Nevin Manimala

BMC Med. 2025 Jun 9;23(1):338. doi: 10.1186/s12916-025-04162-3.

ABSTRACT

BACKGROUND: Adenomyosis is associated with lower implantation and higher miscarriage rates. Studies on recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF) have shown that endometrial immune cell populations play a crucial role during implantation and early pregnancy. In women with adenomyosis, improved pregnancy outcomes following assisted reproductive technologies (ART) and pre-treatment with GnRH-agonists (GnRH-a) prior to frozen embryo transfer (FET) have been reported. We aimed to compare the endometrial immune cell populations of women with adenomyosis to those of women with RPL and RIF, and to characterise endometrial leucocyte subpopulations within the adenomyosis group before and after GnRH-a.

METHODS: We conducted a prospective study between 2021 and 2024. Women with infertility and adenomyosis undergoing ART underwent one endometrial biopsy 6-9 days after oocyte retrieval and a second biopsy after 3 months of GnRH-a prior to FET. Women in the RPL and RIF groups underwent one endometrial biopsy in the midluteal phase. We performed flow cytometry (FC) to characterise immune cell populations and immunohistochemistry (IHC) to analyse uterine natural killer cells (uNKs) and plasma cells (PC). The Kruskal-Wallis test was used for comparisons between the study groups, and the Wilcoxon signed rank tests were used for paired samples before and after GnRH-a.

RESULTS: Endometrial leucocyte subpopulations at baseline showed no significant differences between the adenomyosis (n = 20), the RPL (n = 40) and RIF (n = 15) group. In the adenomyosis group, following GnRH-a, we observed a significant decrease in the percentage of monocytes, from 77% (IQR 71, 82) to 71% (IQR 65, 75) (adj. p = 0.030). Baseline IHC showed elevated plasma cell concentrations (≥ 5/mm²) in 1/20 adenomyosis patients (5%), 4/40 RPL patients (10%) and 1/15 RIF patients (6.7%) while uNK cells were elevated (≥ 300/mm²) in 8/20 adenomyosis patients (40%), 11/40 RPL patients (27.5%) and 1/15 RIF patients (6.7%).

CONCLUSIONS: Women with infertility and adenomyosis showed a similar endometrial immune profile as women with RPL and RIF. The beneficial effect of GnRH-a prior to FET in women with adenomyosis may be mediated through effects on monocyte subpopulations. Based on the high prevalence of elevated uNK cells in patients with adenomyosis, we suggest testing women with adenomyosis undergoing ART before FET.

PMID:40484943 | DOI:10.1186/s12916-025-04162-3

Malar J. 2025 Jun 8;24(1):181. doi: 10.1186/s12936-025-05288-8.

ABSTRACT

BACKGROUND: It remains unclear how household structure and practices can contribute to Uganda’s goal of becoming a malaria-free nation by 2040. Effective malaria prevention and control require the implementation of measures such as long-lasting insecticidal nets, indoor residual spraying (IRS), treatment with artemisinin-based combination therapy (ACT), maintaining suitable housing structures, and practicing environmental management at the household level. This study examines household structure and practices related to malaria prevalence in children under five years old, as well as prevention and control efforts across five districts in Northern Uganda.

METHODS: A cross-sectional survey was conducted in five districts (Gulu, Omoro, Amuru, Pader, and Lamwo) from November 2022 to March 2023 to assess malaria prevalence, prevention practices, and health-seeking behaviours. Data were collected using rapid diagnostic tests for Plasmodium falciparum, observational checklists, and pre-tested questionnaires, with analysis performed using IBM SPSS Statistics.

RESULTS: The survey included 597 households and 4524 individuals, with 25.6% being children under five years of age. Of 1157 children under five, 597 (51.6%) were tested, revealing RDT positive prevalence of 44.1%. Most households had over seven members, with an average of 3.69 people per bed net. While 77.6% of households owned mosquito nets, visual inspection revealed 70.2% were torn, and only 48.7% of individuals slept under a net the night before the survey. IRS coverage was low, with 97.7% of households not sprayed in the last three months. Health-seeking behaviour predominantly involved government health centers. Housing structures, particularly mud/clay walls and grass-thatched roofs, were significantly associated with higher malaria prevalence (p < 0.001). Were their enough untreated nets?

CONCLUSION: A high prevalence of malaria was observed in children under five years old. This was closely linked to the poor use of bed nets, low coverage of IRS, and inadequate housing structures, which primarily consisted of grass-thatched roofs and mud or clay walls. The study highlights the urgent need for improved housing, IRS, and consistent use of insecticide-treated nets to reduce malaria prevalence.

PMID:40484941 | DOI:10.1186/s12936-025-05288-8

Infect Dis Poverty. 2025 Jun 9;14(1):44. doi: 10.1186/s40249-025-01317-5.

ABSTRACT

BACKGROUND: Dengue is a major global health threat with varied clinical manifestations across age groups, countries, and regions. This study aims to estimate global dengue disability weights (DWs) based on clinical manifestations data and examine variations across different demographics and geographical areas. These findings will inform public health strategies and interventions to reduce the global burden of dengue.

METHODS: We conducted a systematic search across six databases (Scopus, Web of Science, PubMed, China National Knowledge Infrastructure, Wanfang Data, and Database of Chinese sci-tech periodicals) for studies on human dengue clinical manifestations or infection from the establishment of each database through December 31, 2023. DWs were estimated by combining clinical manifestations frequencies with corresponding DW values derived from the Global Burden of Disease (GBD) study, using Monte Carlo simulations to generate uncertainty intervals. Odds ratios (ORs) with 95% confidence intervals (CI) and Chi-square tests were performed to compare clinical manifestations between adults and children.

RESULTS: A total of 35 adult studies (7109 cases) and 17 pediatric studies (2996 cases) were analysed. Adults had higher rates of muscle pain (OR = 9.18; 95% CI: 8.17-10.33) and weak (OR = 4.95; 95% CI 4.12-5.98). Children showed higher frequencies of decreased appetite (OR = 0.12; 95% CI: 0.11-0.14) and lymphadenectasis (OR = 0.04; 95% CI: 0.03-0.06). Severe dengue was more prevalent in children (8.2%) than adults (4.6%). The global DW for universal dengue was 0.3258 in adults and 0.4022 in children, with Indian children showing the highest DW for severe dengue (0.6991) and Chinese adult showing the highest DW for severe dengue (0.7214). Regionally, most studies were from South and Southeast Asia, with India contributing the largest number of publications (80 articles). Additionally, India had the highest dengue disease burden in 2021 (352,468.54 person-years).

CONCLUSIONS: These findings reveal important age and regional differences in dengue disease burden. There is a relative lack of research on dengue clinical manifestations in several high-burden countries in the Americas, and these gaps may affect the comprehensiveness and accuracy of global dengue disability weight estimates. These highlight the urgent need for targeted interventions and optimized resource allocation to mitigate its global impact.

PMID:40484939 | DOI:10.1186/s40249-025-01317-5

BMC Womens Health. 2025 Jun 8;25(1):285. doi: 10.1186/s12905-025-03841-w.

ABSTRACT

SYNOPSIS: Health inequalities intensified, burden shifting to low-resource regions despite preventive advancements. HPV and screening rates diverged by SDI, highlighting coverage gaps. Screening and vaccination inversely linked to disease burden, underscoring critical efficacy. Innovative modeling exposed disparities, advocating SDI-stratified interventions.

OBJECTIVE: This study analyzes global and regional cervical cancer trends (1990-2021) across different Socio-Demographic Index (SDI) levels, highlighting health inequalities, assessing the impact of HPV vaccination and screening, and modeling future trends. The findings aim to inform targeted prevention policies, reduce regional disparities, and promote global health equity.

METHODS: Data were sourced from the Global Burden of Disease study 2021(GBD 2021), OECD, and WHO. The focus was on incidence and disability-adjusted life years (DALYs) of cervical cancer. Time trends were analyzed by SDI regions, alongside health inequality assessments. Correlation analyses examined links between screening rates, HPV vaccination coverage, and disease burden.

RESULTS: From 1990 to 2021, global age-standardized incidence rate and age-standardized DALYs rates declined significantly, with estimated annual percentage changes (EAPC) of -0.54% (95% CI: -0.63 to -0.44) and – 1.27% (95% CI: -1.36 to -1.18). However, significant differences exist in specific patterns of change across SDI regions: exhibited an upward incidence trajectory. From 1990 to 2021, the burden of cervical cancer disease shifted from developed to less developed regions. Correlation analysis showed negative associations between screening rates and DALYs (r = -0.56, p < 0.01) and between vaccination coverage and incidence (r = -0.35, p < 0.01).

CONCLUSION: Although the global cervical cancer burden has decreased, significant regional disparities remain. Future policies should focus on tailored interventions, with low-resource regions strengthening healthcare infrastructure and implementing minimum effective preventive measures, while high-SDI regions shift to precision public health approaches. Policymakers must also incorporate culturally sensitive health education to address social barriers, challenge misconceptions, and empower communities, ultimately reducing preventable cervical cancer morbidity.

PMID:40484937 | DOI:10.1186/s12905-025-03841-w

BMC Med. 2025 Jun 9;23(1):344. doi: 10.1186/s12916-025-04187-8.

ABSTRACT

BACKGROUND: Dietary guidelines recommend replacing saturated fatty acid with unsaturated fats, particularly polyunsaturated fatty acids. Cohort studies do not suggest a clear benefit of higher intake of polyunsaturated fatty acids but, in contrast, higher circulating linoleic acid (LA) levels-reflective of dietary LA intake, are associated with a reduced risk of type 2 diabetes. However, genetic variants in the fatty acid desaturase 1 gene (FADS1) may influence individual responses to plant-based fats. We explored whether FADS1 variants influence the relationships of LA and α-linolenic acid (ALA) intakes and nut consumption with plasma phospholipid fatty acid profiles and type 2 diabetes risk in a large-scale cohort study and a randomized controlled trial.

METHODS: In the EPIC-InterAct case-cohort (7,498 type 2 diabetes cases, 10,087 subcohort participants), we investigated interactions of dietary and plasma phospholipid fatty acids and nut consumption with FADS1 rs174547 in relation to incident type 2 diabetes using weighted Cox regression. In PREDIMED (492 participants in the Mediterranean Diet + Nuts intervention group, 436 participants in the control group), we compared changes in plasma phospholipid FAs from baseline to year 1.

RESULTS: In EPIC-InterAct and PREDIMED, nut consumption was positively associated with LA plasma levels and inversely with arachidonic acid, the latter becoming stronger with increasing number of the minor rs174547 C allele (p interaction EPIC-InterAct: 0.030, PREDIMED: 0.003). Although the inverse association of nut consumption with diabetes seemed stronger in participants with rs174547 CC-genotype (HR: 0.73, 95% CI: 0.54-1.00) compared with CT (0.94, 0.81-1.10) or TT (0.90, 0.78-1.05) in EPIC-InterAct, this interaction was not statistically significant.

CONCLUSIONS: FADS1 variation modified the effect of nut consumption on circulating FAs. We did not observe clear evidence that it modified the association between nut consumption and type 2 diabetes risk.

PMID:40484934 | DOI:10.1186/s12916-025-04187-8

BMC Oral Health. 2025 Jun 8;25(1):943. doi: 10.1186/s12903-025-06332-4.

ABSTRACT

BACKGROUND: Oral hygiene behavior has been increasingly recognized as a potential contributor to chronic disease prevention. This scoping review aimed to synthesize existing evidence on the associations between tooth brushing behavior (as a proxy for oral hygiene) and major chronic health outcomes, including cardiovascular events (e.g., myocardial infarction, atrial fibrillation, heart failure), stroke (ischemic, hemorrhagic, and subarachnoid), hypertension (HTN), metabolic syndrome (MetS), and chronic kidney disease (CKD).

METHODS: A comprehensive literature search was conducted using four databases: Ovid-MEDLINE, EMBASE, CINAHL, and the Cochrane Library. The study selection process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Two reviewers independently screened and selected eligible studies and extracted relevant data. A total of 142 full-text articles were assessed for eligibility.

RESULTS: Twenty-one studies were included in the final review. Most studies reported that a lower frequency of tooth brushing was associated with a higher risk of cardiovascular events, stroke, HTN, MetS, and CKD. Additionally, several studies suggested that maintaining good oral hygiene in individuals with HTN or diabetes mellitus (DM) may be associated with a reduced risk of cardiovascular complications.

CONCLUSION: Frequent tooth brushing, as a key component of oral hygiene, may be associated with a reduced risk of several chronic health outcomes, particularly cardiovascular and metabolic diseases. However, the current body of evidence is predominantly based on observational studies. Further longitudinal and interventional research is warranted to clarify the directionality and potential causal pathways linking oral hygiene behavior to systemic health outcomes.

PMID:40484932 | DOI:10.1186/s12903-025-06332-4

BMC Med. 2025 Jun 9;23(1):342. doi: 10.1186/s12916-025-04190-z.

ABSTRACT

BACKGROUND: Early diagnosis of low ejection fraction (EF) remains challenging despite being a treatable condition. This study aimed to evaluate the effectiveness of an electrocardiogram (ECG)-based artificial intelligence (AI)-assisted clinical decision support tool in improving the early diagnosis of low EF among inpatient patients under non-cardiologist care.

METHODS: We conducted a pragmatic randomized controlled trial at an academic medical center in Taiwan. 13,631 inpatient patients were randomized to either the intervention group (n = 6,840) receiving AI-generated ECG results or the control group (n = 6,791) following standard care. The primary outcome was the incidence of newly diagnosed low EF (≤ 50%) within 30 days following the ECG. Secondary outcomes included echocardiogram utilization rates, positive predictive value for low EF detection, and cardiology consultation rates. Statistical analysis included hazard ratios (HR) with 95% confidence intervals (CI) for time-to-event outcomes and chi-square tests for categorical variables.

RESULTS: The intervention significantly increased the detection of newly diagnosed low EF in the overall cohort (1.5% vs. 1.1%, HR 1.50, 95% CI: 1.11-2.03, P = 0.023), with a more pronounced effect among AI-identified high-risk patients (13.0% vs. 8.9%, HR 1.55, 95% CI: 1.08-2.21). While overall echocardiogram utilization remained similar between groups (17.1% vs. 17.3%, HR 1.00, 95% CI: 0.92-1.09), the intervention group demonstrated higher positive predictive value for identifying low EF among patients receiving echocardiogram (34.2% vs. 20.2%, p < 0.001). Post-hoc analysis revealed increased cardiology consultation rates among high-risk patients in the intervention group (29.3% vs. 23.5%, p = 0.027).

CONCLUSIONS: Implementation of an AI-ECG algorithm enhanced the early diagnosis of low EF in the inpatient setting, primarily by improving diagnostic efficiency rather than increasing overall healthcare utilization. The tool was particularly effective in identifying high-risk patients who benefited from increased specialist consultation and more targeted diagnostic testing.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05117970.

PMID:40484925 | DOI:10.1186/s12916-025-04190-z

BMC Health Serv Res. 2025 Jun 9;25(1):814. doi: 10.1186/s12913-025-12874-8.

ABSTRACT

BACKGROUND: Since August 2017, approximately 960,000 Rohingya refugees have settled in Cox’s Bazar, Bangladesh. Water, sanitation, and hygiene (WASH) infrastructure and programs were implemented across the camps to address the needs of the population and reduce the burden of linked infectious diseases. However, monitoring and maintenance of this infrastructure has been inconsistent. This study aimed to assess progress in WASH in the camps of Cox’s Bazar since the early emergency phase in 2018, and to update the priorities for intervention.

METHODS: From January to March 2022, a lot quality assurance sampling (LQAS) survey was conducted across 19 camps. Nineteen households were randomly selected per camp. Data on access to and quality of WASH services, household practices, and health outcomes including skin infections among children under five years of age were collected. Crude and weighted averages with 95% confidence intervals were calculated for each indicator and compared with targets pre-defined based on Sphere guidelines and Médecins Sans Frontières WASH experts. Chi-squared tests were used to compare the results to a 2018 LQAS survey.

RESULTS: More than half of the indicators (59%; 16/27) did not meet the pre-determined targets. Performance was adequate on three of five water quality and supply indicators, with less than half of households (44%, 95% CI: 39-49%) reporting that water was continuously available in the past week. Regarding water storage, performance on three indicators was considered adequate, as the proportion of households that keep water for less than one day was 27% (95% CI: 23-32%). Of six hygiene indicators, adequate performance was identified for only one. Performance on the sanitation indicators was inadequate, with 11% (95% CI: 8-15%) of households using an improved sanitation facility. In solid waste management, two of four indicators suggested adequate performance, and for health outcomes, the proportion of children who hadn’t shown any skin infection was inadequate at 69% (95% CI: 64-73%).

CONCLUSIONS: Improvements in the WASH situation in Cox’s Bazar have been observed in 2022 compared to 2018. However, significant gaps remain in water supply, sanitation facilities, and hygiene services. LQAS can be an effective monitoring tool to support long-term multisectoral interventions in protracted emergencies.

PMID:40484924 | DOI:10.1186/s12913-025-12874-8

Int Wound J. 2025 Jun;22(6):e70703. doi: 10.1111/iwj.70703.

ABSTRACT

High specification mattresses periodically redistribute pressure using alternating air cells, offloading tissues. This study aimed to evaluate the effects of alternating air pressure gradients on sacral tissue physiology. This randomised cross-over study recruited 15 healthy participants to test the three mattress settings (fast cycle, normal cycle, and slow cycle). Participants were asked to adopt supine, lateral, and high sitting (head of bed at 40°) postures, whilst transcutaneous tissue gas tensions and interface pressures at the sacrum were continuously monitored. Comparison between mattress settings and postures showed no statistical difference (p > 0.05) between peak pressure index values at the sacrum for each air inflation cycle speed setting. By contrast, a significantly higher sacral (p < 0.05) contact area was observed for high sitting. During high sitting, ischemic responses during both fast and normal air inflation cycle speed settings were recorded. During the slow air inflation cycle speed, most participants (60%-100%) showed high levels of perfusion. The present study identified a main effect of posture on interface pressure and perfusion over the sacrum. The alternating mattress speed influenced local tissue perfusion, with the greatest changes in tissue oxygenation occurring in a high-speed setting.

PMID:40484907 | DOI:10.1111/iwj.70703

World J Urol. 2025 Jun 8;43(1):364. doi: 10.1007/s00345-025-05734-x.

ABSTRACT

BACKGROUND: Urinary tract stone disease is quite common in the population, and treatment modalities are constantly evolving. Technological advancements in endourology have led to a shift towards more minimally invasive treatments. Nowadays, robotic flexible ureteroscopy is becoming increasingly popular, showing promising results. This systematic review and meta-analysis aimed to evaluate the outcomes of robotic flexible ureteroscopy.

MATERIALS AND METHODS: We conducted a systematic review in the PubMed, Scopus and Web of Science databases based on the 2020 Preferred Reporting Items for Systematic Review and Meta-Analyses guideline. Study protocol was registered at PROSPERO (CRD420251017383). All robotic flexible studies published until April 2025, which defined and provided the stone-free rate, were included. To assess surgical efficacy and reliability, stone size, operation time, and complications were also evaluated. Stone size was measured in a one-dimensional manner, based on the maximum length.

RESULTS: A total of 320 studies were initially identified, with 11 full-text articles meeting the inclusion criteria, involving 656 patients and 660 renal units. The analysis included data from various robotic systems, including the Roboflex Avicenna, ILY, Senhance, and MONARCH platforms. The mean pooled stone-free rate was 86.0%, with a range from 57.7 to 96.5%, indicating variability across studies. The use of a random-effects model was justified by the presence of moderate-to-substantial heterogeneity across studies (I² = 63.5%, τ² = 0.627), and a statistically significant Q-test (p = 0.0022). The studies defined stone-free status as either complete stone clearance or residual fragments smaller than 2 mm.

CONCLUSION: The analysis suggests that robotic URS is an effective and feasible treatment option for selected patients with urinary stones. Future research should focus on standardized reporting, comparative effectiveness studies, and cost-benefit analyses, while also addressing surgeon-centered outcomes such as ergonomic strain and musculoskeletal pain, to better define the role of robotic technology in endourological practice.

PMID:40484898 | DOI:10.1007/s00345-025-05734-x