Category: Nevin Manimala

BMC Oral Health. 2025 Dec 27. doi: 10.1186/s12903-025-07567-x. Online ahead of print.

ABSTRACT

Odontogenic keratocyst (OKC) is a challenging jaw lesion known for its aggressive behavior and high recurrence rate. Concerns about the safety and effectiveness of existing adjuvant treatments have encouraged the search for safer alternatives such as 5-Fluorouracil (5-FU). This systematic review and meta-analysis evaluated the efficacy of 5-FU as an adjunctive therapy for OKC. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive search was conducted in PubMed, Embase, Scopus, and Google Scholar up to August 1, 2024. Eligible studies included OKC cases treated with 5-FU, alone or combined with surgery. Risk of bias was assessed using the Cochrane ROB-2 tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies. Data were pooled using inverse variance weighting, and heterogeneity was evaluated using the I² statistic. Fourteen studies (282 lesions) were included, comprising randomized controlled trials, cohort studies, and case reports of varying quality. Moderate heterogeneity was observed (I² = 37-57%). In five comparative studies, no recurrences occurred in the 5-FU group versus 24.21% in the modified Carnoy’s solution (MCS) group (p < 0.001). Postoperative paresthesia as also lower with 5-FU (18.82% vs. 37.89%, p = 0.012). Compared with segmental resection, 5-FU achieved similar recurrence prevention but with much lower morbidity, including fewer permanent sensory deficits (9.09% temporary in 5-FU vs. 100% permanent in segmental resection, p < 0.001). Bone density was significantly higher after 5-FU treatment than with enucleation alone (p < 0.001). No systemic or severe local side effects were reported. 5-FU appears to be a highly promising adjunctive therapy for OKC, offering effective recurrence prevention with minimal morbidity However, current evidence remains limited by small sample sizes, study heterogeneity, and non-randomized designs. Larger, well-designed trials with long-term follow-up are needed to confirm these findings.

PMID:41454329 | DOI:10.1186/s12903-025-07567-x

BMC Neurol. 2025 Dec 26. doi: 10.1186/s12883-025-04572-z. Online ahead of print.

NO ABSTRACT

PMID:41454312 | DOI:10.1186/s12883-025-04572-z

BMC Endocr Disord. 2025 Dec 26. doi: 10.1186/s12902-025-02134-5. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to compare the reduction in hospital admissions due to hypoglycemia and the decrease in HbA1c levels between empagliflozin and sulfonylurea, alongside the standard care provided to patients with type 2 diabetes during fasting.

METHODOLOGY: A single-center prospective observational cohort study was conducted from March to June 2022. Patients were treated with stable doses of empagliflozin, sulfonylureas, metformin, and DPP-4 inhibitors at least two months before fasting. Stability was defined as unchanged doses for at least one month. Participants’ BMI distribution and treatment regimens were clarified. The eGFR cutoff of < 60 ml/min/1.73 m² was chosen based on international standards for renal function in diabetes.

RESULTS: Females were in the majority (60.3%) in the intervention (case) group. Most had ages ranging from 41 to 60 years; the empagliflozin group reported slightly fewer hypoglycemic events (26.5%) compared to the sulfonylurea group (31%), and both groups demonstrated statistically significant reductions in HbA1c levels (p < 0.0001), with a similar mean decrease of approximately 0.5%, during fasting, without changes in baseline antidiabetic medications. An odds ratio of 0.387 indicated a trend toward further HbA1c reduction with increasing empagliflozin dose. However, differences in baseline weight between groups may have influenced outcomes. Separate data for modern versus conventional sulfonylureas were analyzed, showing consistency in hypoglycemic event rates across both types.

CONCLUSIONS: Empagliflozin is effective for type 2 diabetic patients during Ramadan fasting in modestly reducing the hypoglycemic events requiring hospital admissions. While both empagliflozin and sulfonylureas led to comparable reductions in HbA1c, larger, controlled studies are warranted to further evaluate clinical outcomes and control for baseline differences.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41454305 | DOI:10.1186/s12902-025-02134-5

BMC Ophthalmol. 2025 Dec 26. doi: 10.1186/s12886-025-04589-5. Online ahead of print.

ABSTRACT

BACKGROUND: Diabetic retinopathy (DR) is a prevalent microvascular complication of diabetes mellitus and a significant cause of blindness worldwide, In Sub-Saharan Africa (SSA), the epidemic of diabetes is rapidly expanding, with hundreds of millions expected by 2045, and DR is approximated to afflict about one-third of individuals with diabetes in the region Nevertheless, the total burden of DR in SSA has not been methodically estimated.

OBJECTIVE: We sought to estimate the pooled prevalence of DR in adults with diabetes in SSA and investigate sources of variation.

METHODS: We performed a systematic review and meta-analysis according to PRISMA 2020 guidelines. We searched PubMed, AJOL, Google Scholar, and other sources through mid-2024 for observational studies (cross-sectional or cohort) that reported DR prevalence in adults with diabetes in SSA. Two reviewers screened records, extracted data (study, country, design, sample size, DR cases), and evaluated quality using the JBI checklist. Random-effects meta-analysis (logit transformation) estimated pooled prevalence and 95% confidence intervals (CI), Heterogeneity was measured by Cochran’s Q and I², and τ² was reported. Subgroup meta-analysis by region (East, West, Central, and Southern Africa) and meta-regression by country (fixed categorical moderator) were conducted. Funnel plots and Egger’s test (p < 0.05) examined publication bias.

RESULTS: We pooled 30 studies (N = 16,329 individuals) from 18 SSA countries, Most were hospital-based and cross-sectional; no study was excluded due to high bias. The overall pooled prevalence of DR among individuals with diabetes was 25.5% (95% CI: 20.7%-31.0%) (Logit = -1.072, 95% CI -1.345 to -0.799; p < 0.001). Heterogeneity was very high (I² ≈ 96%, τ² = 0.433). Subgroup analysis revealed differences by sub region: East Africa 31.8%, Southern Africa 29.6%, West Africa 27.4%, and Central Africa 13.7%. A meta-regression with country as moderator was not statistically significant (F = 0.94, p = 0.560). Egger’s test demonstrated significant asymmetry (p < 0.001), although the weighted regression test was no significant (p = 0.154), which suggests potential publication bias.

CONCLUSION: About a quarter of diabetics in SSA have DR. This is similar to regional estimates (28% in East Africapubmed.ncbi.nlm.nih.gov) but slightly lower than the overall Africa average (~36%)pubmed.ncbi.nlm.nih.gov. The high heterogeneity suggests that the prevalence of DR is highly variable throughout SSA. Restricted access to eye care, late diagnosis, and inadequate glycemic control in SSA are probably responsible for this, these findings highlight the urgent need for systematic diabetic retinopathy screening and management programs in sub-Saharan Africa.

PMID:41454302 | DOI:10.1186/s12886-025-04589-5

BMC Surg. 2025 Dec 26. doi: 10.1186/s12893-025-03447-x. Online ahead of print.

ABSTRACT

BACKGROUND: Abdominal ectopic bronchogenic cysts (EBCs) are rare congenital malformations that are frequently misdiagnosed preoperatively due to their nonspecific and often asymptomatic presentation. This study aimed to elucidate the clinical characteristics, diagnostic challenges, and optimal management of abdominal EBCs by integrating data from a sizable single-institutional case series with a comprehensive literature review.

METHODS: We conducted a retrospective analysis of 12 patients with pathologically confirmed abdominal bronchogenic cysts who were treated at our institution from January 2015 to January 2024. Data on demographic characteristics, clinical presentation, imaging features, surgical management, and pathological findings were collected. A comprehensive review of the pertinent literature was also performed to identify published case reports and series. Data are presented using descriptive statistics, including medians and proportions.

RESULTS: The cohort comprised 12 patients (7 male, 5 female) with a median age of 46 years. Eight patients (66.7%) were symptomatic. The most common symptom was epigastric pain, presenting in 7 patients (58.3%). Eleven cysts (91.7%) were located in the upper abdominal retroperitoneum. Eleven patients (91.7%) were misdiagnosed preoperatively. Laparoscopic complete resection was achieved in 9 patients (75%), while 3 patients (25%) underwent open surgery. The diagnosis was histologically confirmed in all cases by the identification of ciliated pseudostratified columnar epithelium. One patient (8.3%) experienced recurrence following initial fenestration and required reoperation.

CONCLUSIONS: Abdominal bronchogenic cysts present a considerable diagnostic challenge, resulting in a high preoperative misdiagnosis rate. It should be considered in the differential diagnosis of an abdominal cystic neoplasm. Laparoscopic complete resection represents a safe and effective therapeutic approach, yielding favorable outcomes. Complete surgical excision is paramount to prevent recurrence. Surgical intervention is, therefore, recommended to achieve both diagnostic confirmation and definitive therapy.

PMID:41454289 | DOI:10.1186/s12893-025-03447-x

BMC Infect Dis. 2025 Dec 26. doi: 10.1186/s12879-025-12324-0. Online ahead of print.

ABSTRACT

BACKGROUND: Cutaneous leishmaniasis (CL) and other skin diseases impose a high disease burden in Ethiopia, yet access to care is poor due to limited and centralized diagnostics and treatment. Decentralizing care could improve this but may necessitate substantial changes to the healthcare system. This study aimed to assess the available resources and the knowledge and skills of healthcare professionals for decentralizing the diagnosis and care of CL and common skin diseases to lower healthcare facilities.

METHODS: A cross-sectional study was conducted in South Ethiopia, from May to July 2023, involving 11 health centers, four primary hospitals, and one general hospital. Infrastructure was assessed on-site. Resources, knowledge, and skills of staff members regarding the treatment of CL and other skin diseases were collected using a newly developed questionnaire, comprising 25 knowledge-based and 14 skill-based questions. Skills were assessed via lesion and pathogen images. Descriptive statistics for the different variables studied and inferential statistics based on (confidence) interval estimation were reported.

RESULTS: Most facilities had equipment for diagnosis and localized treatment. Adequate hospitalization space and necessary equipment for systemic treatment of CL were found in 3 out of 4 primary hospitals, but none of the health centers. Consumable and drug shortages were common across all facilities. The median score of BSc laboratory technologists was significantly higher than that of diploma technicians (i.e. 29 vs. 15 out of a maximum of 39, p < 0.001). Clinical staff scores varied significantly across education levels (p = 0.007), with physicians scoring the highest (median 33, IQR 31-36), followed by health officers (median 29, IQR 27-32), BSc nurses (median 28, IQR 16-36), and diploma nurses (median 25, IQR 19-29). Notably, no significant differences in median scores were observed between primary hospitals and health centers for clinical and laboratory staff.

CONCLUSIONS: Decentralizing the diagnosis and treatment of common skin diseases and localized CL treatment to health centers appears feasible with facility adjustments, continuous training, and reliable supply chains, while referring CL cases requiring systemic treatment to primary hospitals. Strong strategic efforts to maintain staff knowledge and skills and tackle supply shortages are crucial for successful decentralization.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41454287 | DOI:10.1186/s12879-025-12324-0

BMC Musculoskelet Disord. 2025 Dec 27. doi: 10.1186/s12891-025-09452-8. Online ahead of print.

ABSTRACT

BACKGROUND: Myofascial trigger points (MTrPs) in the upper trapezius are prevalent in individuals with shoulder pain and may interfere with neuromuscular control and kinematics during shoulder movements. The purpose of this study was to compare shoulder muscle activation patterns and kinematic parameters, particularly scapulohumeral rhythm (SHR), between individuals with upper trapezius MTrPs and the healthy group during shoulder abduction.

METHODS: An observational study was conducted with participants assigned to either a trigger point group (n = 15) or a healthy group (n = 13). Surface electromyography (EMG) recorded activation of eight shoulder muscles during abduction. Kinematic analysis quantified SHR, scapular, and glenohumeral motion. Statistical comparisons were made using independent t-tests with SPSS version 17, considering a p-value of less than 0.05 as significant.

RESULTS: No statistically significant differences were observed in peak EMG amplitudes, onset timing, or root mean squared activity between groups for any muscle ( p > 0.05). However, the trigger point group exhibited a significantly prolonged rise time (1.21 ± 0.51) compared with the healthy group (0.68 ± 0.39; d = 0.90, p < 0.001), as well as an increased SHR (4.84 ± 0.77) compared with the healthy group (4.23 ± 0.50; d = 0.90, p = 0.026), respectively. These findings suggest a disruption in glenohumeral-scapular coordination, potentially indicative of compensatory neuromuscular adaptations associated with the presence of trigger points. Other kinematic variables, including maximum scapular upward rotation and anterior tilt, did not differ significantly.

CONCLUSION: Upper trapezius MTrPs are associated with increased SHR and prolonged rise time during abduction, reflecting altered shoulder coordination. Combining kinematic assessments with advanced EMG timing analyses may provide more sensitive markers of subtle neuromuscular changes associated with MTrPs.

PMID:41454245 | DOI:10.1186/s12891-025-09452-8

J Clin Densitom. 2025 Dec 11;29(1):101658. doi: 10.1016/j.jocd.2025.101658. Online ahead of print.

ABSTRACT

BACKGROUND: Osteoporosis is the most common metabolic bone disease in the elderly. This study aimed to assess whether routine T1-weighted MR images can visually indicate the presence of osteoporosis by estimating vertebral bone marrow fat content.

METHODS: Lumbar spine MRI and DEXA scans from 320 patients (performed within a 6-month interval) were retrospectively reviewed. Two radiologists independently graded the percentage of high T1 signal within the L4 vertebral body into <50 % or ≥50 %, representing marrow fat content. Visual fat scores were compared with T-scores from DEXA scans. Inter-reader agreement was assessed using Cohen’s and Fleiss’ kappa statistics. Spearman’s correlation was used to evaluate the association between MRI grading and DEXA scores.

RESULTS: Of the 320 patients (mean age 56.8 years; 80.3 % female), 48.4 % had osteopenia or osteoporosis. Visual MRI grading yielded 141 patients with <50 % and 179 with ≥50 % marrow fat. A weak but statistically significant correlation was observed between MRI visual fat scores and DEXA T-scores (ρ = 0.139, p = 0.013). Inter-reader agreement was moderate (Cohen’s kappa = 0.509, 95 % CI: 0.415 to 0.603).

CONCLUSION: Routine T1-weighted lumbar spine MRI may serve as an opportunistic screening tool for osteoporosis. Visual estimation of vertebral marrow fat content shows potential to identify patients who may benefit from further DEXA evaluation.

PMID:41453250 | DOI:10.1016/j.jocd.2025.101658

Aquat Toxicol. 2025 Dec 21;291:107690. doi: 10.1016/j.aquatox.2025.107690. Online ahead of print.

ABSTRACT

Aluminum (Al) is a widespread aquatic neurotoxic pollutant, yet its brain accumulation is seldom quantified in fish neurotoxicity studies. Here, we investigated the neurobehavioral and molecular consequences of acute waterborne Al exposure in adult zebrafish (n = 227). Fish were exposed for 96 h to 50 mg/L AlCl₃ at pH 5.0 and then transferred to clean water for a 7-day depuration period. Despite the absence of statistically significant Al accumulation in either brain or carcass, exposed animals exhibited consistent neurobehavioral impairments, including reduced non-associative learning (short-term habituation of the acoustic startle response), anxiety- and depression-like phenotypes (positive geotaxis and negative scototaxis), and increased aggressive-like behavior. All behavioral alterations were fully reversed after depuration, indicating a transient effect. Brain oxidative stress markers (catalase, superoxide dismutase, lipid peroxidation), neurotransmitter levels, and acetylcholinesterase activity remained largely unchanged, arguing against a direct, generalized disruption of brain biochemistry. In contrast, brain expression of appa, gfap, and cat was significantly upregulated immediately after exposure and returned to control levels after depuration, suggesting an early but reversible stress and glial response. Overall, these findings show that short-term acidic Al exposure can induce reversible cognitive and affective disturbances in zebrafish in the absence of detectable brain accumulation, highlighting the importance of transient molecular stress pathways in acute aluminum neurotoxicity.

PMID:41453237 | DOI:10.1016/j.aquatox.2025.107690

Public Health Nutr. 2025 Dec 26:1-25. doi: 10.1017/S1368980025101729. Online ahead of print.

ABSTRACT

OBJECTIVE: A Body Shape Index (ABSI) is a validated anthropometric measure describing body shape independently of BMI and height. This study aimed to evaluate the association between ABSI and dietary quality and eating behaviors in a Mediterranean clinical population.

DESIGN: We conducted a cross-sectional study analyzing associations between ABSI and diet/behavior using Pearson correlations and multivariable linear regressions adjusted for age, sex, and BMI.

SETTING: The study took place at a Mediterranean diet-based nutrition clinic in Rome, Italy.

PARTICIPANTS: The sample included 1,640 adult patients attending follow-up visits at the clinic. ABSI z-scores were calculated and standardized by age and sex. Weekly food intake was assessed using 7-day food diaries, and behavioral preferences were collected via structured questionnaires.

RESULTS: The Pearson correlation between BMI and internal zABSI was weak but statistically significant (r = 0.113, p < 0.0001), confirming that ABSI captures body shape independently from BMI. As expected, ABSI strongly correlated with waist circumference (r = 0.78, p < 0.001). Playing a sport was inversely associated with zABSI (β = -0.365, p < 0.001). Nighttime eating (β = 0.237, p = 0.001), snacking between meals (β = 0.133, p = 0.014), and preference for sweet over salty foods (β = 0.025, p = 0.010) were positively associated with higher ABSI values.

CONCLUSIONS: In this Mediterranean clinical sample, ABSI identified behavioral and dietary correlates of body shape-related risk. Promoting physical activity and addressing nighttime eating may help improve anthropometric profiles linked to abdominal fat distribution.

PMID:41451686 | DOI:10.1017/S1368980025101729