54.7% disagreed, reflecting divided perceptions within the sample. Respondents identified several perceived gaps, including limited awareness of Mpox-specific protocols, insufficient training, inadequate diagnostic capacity, and fragmented coordination across sectors. A substantial proportion of respondents reported system-related challenges, with 83.3% perceiving laboratory facilities as inadequate and 78.6% noting the absence of contingency plans. In addition, 57.1% indicated that their organizations lacked staff trained on Mpox, and 59.5% reported no stockpiles of personal protective equipment. Overall, the surveyed professionals expressed mixed perceptions of preparedness, with notable concerns regarding resource allocation, infrastructure, and policy implementation.

CONCLUSIONS: The study identifies perceived gaps among the 42 surveyed surveillance professionals regarding Mpox preparedness in Ethiopia, highlighting the need for enhanced training, strengthened infrastructure, improved coordination, and more equitable resource distribution. Addressing these gaps through targeted interventions may help strengthen disease surveillance capacity and improve the ability to detect, respond to, and manage emerging health threats such as Mpox.

PMID:42251460 | DOI:10.1186/s41182-026-00994-8

J Pharm Health Care Sci. 2026 Jun 6. doi: 10.1186/s40780-026-00592-0. Online ahead of print.

ABSTRACT

BACKGROUND: Antibiotic resistance has emerged largely due to the improper use of antibiotics in clinical practice, although most acute diarrheal diseases resolve without antibiotic treatment and should be reserved for cases of invasive bacterial or dysenteric diarrhea. This study aimed to assess the patterns of antibiotic use for acute diarrheal diseases at Nigist Elleni Mohammed Memorial Teaching Hospital (NEMMTH) in Central Ethiopia.

METHODS: A retrospective cross-sectional study was conducted to assess patients treated for diarrhea between January 1 and June 30, 2023. The appropriateness of antibiotic prescriptions for diarrhea was evaluated according to the Ethiopian Standard Treatment Guidelines. Data were collected using a structured abstraction form, and patient charts were selected through systematic random sampling. The analysis was performed using the Statistical Package for Social Sciences version 25.

RESULTS: Among 302 patients evaluated, 53.3% were female and 46.4% were children under five years old. Of the 302 patients, 57.6% had watery diarrhea. A total of 74.5% of patients received at least one antibiotic, of whom 73.5% received a single antibiotic during the treatment of acute diarrheal cases. The most commonly prescribed antibiotics were metronidazole (18.2%), cotrimoxazole (17.5%), and ciprofloxacin (11.6%). The proportion of inappropriate antibiotic prescribing was 77.1%.

CONCLUSIONS: This study found a high level of inappropriate antibiotic use for acute diarrheal disease at NEMMTH. Metronidazole and cotrimoxazole are the most commonly prescribed antibiotics. Ensuring proper management by adhering to the standard treatment guidelines is crucial.

PMID:42251448 | DOI:10.1186/s40780-026-00592-0

AIDS Res Ther. 2026 Jun 6. doi: 10.1186/s12981-026-00895-0. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence on COVID-19 among people living with HIV (PLWH) remains mixed and context-dependent.

METHODS: We prospectively followed 64 PLWH receiving antiretroviral therapy at a tertiary university hospital in Martin, Slovakia (September 2020-September 2021). SARS-CoV-2 infection was confirmed by RT-PCR.

RESULT: COVID-19 was diagnosed in 54 of 64 participants (84.4%) and was generally mild; none required intensive care, and no deaths were reported. There were no statistically significant differences between PLWH who did and did not develop COVID-19 with respect to age, duration of HIV infection, CD4 cell count, or viral suppression. Participants who developed COVID-19 were more likely to have at least one documented comorbidity; however, this did not appear to translate into severe outcomes in this small cohort. Among those with COVID-19, exploratory comparisons showed no clear differences in short-term outcomes according to mRNA vaccination status.

CONCLUSIONS: In this small exploratory cohort of ART-treated individuals in Slovakia, we did not identify clear clinical or HIV-related predictors of COVID-19 outcomes; however, the study was underpowered and the findings should be interpreted cautiously.

PMID:42251430 | DOI:10.1186/s12981-026-00895-0

AIDS Res Ther. 2026 Jun 6. doi: 10.1186/s12981-026-00893-2. Online ahead of print.

ABSTRACT

We assessed the association between dolutegravir (DTG)-based antiretroviral therapy and kidney abnormalities among young people living with HIV in Kampala, Uganda. Cross-sectional albumin-creatinine ratio (ACR), proteinuria, and estimated glomerular filtration rate (eGFR) were measured. Among 483 participants, the mean serum creatinine was higher (0.68 vs. 0.59) and creatinine-based eGFR lower (118.8 vs. 113.9), among those on TDF/DTG. Cystatin C-based eGFR, prevalences of elevated ACR (9.6% vs. 13.0%), proteinuria (28.3% vs. 30.2%), and eGFR < 90 ml/min/1.73 m² (40.1% vs. 46.9%) were similar. Kidney abnormalities were not associated with regimen, supporting the need for longitudinal studies to clarify progression risk.

PMID:42251428 | DOI:10.1186/s12981-026-00893-2

J Cardiothorac Surg. 2026 Jun 6. doi: 10.1186/s13019-026-04309-0. Online ahead of print.

ABSTRACT

BACKGROUND: Preoperative intravenous iron has become increasingly popular as a strategy to optimize hemoglobin before major surgery. However, its potential benefit in non-anaemic patients undergoing cardiac surgery remains unclear. To address this uncertainty, we conducted a systematic review and meta-analysis to investigate whether preoperative IV iron reduces red blood cell transfusion requirements and improves hematologic and clinical outcomes in adults with normal baseline hemoglobin undergoing cardiac surgery.

METHODS: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library until October 2025 for randomized controlled trials. Eligible studies compared preoperative IV iron to a control (placebo, saline, or standard care) in non-anaemic (per WHO definition) adult patients (≥ 18 years) undergoing cardiac surgery. The primary outcomes were the incidence of postoperative RBC transfusion and the number of units transfused. Secondary outcomes included postoperative hemoglobin level, Postoperative iron indices, length of ICU stay, length of hospital stay (LOS), overall postoperative infection, All-cause mortality, and adverse events possibly related to IV iron (hypersensitivity, anaphylaxis). We used the Cochrane ROB 2 tool for bias assessment and for evidence certainty. Pooled Risk ratios, odds ratios, mean difference, and standardized mean difference with 95% confidence intervals were calculated using random-effects models, with the fixed-effects model applied when heterogeneity was absent or low (I² < 10%).

RESULTS: From 529 initial records, 3 RCTs met the inclusion criteria, encompassing 338 patients. The overall risk of bias was low to moderate. Preoperative IV iron significantly reduced the incidence of postoperative RBC transfusion compared to the control group (Risk Ratio [RR] = 0.62; 95% CI 0.43-0.88; p = 0.008; I² = 0%), representing a 38% relative risk reduction. Furthermore, IV iron significantly decreased the mean number of RBC units transfused (Mean Difference [MD] = – 1.08 units; 95% CI – 1.61 to – 0.54; I² = 0%). While no significant difference was observed in hemoglobin levels at 48 h or one week postoperatively, the IV iron group showed significantly higher hemoglobin at 4-6 weeks (MD = 0.84 g/dL; 95% CI 0.41-1.26; p = 0.0001). IV iron also significantly increased postoperative serum ferritin and transferrin saturation. There were no statistically significant differences in overall postoperative infection rates (RR = 1.16; 95% CI 0.64-2.08) or all-cause mortality (Risk Difference = – 0.00; 95% CI – 0.03 to 0.03). The GRADE certainty of evidence for the primary outcome was moderate.

CONCLUSION: In non-anaemic adult patients undergoing cardiac surgery, preoperative IV iron administration significantly reduces the incidence of postoperative RBC transfusion and the total volume of blood transfused. This intervention also improves hemoglobin levels during the 4-6 week recovery period without an increased risk of infection or mortality. The moderate-certainty evidence suggests this is a beneficial strategy, though further adequately powered RCTs are warranted to strengthen these findings.

PROSPERO REGISTRY REFERENCE: CRD420251161421.

PMID:42251415 | DOI:10.1186/s13019-026-04309-0

BMC Palliat Care. 2026 Jun 6. doi: 10.1186/s12904-026-02184-z. Online ahead of print.

ABSTRACT

BACKGROUND: Advance care planning (ACP) is important in cancer care, but discussions are often delayed or inconsistently implemented. Online ACP decision aid programmes may support ACP participation, although their effects in adults with cancer remain unclear.

METHODS: A systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, the Cochrane Library, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and supplementary sources was conducted from inception to 10 March 2026. Quantitative studies evaluating online ACP decision aid programmes for adults with cancer were included. Risk of bias was assessed using appropriate tools according to study design. Meta-analyses were performed using fixed- or random-effects models.

RESULTS: Twelve studies met the eligibility criteria, including 10 randomised controlled trials, 1 pre-post study, and 1 single-arm quantitative evaluation study. Most studies were conducted in the USA. Pooled evidence showed that online ACP decision aid programmes significantly improved ACP documentation (OR = 2.06, 95% CI 1.29 to 3.27, p = 0.002) and ACP engagement (MD = 0.28, 95% CI 0.15 to 0.40, p < 0.0001). No statistically significant effects were found for AD completion (OR = 1.37, 95% CI 0.54 to 3.45, p = 0.50), satisfaction (MD = 0.15, 95% CI -0.25 to 0.55, p = 0.47), decisional conflict (MD=-0.72, 95% CI -5.87 to 4.43, p = 0.78), or anxiety (MD=-0.76, 95% CI -1.67 to 0.16, p = 0.11). Sensitivity analyses suggested that the findings for ACP documentation and ACP engagement were relatively robust, whereas the results for satisfaction and anxiety were less stable.

CONCLUSIONS: Online ACP decision aid programmes may support ACP in adults with cancer, particularly by improving ACP engagement and ACP documentation. However, evidence for benefits beyond ACP process outcomes remains limited or inconsistent. Further rigorous studies are needed to identify effective programme features and implementation strategies.

PMID:42251411 | DOI:10.1186/s12904-026-02184-z