Category: Nevin Manimala

BMC Surg. 2025 Aug 9;25(1):358. doi: 10.1186/s12893-025-03118-x.

ABSTRACT

BACKGROUND: The quality and completeness of surgery remains critical for optimal oncological outcomes in breast cancer. A key indicator of surgical completeness is the resection margin status, which should ideally be negative, indicated by no ink on invasive tumor. However, such data is rarely reported from sub-Saharan Africa. This study aims to describe the clinical characteristics of women with non-metastatic breast cancer who underwent a mastectomy, and identify the factors influencing the resection margin status at a cancer hospital in Tanzania.

METHODOLOGY: This was a retrospective cohort study analyzing clinical and pathological data of female patients, with a histologically confirmed breast cancer at stage I-III, who underwent a mastectomy at Muhimbili National Hospital in Tanzania. Data were extracted from histopathology reports and clinical records, focusing on margin status and associated variables including age, tumor size (T-status), nodal involvement (N-status), histological subtype, grade, luminal subtype, laterality, and receipt of neo-adjuvant therapy. The primary outcome was margin status post mastectomy. Descriptive statistics were used to summarize patient characteristics, and chi-square tests were applied to assess associations between variables and margin status. Statistical significance was set at p < 0.05.

RESULTS: Out of the 1,020 patients analyzed, margin status was documented for 976 cases. Among these, 801 patients (82.1%) had negative margins, while 175 (17.9%) had positive or close margins; of the latter, 88.6% were positive and 11.4% close. Most patients with margin involvement (88%) had only a single margin affected. The deep margin was most frequently involved in 87% of patients with involved margins, followed by the superior margin in 57%. Margin involvement was significantly higher among younger patients, particularly those under 30 years of age (p < 0.001), and was also strongly associated with advanced T-status (p < 0.001), especially T4 tumors, where 31.7% had involved margins. No significant associations were found with histological subtype, luminal classification, laterality, receipt of neoadjuvant therapy.

CONCLUSION: This study revealed a high rate of margin positivity following mastectomy, largely driven by advanced tumor stage and young age at presentation. To improve surgical outcomes in low-resource settings, we recommend interventions to improve earlier diagnosis and expanded use of neoadjuvant therapy for patients with locally advanced disease.

PMID:40783732 | DOI:10.1186/s12893-025-03118-x

BMC Surg. 2025 Aug 9;25(1):350. doi: 10.1186/s12893-025-03078-2.

ABSTRACT

BACKGROUND: Laparoscopic rectal surgery in female patients poses challenges due to limited pelvic space and obstructing reproductive structures. Uterine manipulators, widely used in gynecological surgery, may enhance intraoperative exposure during rectal resections, but evidence in colorectal settings is sparse.

METHODS: This retrospective cohort study included 40 female patients undergoing laparoscopic rectal cancer surgery between October 2024 and January 2025. Patients were divided into two groups based on the use of a uterine manipulator. Preoperative characteristics, intraoperative findings, and postoperative outcomes were compared, including exposure quality, operative time, lymph node harvest, neoadjuvant treatment response, and recovery parameters.

RESULTS: Intraoperative exposure was significantly better in the manipulator group (VAS 8.8 ± 0.9 vs. 6.05 ± 1.5; p < 0.001). Other perioperative parameters such as operative time, bleeding, lymph node harvest, and ICU admission showed no statistically significant differences. Among patients who received neoadjuvant therapy, pathological response did not differ between groups. Hospital stay was slightly shorter and pain scores marginally higher in the manipulator group, without statistical significance.

CONCLUSION: Uterine manipulators significantly improve exposure during laparoscopic rectal surgery in women without adversely affecting oncological or perioperative outcomes. They may be considered a useful adjunct in challenging pelvic dissections.

PMID:40783731 | DOI:10.1186/s12893-025-03078-2

BMC Surg. 2025 Aug 9;25(1):362. doi: 10.1186/s12893-025-03128-9.

ABSTRACT

BACKGROUND: Abdominal re-operation, or relaparotomy, refers to any repeat surgical intervention performed for intra-abdominal or wound complications during the same hospital admission or within 60 days of the initial operation. However, the regional level of relaparotomy remains unknown in East Africa. Hence, the objective of this systematic review and meta-analysis was to estimate the prevalence of relaparotomy and its associated factors in East Africa.

METHODS: Studies were accessed through an electronic web-based search strategy from PubMed, Cochrane Library, Google Scholar, Embase, PsycINFO, and CINAHL by using a combination of search terms. The quality of each included article was assessed using criteria adapted from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). All statistical analyses were done using STATA version 17 software for windows, and meta-analysis was carried out using a random-effects method. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for reporting results.

RESULTS: The overall prevalence of relaparotomy was determined to be 17.36% (95% CI: 7.03-27.68; I² = 99.89%). Patients OR latency of > 60 h was 2.33 times more likely to undergo re-laparotomy compared with patients operated in < 60 h (AOR = 2.33 (95%CI [1.22-3.45)). Patients with anastomotic leak were 2 times more likely to undergo re-laparotomy compared to patients without leak (AOR = 2 (95%CI [1.35-2.64)). Older patients were 4.13 times more likely to undergo re-laparotomy compared to young patients (AOR = 4.13 (95%CI [-4.62-12.89)).

CONCLUSION: This meta-analysis provides valuable insights into the prevalence and associated factors of relaparotomy, highlighting key regional variations and patient characteristics. The study identified several factors influencing the prevalence of relaparotomy, including the duration of illness, low systolic blood pressure, anastomotic leaks, delayed surgical intervention, and age.

PMID:40783728 | DOI:10.1186/s12893-025-03128-9

BMC Public Health. 2025 Aug 9;25(1):2719. doi: 10.1186/s12889-025-24078-0.

ABSTRACT

BACKGROUND: Stunting, a condition in which children fail to achieve their expected height for age, is a significant public health problem, particularly in low- and middle-income countries. The nutrition and caring practices of mothers and children during the first 1000 days of life determine the ability of a child to develop, learn, and thrive; however, mothers who work may not be able to ensure that their child is receiving adequate nutrition in the early stages of life. This study aimed to identify the determinants of working mothers’ stunting prevention behavior, including individual factors, work-related stress, well-being, knowledge, and attitudes toward the behavior of working mothers in supporting the prevention of stunting in West Java Province, Indonesia.

METHODS: This study used a cross-sectional design with a total sample of 225 working mothers in 78 offices mapped in Bandung city, Bekasi city, Bekasi Regency, Karawang Regency, West Bandung Regency, and Sumedang Regency in West Java Province, Indonesia. The inclusion criteria were as follows: working mothers aged 18 and above who reside and work in 6 cities/regencies of the study, have at least one child under the age of 5 years, and have consented to participate. The questionnaire consisted of demographic data and health characteristics, as well as questionnaires on knowledge, attitudes, work-related stress, well-being, and stunting prevention behavior. The data were analyzed using chi-square tests and logistic regression.

RESULTS: Among the 19 variables, two determinant factors influence stunting prevention behavior among working mothers in West Java Province, Indonesia. These factors are working mothers’ well-being (OR 3.30, P < 0.001) and knowledge about stunting prevention (OR 2.79, P < 0.001). A low level of well-being among working mothers increases the risk of poor stunting prevention behavior by 3.30 times. Similarly, insufficient knowledge about stunting prevention increases this risk by 2.79 times. The interplay between well-being and knowledge may improve mothers’ stunting prevention behavior.

CONCLUSIONS: Working mothers’ well-being and knowledge of stunting prevention affect their stunting prevention behavior. This study is the first in Indonesia to explore the determinant factors of stunting prevention behavior among working mothers. Working mothers should receive special attention from the government regarding their rights to improve their well-being and knowledge related to their health. Further research should adopt longitudinal and intervention-based designs, include other caregivers, and explore diverse geographic and employment settings. Research on workplace and policy-level support systems is also recommended to inform more comprehensive strategies for improving child health outcomes.

PMID:40783720 | DOI:10.1186/s12889-025-24078-0

BMC Nephrol. 2025 Aug 9;26(1):447. doi: 10.1186/s12882-025-04380-0.

ABSTRACT

BACKGROUND: Low socioeconomic status (SES) has been linked to poorer outcomes among patients with advanced chronic kidney disease, including those undergoing maintenance hemodialysis. Limited data are available from Sub-Saharan Africa. In this region, traditional SES indicators like education and income can be challenging to measure. Household wealth may serve as a more reliable SES indicator. Our aim was to evaluate SES using household wealth, its association with non-adherence, quality of life, anxiety and depression among hemodialysis patients in Cameroon.

METHODS: A cross-sectional study was conducted over four months in one urban and one semi-urban hemodialysis facilities in Cameroon. Consenting adult patients on maintenance hemodialysis for at least three months were included. Patients with cognitive impairment or language barriers (English or French) were excluded. Household wealth was assessed using the World Bank’s household wealth index adapted for Cameroon. Non-adherence was defined as missing ≥ 2 hemodialysis sessions within a six-week period. Quality of life was evaluated using the Kidney Disease Quality of Life-36 (KDQOL-36) questionnaire. Anxiety and depression risk were assessed using the Hospital Anxiety and Depression Scale (HADS); p-values < 0.05 were considered statistically significant.

RESULTS: A total of 199 participants were included, with 52.8% (n = 109) males and a median age of 46 [IQR 36-56] years. Poverty affected 47.7% (n = 95) of participants, urban dwellers being more susceptible (52.5% n = 73 vs. 36.7% n = 22, p = 0.039). Poor participants had a greater percentage of patients < 46 years (56.8% n = 58 vs. 49% n = 40, p = 0.001) and unmarried status (43.1% n = 41 vs. 28.9% n = 30, p = 0.014). Non-adherence frequency was higher among poorer participants (42% n = 40 vs. 25% n = 26, p = 0.01). Globally, the quality of life was low across all household wealth groups. However, poorer participants experienced less physical function impairment (39% n = 37 vs. 52.9% n = 55, p = 0.04), fewer emotional role limitations (9.5% n = 9 vs. 19.2% n = 20, p = 0.048), and less depression (13.7% n = 13 vs. 26% n = 27, p = 0.04). In multivariate analysis, poverty increased the risk of non-adherence by 4.3 (95%CI 2.063-8.969, p < 0.001) and decrease the risk of depression by 0.7 (95%CI 0.063-0,963, p = 0.045).

CONCLUSION: Poverty, as assessed by household wealth, is common among hemodialysis patients, particularly the younger patients and urban dwellers. It is associated with increased risk of non-adherence but a lesser risk of depression.

PMID:40783719 | DOI:10.1186/s12882-025-04380-0

BMC Med Res Methodol. 2025 Aug 9;25(1):194. doi: 10.1186/s12874-025-02639-6.

ABSTRACT

BACKGROUND: We performed a systematic survey to collate studies on prediction models developed on the basis of meta-analysis in medicine and summarize key steps involved in model development.

METHODS: We systematically searched Web of Science, PubMed and Embase until April 2023 and included those that developed prediction models on the basis of meta-analysis. The data were summarized via narrative synthesis.

RESULTS: The search strategy identified 23 studies with 25 prediction models that met the eligibility criteria. The predicted outcomes focused on complications of diabetes, mortality, cognitive impairment, gestational diabetes, bronchopulmonary dysplasia, bacterial sinusitis, seizures, and psychosis. Twenty-three prediction models reported AUCs, with a median value of 0.77 (range: 0.59-0.91). Ten prediction models were developed with sample sizes exceeding 10,000 participants. The key steps in developing prediction models via meta-analysis include (1) confirming that the prediction model meets clinical needs before starting, (2) collecting data through meta-analysis to select predictors, (3) developing prediction models, (4) validating prediction model performance, (5) presenting and interpreting models and (6) reporting models.

CONCLUSION: The development of prediction models based on meta-analysis may represent a promising approach, which demonstrates good discrimination. Guidance is necessary to support the design, implementation and reporting of future prediction model development via meta-analysis.

PMID:40783714 | DOI:10.1186/s12874-025-02639-6

BMC Oral Health. 2025 Aug 9;25(1):1310. doi: 10.1186/s12903-025-06701-z.

ABSTRACT

BACKGROUND: Orodental anomalies encompass a range of dental conditions affecting tooth number, morphology, and eruption patterns. Among these, supernumerary teeth (hyperdontia) are of particular clinical significance due to their potential to disrupt occlusion, eruption, and alignment. This study aimed to (i) determine the prevalence of orodental anomalies, (ii) characterize the radiographic features of supernumerary teeth, and (iii) assess the associations of supernumerary teeth with other dental anomalies in a Thai population using panoramic radiographs.

METHODS: A retrospective review of 2,925 panoramic radiographs (PRs) was conducted to identify and classify orodental anomalies, both developmental and acquired, with emphasis on supernumerary teeth. Data was analyzed using descriptive statistics, chi-square tests, and logistic regression models. Inter- and intra-observer agreement was evaluated using Fleiss’ Kappa coefficient.

RESULTS: Orodental anomalies were observed in 56.0% of individuals. The most common anomaly was tooth impaction (37.4%), followed by periapical radiolucency (13.5%) and hypodontia (5.1%). Supernumerary teeth were identified in 1.2% of cases, most frequently as single (76.7%), unerupted (70%), and supplemental-type teeth (76.7%), predominantly located in the mandibular parapremolar region (50%). Significant bivariate associations were found between supernumerary teeth and both microdontia (p = 0.001) and tooth impaction (p < 0.002). However, these associations were not statistically significant in multivariable analyses after adjusting for gender.

CONCLUSION: The study identified a range of orodental anomalies in the Thai population using panoramic radiographs, with tooth impaction being the highest prevalent orodental anomaly. The study also focused on characterizing the supernumerary teeth, which were significantly associated with other anomalies such as impaction and microdontia in bivariate analysis, though this association was not confirmed by logistic regression. Despite this, the observed co-occurrence highlights the need for thorough radiographic evaluation in cases presenting with eruption disturbances or tooth size anomalies. These findings underscore the importance of incorporating anomaly screening in routine dental radiography and warrant multicenter investigations for broader generalizability.

PMID:40783701 | DOI:10.1186/s12903-025-06701-z

BMC Cardiovasc Disord. 2025 Aug 9;25(1):594. doi: 10.1186/s12872-025-05069-w.

ABSTRACT

BACKGROUND: Regular intramuscular injection of benzathine penicillin every two to four weeks is a critical and cost-effective secondary prevention strategy for reducing morbidity and mortality from rheumatic heart disease (RHD), particularly in resource-limited settings like Ethiopia. However, there is limited evidence of adherence to this prophylaxis. Therefore, this study aimed to assess adherence to benzathine penicillin prophylaxis used for secondary prevention and its associated factors among patients with RHD attending follow-up clinics at two public referral hospitals in Bahir Dar, Ethiopia.

METHODS: A hospital-based cross-sectional study was conducted among 346 patients with RHD attending the follow-up clinic at Tibebe Ghion and Felege Hiwot specialized hospitals from October 1st, 2023 to January 20, 2024. Data was collected through questionnaire-based face-to-face interviews and a review of medical records. The data was entered into EpiData version 3.1 and exported to SPSS version 27 for analysis. Binary logistic regression analysis was performed to identify factors associated with good adherence to benzathine penicillin prophylaxis. Adjusted odds ratio at a p-value of less than 0.05 was used to assess the strength of the statistical association.

RESULTS: Among 346 patients with RHD (97% response rate), the study found an overall adherence rate of 63.6% (95% CI, 58.6-68.8) to benzathine penicillin G (BPG) prophylaxis. Factors associated with good adherence included mild to moderate pain at the injection site (AOR = 2.44; 95% CI 1.45-4.09), good awareness of the purpose of BPG (AOR = 1.99; 95% CI, 1.11-3.59), urban residence of patients (AOR = 3.58, 95% CI 1.99-6.41), prophylaxis duration of ≤ 5 years (AOR = 4.15, 95% CI 1.58-10.88), prophylaxis duration 5-10 years (AOR = 3.83, 95% CI 1.32-11.13), and no history of admission in the last year (AOR = 3.05; 95% CI 1.67-5.54).

CONCLUSIONS: The level of good adherence in this study is sub-optimal. Factors positively associated with adherence included urban residence, mild to moderate injection site pain, awareness of BPG purpose, shorter prophylaxis duration, and absence of recent hospital admissions. To improve adherence, healthcare providers should implement targeted patient education programs and adopt effective pain management strategies as part of routine follow-up care.

PMID:40783693 | DOI:10.1186/s12872-025-05069-w

BMC Cancer. 2025 Aug 9;25(1):1294. doi: 10.1186/s12885-025-14668-x.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitors (ICIs) are medications used in cancer immunotherapy. However, treatment with ICIs may lead to adverse effects, particularly myocarditis and pericarditis. This practical pharmacovigilance study investigates the relationship between ICIs and myocarditis and pericarditis using the FAERS (U.S. FDA Adverse Event Reporting System) database.

RESEARCH DESIGN AND METHODS: Data on myocarditis and pericarditis related to ICIs were extracted from the FAERS database for the period from 2014Q1 to 2023Q4. Data mining was performed using the Bayesian Confidence Propagation Neural Network (BCPNN) and the Reporting Odds Ratio (ROR).

RESULTS: A total of 1112 cases involving 1134 adverse event (AE) reports related to ICIs-associated noninfectious myocarditis/pericarditis (NM/P) were extracted from the FAERS database. After excluding reports with missing data, the primary reporters were physicians, consumers, and pharmacists, with the United States and Japan being the main reporting countries. The cases showed a greater percentage of males than females, with a median age of 67 years, a median weight of 65 kg, and a median onset time of 28 days. The signal strength of ICIs-associated NM/P, from highest to lowest, was as follows: Pembrolizumab (ROR: 12.32, 95% CI: 11.28-13.45, IC 025: 3.45) > Nivolumab (ROR: 11.23, 95% CI: 10.13-12.44, IC 025: 3.30) > Atezolizumab (ROR: 10.62, 95% CI: 8.67-13.02, IC 025: 3.10) > Ipilimumab (ROR: 10.25, 95% CI: 8.34-12.58, IC 025: 3.04) > Durvalumab (ROR: 9.25, 95% CI: 7.21-11.88, IC 025: 2.83).

CONCLUSION: This study indicates that ICIs-associated NM/P significantly increases the mortality risk among cancer patients, particularly with the use of nivolumab and pembrolizumab. Strong signals for NM/P were observed with PD-1 inhibitors, pembrolizumab-based regimens, and the combination of nivolumab and ipilimumab. Additionally, a body weight of ≥ 75 kg and the use of nivolumab and ipilimumab may be potential significant risk factors for NM/P.

PMID:40783691 | DOI:10.1186/s12885-025-14668-x

BMC Cardiovasc Disord. 2025 Aug 9;25(1):592. doi: 10.1186/s12872-025-05072-1.

ABSTRACT

BACKGROUND: As a major modifiable risk factor for cardiovascular diseases worldwide, hypertension novel biomarkers that integrate inflammatory and metabolic pathways may improve risk stratification. The association between the red cell distribution width-to-albumin ratio (RAR), a newly identified inflammatory biomarker, and hypertension has not been systematically evaluated in population-based studies.

METHODS: A cross-sectional study included 7,878 adults. Weighted multivariable logistic regression and threshold effect models were employed to analyze nonlinear associations, with subgroup analyses exploring heterogeneity.

RESULTS: RAR showed a linear positive association with hypertension (adjusted OR = 1.26 per unit, 95%CI:1.09-1.44, P < 0.05), a threshold effect was observed. Piecewise regression revealed a significant association when RAR ≥ 3.4, with a higher hypertension prevalence (adjusted OR = 1.34, 95%CI:1.17-1.54), while no association existed below 3.4 (P = 0.408). For those aged 40-60 years, the inflection point was RAR = 3.92 (95%CI:3.76-4.51), with stronger associations observed below this threshold (OR = 1.80, 95%CI:1.33-2.43). Subgroup analyses revealed significant heterogeneity: diabetics exhibited stronger associations than non-diabetics (interaction P = 0.02), and enhanced associations were also observed in females and individuals aged > 40 years.

CONCLUSION: This study confirmed a linear positive correlation between red blood cell distribution width and albumin ratio (RAR) and the prevalence of hypertension, RAR ≥ 3.4 was associated with higher hypertension prevalence and may help identify high-risk subgroups, particularly among diabetics, but its predictive value warrants validation through prospective cohort studies.

PMID:40783688 | DOI:10.1186/s12872-025-05072-1