Category: Nevin Manimala

J Orthop Surg Res. 2025 Aug 30;20(1):802. doi: 10.1186/s13018-025-06231-y.

ABSTRACT

BACKGROUND: Multi-limb amputations are extremely rare and devastating injuries, particularly in the context of civilian disasters. The 2023 Türkiye earthquake resulted in a significant number of complex traumatic injuries, including multiple limb amputations. This study aims to investigate early mortality, surgical complications, and functional outcomes at two-year follow-up in civilian patients who underwent two or more limb amputations following the disaster.

METHODS: A retrospective analysis was conducted on 22 patients who sustained multiple limb amputations after the earthquake. Demographic data, amputation levels, surgical interventions, complications, and outcomes at two-year follow-up were recorded. The primary outcomes were mortality, the number and type of reoperations, and functional recovery at two years.

RESULTS: Among the cohort, two-limb amputations were performed in 17 patients, three-limb amputations in 4 patients, and four-limb amputation in 1 patient. Twenty patients required at least one additional surgical procedure during hospitalization, most commonly surgical debridement for soft tissue infection. Eight patients died, of whom five had undergone amputation of three or more limbs. Sepsis was the leading cause of death. Follow-up data at two years were available for 14 survivors. Of these, only 3 patients were able to ambulate independently using prosthetic devices. Phantom limb pain was reported in 6 patients, and all received medical management. The average hospital stay exceeded 80 days in patients with bilateral amputations.

CONCLUSIONS: This study presents one of the largest case series of multi-limb amputees following a civilian earthquake. The findings highlight the high rate of reoperation, substantial mortality, and limited functional recovery at two-year follow-up in this population. Early multidisciplinary rehabilitation strategies should be prioritized to improve outcomes in future mass-casualty settings.

PMID:40886017 | DOI:10.1186/s13018-025-06231-y

AIDS Res Ther. 2025 Aug 30;22(1):86. doi: 10.1186/s12981-025-00776-y.

ABSTRACT

OBJECTIVES: The diversity of HIV-1 genotypes among Men who have sex with men (MSM) globally has changed considerably. The purpose of this study to assess the global prevalence of HIV-1 genotypes among MSM.

METHODS: PubMed, Embase, Scopus, and Web of Science were systematically searched to identify the articles. Pooled prevalence of HIV-1 genotypes was calculated and subgroup analyses were performed to examine the prevalence estimates across time and locations.

RESULTS: A total of 95 studies were included in the final analysis, including 84,622 successfully genotyped samples. The predominant strains were CRF01_AE (34.46%), subtype B (31.16%), and CRF07_BC (24.72%). In subgroup analyses, Subtype B and C showed a declining trend over the years. However, CRF07_BC exhibited a consistent year-on-year increase, while CRF01_AE experienced a slight reduction after 2018. Notably, both subtypes currently account for more than 35% of the total. In addition, the distribution of HIV-1 subtypes in this population shown a clear regional distribution. Regionally, subtype B predominated in Latin America and Europe, CRF01_AE and CRF07_BC in Asia and China, while subtype C and CRF02_AG were dominant in Africa and the Middle East.

CONCLUSIONS: Global and regions MSM HIV-1 subtypes are becoming more complex over time and the prevalence of recombinant viruses is increasing. Ongoing and effective surveillance of the global and regional molecular epidemiology of HIV-1 in MSM is critical for developing targeted preventive control measures against HIV.

PMID:40886010 | DOI:10.1186/s12981-025-00776-y

J Orthop Surg Res. 2025 Aug 30;20(1):806. doi: 10.1186/s13018-025-06242-9.

ABSTRACT

BACKGROUND: Perioperative blood loss and the need for transfusion are significant concerns in total knee arthroplasty (TKA). Topical tranexamic acid (TXA) is commonly used to reduce bleeding and is administered either via intra-articular (IAI) or peri-articular injection (PAI). This study aimed to compare the efficacy of PAI and IAI of TXA in reducing the postoperative drainage volume and blood transfusion rates in patients undergoing TKA.

METHODS: One hundred patients who underwent simultaneous bilateral TKA were included in this retrospective cohort study. The patients were divided into two groups: Group A received 1 g TXA via PAI and 1 g TXA via IAI in one knee, with 2 g TXA via IAI in the other knee; and Group B received 2 g TXA via PAI in one knee and 2 g TXA via IAI in the other knee. Postoperative outcomes, including blood loss, hemoglobin (Hb) levels, transfusion rates, and surgical duration, were collected and analyzed.

RESULTS: Group A demonstrated a significantly greater decrease in postoperative Hb levels (-2.03 ± 0.15 mg/dL) than Group B (-1.29 ± 0.11 mg/dL). Knees treated with PAI (391.10 ± 25.45 mL) or PAI + IAI (412.80 ± 26.76 mL) had significantly lower drainage volumes than those treated with IAI alone (523.50 ± 17.47 mL, p < 0.001). No significant differences were observed between the PAI and PAI + IAI subgroups. No major complications such as deep vein thrombosis or wound infections were noted.

CONCLUSIONS: PAI of TXA, either alone or in combination with IAI, is more effective in reducing postoperative blood loss in TKA procedures than IAI alone. These findings support the use of PAI, particularly with a higher dose of 2 g TXA, as a safe and effective method for minimizing drainage output in patients undergoing TKA.

PMID:40886003 | DOI:10.1186/s13018-025-06242-9

J Orthop Surg Res. 2025 Aug 30;20(1):812. doi: 10.1186/s13018-025-06190-4.

ABSTRACT

BACKGROUND: Intra-articular injection of mesenchymal stem cells (MSCs) has emerged as a promising therapy for knee osteoarthritis (OA). However, uncertainty remains regarding the optimal cell dose for maximizing clinical benefit. This systematic review and meta-analysis aimed to evaluate the efficacy of MSC injections for knee OA and investigate the relationship between cell dose and treatment outcome.

METHODS: A comprehensive literature search was conducted in PubMed and Scopus for randomized controlled trials (RCTs) published between 2015 and 2025. Eligible studies were RCTs that used intra-articular MSC injections for knee OA, and WOMAC scores were reported at baseline and 12-month follow-up. Standardized mean differences (SMDs) were pooled using a random-effects model. Subgroup analysis and meta-regression were performed to evaluate the effect of MSC dose on treatment outcomes.

RESULTS: Eight treatment arms from six RCTs involving 300 patients were included. The pooled SMD in the WOMAC score at 12 months was -1.35 (95% CI: -1.97 to -0.74), indicating a moderate to large treatment effect. MSC doses of ≤ 25 million cells were associated with statistically significant improvement, while higher doses did not demonstrate additional benefit. Meta-regression confirmed no significant dose-response relationship. Heterogeneity was moderate (I2 = 49.8%).

CONCLUSION: Intra-articular MSC therapy significantly improves clinical outcomes in knee OA at 12 months, with lower doses (≤ 25 million cells) appearing to be both effective and potentially more efficient. These findings support dose optimization as a critical consideration in advancing MSC therapy.

PMID:40886001 | DOI:10.1186/s13018-025-06190-4

Int Breastfeed J. 2025 Aug 30;20(1):69. doi: 10.1186/s13006-025-00758-w.

ABSTRACT

BACKGROUND: The first primary care visit of the newborn aims to assess neonatal feeding, promote breastfeeding, and identify potential health issues. This study examines the relationship between the timing of the first visit and the prevalence of exclusive breastfeeding (EBF) at one month of life.

METHODS: This prospective, observational, analytical study was conducted in Spain through a paediatric research network. Data were collected from newborns at both the first visit and the one-month check-up. Selected variables were compared with those from a 2014 study by the same network to estimate EBF rates at the first visit. The primary outcome was EBF prevalence at one month, measured using 2024 data. EBF was defined as receiving only breast milk in the past 24 h. To analyse factors associated with EBF over time, generalised estimating equation models with binomial distribution and logit link function were used in univariate and multivariate analyses.

RESULTS: A total of 1952 cases were collected in 2024, with the first visit at 9.3 ± 6.1 days after discharge, compared to 2047 cases in 2014 at 10.7 ± 6.3 days. EBF prevalence at the first visit was 63.1% in 2014 and 62.6% in 2024. In 2024, EBF prevalence at one month was 55.0% (95% CI 52.7, 57.3). Previous maternal breastfeeding experience was the strongest predictor of EBF at one month (AOR 14.61, 95% CI 5.04, 42.33). Having the first visit within 7 days of life was associated with higher EBF maintenance at one month in univariate analysis (OR 1.34, 95% CI 1.17, 1.53), but not in multivariate analysis (AOR 0.90, 95% CI 0.47, 1.74).

CONCLUSIONS: The first primary care visit of the newborn occurs late in Spain. Rates of EBF have declined over the past decade, highlighting the need for targeted interventions that address modifiable determinants. The strongest predictor for EBF at one month is having previous breastfeeding experience. Early postnatal follow-up of newborns in primary care appears to have a beneficial effect on EBF maintenance at one month, although other determinants may mediate or influence its impact.

PMID:40885997 | DOI:10.1186/s13006-025-00758-w

BMC Health Serv Res. 2025 Aug 30;25(1):1156. doi: 10.1186/s12913-025-13200-y.

ABSTRACT

BACKGROUND: Burnout affects the physical and mental health of residents. This study aims to investigate the association between burnout and health across biological, psychological, and social domains among Chinese residents.

METHOD: A cross-sectional study was conducted from July 2022 to June 2024 at Peking Union Medical College Hospital in China. A total of 274 resident physicians were recruited, with 207 providing valid responses. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), while general health was measured using the Union Physio-Psycho-Social Assessment Questionnaire (UPPSAQ-70). Self-efficacy and subjective incompetence were also evaluated. Network analysis was applied to identify the centrality of various health factors in relation to burnout.

RESULTS: The overall prevalence of burnout was 74.4% (95% CI: 68.5-79.9%). Emotional exhaustion and depersonalization were significantly higher in male physicians compared to females, while younger physicians (aged ≤ 30 years) reported higher burnout in personal achievement. Network analysis identified strong connections between burnout dimensions (emotional exhaustion and depersonalization) and mental health symptoms such as anxiety, fatigue, and depression. Sleep, anxiety, and self-efficacy were found to be central nodes in the network, indicating their crucial role in resident physicians’ well-being.

CONCLUSIONS: This study found a high prevalence of burnout among resident physicians, with significant links between burnout and mental health conditions. Anxiety and fatigue emerge as core symptoms in the burnout network, suggesting that interventions should address these factors. Additionally, self-efficacy plays a crucial role in burnout.

PMID:40885990 | DOI:10.1186/s12913-025-13200-y

BMC Health Serv Res. 2025 Aug 30;25(1):1155. doi: 10.1186/s12913-025-13278-4.

ABSTRACT

BACKGROUND: Long wait times at health facilities negatively affect contraceptive access and cause dissatisfaction with care. Conventional data collection methods, such as population-based surveys and exit interviews, may not accurately capture wait times due to methodological challenges including recall and social desirability bias.

METHODS: We compared mystery client observations conducted in all public facilities in Kisumu County, Kenya with data from a population-based sample of women of reproductive age (18-49, n = 744) in Kisumu County. We compared recalled wait times from women who used public facilities in the last year for their last contraceptive method with wait times recorded by mystery clients (n = 401) presenting as first-time family planning users, and analyzed quotes from mystery clients who mentioned long waits.

RESULTS: Most mystery clients reported wait times between 1-2 h (49%) or over 2 h (33%), whereas most women surveyed in their homes recalled being seen within 30 min at their most recent visit for family planning (74%). When stratified by facility type, mystery clients waited the longest at dispensaries and basic health centers (median wait time of 110 min) and the shortest wait times at primary and secondary care hospitals (median of 82.5 min). In the survey, women recalled waiting a median of 15 min at basic health centers, 20 min at dispensaries, and 30 min at hospitals. Common causes of long waits reported by mystery clients in qualitative data included late facility openings, late providers, or prioritization of other patients. More than half of mystery clients reported spending less than 5 min with providers (59%), compared to only 8% of women surveyed.

CONCLUSIONS: Triangulation of data between different sources can provide a more nuanced understanding of long wait times, their causes, and how they impact contraceptive seekers. We find that in comparison, these different methods of data collection answer distinct questions about wait times, time spent with provider, and their impacts on contraceptive seekers. Both forms of data are useful to policy makers and stakeholders. We recommend data collection efforts aimed at improving quality of services and adherence to national guidelines consider supplementing standard data collection methods with mystery clients.

PMID:40885988 | DOI:10.1186/s12913-025-13278-4

BMC Psychol. 2025 Aug 30;13(1):989. doi: 10.1186/s40359-025-03223-9.

ABSTRACT

OBJECTIVE: Impaired Activities of Daily Living (ADL) can have a negative impact on the psychological well-being of older adults. This study categorises ADL into Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL). By utilising nationally representative cross-sectional data, we explore the association between ADL and BADL limitations and depressive symptoms among the elderly population in China. In addition, this study explored the relationships between BADL, IADL and depression risk in elderly people at the individual and provincial levels and in rural and urban subgroups.

METHODS: The China Health and Retirement Longitudinal Study(CHARLS) survey used a multistage probability‒proportional‒to-size (PPS) sampling technique. Province-level socioeconomic characteristics were merged with microdata for respondents over 60 years of age from the 2020 China Health and Retirement Longitudinal Study (CHARLS 2020) Wave 5 (n = 10,036) by the author. The respondents were asked whether their BADL and IADL were limited. The risk of depression was assessed using the 10-item Centre for Epidemiological Studies Depression Scale (CES-D 10). The chi-squared test was used to explore whether having a disability that limits BADL and IADL was associated with mental health status. A binary logistic regression model was used to evaluate this association further after controlling for confounding factors.

RESULTS: Overall, 27.5% (2759/10036) and 25.7% (2776/10036) of the participants over 60 years of age were limited in their BADL and IADL, respectively. Regression analyses revealed that older adults whose BADL were not limited (OR = 1.942, 95% CI: 1.638-2.303, P <.001) and whose IADL were not limited (OR = 1.775, 95% CI: 1.485-2.122, P <.001) had a lower risk of depression than older adults whose BADL and IADL were limited. In addition, older adults who were female (P <.001), were 60-69 years (P <.005), had a partner (P <.001), were literate (P <.001), lived in a rural area (P <.001), had a retirement pension (P <.001), had three or more children (P <.001), did not have any chronic diseases (P <.001), had a fair SRH score (P <.001), drank alcohol (P <.001), exercised (P <.005), did not participate in social activities (P <.001), or had an above average per capita household consumption (P <.001) lived in provinces with the first quartile of GDP per capita (P <.001) and lived in provinces with the second quartile of the number of beds in medical institutions per 10,000 persons (P <.001) were more likely to experience depressive symptoms, while smoking had no effect. In a binary logistic regression, older adults who were single (OR = 0.669, 95% CI = 0.551, 0.812), illiterate (OR = 0.646, 95% CI = 0.504, 0.828), living in rural areas (OR = 1.485, 95% CI = 1.270, 1.735), without retirement pensions (OR = 0.671, 95% CI = 0.582, 0.819) and with very bad SRH scores (OR = 0.411, 95% CI = 0.311, 0.544) had a greater risk of depressive symptoms. In the binary logistic regression analysis of the urban and rural subgroups separately, the results indicated that old people whose BADL or IADL were not limited were associated with a risk of depression, especially rural (P <.001) and urban (P <.001) participants.

CONCLUSIONS: The present study provides evidence of an association between BADL, IADL and depression in older Chinese adults. This study revealed that individuals with limited BADL and limited IADL were predominantly depressed older adults. Binary logistic regression models suggested that disabilities limiting BADL and IADL were more likely to be associated with depressive symptoms in rural Chinese older adults. Findings underscore the need for targeted rural interventions (e.g., subsidised mobility aids and caregiver training) to mitigate depression risk.

PMID:40885987 | DOI:10.1186/s40359-025-03223-9

BMC Public Health. 2025 Aug 30;25(1):2977. doi: 10.1186/s12889-025-24097-x.

ABSTRACT

BACKGROUND: Given the growing global burden of Alzheimer’s Disease and Other Dementias (ADODs) and inequalities in its distribution, it is of great necessity to analyze the trends and cross-country inequalities in the burden of ADODs globally and in China from 1990 to 2021.

METHODS: Estimates and 95% uncertainty intervals (UIs) for incidence, prevalence, and disability-adjusted life years (DALYs) of ADODs were obtained from the Global Burden of Diseases Study (GBD) 2021. We described the epidemiology of ADODs at global, regional, and national levels, conducting temporal trend analyses using estimated annual percentage change, joinpoint regression, and age-period-cohort model. Additionally, we performed spatial autocorrelation, decomposition, and cross-country inequality analyses, comparing the burden in China to global trends.

RESULTS: The global burden of ADODs increased overall from 1990 to 2021. GBD 2021 estimated 9,837,056 incident cases, 56,856,688 prevalent cases, and 36,332,687 DALYs for ADODs worldwide in 2021, with the highest case number in East Asia and highest age-standardized rate of DALYs in central sub-Saharan Africa. Spatial trends analyses showed hot spots in sub-Saharan Africa, the Middle East and North Africa, Europe, and High-income North America. Decomposition analysis revealed that changes in DALYs were primarily driven by population growth and aging, followed by prevalence, case fatality, and disease severity. Significant increases in absolute and relative sociodemographic index (SDI)-related inequalities in DALYs were observed from 1990 to 2021, with 318.19 to 759.97, and 0.43 to 0.49, respectively.

CONCLUSION: The burden of ADODs globally and in China showed overall increasing trends from 1990 to 2021. This increase was primarily driven by population growth and aging. Countries with high SDI values faced a disproportionately large burden of dementia, and SDI-related inequalities among countries exacerbated over time. These findings highlight significant challenges for the prevention and control of ADODs globally and in China.

PMID:40885984 | DOI:10.1186/s12889-025-24097-x

BMC Public Health. 2025 Aug 30;25(1):2973. doi: 10.1186/s12889-025-24476-4.

ABSTRACT

BACKGROUND: One of the core features of mental health is psychological well-being, which includes enjoyment, pleasure, happiness, fulfillment, and resilience. Assessing psychological well-being might be a useful indicator in determining the effectiveness of a research study or the appropriateness of a clinical intervention. The gender and sexually diverse people (GSDP), including men who have sex with men (MSM), male sex workers (MSW), and transgender women (hijra), are subject to widespread stigma and discrimination in Bangladesh that imposes a great mental health burden by compromising their mental health and well-being. The Bangla WHO-5 Well-being Index may be considered a promising and useful instrument for assessing the well-being of GSDP. However, the psychometric properties of the Bangla WHO-5 Well-being Index on GSDP have never been explored in Bangladesh.

METHODS: Data were collected from 229 GSDP, including self-identified gay men, during their screening for enrollment in a Pre-exposure prophylaxis (PrEP) pilot intervention. The WHO-5 Well-being Index (WHO-5) was administered between February 2022 and August 2022. Confirmatory factor analysis, along with reliability and validity assessments of the WHO-5, were conducted using IBM SPSS software version 24 and AMOS 18.

RESULTS: The scale showed very good results with regard to internal consistency, where Cronbach’s alpha value was found to be 0.856. With regard to divergent validity, the scale manifested a significant negative correlation with depression (r= -0.753, p < 0.01), anxiety (r= -0.614, p < 0.01), and stress (r= -0.702, p < 0.01) subscales of the Bangla Depression Anxiety and Stress (DASS-21) scale. Convergent validity was supported by Average Variance Extracted (0.64) and Composite Reliability (0.89) values. The single-factor structure of the scale was confirmed by the confirmatory factor analysis (χ² = 8.244, χ²/df = 1.648, GFI = 0.989, RMSEA = 0.053, TLI = 0.986, CFI = 0.993, and SRMR = 0.0218).

CONCLUSIONS: Findings of the present analysis indicate that the Bangla WHO-5 Well-being Index is a valid and reliable instrument to assess psychological well-being among GSDP in Bangladesh and is comparable with the original version of the scale in terms of psychometric properties.

PMID:40885982 | DOI:10.1186/s12889-025-24476-4