Nevin Manimala

J Orthop Surg Res. 2025 Aug 23;20(1):794. doi: 10.1186/s13018-025-05805-0.

ABSTRACT

BACKGROUND: Knee osteoarthritis (OA) is a prevalent condition influenced by various biochemical, anatomical, and lifestyle factors. Vitamin D deficiency has been implicated in OA, but its role in disease severity and associated symptoms remains unclear. We aimed to investigate the prevalence of vitamin D deficiency in knee OA patients and its relationship with inflammatory markers and clinical symptoms.

METHODS: This retrospective study analyzed 986 patients with knee OA over a 3.5-year period. Vitamin D levels, ESR, and platelet counts were assessed, along with demographic and clinical data. Statistical analyses were conducted to explore associations.

RESULT: This study involved 986 patients with knee OA, majority of them (85% ) were female with mean age 52.95 ± 12.44 years. More than half of patients 59.7% had unilateral knee OA and 40.3% had bilateral knee OA. The mean value of Vitamin D3 was 25.35 ± 14.125. Vitamin D deficiency was observed in 70.9% of patients, with moderate deficiency being most prevalent (36.94%). No significant association was found between vitamin D levels and inflammatory markers. However, a strong association was observed between vitamin D deficiency and symptoms like polyarthralgia (p < .05)., Bilateral OA was associated with higher vitamin D deficiency levels compared to unilateral OA (P < .001).

CONCLUSION: OA more prevalence among female .As well as, vitamin D deficiency is highly prevalent in knee OA patients and its severity associated with Bilateral OA and polyarthralgia but not with inflammatory markers. Future research should focus on the long-term impact of vitamin D supplementation and the molecular mechanisms underlying these disparities.

PMID:40849628 | DOI:10.1186/s13018-025-05805-0

BMC Womens Health. 2025 Aug 23;25(1):406. doi: 10.1186/s12905-025-03940-8.

ABSTRACT

BACKGROUND: Menstrual symptoms are a prevalent and frequently encountered woman’s health condition. This study aimed to examine the effect of exercise on menstrual symptoms, sleep quality, fatigue, and physical activity levels.

METHODS: The study was designed as a randomized controlled trial between September 2023 and December 2023. The study included 54 women aged 18 to 45 years. The participants were allocated to the exercise or the control group using simple randomization with a sealed envelope method. All participants were evaluated with the Menstrual Symptom Questionnaire (MSQ), the Menstrual Distress Questionnaire (MDQ), the Fatigue Severity Scale (FSS), the Pittsburgh Sleep Quality Index (PSQI), and the International Physical Activity Questionnaire-Short Form (IPAQ) before and after treatment. The control group did not receive an exercise program. The exercise group received strengthening, flexibility, and balance exercises. A moderate-intensity aerobic exercise and walking program was implemented at least three days per week. The study spanned three menstrual cycles for each woman and lasted an average of 12 weeks.

RESULTS: Within-group analysis showed a significant decrease in MSQ (p=0.001), MDQ (menstrual) (p=0.002), FSS (p=0.003), and PSQI (p=0.001) scores after exercise. In contrast, the IPAQ score increased significantly in the exercise group p=0.001). In the control group, a significant decrease was observed only in the MDQ (intermenstrual) score (p=0.915). A comparison of the pre-treatment and post-treatment changes in the exercise and control groups revealed a significant decrease in MSQ (p=0.001), MDQ (menstrual) (p=0.023), and PSQI scores (p=0.001) and an increase in IPAQ scores (p=0.001) in the exercise group compared to the control group. However, the decrease in MDQ (pre-menstrual and intermenstrual) (p=0.626^, p=0.348) and FSS scores (p=0.102) were not statistically different between the groups.

CONCLUSIONS: In conclusion, exercise can decrease the menstrual symptoms in women with menstrual symptoms as a primary outcome. Second, exercise can also increase their sleep quality. Therefore, it can be employed as a non-pharmacological adjuvant method to help women manage their symptoms.

TRIAL REGISTRATION: The protocol is registered with http://clinicaltrials.gov/ (17/August/2023, Clinical Trial, NCT06006507).

PMID:40849627 | DOI:10.1186/s12905-025-03940-8

BMC Cardiovasc Disord. 2025 Aug 23;25(1):628. doi: 10.1186/s12872-025-04974-4.

ABSTRACT

BACKGROUND: Mitral regurgitation (MR) presents either as primary or secondary, with options for surgical or transcatheter repair. Thromboembolic risks following surgery are significant despite the use of antithrombotic medications, and guidelines for postoperative anticoagulation therapy lack consistency. This systematic review aims to compare antithrombotic medications after mitral valve repair (MVR). In this study, we intend to compare antithrombotic medications after MVR.

MATERIALS AND METHODS: The study followed the Cochrane handbook and PRISMA guidelines. We systematically searched databases (PubMed, Scopus, Ovid, Cochrane, Web of Science) until June 2024 for TMVR studies using specific criteria. Quality assessment utilized the Newcastle-Ottawa scale. Data extraction encompassed study characteristics and outcomes. Primary outcomes included thromboembolic events and bleeding within six months. Statistical analysis employed R software to assess heterogeneity and publication bias.

RESULTS: From the 121 articles screened, 12 were included in the study. These cohort studies, involving 20,644 participants, spanned from 2008 to 2022. While most studies were of good to high quality, some exhibited lower quality. Analysis favored oral anticoagulants (OAC) over single antiplatelet therapy (SAPT) for reducing bleeding risk (RR = 0.31, 95% CI: [0.11-0.87], P < 0.05), with moderate heterogeneity. Thromboembolic events did not significantly differ among interventions. Transient ischemic attacks and stroke outcomes were similar between SAPT and vitamin K antagonists (VKA). Six-month mortality rates were comparable between SAPT and VKA, with notable heterogeneity and higher mortality with SAPT in one study. Qualitative synthesis highlighted procedural success rates and bleeding complications across different interventions in transcatheter mitral valve repair studies.

CONCLUSION: OACs showed a lower risk of bleeding compared to antiplatelet therapies, while VKAs and OAC + SAPT may reduce thromboembolic events. No significant differences were found in stroke, TIA, or short-term mortality. These findings support individualized therapy and highlight the need for further randomized trials.

PMID:40849614 | DOI:10.1186/s12872-025-04974-4

BMC Nephrol. 2025 Aug 23;26(1):486. doi: 10.1186/s12882-025-04420-9.

ABSTRACT

BACKGROUND: Nephrotic syndrome is a common glomerular disorder. Treatment typically begins with corticosteroids, but patient response varies. Differentiating between steroid-sensitive nephrotic syndrome (SSNS) and steroid-resistant nephrotic syndrome (SRNS) early in the disease course is important, as SRNS is associated with a higher risk of poor long-term outcomes. Neutrophil gelatinase-associated lipocalin (NGAL), a biomarker released in response to tubular injury, has emerged as a potential non-invasive marker for renal damage.

METHODS: We conducted a systematic review and meta-analysis of studies reporting NGAL levels in SSNS and SRNS, based on the PRISMA guidelines. A comprehensive literature search was conducted using PubMed, Scopus, Web of Science, ScienceDirect, and the WHO Virtual Health Library Regional. The statistical analysis was performed using a random-effects model to estimate the standardized mean difference (SMD) with a 95% confidence interval.

RESULTS: A total of 16 studies were included. Meta-analyses revealed significantly higher urinary NGAL levels in both SSNS and SRNS patients compared to healthy controls. Urinary NGAL levels were significantly higher in SSNS and SRNS patients compared to healthy controls, with SMD = 0.78 (95% CI: 0.434-1.128, P < .001) and SMD = 2.56 (95% CI: 1.152-3.971, P < .001), respectively. Patients with SRNS had markedly higher urinary NGAL levels than those with SSNS (SMD = 1.889, 95% CI: 0.819-2.959, P < .001). ROC analyses across several studies demonstrated moderate to strong discriminative ability of urinary NGAL in distinguishing between SRNS and SSNS.

CONCLUSION: Urinary NGAL demonstrated strong potential as a non-invasive biomarker for distinguishing between SRNS and SSNS, supporting its clinical utility in early diagnosis, risk stratification, and management.

PMID:40849613 | DOI:10.1186/s12882-025-04420-9

BMC Pregnancy Childbirth. 2025 Aug 23;25(1):881. doi: 10.1186/s12884-025-07902-8.

ABSTRACT

BACKGROUND: Modern medicine has significantly transformed the process of childbirth among women. The preferred mode of childbirth has become of global interest to many researchers due to the steady rise in recent caesarean section (CS) rates. While CS is often viewed as a life-saving intervention, it is associated with both immediate and long-term complications for the mother, newborn, and future pregnancies. To better understand the medical and non-medical reasons for CS among women, this study was conducted to identify the socio-demographic and obstetric factors that influence CS in the Tamale Metropolis.

METHODOLOGY: A retrospective cross-sectional study was conducted among 318 postpartum mothers at the Tamale Teaching Hospital. Descriptive analysis, univariate logistic regression and stepwise multivariate logistic regression model were conducted, with a p-value < 0.05 considered statistically significant.

RESULTS: The majority of respondents (63.5%) were below 30 years. Almost all respondents (95.3%) were enrolled in the National Health Insurance Scheme (NHIS). The majority (95.91%) had single births. Most respondents (91.2%) had spontaneous vaginal delivery. The prevalence of CS was 8.8%. Significant factors influencing the preference for CS were maternal age above 30 years (aOR = 2.27, 95% CI = 1.01-5.12), rural settlement (aOR = 0.31, 95% CI = 0.10-0.92), twin delivery (aOR = 6.88, 95% CI = 1.64-28.95), and obstetric complication (aOR = 10.55, 95% CI = 2.42-46.04).

CONCLUSION: There is a need to focus on initiatives that address regional disparities, enhance access to comprehensive maternal healthcare services, and promote informed decision-making regarding mode of delivery to ultimately improve maternal and infant health outcomes.

PMID:40849612 | DOI:10.1186/s12884-025-07902-8

BMC Cardiovasc Disord. 2025 Aug 23;25(1):629. doi: 10.1186/s12872-025-05070-3.

ABSTRACT

BACKGROUND: Acute coronary syndrome (ACS) remains a leading cause of global cardiovascular morbidity and mortality, with elevated low-density lipoprotein cholesterol (LDL-C) being a key modifiable risk factor. Despite statin therapy, many patients fail to achieve optimal LDL-C targets, highlighting the need for adjunctive treatments such as PCSK9 inhibitors (e.g., Evolocumab and Alirocumab). However, comparative evidence on their efficacy and safety in ACS patients remains limited.

OBJECTIVE: To systematically evaluate the efficacy and safety of PCSK9 inhibitors (Evolocumab and Alirocumab) in patients with ACS, focusing on LDL-C reduction and major adverse cardiovascular events (MACE).

METHODS: A comprehensive search was conducted in PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and the WHO International Clinical Trials Registry. Eligible randomized controlled trials (RCTs) assessed PCSK9 inhibitors in ACS patients and reported outcomes on LDL-C and MACE. Both direct and network meta-analyses were performed to compare effect sizes across interventions. No direct head-to-head trials between Evolocumab and Alirocumab were identified.

RESULTS: Nine RCTs involving 37,934 patients were included. Direct meta-analysis showed that PCSK9 inhibitors significantly reduced LDL-C (mean difference [MD]: – 52.7 mg/dL; 95% CI: – 61.2 to – 44.1) and lowered the risk of MACE (odds ratio [OR]: 0.79; 95% CI: 0.68-0.93). In subgroup analysis, Evolocumab produced greater LDL-C reductions, while Alirocumab showed a stronger trend toward MACE reduction, though not statistically significant (OR: 0.84; 95% CI: 0.68-1.03). Network meta-analysis confirmed these patterns but revealed no statistically significant differences between the two agents.

CONCLUSION: PCSK9 inhibitors significantly improve lipid profiles and reduce cardiovascular event risk in ACS patients. While Evolocumab and Alirocumab offer similar overall benefits, their differential effects on LDL-C and MACE warrant further investigation. These findings support the role of PCSK9 inhibitors in secondary prevention strategies for high-risk cardiovascular populations.

PMID:40849610 | DOI:10.1186/s12872-025-05070-3

Discov Oncol. 2025 Aug 23;16(1):1601. doi: 10.1007/s12672-025-03336-y.

ABSTRACT

BACKGROUND: The causal relationship between interleukin-7 levels and neuroblastoma risk remains unclear, and optimal radiation therapy timing lacks definitive evidence. This study investigated causal associations using Mendelian randomization while examining radiation therapy timing effects.

METHODS: We conducted two-sample Mendelian randomization analysis using GWAS summary statistics for interleukin-7 levels and neuroblastoma with three SNPs as instrumental variables. Multiple MRmethods included inverse variance weighted (IVW), MR-Egger, weighted median, and mode approaches. Additionally, 1,007 neuroblastoma patients from SEER database (2000-2018) were analyzed comparing preoperative (n = 416) versus postoperative (n = 591) radiation therapy using propensity score matching and Cox regression models.

RESULTS: Mendelian randomization revealed significant positive causal association between elevated interleukin-7 levels and increased neuroblastoma risk. The IVW method showed higher interleukin-7 levels associated with 3.6-fold increased odds (OR = 3.585, 95% CI: 1.216-10.575, p = 0.021). In clinical analysis, preoperative radiation demonstrated superior survival outcomes with 27% mortality reduction (HR = 0.73, 95% CI: 0.55-0.97, p = 0.031). Subgroup analysis revealed significant racial differences, with White patients deriving greatest benefit from preoperative radiation (HR = 0.57, 95% CI: 0.42-0.78, p < 0.001).

RESULTS: This study provides evidence for causal relationship between interleukin-7 levels and neuroblastoma risk, suggesting inflammatory pathways’ role in pathogenesis.

PMID:40849609 | DOI:10.1007/s12672-025-03336-y

Sci Rep. 2025 Aug 23;15(1):31065. doi: 10.1038/s41598-025-17115-w.

ABSTRACT

This prospective study aimed to investigate changes in corneal higher-order aberrations (HOAs) in myopic children using orthokeratology (ortho-k) lenses and their relationship with myopia progression. A total of 112 children aged 8-13 years were divided into group A (axial elongation ≤ 0.1 mm/y with ortho-k) and group B (axial elongation > 0.1 mm/y with ortho-k). At baseline, 1, 6, and 12 months following the initiation of lens wear, HOAs and corneal peripheral defocus were evaluated. Ninety-three patients completed the 1-year follow-up. The mean axial elongation was – 0.07 ± 0.15 mm/y in group A, versus 0.32 ± 0.17 mm/y in group B. No statistical differences were observed in HOAs and corneal peripheral defocus at 1, 6, and 12 months (F = 0.653, 0.878; P > 0.05). Multivariate linear regression showed axial elongation was negatively correlated with ∆HOAs, peripheral defocus, and ∆horizontal coma (standardized beta=-0.331, -0.318, -0.209; P = 0.006, 0.001, 0.010, respectively) and positively correlated with the treatment zone diameter (standardized beta = 0.261, P = 0.003). Multivariate logistic regression identified ∆HOAs, peripheral defocus, ∆horizontal coma, and treatment zone as key factors distinguishing group A from group B (OR = 0.009, 0.455, 0.123, 12.172; P = 0.036, 0.003, 0.032, 0.019, respectively). The ROC curve for ∆HOAs had an area of 0.803 with a cut-off value of 0.834 μm. The ∆HOAs were more effective independent predictors of axial elongation than corneal peripheral defocus in children using ortho-k lenses. The ∆HOAs greater than 0.834 μm may lead to axial elongation ≤ 0.1 mm/y. These findings can be beneficial to fitting and optimizing ortho-k lenses.

PMID:40849596 | DOI:10.1038/s41598-025-17115-w

Surg Today. 2025 Aug 23. doi: 10.1007/s00595-025-03118-7. Online ahead of print.

ABSTRACT

PURPOSE: To compare the safety and efficacy of barbed and non-barbed sutures for fascial closure in abdominal surgery.

METHODS: A systematic literature search through February 2025 identified studies comparing overall surgical site infections (SSI), fascial complications, and hospital stays between barbed and non-barbed sutures. A meta-analysis using random-effects models calculated odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs).

RESULTS: Seven studies involving 12,278 patients (barbed group, n = 4912; non-barbed group, n = 7366) were included. The overall SSI rates were 1.9% and 4.0% in the barbed and non-barbed groups, respectively. Barbed sutures significantly reduced overall SSIs (OR, 0.41; 95% CI: 0.31-0.53; P < 0.001) without statistical heterogeneity. Barbed suture also significantly reduced the length of hospital stay (MD, – 1.13; 95% CI: – 1.42- – 0.83, P < 0.001) without statistical heterogeneity. No significant difference was observed in fascial complications between the groups (OR, 0.66; 95% CI: 0.36-1.22, P = 0.19).

CONCLUSIONS: This is the first meta-analysis to focus specifically on barbed sutures for abdominal fascial closure. Barbed sutures significantly reduce SSI and hospital stay without increasing fascial complications, thus suggesting that they are safe and efficient options for abdominal wall closure.

PMID:40849594 | DOI:10.1007/s00595-025-03118-7

Sci Rep. 2025 Aug 23;15(1):31012. doi: 10.1038/s41598-025-16539-8.

ABSTRACT

In multi-objective particle swarm optimization, achieving a balance between solution convergence and diversity remains a crucial challenge. To cope with this difficulty, this paper proposes a novel multi-objective particle swarm algorithm, called ASDMOPSO, which aims to improve the optimization efficiency through the angular division of the archive and the dynamic update strategy. The algorithm efficiently classifies non-dominated solutions by dividing the external archive region into equal angles, thus achieving fine management and diversity maintenance of solutions during the optimization process. When the external archive overflows, the algorithm removes the solution in the highest density region using the congestion distance metric. At the same time, the research presents a multi-stage initialization approach. This method splits the random population into two subpopulations. Subsequently, a genetic algorithm and a differential evolutionary algorithm are utilized for optimization purposes in each subpopulation, respectively. As a result, the quality of the initial population is enhanced. To explore the solution space more efficiently, this paper designs a dynamic flight parameter adjustment technique. This technique balances exploration and exploitation by adjusting the optimization algorithm parameters in real time. The proposed algorithm is compared with several representative multi-objective optimization algorithms on 22 benchmark functions, and statistical tests, sensitivity analysis, and complexity analysis are conducted. The experimental results show that the ASDMOPSO algorithm is more competitive than other comparison algorithms, with significantly improved optimization efficiency. For example, on the ZDT4 test function, its average IGD value is 0.032, outperforming the standard PSO algorithm and surpassing all other comparison algorithms, thereby validating the algorithm’s superiority in complex multi-objective optimization problems.

PMID:40849576 | DOI:10.1038/s41598-025-16539-8