Nevin Manimala

BMC Womens Health. 2026 Jul 13. doi: 10.1186/s12905-026-04534-8. Online ahead of print.

ABSTRACT

BACKGROUND: Tubo-ovarian abscess (TOA) is a severe complication of pelvic inflammatory disease (PID). Conservative antibiotic therapy is the preferred first-line treatment; however, treatment failure necessitates surgical intervention in a subset of patients. This study aimed to identify risk factors associated with antibiotic treatment failure in TOA through a systematic review and meta-analysis, thereby providing evidence for clinical decision-making.

METHODS: A systematic search was conducted in PubMed, Embase, the Cochrane Library and Web of Science to identify controlled studies on risk factors for antibiotic treatment failure in TOA published between database inception and December 2025. The Newcastle-Ottawa Scale was used to assess the quality of the literature. Mean differences (MDs) or odds ratios with 95% confidence intervals were calculated. Heterogeneity was assessed using the I² statistic and the Q test.

RESULTS: Thirteen studies involving 1,759 patients were included. The meta-analysis revealed that patients in the antibiotic treatment failure group were significantly older (MD = 3.61 years, P < 0.0001) and had significantly larger abscess diameters (MD = 18.43 mm, P < 0.0001) than those in the success group. Furthermore, higher gravidity (MD = 0.59, P = 0.0001) and parity (MD = 0.32, P = 0.002) were identified as significant risk factors for treatment failure. No statistically significant associations were found between treatment failure and history of smoking, history of PID, intrauterine device use, palpable pelvic mass or positive pathogen culture.

CONCLUSION: Advanced age, larger abscess diameter and multiparity are potential risk factors for antibiotic treatment failure in TOA. For such high-risk patients, more aggressive monitoring or early combined minimally invasive drainage strategies are recommended.

PMID:42443874 | DOI:10.1186/s12905-026-04534-8

BMC Oral Health. 2026 Jul 13. doi: 10.1186/s12903-026-08814-5. Online ahead of print.

ABSTRACT

BACKGROUND: Dental anxiety remains a major challenge in clinical dentistry, often preventing patients from seeking necessary treatment and compromising oral health outcomes. Although psychological scales such as Corah’s Dental Anxiety Scale are widely used to assess anxiety, objective biochemical markers could provide valuable complementary information. Opiorphin, an endogenous peptide known for its analgesic and antidepressant-like effects, has recently emerged as a potential biomarker for stress and pain regulation. However, the role of Opiorphin in dental anxiety remains largely unexplored; therefore, to the best of our knowledge, the present investigation represents an initial effort to address this gap in the literature. This study aimed to estimate salivary opiorphin levels in patients undergoing routine dental checkups and examine their correlation with anxiety levels using Corah’s Dental Anxiety Scale. Additionally, it sought to evaluate the relationship between salivary opiorphin and the established dental anxiety biomarker, salivary alpha-amylase.

METHODS: Fifty-six adult participants aged 20-60 years who reported for routine dental checkups without associated pain, systemic illness, or recent analgesic use were enrolled. Corah’s Dental Anxiety Scale was used to evaluate anxiety, and unstimulated saliva samples were collected. Opiorphin levels were quantified using a human opiorphin ELISA kit, while salivary alpha-amylase activity was determined using a human AMY1 ELISA kit.

RESULTS: A strong, statistically significant positive correlation was found between anxiety scores and salivary opiorphin levels, whereas no significant relationship was observed with salivary alpha-amylase.

CONCLUSION: These findings indicate that salivary opiorphin may serve as a novel, non-invasive biomarker for dental anxiety, offering new avenues for early detection and individualized management of anxious patients.

PMID:42443869 | DOI:10.1186/s12903-026-08814-5

BMC Musculoskelet Disord. 2026 Jul 13. doi: 10.1186/s12891-026-10204-5. Online ahead of print.

ABSTRACT

OBJECTIVE: Retrospective cohort study to evaluate the efficacy and safety of ultrasound-guided myofascial platelet-rich plasma (PRP) injection for myofascial pain syndrome (MPS)-induced chronic low back pain.

METHODS: Fifty-eight patients treated between May and December 2024 received a single ultrasound-guided PRP injection (n = 32) or two weekly normal saline injections (n = 26), and both groups underwent myofascial hydrodissection targeting trigger points in the longissimus lumborum. Pain intensity was assessed via Visual Analog Scale (VAS), functional disability by the Oswestry Disability Index (ODI). Surface electromyography (sEMG) measured neuromuscular activity through root mean square (RMS) and median frequency (MF). Statistical analyses used SPSS v.27.

RESULTS: Both groups showed significant VAS reduction at 12 weeks (p < 0.001), with greater improvement in the PRP group (r = 0.501). PRP also yielded significant ODI improvement (r = 0.611) exceeding the minimum clinically important difference. RMS values decreased markedly in the PRP group (p = 0.001) and modestly in the NS group (p = 0.006). MF demonstrated a transient decline at week 4 (p = 0.014). No adverse events occurred.

CONCLUSIONS: Ultrasound-guided myofascial PRP injection effectively reduces pain, enhances function, and modulates MTrPs activity in MPS at short-term follow-up, with good safety. These results support further randomized trials to validate the rehabilitative benefits of PRP for chronic low back pain.

PMID:42443868 | DOI:10.1186/s12891-026-10204-5

BMC Musculoskelet Disord. 2026 Jul 13. doi: 10.1186/s12891-026-10201-8. Online ahead of print.

ABSTRACT

BACKGROUND: Primaryshoulder arthroplasty is increasingly used to treat degenerative and traumatic shoulder conditions. This study aims to analyze incidence trends of primary shoulder arthroplasty in Sweden from 2008 to 2023 and to evaluate temporal changes in surgical and fixation methods, with projections for future incidence rates through 2025 and 2030.

METHODS: A retrospective, population-based study combining data from the Swedish National Patient Register (NPR) and the Swedish Shoulder Arthroplasty Register (SSAR). All patients aged ≥ 15 years undergoing primary shoulder arthroplasty between January 1, 2008 and December 31, 2023 were included. Incidence rates were calculated per 100,000 inhabitants, and regression modelling based on best fit were used to assess temporal trends and projections through 2030.

RESULTS: 28,632 primary shoulder arthroplasties were performed (women: 18,569; men: 10,063). Overall incidence increased from 13.2 to 32.7 per 100,000. Women had higher increases in absolute incidence rates (17.4 to 41.2) while men showed a greater relative increase (8.8 to 24.2). HA declined steadily, becoming the least used method. Usage of RTSA increased, becoming the most common method in individuals aged ≥ 65 years. Cemented fixation declined across both age groups.

CONCLUSION: The incidence of primary shoulder arthroplasty in Sweden more than doubled between 2008 and 2023, with a shift towards RTSA, away from HA and cemented fixation. Projections indicate continued growth through 2030.

PMID:42443864 | DOI:10.1186/s12891-026-10201-8

BMC Public Health. 2026 Jul 13. doi: 10.1186/s12889-026-28552-1. Online ahead of print.

ABSTRACT

BACKGROUND: Treatment adherence in type 2 diabetes(T2D) is essential for glycemic control and preventing complications. The aim of the present study was to determine the status of adherence behaviors to diabetes treatment and identify sociodemographic factors associated with these behaviors in patients with type 2 diabetes in southern Iran.

METHODS: This cross‑sectional study was conducted from November 2022 to January 2023 among patients with type 2 diabetes attending a diabetes clinic in Bandar Abbas. A total of 396 patients were included using systematic sampling. Data were collected using a validated researcher-made questionnaire that assessed sociodemographic characteristics and five treatment-adherence behaviors, including regular medication use, blood glucose monitoring, physician visits, dietary adherence, and physical activity. Associations between demographic and disease-related factors and the outcomes were assessed using multivariable logistic regression, and crude and adjusted odds ratios with 95% confidence intervals were reported. All statistical analyses were performed using SPSS version 24.

RESULTS: Participants (n = 396) had a mean age of 54.4 ± 11.5 years (range: 27-78). Among the treatment adherence behaviors, regular medication use showed the highest level of adherence (86.9%), while regular physical activity had the lowest level (49.7%). In the multivariable analysis, frequent medication use was associated with older age, higher education, higher economic status, and diabetes duration of 6-10 years. Frequent blood glucose monitoring was associated with female sex, older age, and diploma education. Frequent physician visits were associated with older age and longer diabetes duration. Dietary adherence was associated with university education, and frequent physical activity was associated with living alone.

CONCLUSIONS: The findings suggest that adherence to treatment among patients with T2Dvaries across different domains and is shaped by individual, social, and clinical factors. It seems that, Lifestyle behaviors such as diet and physical activity are largely influenced by social and environmental contexts, whereas healthcare‑seeking behaviors are more closely linked to disease severity and patients’ interaction with the health system.

PMID:42443860 | DOI:10.1186/s12889-026-28552-1

BMC Med Inform Decis Mak. 2026 Jul 13. doi: 10.1186/s12911-026-03711-x. Online ahead of print.

ABSTRACT

BACKGROUND: The red blood cell distribution width-to-albumin ratio (RAR), an emerging biomarker integrating inflammation and nutritional status, has not been systematically evaluated for its prognostic value in breast cancer patients admitted to intensive care units (ICU).

METHODS: We conducted a retrospective cohort study using data from the MIMIC-IV 3.1 database, including 881 adult breast cancer patients admitted to the ICU. Patients were stratified into high- and low-RAR groups based on maximally selected rank statistics. Kaplan-Meier analysis, multivariable Cox proportional hazards models, restricted cubic splines, subgroup analysis, time-dependent concordance index (C-index) curves and Boruta feature selection (iterative random forest with shadow feature comparison) were applied to assess the association between RAR and 1-year all-cause mortality. Robustness was examined using E-value and propensity score weighting methods.

RESULTS: Patients with high RAR (> 4.96) had significantly higher 1-year mortality compared to those with low RAR (log-rank P < 0.001). In adjusted models, high RAR independently predicted mortality (HR = 1.65, 95% CI: 1.33-2.06). Across the four models, E-values for the point estimates ranged from 2.18 (fully adjusted model, HR 1.65) to 2.82 (unadjusted model, HR 2.19); the E-value for the lower confidence limit of the primary model was 1.73. Each standard deviation increase in RAR was associated with a 17% higher mortality risk (HR = 1.17, 95% CI: 1.09-1.25). Restricted cubic spline analysis demonstrated a linear dose-response relationship (P for nonlinearity > 0.05). Incorporating RAR into SOFA and APS III scores improved prognostic performance (P < 0.001). Feature importance ranking further highlighted RAR as a major predictor. Sensitivity analyses using overlap-weighting (HR = 1.56, 95% CI: 1.25-1.96) and matching-weighting (HR = 1.53, 95% CI: 1.22-1.93) confirmed robustness.

CONCLUSION: RAR is an easily obtainable biomarker derived from routine laboratory testing that may enhance risk stratification for ICU-admitted breast cancer patients. Its integration into prognostic models may facilitate early decision support.

PMID:42443857 | DOI:10.1186/s12911-026-03711-x

BMC Oral Health. 2026 Jul 14;26(1):1249. doi: 10.1186/s12903-026-09151-3.

ABSTRACT

BACKGROUND: The structural integrity of teeth after endodontic retreatment depends on the amount of remaining dentin. Excessive instrumentation can weaken roots and predispose them to fracture. This study evaluated the fracture resistance of maxillary premolars following non-surgical retreatment (NS-ReT) with Retreaty and XP-endo Rise systems.

MATERIALS AND METHODS: Forty-eight maxillary first premolar roots were randomly assigned to 4 groups (n = 12); G1-NC (Negative control, non-instrumented), G2-PC (Positive control, instrumented, not obturated), G3-RETY (Retreaty), and G4-XPER (XP-endo Rise). G2, G3 and G4 groups were prepared using the iRace system. Groups G3 and G4 were obturated with gutta-percha and resin sealer. Gutta percha removal was performed using Retreaty (G3-RETY) and XP-endo Rise retreatment files (G4-XPER). All samples were subjected to fracture testing using a universal testing machine & the maximum fracture load (N) was recorded. Gutta percha removal times (Tf) and total time of retreatment were also measured. Statistical analysis was performed using a mixed-model analysis of variance (ANOVA) (α = 0.05).

RESULTS: The fracture resistance of G1-NC (942.92 ± 24.73 N) had significantly higher values compared to all other groups. Fracture values for the G2-PC (829.62 ± 71.55 N) and the G3-RETY (818.29 ± 73.14 N) did not significantly differ from each other (p = 1.000), but both were significantly higher than the G4-XPER (489.37 ± 33.47 N). The total time of retreatment was significantly reduced when using the G3-RETY (3.89 ± 0.84 min) compared to the G4-XPER (13.30 ± 2.05 min), p < .001.

CONCLUSIONS: Teeth retreated using the Retreaty instruments demonstrated superior fracture resistance compared to XP-endo Rise and their values were comparable to the positive control group. Moreover, Retreaty file system showed faster gutta-percha removal and canal preparation during retreatments.

PMID:42443856 | DOI:10.1186/s12903-026-09151-3

BMC Med Educ. 2026 Jul 13. doi: 10.1186/s12909-026-09908-y. Online ahead of print.

ABSTRACT

BACKGROUND: Nursing remains a predominantly female profession in many societies despite increasing efforts to promote gender diversity. Increasing male participation in nursing is important for workforce diversity and equity, inclusive professional representation, and strengthening healthcare delivery. Persistent societal and cultural stereotypes may influence male students’ career choices, professional identity, and commitment to the profession. However, evidence on the experiences of male nursing students in Ghana remains limited. This study assessed societal perceptions influencing male students’ choice of nursing, examined cultural beliefs shaping their perceptions of the profession, and determined self-acceptance among male nursing students at Kwame Nkrumah University of Science and Technology, Obuasi Campus, Ghana.

METHODS: A quantitative cross-sectional study was conducted in July 2025 among male Bachelor of Science Nursing students. Of 101 eligible students, a target sample of 81 was estimated using Slovin’s formula, and all available eligible students were invited to participate. Eighty completed questionnaires were analysed. Data were collected using a structured, validated questionnaire and analysed using descriptive statistics and Pearson’s chi-square tests in IBM SPSS version 26.

RESULTS: Most respondents reported that nursing was perceived in their communities as a profession for women (71.3%), while 73.8% had experienced discouragement or negative comments because they were male nursing students. Nearly half (48.8%) indicated that nursing was culturally regarded as a female profession. Societal perceptions were significantly associated with selecting nursing as a first-choice programme (χ² = 12.677, p = 0.002). Cultural perceptions were not significantly associated with students’ feelings towards nursing (χ² = 11.337, p = 0.079). Self-acceptance differed significantly across academic levels (χ² = 18.606, p = 0.005). Only 46.3% intended to practice nursing after graduation.

CONCLUSION: Societal stereotypes and cultural expectations continue to shape male students’ professional identity in nursing. Gender-inclusive education, mentorship, visible male role models, and public awareness may improve recruitment and retention. Findings should be interpreted cautiously because of the single-site, cross-sectional design and non-probability sampling.

PMID:42443850 | DOI:10.1186/s12909-026-09908-y

BMC Womens Health. 2026 Jul 13. doi: 10.1186/s12905-026-04673-y. Online ahead of print.

ABSTRACT

BACKGROUND: Chlamydia trachomatis (C. trachomatis) is a leading cause of sexually transmitted infections (STIs) in resource-limited settings. In low-income contexts such as Cameroon, the epidemiology of this bacterium remains poorly documented. This study aimed to determine the prevalence and risk factors of C. trachomatis infection among women of reproductive age in the West Region of Cameroon, and to assess the analytical performance and concordance of cryptic plasmid and major outer membrane protein (MOMP)-based real-time PCR (R-T PCR) assays.

MATERIALS AND METHODS: A cross-sectional study was conducted among 570 women of reproductive age presenting at four selected health facilities in the West Region of Cameroon. Endocervical swabs were collected and analyzed using R-T PCR targeting the MOMP and cryptic plasmid genes to detect C. trachomatis DNA. Socio-demographic, behavioral, and clinical data were recorded using a structured questionnaire. Statistical analyses were performed using SPSS version 24. Multivariable logistic regression was used to identify factors associated with C. trachomatis infection. Diagnostic performance of MOMP and cryptic plasmid R-T PCR was evaluated using Cohen’s kappa statistic and McNemar’s test, with ompA R-T PCR assay, used as the comparator.

RESULTS: The prevalence of C. trachomatis infection was 12.98%. Infection was associated with secondary education level (aOR = 7.39, [95% CI]: 2.24-24.41), Bantu ethnicity (aOR = 6.52, [95% CI]: 2.35-18.11), being a secondary school student (aOR = 3.04, [95% CI]: 1.24-7.46), lack of knowledge of transmission routes (aOR = 5.91, [95% CI]: 2.16-16.12), postcoital pain (aOR = 14.86, [95% CI]: 4.12-55.10) and history of miscarriage (aOR = 2.40, [95% CI]: 0.94-6.08).

CONCLUSIONS: Study shows that genital Chlamydia trachomatis infection was identified among women of reproductive age in the West Region of Cameroon and was associated with education level, ethnicity, occupation, limited knowledge of transmission routes, postcoital pain, and history of miscarriage. Cryptic plasmid-based R-T PCR showed acceptable diagnostic performance in this setting. These findings support strengthening sexual health education and considering the integration of C. trachomatis testing into reproductive health services in similar contexts.

PMID:42443847 | DOI:10.1186/s12905-026-04673-y

BMC Musculoskelet Disord. 2026 Jul 13. doi: 10.1186/s12891-026-10187-3. Online ahead of print.

ABSTRACT

OBJECTIVE: This study compared Hounsfield unit (HU) measurements obtained from different regions of interest (ROIs) on lumbar CT for assessing bone mineral density (BMD) and discriminating osteoporosis and thoracolumbar fragility fracture status, aiming to evaluate whether ROI selection meaningfully influences HU-based assessment.

METHODS: Five HU measurement methods were evaluated using lumbar CT. Their correlations with dual-energy X-ray absorptiometry (DEXA)-derived BMD and their discriminative performance for osteoporosis and thoracolumbar fragility fracture status were analyzed. Receiver operating characteristic (ROC) curves were constructed, and pairwise comparisons of areas under the curve (AUCs) were performed using the DeLong test. A sensitivity analysis was additionally conducted after excluding substituted vertebral levels and recalculating mean lumbar HU using only non-substituted vertebrae.

RESULTS: All five HU measurement methods showed significant correlations with DEXA-derived BMD, and no statistically significant differences in discriminative performance were observed among the five ROI methods in the primary analysis. In the sensitivity analysis excluding substituted vertebral levels, the AUCs remained comparable across methods for osteoporosis (0.816-0.826) and thoracolumbar fragility fracture status (0.677-0.689), with all pairwise DeLong tests showing no statistically significant differences (all p > 0.05).

CONCLUSION: Different lumbar CT ROI methods demonstrated comparable performance in assessing BMD and discriminating thoracolumbar fragility fracture status, and sensitivity analysis confirmed that exclusion of substituted vertebral levels did not materially affect the results. No ROI method showed statistically significant superiority, suggesting that ROI selection may be guided by clinical feasibility and workflow convenience rather than by diagnostic performance alone.

ADVANCES IN KNOWLEDGE: This study compares five commonly used lumbar CT HU measurement methods and shows that their performance is broadly similar. The findings suggest that ROI selection may be guided primarily by clinical feasibility and workflow convenience, although further external validation is required before routine clinical application.

PMID:42443845 | DOI:10.1186/s12891-026-10187-3