Category: Nevin Manimala

BMC Pregnancy Childbirth. 2025 Oct 1;25(1):999. doi: 10.1186/s12884-025-08091-0.

ABSTRACT

BACKGROUND: Recently, transvaginal ultrasound (TVS) has been proposed as an adjunct to transabdominal ultrasound (TAS) to help guide the management of PAS. However, the diagnostic accuracy of either technique, or both in combination, is dependent on the experience of the operator. This study aimed to evaluate the diagnostic accuracy of combined TAS and TVS techniques for PAS in differently-experienced operators.

METHODS: This study evaluated singleton pregnant women with placenta previa and suspected PAS from gestational age 28 weeks until delivery who had ultrasounds at a PAS tertiary referral center between January 2020 and November 2023. PAS was diagnosed following the International Federation of Gynecology and Obstetrics (FIGO) classification system and confirmed histopathologically. Retrospective evaluations were performed by two operators with different levels of experience, who were blinded to the clinical data and final diagnosis. Using stored images and video clips, they assessed the sonographic features selected from a Modified Delphi study of ultrasound signs associated with PAS. Inter-observer reliability was assessed using the kappa statistic. The predicted probability of PAS diagnosis was evaluated using a diagnostic accuracy test.

RESULTS: The images and related information of 70 pregnant women were used for the study. Fifty-five (78.57%) had PAS and 15 (21.43%) had placenta previa only. TAS with adjunctive TVS showed excellent interobserver agreement for all ultrasound features. Interobserver agreement in diagnosing PAS significantly improved with the adjunct method, achieving excellent agreement (0.92, p < 0.01). The diagnostic accuracy of the lower-experienced operator increased from 81.40% to 94.30% and the higher-experienced operator from 94.30% to 97.10%.

CONCLUSIONS: Prenatal diagnosis of PAS using TAS with adjunct TVS improved the PAS diagnostic accuracy, especially in the lower-experienced operator. These findings confirm the value of using TAS with TVS in the prenatal evaluation of high-risk pregnancies with suspected PAS.

PMID:41034796 | DOI:10.1186/s12884-025-08091-0

BMC Musculoskelet Disord. 2025 Oct 1;26(1):890. doi: 10.1186/s12891-025-09096-8.

ABSTRACT

PURPOSE: This study aims to develop a computational model to assess the cumulative probability of meniscal failure in the knee joint during running.

METHODS: The knee joint forces of twelve male participants were measured while running at speeds of 9 km/h, 12 km/h, and 15 km/h. These forces were used as boundary conditions in a finite element model. The proportion of high-stress elements in the meniscus during the support phase was calculated, and a Weibull distribution-based failure model was used to compute the cumulative injury probabilities of the meniscus over 360 days at the three running speeds.

RESULTS: Running speed had a significant main effect on this ratio(p = 0.041, F = 3.393, η_p² = 0.117), the ratio during the stance phase at 15 km/h was greater than at 9 km/h(p = 0.036, F = 5.402, Cohen’s d = 1.248), but this difference was not statistically significant when compared to 12 km/h(p = 0.513, F = 1.068, Cohen’s d = 0.224); similarly, there was no significant difference between 9 km/h and 12 km/h(p = 0.139, F = 1.335, Cohen’s d = 0.921).

CONCLUSIONS: Faster running speeds result in higher knee joint reaction forces, however, the probability of meniscal failure is lower. The risk of meniscal failure is more strongly associated with the frequency of stress applications than with the magnitude of the stress itself. Slower running speeds require more gait cycles to complete the same running distance, thereby prolonging loading duration and increasing the number of stress applications.

PMID:41034787 | DOI:10.1186/s12891-025-09096-8

BMC Anesthesiol. 2025 Oct 1;25(1):473. doi: 10.1186/s12871-025-03337-y.

ABSTRACT

INTRODUCTION: The study aimed to compare anesthesia maintenance using total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) and investigating their effects on bleeding volume, intraoperative hemodynamic changes, and postoperative complications in women patients undergoing abdominal myomectomy.

METHODS: A double-blind randomized controlled trial was conducted on patients undergoing abdominal myomectomy at a large non-university hospital in northwest Iran in 2023. A total of 60 eligible patients were randomly assigned to two groups of TIVA (n = 30) and IA (n = 30) anesthesia methods. The study groups’ allocation was blinded to the anesthesiology provider and she was responsible for anesthesia and patient monitoring. The study outcomes were hemodynamic changes, bleeding during the surgery, anesthesia time, hospitalization, and postoperative complications between the study groups.

RESULTS: There were no significant differences in surgical indications, myoma size, hemoglobin levels, or clinical and obstetric characteristics before surgery between the two study groups (p > 0.05). The average blood loss (201.8 vs. 391.0 ml; P = 0.001), postoperative hemoglobin levels (11.6 vs. 10.5; P = 0.005), anesthesia times (100.6 vs. 114.3 min; P = 0.003), and hospitalization days (2.06 vs. 2.36; P = 0.005) showed statistically significant differences between the TIVA and IA groups, respectively. Mean arterial pressure (MAP) and heart rate values were significantly higher in the IA group compared to the TIVA group (P < 0.05). No muscle stiffness, dizziness, or respiratory depression were observed after surgery in either study group. The proportion of shivering in the TIVA and IA groups was 16.7% and 43.3%, respectively, indicating a significant statistical difference (P = 0.024). The proportion of optimal surgeon performance was reported to be higher in the TIVA group compared to the IA group (P = 0.014).

CONCLUSION: According to the findings of this study, the use of the TIVA method compared to IA during the maintenance of general anesthesia was linked to a reduction in intraoperative bleeding and transfusion requirements, as well as increased optimal surgeon performance in patients undergoing abdominal myomectomy. Furthermore, patients in the TIVA group experienced fewer complications during and after surgery, along with a shorter hospital stay.

TRIAL REGISTRATION: The study protocol was retrospectively registered and confirmed in the Iranian Registry of Clinical Trials under the number (IRCT20220930056059N1). Registration date: 2022-11-13. Expected recruitment start date: 2022-11-11.

PMID:41034776 | DOI:10.1186/s12871-025-03337-y

BMC Ophthalmol. 2025 Oct 1;25(1):527. doi: 10.1186/s12886-025-04358-4.

ABSTRACT

BACKGROUND: TransPRK, SMILE, and FS-LASIK are widely used surgical procedures for myopia correction, but differences in postoperative visual quality and optical zone design remain a subject of clinical interest. This study aimed to compare visual outcomes, higher-order aberrations (HOAs), contrast sensitivity, optical zone diameter, and corneal biomechanics among these three techniques.

METHODS: In this prospective cohort study, 82 patients (164 eyes) with myopia were randomly assigned to undergo TransPRK (n = 56 eyes), SMILE (n = 52 eyes), or FS-LASIK (n = 56 eyes). All procedures were performed at a single center, and patients were followed for six months postoperatively. Outcome measures included uncorrected visual acuity (UCVA), HOAs, contrast sensitivity under both bright and dark conditions, optical zone diameter, refractive error, corneal biomechanical parameters (corneal hysteresis and resistance factor), and subjective symptoms such as nighttime glare and halos. Statistical analysis involved ANOVA and chi-square tests.

RESULTS: At six months, all groups achieved comparable UCVA (≥ 96% achieving ≥ 1.0), but the TransPRK group demonstrated significantly lower total HOAs (0.25 ± 0.07 μm) and spherical aberrations (+ 0.05 ± 0.02 μm) than SMILE and FS-LASIK (P < 0.001). TransPRK also showed superior contrast sensitivity, particularly in low-light conditions (6 cpd: 1.05 ± 0.12 log units, P < 0.001). All techniques demonstrated comparable efficacy (indices > 1.0), with non-significant trends favoring SMILE for UCVA (98.08%) and TransPRK for refractive stability (-0.12 ± 0.25D; all P > 0.05). The SMILE group preserved the best corneal biomechanics (CH: 10.1 ± 1.1 mmHg; CRF: 10.5 ± 1.3 mmHg), while FS-LASIK had the highest incidence of nighttime glare (26.8%) and halos (23.2%) (P < 0.05).

CONCLUSIONS: TransPRK has good postoperative visual quality, but its advantages may be mediated by its larger optical zone design. In terms of night vision performance, SMILE surgery can effectively preserve the biomechanical properties of the cornea, while FS-LASIK achieved comparable 6-month acuity; we did not assess time-to-recovery. Selection of surgical modality should be individualized based on patient-specific anatomical and lifestyle factors.

PMID:41034774 | DOI:10.1186/s12886-025-04358-4

BMC Public Health. 2025 Oct 1;25(1):3257. doi: 10.1186/s12889-025-24530-1.

ABSTRACT

BACKGROUND: The COVID-19 pandemic disproportionately affected various demographics and regions in the United States. Understanding disparities in COVID-19 mortality is essential for promoting health equity and guiding future responses.

OBJECTIVE: To examine demographic and regional disparities in age-adjusted and proportionate COVID-19 mortality in the US from 2020 to 2023.

DESIGN, SETTING, AND PARTICIPANTS: In this repeated cross-sectional study, data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database were used to analyze death certificates from 2020 to 2023 for COVID-19-related mortality among persons aged ≥ 15 years in the U.S.

MAIN OUTCOME MEASURES: Age-adjusted mortality rate (AAMR) per 100,000 persons, Rate ratio (with 95% CI), and proportionate mortality of COVID-19, calculated using descriptive statistics.

RESULTS: From 2020 to 2023, 1,167,362 (8.91%) of 13,098,787 total deaths in the U.S. were attributed to COVID-19. The AAMR peaked in 2021 at 147.0 (95% CI: 146.6-147.5) per 100,000, with 13.45% of all deaths related to COVID-19, decreasing to 23.1 (2.49%) by 2023. Males exhibited a 1.56-fold higher AAMR than females. Non-Hispanic (NH) American Indian/Alaska Native experienced the highest cumulative AAMR (154), followed by NH Native Hawaiian/Pacific Islander (124.2) and NH African American (123.9) populations. Hispanics had the highest proportionate mortality, with COVID-19 contributing to 23.55% of all deaths in 2021. The oldest age group (≥ 75 years) had the highest cumulative AAMR, 71.6 times higher compared to the youngest group (15-44 years), whereas the highest proportionate mortality was seen in middle-aged adults (45-74 years). Regionally, the Southern U.S. census region recorded the highest cumulative and annual AAMR, except for the Northeast, in 2020.

CONCLUSION: From 2020 to 2023, males, older adults, and racial/ethnic minority groups, notably NH AI/AN, NH NH/PI, NH African American, and Hispanic populations, experienced higher COVID-19 mortality. Regionally, the Southern U.S. Census region had the highest COVID-19 mortality, except for the Northeast, in 2020. These disparities underscore the importance of implementing equitable public health strategies and ensuring preparedness for future health crises.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41034766 | DOI:10.1186/s12889-025-24530-1

BMC Pregnancy Childbirth. 2025 Oct 1;25(1):997. doi: 10.1186/s12884-025-08134-6.

ABSTRACT

BACKGROUND: Geographic access to healthcare continues to pose a significant challenge for pregnant women in rural areas of sub-Saharan Africa, resulting in consistently high rates of maternal mortality. Geographic barriers can persist even in settings where financial barriers have been reduced and health system strengthening (HSS) efforts are in place. The aim of this study is to gain a precise understanding of spatiotemporal changes in access to and utilization of maternal care services in a rural district of Madagascar benefiting from HSS support.

METHODS: We collected geolocated monthly information at the village level on antenatal care visits, deliveries and postnatal visits from the registries of 18 public primary health centers in Ifanadiana District, from 2016 to 2018. Similar data were collected from a district-representative cohort via surveys on over 1500 households done in 2016 and 2018. We estimated precise travel time from each village to the nearest health center to understand spatio-temporal variations in maternal care access, and to assess the impact of geographic barriers via statistical analyses while controlling for health system factors.

RESULTS: Women who lived within a one-hour walk from a health facility in the HSS catchment area had rates of per capita utilization of most maternal health services were roughly twice that those who lived 1-2 h away and three times higher than those who lived over 2 h away (e.g. relative change for delivery at a health center was 0.60 [0.53-0.67] and 0.40 [0.36-0.45] for women living 1-2 h and over 2 h from a facility, respectively). The exception was the first antenatal care visit (ANC1), for which travel time had more modest effect (e.g. relative change of 0.72 [0.67-0.77] over 2 h). Improvements to primary care services due to HSS in this setting were only observed among women living within two hours from health centers. Statistical models revealed that women’s travel time from a health facility was the strongest determinant of maternal care service utilization.

CONCLUSION: This study shows how a combination of geo-located health system information and population-representative data can help assess the impact of geographical barriers to maternal care in rural areas of sub-Saharan Africa. It highlights that women who live more than 2 h from a health facility had virtually no access to maternal health services despite efforts in place to reduce financial barriers to care and strengthen the health system.

PMID:41034758 | DOI:10.1186/s12884-025-08134-6

BMC Ophthalmol. 2025 Oct 1;25(1):530. doi: 10.1186/s12886-025-04379-z.

ABSTRACT

BACKGROUND: To investigate the factors related to the change in axial length after repeated low-level red-light(RLRL) therapy.

METHODS: A retrospective case study. A total of 323 children and adolescents who underwent RLRL therapy concurrently with their eye examinations at Wuhan Children’s Hospital from 2022 to 2023 were included. The biological eye parameters, including the axial length (AL), spherical equivalent refractive (SER), the subfoveal choroidal thickness (SFCT), intraocular pressure (IOP), corneal curvature and corneal thickness, were recorded at baseline, 3-month, 6-month, 12-month, 12-month, 18-month and 24-month. The factors related to the degree of change in axial length were analyzed.

RESULTS: There was a statistical difference in the amount of AL changes during the follow-up (F = 16.12, P < 0.001), and the amount of AL changes was significant at the 6-month follow-up (△AL=-0.16 ± 0.18), and then gradually decreased with the extension of follow-up time. There was a statistically positive correlation between baseline AL and baseline SER and changes in AL (P < 0.05). The axial regression in high myopia group was significantly greater than that in mild and moderate myopia group (P < 0.05). There was also a statistically positive correlation between age and changes in AL (P < 0.05). At the follow-up of 6 months, 12 months, 18 months, combined with other myopia prevention and control was correlated with the change of AL (P < 0.05). Baseline corneal thickness, baseline corneal curvature and baseline IOP were not correlated with changes in AL (all P > 0.05).

CONCLUSION: The longer the baseline AL, the higher SER, the thinner SFCT, the older the age and the combination of other myopia prevention and control measures, the more obvious the change of AL. However, the changes of AL were not affected by IOP, corneal curvature and corneal thickness.

PMID:41034752 | DOI:10.1186/s12886-025-04379-z

BMC Public Health. 2025 Oct 1;25(1):3275. doi: 10.1186/s12889-025-24490-6.

ABSTRACT

BACKGROUND: Physical inactivity among adults in the United Arab Emirates (UAE) is a growing public health concern, contributing to chronic diseases and increased healthcare burdens. Understanding physical activity literacy (PAL) and behaviour, along with associated sociodemographic factors, is essential for designing effective interventions.

METHODS: A cross-sectional study was conducted among 630 adults in UAE, using a validated self-administered questionnaire. The tool assessed knowledge of physical activity and its health benefits, engagement in physical activity, and sociodemographic characteristics. Knowledge scores were categorized as ‘good’ (≥ 6) and ‘poor’ (≤ 5). Data were analysed using SPSS version 28, for associations between literacy, behavior, and demographic factors were analyzed using chi-square tests, with Bonferroni correction for multiple comparisons. Effect sizes and 95% confidence intervals (CI) were reported.

RESULTS: Most participants (95.2%) demonstrated good knowledge of physical activity benefits, though misconceptions persisted regarding its effects on HIV/AIDS (32.4% incorrect) and blood pressure (28.9% incorrect). A high proportion (97.3%) reported engaging in physical activity, with 61% moderately active (3-5 times/week) and 19% highly active (6-7 times/week). There was no statistically significant association between knowledge level and physical activity performance (p = 0.192; odds ratio = 0.359, 95% CI: 0.078-1.647). Significant associations were observed between literacy level and gender (p = 0.001) as well as employment status (p = 0.002), with females and unemployed individuals more likely to have higher literacy. Physical activity engagement was not significantly associated with any sociodemographic variable.

CONCLUSIONS: Although both knowledge and participation levels are high among adults in UAE, targeted educational interventions are needed to address persistent misconceptions, especially regarding specific health outcomes. Tailoring these interventions based on gender and employment status may improve their effectiveness and promote sustained physical activity engagement across different population groups in the UAE.

PMID:41034750 | DOI:10.1186/s12889-025-24490-6

BMC Cancer. 2025 Oct 1;25(1):1491. doi: 10.1186/s12885-025-14883-6.

ABSTRACT

INTRODUCTION: Brain tumor symptoms may affect the patients’ caregivers. This study aimed to explore the mediation roles of hope and social support in the relationship between fatigue and burden in brain tumor caregivers.

METHODS: This is a cross-sectional study on 280 caregivers of brain tumor patients. Adult Hope Scale, Zarit Burden Interview, Personal Resources questionnaire 85, and Multidimensional Fatigue Inventory were used. The mediator model by the SPSS Macro PROCESS (Model 4, and 6) was used.

RESULTS: Over half of caregivers reported moderate fatigue and social support, with half experiencing moderate to severe caregiving burden. Moreover, 60.4% were moderately to highly hopeful. Significant relationships were found between fatigue and hope (r=-0.57, p < 0.001), social support (r=-0.65, p < 0.001), and burden (r = 0.63, p < 0.001), as well as between hope and social support (r = 0.57, p < 0.001). Fatigue, social support, and hope predicted the caregivers’ burden. The indirect effect of fatigue on burden by hope was significant (Effect = 0.16, 95% CI 0.02 to 0.30). The indirect effect of fatigue on burden by social support was also significant (Effect = 0.38, 95% CI 0.21 to 0.57). The indirect effect of fatigue on burden by hope and social support was significant (Effect = 0.12, 95% CI 0.04 to 0.21).

CONCLUSION: The results of this study showed that hope and social support should be improved in the caregivers of brain tumor patients. By conducting interventions in this field, it is possible that the burden of caregivers is decreased in situations with high fatigue.

PMID:41034745 | DOI:10.1186/s12885-025-14883-6

BMC Bioinformatics. 2025 Oct 1;26(1):237. doi: 10.1186/s12859-025-06155-8.

ABSTRACT

BACKGROUND: Prior results for tRNA and 5S rRNA demonstrated that secondary structure prediction accuracy can be significantly improved by modifying the parameters in the multibranch loop entropic penalty function. However, for reasons not well understood at the time, the scale of improvement possible across both families was well below the level for each family when considered separately.

RESULTS: We resolve this dichotomy here by showing that each family has a characteristic target region geometry, which is distinct from the other and significantly different from their own dinucleotide shuffles. This required a much more efficient approach to computing the necessary information from the branching parameter space, and a new theoretical characterization of the region geometries.

CONCLUSIONS: The insights gained point strongly to considering multiple possible secondary structures generated by varying the multiloop parameters. We provide proof-of-principle results that this significantly improves prediction accuracy across all 8 additional families in the Archive II benchmarking dataset.

PMID:41034743 | DOI:10.1186/s12859-025-06155-8