Nevin Manimala

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

BMC Oral Health. 2026 Jul 13. doi: 10.1186/s12903-026-09010-1. Online ahead of print.

ABSTRACT

BACKGROUND: To investigate age-related differences in transverse intermolar width and crown torque of maxillary and mandibular first permanent molars in adolescents, and to explore whether molar torque changes are associated with differential transverse growth.

METHODS: A total of 410 dental casts and corresponding posteroanterior cephalograms from 108 Chinese subjects (38 males and 70 females) aged 8-18 years were analyzed using a retrospective observational design with partially repeated measures. For subjects with records available at multiple ages, all eligible records were included to improve age-group representation. Maxillary and mandibular basal bone widths were measured on posteroanterior radiographs. Dental casts were digitized and analyzed to obtain intermolar width and molar crown torque. Statistical analyses included linear mixed-effects models for sex comparisons, one-way ANOVA with Bonferroni correction for age-group comparisons, Pearson correlation analysis, and sensitivity analysis.

RESULTS: Both maxillary and mandibular basal bone widths were greater in older age groups, with mandibular basal width exceeding that of the maxilla. Despite this skeletal pattern, maxillary intermolar width increased more than mandibular intermolar width (3.16 mm vs. 1.44 mm). Maxillary first molars exhibited a progressive shift toward palatal angulation of 7.43°, whereas mandibular first molars showed a buccal angulation change of 14.04°, both tending toward a more neutral buccolingual angulation.

CONCLUSIONS: In this Chinese population aged 8-18 years, transverse skeletal growth of the mandible exceeded that of the maxilla, whereas maxillary intermolar width increased more than mandibular intermolar width. Coordinated molar torque adjustments were observed alongside this skeletal-dental discrepancy and may reflect a dentoalveolar compensatory adaptation contributing to transverse occlusal coordination.

PMID:42443844 | DOI:10.1186/s12903-026-09010-1

BMC Surg. 2026 Jul 13. doi: 10.1186/s12893-026-03809-z. Online ahead of print.

ABSTRACT

BACKGROUND: The prognostic value of circumferential resection margin (CRM) width after neoadjuvant-treated esophagectomy remains uncertain.

OBJECTIVE: To assess whether CRM distance predicts early (12-month) locoregional recurrence (LRR) following hybrid Ivor-Lewis esophagectomy.

DESIGN/SETTING: Retrospective observational cohort at a tertiary cancer center, April 2023-October 2024.

PARTICIPANTS: Consecutive adults who underwent two-stage (hybrid) esophagectomy for malignancy; emergencies and abandoned resections excluded.

EXPOSURE: Pathologic CRM measured in millimeters, analyzed continuously and by RCPath thresholds (≤ 1 mm vs. > 1 mm).

MAIN OUTCOMES: Primary-12-month locoregional recurrence (LRR). Secondary-any recurrence and recurrence-free survival (RFS).

RESULTS: Sixty-three resections were analyzed. CRM was measurable in 45 (71.4%). Median CRM was 2.0 mm (IQR 1.0-3.0). Six patients (9.5%) developed recurrence within 12 months-five locoregional and one distant. One of twenty-nine pathological complete responders (pCR, 3.4%) recurred. Univariable analysis did not demonstrate a significant association between CRM distance and early recurrence. Kaplan-Meier analysis showed no statistically significant difference in recurrence-free survival between CRM categories.

CONCLUSIONS: Early recurrence occurred in 9.5% of patients, predominantly locoregional. CRM distance, whether analyzed continuously or using RCPath thresholds, was not associated with early recurrence. These findings suggest that, within this single-center cohort, early relapse may reflect underlying tumor biology rather than marginal radial clearance, although results should be interpreted with caution given limited event numbers.

PMID:42443838 | DOI:10.1186/s12893-026-03809-z

BMC Public Health. 2026 Jul 14. doi: 10.1186/s12889-026-28463-1. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Early initiation of substance use and concurrent use of multiple drugs are critical factors linked to adverse health outcomes. Thus, this study aimed to investigate the demographic, behavioral, and psychiatric associates of early-onset and poly-drug use among individuals with substance use disorders in Western Iran.

METHODS: In this cross-sectional study, data were collected from the Addiction Disorders Registry of inpatients admitted to Farabi Hospital in Kermanshah, Iran. A total of 1,030 individuals diagnosed with substance use disorders were included in the analysis. Data were gathered through structured clinical interviews and reviews of medical records. Statistical analyses included descriptive statistics, chi-square tests, t-tests, Mann-Whitney U tests, and logistic regression models.

RESULTS: Participants who began using substances before the age of 18 had a significantly lower mean age. Poly-drug users also tended to be younger. Logistic regression analysis indicated that male gender, being single, curiosity-driven initiation of use, and the presence of bipolar or personality disorders were significantly associated with early-onset substance use. Additionally, poly-drug use was associated with younger age, male gender, divorced marital status, and the presence of depressive disorders.

CONCLUSION: Demographic and psychiatric characteristics linked to early initiation and poly-drug use. These findings underscore the need for targeted prevention and intervention strategies that focus on vulnerable subgroups.

PMID:42443837 | DOI:10.1186/s12889-026-28463-1

BMC Pediatr. 2026 Jul 13. doi: 10.1186/s12887-026-07229-z. Online ahead of print.

ABSTRACT

BACKGROUND: Bone mineral density (BMD) is crucial for evaluating bone health, particularly in the pediatric population. Physical parameters such as lower body strength (assessed by jump tests) and handgrip strength (a marker of musculoskeletal health) have been linked to BMD. This study aims to investigate the association between upper and lower limb strength and BMD of the forearm and femur in children and adolescents stratified by sex.

METHODS: This cross-sectional study involved 57 participants (aged 9 ± 2 years) from a philanthropic institution in Brazil. Participants were assessed for anthropometric measurements, somatic maturation, and BMD and lean soft tissue using Dual X-ray Absorptiometry (DXA). Handgrip strength was measured using a dynamometer, and horizontal and vertical jump performances were also assessed. Statistical analyses included Quantile Regression to examine the relationships between strength measures and BMD, adjusted for somatic maturation and lean soft tissue.

RESULTS: Significant positive associations were found between handgrip strength and femoral BMD, especially in boys (Femoral neck: β = 12.65; 95%CI = 2.39; 22.92,; Trochanter: β = 17.37; 95%CI = 5.04; 29.70; Total femur: β = 11.13 95%CI = 0.98; 21.27).

CONCLUSION: Upper and lower limb muscle strength, particularly handgrip and vertical jump performance, were positively associated with BMD of the forearm and femur in children and adolescents with low socioeconomic status, with associations observed in boys.

PMID:42443834 | DOI:10.1186/s12887-026-07229-z

BMC Public Health. 2026 Jul 14. doi: 10.1186/s12889-026-28450-6. Online ahead of print.

ABSTRACT

BACKGROUND: China’s rapid urbanization has coincided with a substantial rise in poor vision (PV) and myopia prevalence among youth. Understanding this association is crucial for formulating evidence-based ocular health strategies.

METHODS: We analyzed nationally representative data from 640,266 children and adolescents (7-18 years) across three waves (2010, 2014, 2019) of the Chinese National Surveys on Students’ Constitution and Health. Urbanization-related characteristics were derived from official statistical data and satellite remote sensing data. Six urbanization factors were extracted by exploratory factor analysis, and a composite score of urbanization was constructed. Bivariate spatial autocorrelation analysis and β mixed-effects models are utilized to evaluate the associations of urbanization with PV and myopia prevalence.

RESULTS: The prevalence of PV and myopia increased from 2010 to 2019, and both show a similar spatial correlation with urbanization scores. Urbanization scores were positively associated with PV prevalence (β: 0.03; 95% CI: 0.00-0.05), whereas the association with myopia prevalence was non-significant (β: 0.03; 95% CI: -0.00-0.05). After adjusting for all factors, economic factors (PV: β: 0.12; 95%CI: 0.07 ~ 0.18. Myopia: 0.14; 0.08 ~ 0.20) and innovative capacity (PV: β: 0.08; 95%CI: 0.02 ~ 0.14. Myopia: β: 0.07; 95%CI: 0.01 ~ 0.13) were positively associated with PV and myopia prevalence.

CONCLUSIONS: The positive association between urbanization and both PV and myopia prevalence underscores the imperative to integrate health into all policies. This calls for aligning urban development with preventive eye health strategies through enhanced eye care services and optimized urban environments, with a particular focus on economically dynamic regions.

PMID:42443833 | DOI:10.1186/s12889-026-28450-6