Nevin Manimala

BMC Oral Health. 2026 May 25. doi: 10.1186/s12903-026-08639-2. Online ahead of print.

ABSTRACT

BACKGROUND: Additive manufacturing of cobalt-chromium (Co-Cr) and titanium (Ti-6Al-4 V) alloys is increasingly used in prosthetic dentistry. Acidic oral environments associated with gastroesophageal reflux disease (GERD) may negatively influence the surface integrity and corrosion resistance of dental materials. This in vitro study assessed the effects of simulated gastric acid on the corrosion resistance, surface morphology, and topographical changes of selective laser melting (SLM) Co-Cr and Ti-6Al-4 V alloys.

METHODS: Thirty-two additively manufactured specimens (n = 16 per alloy) were randomly distributed into acidic (pH 1.2) and neutral control (pH 6.7 distilled water) subgroups (n = 8). A cyclic static immersion protocol was used to simulate GERD-related acid exposure. Specimens in the acidic group were immersed for 2 min in acidic solution, rinsed without scrubbing to preserve the delicate surface topography, and stored in distilled water at 37 °C, repeated six times daily over nine days with a 24-hour interval maintained between each daily cycle. Control specimens were stored continuously in distilled water at 37 °C. Surface morphology, elemental composition, and topography were evaluated using scanning electron microscopy (SEM) and Abbott-Firestone curve analysis.

RESULTS: In the Co-Cr alloy, immersion in an acidic solution resulted in a decrease in the percentage of all elements, except O, which increased to 6.37 ± 1.77%, with the change being statistically significant (P ≤ 0.05). In contrast, Ti-6Al-4 V also showed a decrease in all elements after immersion, with O rising to 2.26 ± 1.22%, although no changes were statistically significant (P ≥ 0.05). SEM images indicated more oxide deposits on Co-Cr in an acidic solution, which also showed a notable increase in surface roughness, whereas Ti-6Al-4 V exhibited greater stability. The Abbott-Firestone analysis further confirmed that Co-Cr underwent more significant changes in peak formation and exploitation zones than Ti-6Al-4 V did in acidic environments.

CONCLUSIONS: Under simulated gastric acid exposure, Ti-6Al-4 V alloys exhibited superior corrosion resistance and surface stability compared with Co-Cr alloys. These findings support the clinical preference for Ti-6Al-4 V in dental restorations for patients experiencing frequent acidic challenges, such as those with severe GERD.

PMID:42178550 | DOI:10.1186/s12903-026-08639-2

BMC Public Health. 2026 May 25. doi: 10.1186/s12889-026-27841-z. Online ahead of print.

ABSTRACT

BACKGROUND: Female genital mutilation (FGM) and child marriage (CM) remain pervasive in Ethiopia, driven by entrenched social norms, gender inequalities, and economic factors. Despite legal prohibition, national prevalence stands at 65% for FGM and 40% for CM. In response, Population Media Center (PMC) collaborated with the United Nations Population Fund (UNFPA) to implement a multimedia social and behavior change (SBC) intervention to raise awareness, shift attitudes and norms, and reduce the practice of FGM and CM in 4 targeted woredas of southern Ethiopia. This mixed-method study evaluates if and how the intervention was associated with changes in knowledge, attitudes, social norms, and practices related to FGM and CM.

METHODS: A mixed-methods evaluation was conducted in May 2025 using a comparative cross-sectional survey and qualitative interviews. A total of 403(205 exposed and 198 unexposed) survey participants were selected through systematic random sampling. For the qualitative components, 70 participants were purposively selected: 62 participants across 8 focus group discussions and 8 individual in-depth interviews. Respondents were categorized by exposure to the PMC multimedia intervention. Differences in knowledge, attitudes, behavioral intentions, social norms, and practices related to FGM and CM were analyzed. Chi-square tests determined statistical significance (p < 0.05), and quantitative insights were triangulated with qualitative insights.

RESULTS: Of 403 survey participants (205 exposed; 198 non-exposed; 73.7% female), the exposed group demonstrated significantly higher awareness about FGM and CM (93.2% vs. 84.6%, p < 0.001), stronger anti-FGM attitudes (90.2% vs. 81.4%, p = 0.014), and stronger anti-CM attitudes (83.4% vs. 78.1%, p < 0.001) compared to non-exposed participants. Total prevalence was 32.7% for FGM and 4.9% for CM. Qualitative data revealed that FGM persists covertly; families bypass legal restrictions by temporarily relocating girls to other villages for secret procedures. Despite high levels of awareness, deeply rooted sociocultural norms, marriageability myths, economic factors, social acceptability, and religious beliefs continue to perpetuate both practices.

CONCLUSION: Exposure to PMC multimedia SBC engagement was associated with significant differences in awareness and attitudes. However, the continued practice of FGM through covert means underscores the power of interlinked sociocultural and religious norms. Accelerating the abandonment of FGM and CM requires scaling community dialogues, empowering girls and young people, fostering intergenerational dialogue, coordinating stakeholder efforts, and strengthening legal enforcement to move beyond individual attitude shifts toward collective social norm change.

PMID:42178547 | DOI:10.1186/s12889-026-27841-z

BMC Surg. 2026 May 25. doi: 10.1186/s12893-026-03861-9. Online ahead of print.

ABSTRACT

The present study aimed to investigate the efficacy of indocyanine green (ICG) fluorescence-guided laparoscopic hepatectomy for the treatment of liver metastases. Therefore, data from patients with liver metastases who underwent laparoscopic hepatectomy were retrospectively collected. A total of 69 patients were divided into the ICG group (fluorescence-guided) and conventional group, with 24 well-matched pairs analyzed after propensity score matching. Laparoscopic hepatectomy was successfully performed in all patients.The ICG group had significantly wider surgical margins than the conventional group (1.73 ± 0.57 cm vs. 1.04 ± 0.44 cm; P < 0.001). Pre-matching R0 resection rates were 91.9% (ICG) and 90.6% (conventional), with 100% R0 resection achieved in both groups post-matching. Operative time, intraoperative blood loss and postoperative ALT levels were numerically lower in the ICG group without statistical significance. The rates of overall/severe (Clavien-Dindo ≥IIIa) complications and 6-month recurrence were comparable between the two groups (all P > 0.05). In conclusion, ICG fluorescence-guided laparoscopic hepatectomy is safe and feasible for liver metastases, yielding significantly wider surgical margins. Although perioperative outcomes and 6-month recurrence rates were comparable between groups after matching, the ICG-guided approach achieved significantly wider surgical margins-a finding with potential implications for long-term oncological outcomes that warrant further investigation.

PMID:42178544 | DOI:10.1186/s12893-026-03861-9

BMC Neurol. 2026 May 25. doi: 10.1186/s12883-026-05010-4. Online ahead of print.

ABSTRACT

BACKGROUND: Intracerebral hemorrhage (ICH) is associated with poor prognosis, characterized by high acute mortality and long-term disability. Real-time risk stratification using dynamic biomarkers is urgently needed to improve patient outcomes. This study aimed to explore the association between temporal changes in the hemoglobin-to-red blood cell distribution width ratio (HRR) and in-hospital all-cause mortality in patients with ICH.

METHODS: We retrospectively analyzed 2,447 ICH patients from MIMIC-IV and externally validated findings in 3,142 patients from eICU. Cox regression analyzed the association between HRR (baseline and daily dynamic values) and in-hospital mortality. Restricted cubic spline (RCS) models assessed the non-linear relationship between baseline HRR and in-hospital mortality. An optimal baseline HRR cutoff for risk stratification was identified using the maximally selected log-rank statistic and subsequently externally validated. Pearson correlation analysis was applied to evaluate associations between daily HRR and in-hospital mortality, and receiver operating characteristic (ROC) curves were used to examine the time-specific predictive performance of serial HRR values.

RESULTS: HRR exhibited a consistent inverse association with in-hospital all-cause mortality in both cohorts. In fully adjusted Cox models, continuous baseline HRR was associated with lower mortality risk (HR approximately 0.51 in both cohorts), and the highest HRR quartile was associated with a reduced mortality risk compared with the lowest quartile. Both survivors and non-survivors showed progressive HRR declines during 14-day hospitalization. Non-survivors had more pronounced declines (daily reduction approximately 0.017 vs. 0.014 in MIMIC-IV; P for trend difference < 0.001) and consistently lower HRR levels at all time points. Daily HRR was inversely correlated with mortality throughout hospitalization (adjusted HRs < 1.0, P < 0.05), with the strength of this inverse association increasing notably from Day 1 (r = -0.141) to Day 4 (r = -0.225). HRR demonstrated predictive performance comparable to Hb and RDW across time points. In the MIMIC-IV test set, all indicators presented a temporal upward trend within the initial few days, with AUCs reaching 0.631 (HRR), 0.594 (Hb) and 0.630 (RDW) at Day 1, and 0.663, 0.632 and 0.645 at Day 3, respectively. Calibration curves revealed poor predictive performance with overestimation of mortality risk. A baseline HRR cutoff of ≤ 0.74 identified high-risk patients, who had significantly higher mortality (25.14% vs. 12.93% in MIMIC-IV; 17.64% vs. 12.72% in eICU, all P < 0.001).

CONCLUSIONS: This study preliminarily suggests that temporal changes in HRR are associated with in-hospital all-cause mortality in ICH patients. HRR may serve as a complementary dynamic prognostic marker with predictive performance comparable to Hb and RDW, though its utility is limited by poor calibration. Further prospective validation in dedicated ICH cohorts with severity and imaging data is warranted, and future studies should consider underlying diseases and inflammatory status.

PMID:42178542 | DOI:10.1186/s12883-026-05010-4

BMC Pregnancy Childbirth. 2026 May 25. doi: 10.1186/s12884-026-09333-5. Online ahead of print.

ABSTRACT

BACKGROUND: The placenta and umbilical cord play a crucial role in fetal growth, development, and neonatal survival. Although extensively studied in developed countries, quantitative data on placental and umbilical cord morphology in preeclampsia are scarce in Ghana. This study aimed to assess the gross morphometry of preeclamptic placentae and umbilical cords and their relationship with neonatal indices.

METHOD: A cross-sectional study was conducted on 152 freshly delivered placentae (100 normotensive; 52 preeclamptic) at the Holy Family Hospital, Berekum, Ghana. Maternal data collected included age, parity, blood pressure, and occupation. Standard anthropometric techniques were used for placental and umbilical cord measurements after they were fixed with 10% neutral buffered formalin. Statistical analyses included t-test, Chi-square, and Spearman correlation, with significance set at p < 0.05.

RESULTS: Placental and umbilical cord indices differed significantly between preeclamptic and normotensive groups, except for cord length. Moderate to strong correlations were observed between placental and cord indices and neonatal outcomes, but not with neonatal length. Placentae were more often oval, and cords were eccentrically inserted in preeclamptic births compared to normotensive births.

CONCLUSIONS: Preeclampsia is associated with altered placental and umbilical cord morphology and reduced neonatal growth indices. These findings provide baseline data to support multidisciplinary strategies for improved management and pregnancy outcomes in Ghana.

PMID:42178540 | DOI:10.1186/s12884-026-09333-5

BMC Med Educ. 2026 May 25. doi: 10.1186/s12909-026-09437-8. Online ahead of print.

ABSTRACT

BACKGROUND: The dental pulp is a vital tissue integral to tooth vitality and endodontic health. However, awareness and comprehension of pulpal functions among preclinical dental students remain inadequately characterized. Understanding baseline knowledge and attitudes in early dental education can inform pedagogical improvements in oral histology and foundational endodontic instruction. The study evaluates the awareness, knowledge, attitudes, and learning practices related to dental pulp and its functions among preclinical undergraduate dental students.

METHODS: A descriptive cross-sectional study was conducted among 225 preclinical (first and second-year) undergraduate dental students from multiple dental institutions. A validated 20-item structured questionnaire comprising four sections; demographics, knowledge assessment with 6 multiple-choice items, attitude evaluation using 5-point Likert scale with 6 items, and learning practice assessment with 5 items was administered via Google Forms. Data were analyzed using descriptive statistics, frequency distributions, percentages, and comparative analysis between academic years using chi-square and independent t-tests.

RESULTS: Second-year students demonstrated significantly higher knowledge accuracy (61.8%) compared to first-year students (38.2%, p < 0.05). The majority of students (92.4%) correctly identified mastication as a non-function of pulp, and 67.6% recognized A-delta fibers as responsible for sharp, localized pain. However, knowledge gaps were identified: 29.3% of students incorrectly attributed odontoblast function to enamel formation, and only 61.9% understood the physiological constraints limiting pulpal healing capacity. Attitude assessment revealed strong positive perception (mean Likert scores 3.16-4.37), with highest endorsement for understanding pulp structure (4.37) and learning pulp for endodontics (4.25). Exam-driven learning behavior was predominant (57.3%), while visual learning modalities were preferred (33.3% favored videos/3D models and 32.9% preferred textbook reading).

CONCLUSIONS: While preclinical students demonstrate commendable foundational understanding of pulpal anatomy and core functions, specific knowledge gaps and exam-centric learning patterns point the need for enhanced pedagogical approaches. Integration of visual aids, clinically relevant case-based learning, active learning modalities, and structured early clinical correlation could strengthen conceptual understanding and foster deeper engagement with pulp biology, ultimately enhancing preparedness for clinical endodontic practice.

PMID:42178531 | DOI:10.1186/s12909-026-09437-8

BMC Cardiovasc Disord. 2026 May 25. doi: 10.1186/s12872-026-06026-x. Online ahead of print.

ABSTRACT

BACKGROUND: There is a limited body of research examining the association between long COVID and major adverse cardiovascular events (MACE) as well as all-cause mortality. This study aimed to investigate the association between long COVID and both MACE and mortality.

METHODS: This retrospective cohort study utilized multicenter real-world data from the TriNetX research network platform, which contains electronic health records from multiple healthcare organizations. Patients aged 18 years and older who were diagnosed with COVID-19 between 2020 and 2023 were included. The exposure group comprised individuals diagnosed with long-COVID within 3 to 6 months after their initial COVID-19 diagnosis, while the comparison group included COVID-19 patients without a diagnosis of long-COVID. The primary outcomes were the risk of major adverse cardiovascular events (MACE) and all-cause mortality. Follow-up commenced 90 days after the index date and continued until the occurrence of the study outcome or the date of the last available medical record.

RESULTS: The risk of MACE was markedly higher in the long-COVID cohort compared to the non-long-COVID cohort. The overall hazard ratio (HR) for MACE was 4.48 (95% CI: 3.95-5.07). Specific conditions such as coronary artery disease and stroke exhibited particularly high HRs, at 6.48 (5.29-7.95) and 3.46 (2.96-4.04) respectively. Mortality was significantly higher in the long-COVID group, with an HR of 1.53 (1.38-1.69).

CONCLUSIONS: Compared to patients without long COVID, patients with long COVID had a higher risk of developing MACE.

PMID:42178526 | DOI:10.1186/s12872-026-06026-x

BMC Cardiovasc Disord. 2026 May 25. doi: 10.1186/s12872-026-06001-6. Online ahead of print.

ABSTRACT

BACKGROUND: Recurrence after first radiofrequency catheter ablation remains common in patients with non-valvular persistent atrial fibrillation. Cardiovascular-kidney-metabolic burden may contribute to atrial remodeling and adverse ablation outcomes, but its relationship with post-ablation recurrence and downstream atrial substrate markers remains incompletely understood.

METHODS: We retrospectively enrolled 730 patients with non-valvular persistent atrial fibrillation who underwent first-time radiofrequency catheter ablation. Cardiac, kidney, and metabolic domains were integrated into a weighted cardiovascular-kidney-metabolic burden score, and patients were stratified by tertiles. Sequential Cox regression models were constructed to evaluate the association between burden and recurrence after adjustment for clinical characteristics and downstream atrial substrate markers, including left atrial diameter, log(BNP), and fine f-wave. Model discrimination was assessed using Harrell’s C-index and time-dependent receiver operating characteristic analysis.

RESULTS: During follow-up, 228 patients (31.2%) developed recurrence. Compared with the low-burden tertile, intermediate- and high-burden tertiles were associated with a significantly higher risk of recurrence in the primary adjusted model (intermediate vs. low: HR = 1.49, 95% CI 1.05-2.11; high vs. low: HR = 1.60, 95% CI 1.13-2.27). Further adjustment for left atrial diameter, log(BNP), and fine f-wave attenuated these associations, suggesting partial statistical overlap between upstream multisystem burden and downstream atrial substrate abnormalities. In continuous analyses, each 1-standard deviation increase in weighted burden remained associated with recurrence risk. Addition of substrate markers improved model discrimination.

CONCLUSION: Higher cardiovascular-kidney-metabolic burden was associated with recurrence after first ablation in patients with non-valvular persistent atrial fibrillation, suggesting partial statistical overlap between upstream multisystem burden and downstream atrial substrate abnormalities.

PMID:42178525 | DOI:10.1186/s12872-026-06001-6

BMC Gastroenterol. 2026 May 25. doi: 10.1186/s12876-026-04917-z. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the decreasing incidence of gastric cancer in the United States, cancers of the stomach remain one of the leading causes of cancer related death in globally. Most patients are asymptomatic and have advanced disease when diagnosed. Studies have shown similar prognosis for proximal and distal tumors, although most studies exclude lesions in the cardia given overlap with esophageal cancers. Distal tumors involving the pylorus often leads to symptoms, such as gastric outlet obstruction presenting with nausea and emesis, which may lead to earlier diagnosis; therefore, we compared the adjusted survival with gastric adenocarcinomas based on location.

METHODS: Using SEER*Stat software, we performed a retrospective cohort study by extracting U.S. survival data from the Surveillance, Epidemiology and End Results Database for all gastric adenocarcinomas based on location (antrum, body, fundus, pylorus) for the period between 1975 and 2016 for individuals aged > 30 years of age. Survival was compared by calculating relative hazard ratios (HRs) for cancer-specific death in the 5-year period following diagnosis with Cox proportional hazards models, adjusted for covariates, with significance set at p < 0.05. Data were analyzed using SAS 9.4 software and R.

RESULTS: Survival analysis included 31,158 patients and showed no survival benefit comparing adenocarcinomas of the pylorus with those in the antrum (HR 1.02, 95% CI 0.97-1.07), body (HR 1.03, 95% CI 0.97-1.09). However, lower survival was seen for those in the fundus (HR 1.19, 95% CI 1.12-1.27). Male sex (HR 1.13, 95% CI 1.10-1.27), older age (HR 1.26, 95% CI 1.21-1.30), lack of chemotherapy (HR 1.06, 95% CI 1.02-1.10) and absence of surgery (HR 1.45, 95% CI 1.38-1.53) were associated with higher mortality. There were also statistically significant differences across higher stage and grade tumors, racial groups, and marital status.

CONCLUSONS: Despite early presentation of symptoms, our study corroborated data suggesting no difference in prognosis between pyloric gastric adenocarcinomas and proximal tumors, except those in the fundus. While involvement of the pylorus often leads to clear clinical manifestations including weight loss, early satiety, nausea, and emesis, earlier identification of malignancy compared to adenocarcinomas in more indolent locations does not necessarily improve survival outcomes.

PMID:42178521 | DOI:10.1186/s12876-026-04917-z

BMC Microbiol. 2026 May 25. doi: 10.1186/s12866-026-05200-7. Online ahead of print.

ABSTRACT

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are major healthcare-associated infections driven by indwelling devices that facilitate microbial adhesion. This study investigated the distribution of uropathogens in paired urine and catheter samples and evaluated the associations between extended-spectrum beta-lactamase (ESBL) production and clinical factors.

METHODS: A total of 100 paired urine and catheter samples (n = 100 per sample type) were analyzed using a convenience sampling approach. Clinical criteria for CAUTI diagnosis followed standardized protocols. Statistical significance was set at p < 0.05; however, a formal power calculation was not performed.

RESULTS: Catheter-derived specimens demonstrated a higher bacterial yield compared to urine samples Klebsiella spp and Escherichia coli were the predominant isolates. Opportunistic pathogens like Pseudomonas spp were primarily recovered from catheter surfaces. ESBL production was higher among catheter isolates (42/88 isolates; 47.72%) compared to urine isolates (13/51 isolates; 25.4%). A significant association was observed between catheter-derived isolates and ESBL positivity (OR = 2.66, 95% CI: 1.25-5.67, p < 0.05). Advanced age, prolonged catheterization, and chronic diseases were associated with increased bacterial growth; however, these correlations are unadjusted and may be influenced by confounding factors.

CONCLUSION: Urinary catheters serve as reservoirs for MDR uropathogens. While associations were found between device duration and resistance, the use of convenience sampling limits the generalizability of these findings.

PMID:42178517 | DOI:10.1186/s12866-026-05200-7