Nevin Manimala

Cardiovasc Diabetol. 2026 Feb 3. doi: 10.1186/s12933-025-03071-2. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Current clinical risk tools in type 1 diabetes do not include left ventricular dysfunction or inflammation, potentially limiting early risk detection. We aimed to evaluate the associations and predictive value of combining echocardiography with inflammatory biomarkers for mortality and major adverse cardiovascular events (MACE).

METHODS: In a prospective cohort of individuals with type 1 diabetes without known cardiovascular disease, we evaluated whether subclinical left ventricular dysfunction, defined by an elevated ratio of early mitral inflow velocity to early diastolic mitral annular velocity (E/e’) or impaired global longitudinal strain (GLS), combined with elevated levels of an inflammatory biomarker (interleukin-6 [IL-6], soluble urokinase-plasminogen-activator-receptor [suPAR], or high-sensitivity C-reactive-protein [hsCRP]), was associated with all-cause mortality and MACE. Cox models were adjusted for all 10 variables included in the Steno T1 Risk Engine variables: age, sex, systolic blood pressure, duration of diabetes, HbA1c, low-density lipoprotein, estimated glomerular filtration rate, albuminuria status, smoking, and physical activity. C-statistics and net reclassification improvement were assessed.

RESULTS: Among 876 participants (51% male, median age 50 years), 114 deaths occurred over 14.5 years of follow-up. Elevated E/e’ combined with IL-6 or suPAR, but not hsCRP, was independently associated with mortality. Compared with individuals with E/e’ <8 and non-elevated IL-6, the hazard ratio (HR) for E/e’ 8-13 with elevated IL-6 was 2.5 (95% CI 1.4 to 4.6, P < 0.01), and for E/e’ ≥13 with elevated IL-6 was 3.4 (1.5-7.6; P < 0.01). Corresponding HRs for suPAR were 2.4 (1.2 to 4.7, P < 0.01) and 3.9 (1.8 to 8.5, P < 0.01). Adding E/e’ and an inflammatory biomarker increased the C-statistic from 0.839 (Steno T1 Risk Engine alone) to 0.887 (E/e’ and IL6) and 0.868 (E/e’ and suPAR). Findings were similar for GLS and with MACE as the outcome.

CONCLUSIONS: Echocardiography combined with inflammatory biomarkers synergistically identifies individuals with type 1 diabetes, without known cardiovascular disease, who are at high risk of mortality and MACE.

PMID:41634769 | DOI:10.1186/s12933-025-03071-2

Allergy Asthma Clin Immunol. 2026 Feb 3. doi: 10.1186/s13223-026-01013-5. Online ahead of print.

ABSTRACT

BACKGROUND: Antibiotic use in infants is hypothesized to alter the gut microbiota, influencing immune system dysregulation and increasing allergy risk. We aim to assess the prevalence of allergic diseases in children treated with different classes of antibiotics in early life.

METHODS: A retrospective cohort study was conducted from April 2024 to January 2025 in three main hospitals in the West Bank in Palestine. Records of pediatric admissions of children who received antibiotic treatment within their first six months of life were reviewed, followed by parents’ interview regarding the development of allergies.

RESULTS: A total of 423 medical records were included. The average age of children was 7.33 ± 1.38 years (mean ± SD), and 62.41% of them were males. The total prevalence of allergic diseases was 29.55%. Common manifestations of allergies were skin reactions (70.4%), wheezing (16.8%), and respiratory symptoms (10.4%). Among the most common reported triggers were food (10.17%) and dust (7.33%). The most commonly prescribed antibiotics were Beta-lactams; cefotaxime (78.49%), and ampicillin (63.59%). No statistically significant association was found between the number of antibiotics used and the development of allergies (p = 0.45). Similarly, different classes of antibiotics did not show an impact on developing allergies except for Trimethoprim/Sulfamethoxazole (p = 0.05). A significant decrease in allergy was observed with increasing age (p = 0.011).

CONCLUSION: Allergic conditions affect about one third of children treated with antibiotics in early life. While allergic conditions tended to decrease with age, no association was observed between antibiotic number/class and later allergy, except for a hypothesis-generating signal toward lower odds with TMP-SMX.

PMID:41634755 | DOI:10.1186/s13223-026-01013-5

BMC Womens Health. 2026 Feb 3. doi: 10.1186/s12905-026-04310-8. Online ahead of print.

ABSTRACT

BACKGROUND: Incarcerated women face significantly elevated cervical cancer risks compared to the general population due to higher human papillomavirus (HPV) prevalence, limited healthcare access, and socio-demographic vulnerabilities. Despite elevated risk, female inmates are substantially less likely to receive cervical screening. No studies examining cervical screening among incarcerated populations in Nordic countries have been identified.

OBJECTIVE: To examine risk factors for cervical abnormalities, screening experiences, HPV vaccination status, barriers to screening participation, and symptoms among incarcerated women in Norway before and after a cervical screening campaign.

METHODS: A repeated cross-sectional study was conducted in all three Norwegian prisons with women’s wards using a researcher-developed questionnaire. Data were collected at baseline (January/February 2025, n = 77) and post-campaign (May/June 2025, n = 97). The campaign included informational materials, prison visits, and educational sessions. The questionnaire assessed demographics, risk factors, screening history, vaccination status, participation barriers, and symptoms. Data were analyzed using descriptive statistics and chi-square tests.

RESULTS: Most respondents were aged 25-44 years, serving sentences under six months. High prevalence of risk factors was observed: tobacco/snus use (61.0%/53.9% at baseline) and multiple sexual partners (38.2% reported ≥ 5 partners). While 68.8% had prior cervical screening, only 19.6% received screening during incarceration. HPV vaccination rates were low (16.9%). Primary barriers included insufficient information (22.7% baseline, 33.8% post-campaign), fear of pain, previous trauma, and healthcare mistrust. Approximately one-third reported symptoms potentially indicating cervical abnormalities, most commonly persistent lower back pain (52% baseline, 65.6% post-campaign) and pelvic pain (36% baseline, 40.6% post-campaign). No statistically significant differences were observed between baseline and post-campaign responses.

CONCLUSIONS: Incarcerated Norwegian women exhibit multiple cervical cancer risk factors yet face substantial screening barriers during imprisonment. The campaign demonstrated limited impact on screening uptake, suggesting comprehensive sustained interventions are needed. Future strategies should address structural barriers, ensure adequate follow-up care, and explore self-sampling approaches to reduce health disparities in this vulnerable population.

PMID:41634726 | DOI:10.1186/s12905-026-04310-8

Virol J. 2026 Feb 3. doi: 10.1186/s12985-026-03088-3. Online ahead of print.

ABSTRACT

BACKGROUND: West Nile virus (WNV) is primarily transmitted by the bite of Culex mosquitoes, but other mechanisms, such as blood transfusion, have also been described. Since its identification in the Americas in 1999, WNV has circulated consistently in the United States of America (USA); however, although WNV has been detected in humans in South America, no major outbreaks have occurred in more than 20 years. One of the hypotheses to explain this difference is the underdiagnosis of the infection. In Mexico, nine isolated cases have been officially reported since 2003 despite its proximity to the USA. In this study, we aim to demonstrate the circulation of WNV in blood donors from a northern border city of Mexico.

METHODS: Between August and September of 2023, 86 serum samples from volunteer blood donors were collected to determine anti-WNV Immunoglobulin (Ig) G using a commercial enzyme-linked immunosorbent assay (ELISA) kit. In a subgroup of 44 samples, anti-WNV IgM was determined. To corroborate the IgM results, nucleic acid amplification tests (NAAT) were performed to determine RNA of WNV, Dengue and Zika. The participants were questioned about the history of travel to the USA; all of them were residents of the city of Nogales, Sonora, located on the border with the state of Arizona. For the comparison of seronegative and seropositive donor groups, the Chi-square test and Mann-Whitney U test were used for qualitative and quantitative variables, respectively. Additionally, a spatial analysis of seropositive cases was conducted.

RESULTS: One sample was reactive to anti-WNV IgM and IgG; however, all NAAT results were negative. In addition, 19 samples were reactive for IgG, and no statistically significant differences were found between the groups. Seropositive cases showed a geographic pattern of clustering on the outskirts of the city, in areas with low population density.

CONCLUSIONS: Our results strongly suggest recent WNV circulation among residents from the northern border of Mexico. The lack of differences regarding the history and frequency of travel to the USA suggests that contact with the virus occurs in Mexico and that the low reported circulation in the region represents an underdiagnosis of the disease.

PMID:41634716 | DOI:10.1186/s12985-026-03088-3

Cardiovasc Diabetol. 2026 Feb 3. doi: 10.1186/s12933-025-03043-6. Online ahead of print.

ABSTRACT

BACKGROUND: The atherogenic index of plasma (AIP) serves as a crucial indicator for assessing atherosclerotic risk. It reflects the degree of dyslipidaemia and cardiovascular disease (CVD) risk. The cardiometabolic index (CMI) provides a comprehensive evaluation of obesity-related metabolic risk, acting as a key biomarker for predicting multiple cardiometabolic diseases. The relationship between AIP and CMI in patients with non-alcoholic fatty liver disease (NAFLD) and mortality or CVD risk remains unclear.

METHODS: This study included 5792 adult (≥ 18 years) NAFLD patients from the US National Health and Nutrition Examination Survey (NHANES, 1999-2018). Weighted logistic regression and Cox proportional hazards models were employed to investigate the association between AIP, CMI and all-cause mortality, CVD mortality and CVD risk. Restricted cubic spline (RCS) curves assessed non-linear associations. Subgroup analyses and mediation analyses examined the effect modifiers and mediators. The incremental predictive value of AIP and CMI was evaluated. Sensitivity analyses were conducted to validate the robustness.

RESULTS: During follow-up, 721 all-cause deaths (including 241 CVD deaths) and 726 total CVD events were recorded. After adjusting for confounding factors, patients in the highest quartiles of AIP and CMI had a significantly higher risk of specific CVD events. The strongest association was observed for CHF (AIP: OR = 3.157, 95% CI 1.684, 5.922, p < 0.001; CMI: OR = 3.604, 95% CI 1.843, 7.047, p < 0.001), followed by heart attack and CHD. CMI consistently demonstrated a stronger effect than AIP. RCS analysis indicates a non-linear relationship between CMI and CHD, angina pectoris. Subgroup analysis revealed that both AIP and CMI demonstrated high predictive value for all-cause mortality in the 40-60 age cohort. Mediation analysis revealed that Mets, NLR, hypertension and HOMA-IR partially mediated the aforementioned associations. The inclusion of AIP and CMI partially improved the predictive capability of the basic model. Sensitivity analyses validated the robustness of these findings.

CONCLUSIONS: In patients with NAFLD, CMI is a stronger predictor of non-fatal CVD than AIP. While both indices show limited value for predicting mortality, CMI holds promise as a practical supplementary tool for clinical risk assessment.

PMID:41634708 | DOI:10.1186/s12933-025-03043-6

BMC Complement Med Ther. 2026 Feb 3. doi: 10.1186/s12906-026-05265-x. Online ahead of print.

ABSTRACT

BACKGROUND: Hypertension (HTN), a chronic inflammatory condition, is a major cardiovascular risk factor. Dysregulation of inflammatory cytokines and brain-gut peptides contributes to its progression. This study aimed to evaluate the effects of a Tai Chi rehabilitation program on blood pressure, inflammatory cytokines [interleukin-6 (IL-6), interleukin-10 (IL-10)], and brain-gut peptides [neurotensin (NT), gastrin (GAS)] in patients with HTN, hypothesizing that Tai Chi would improve these parameters compared with Fitness exercise or no intervention.

METHODS: A randomized controlled trial enrolled 105 patients with HTN and coronary heart disease. Participants were randomized into the Tai Chi group (n = 35), Fitness group (n = 35), or Blank group (n = 35). The intervention lasted 24 weeks (3 sessions per week, 60 min per session, 40-60% heart rate reserve). Blood pressure and serum levels of IL-6, IL-10, NT, and GAS were measured before and after the intervention using enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed with SPSS version 27, applying paired t-tests, analysis of variance (ANOVA), and Pearson correlation.

RESULTS: Ninety participants completed the study (Tai Chi group: 31, Fitness group: 28, Blank group: 31). The Tai Chi group showed significant reductions in systolic blood pressure (SBP) and IL-6 (p < 0.001), along with increases in IL-10, NT, and GAS (p < 0.001) compared to baseline. Compared with the Fitness group, the Tai Chi group achieved greater increases in NT and GAS (p < 0.05). Compared with the Blank group, the Tai Chi group demonstrated superior reductions in SBP and IL-6 (p < 0.05). Reductions in IL-6 were negatively correlated with increases in NT and GAS (p < 0.001).

CONCLUSION: Tai Chi rehabilitation lowered systolic blood pressure, reduced inflammation, and improved brain-gut peptides, supporting its role as a complementary therapy for hypertension. The modest sample size, 14.3% dropout rate, and recruitment from two hospitals may limit generalizability, and larger multi-center studies with longer follow-up are needed.

TRIAL REGISTRATION: The trial was registered with the International Traditional Medicine Clinical Trial Registry (Registration No. ITMCTR2024000813; registration date: 2024/12/13).

PMID:41634677 | DOI:10.1186/s12906-026-05265-x

BMC Med Educ. 2026 Feb 4. doi: 10.1186/s12909-026-08715-9. Online ahead of print.

ABSTRACT

BACKGROUND: The existing undergraduate training uses comprehensive models, including theoretical, preclinical, and clinical practice, and aims to provide the candidate with the specific knowledge and skills required to perform the relevant treatments. The prevalence of integrating new systems in endodontic education and their contribution to the applicability of endodontic treatments have not been evaluated from the perspective of trainees and educators before/after graduation. This study aimed to determine which endodontic preclinical training model contributes more to clinical applicability and success. In light of the obtained data, it seeks to raise awareness by proposing the most appropriate education model or model combination.

METHODS: A questionnaire was initially prepared and transferred to an online platform. The survey consists of 3 parts and 36 questions in total. The first part is about the participants’ demographics. The second section assessed information on endodontic preclinical training models participants experienced during undergraduate/postgraduate training, their general perspectives on endodontics, and their self-assessment of the contribution of these models to clinical practice competence. The third aimed to determine participants’ knowledge of the material properties used in endodontic simulation, their advantages and disadvantages, and their preferred model based on trainee and educator perspectives. After validating the questionnaire, the data were analysed using Fisher-Freeman-Halton, Pearson chi-square, Yates correction, and Fisher Exact Test with Monte Carlo correction for categorical variables (p < 0.05).

RESULTS: The internal consistency and construct validity demonstrated strong inter-item correlations (r = 0.81-0.90), indicating high internal coherence. The content validity index for all items exceeded the acceptable threshold (≥ 0.80). The distribution of participants (n = 238) was as follows: students (46.8%), dentists (29.1%), PhD students/residents (9.7%), endodontists (7.6%), and lecturers/educators (8.9%). Most participants reported completing preclinical training with only extracted teeth (54.2%). The preclinical training model the current students received had a statistically significant content, with simulated models included (p < 0.003). Among dentists and students trained solely on extracted teeth, those not sympathetic to endodontics were significantly more common (p = 0.042). Those who responded that they understood and practised endodontics better had been trained by simulated models and phantom bodies in addition to extracted teeth (P < 0.001). Participants generally reported that combining extracted teeth, simulated models, and phantom scenarios contributed more to endodontic education (p = 0.001).

CONCLUSIONS: Integrating simulated models into the endodontic training module is highly promising. Advances in materials science and simulation technologies enable the development of realistic models.

PMID:41634668 | DOI:10.1186/s12909-026-08715-9

BMC Public Health. 2026 Feb 3. doi: 10.1186/s12889-026-26443-z. Online ahead of print.

ABSTRACT

BACKGROUND: Inappropriate antibiotic use has become a significant driver of the global burden of antimicrobial resistance (AMR). Our study aims to identify the proportion and associated factors of inappropriate antibiotic use, including self-medication of antibiotics, and non-adherence to antibiotic prescriptions among Myanmar migrants in Thailand.

METHODS: A cross-sectional study was conducted among 348 Myanmar migrants from three Myanmar migrant communities in Samut Sakhon, Thailand. The sample was recruited using convenience sampling, and the survey was conducted using face-to-face interviews. The variables, including predisposing, reinforcing, and enabling factors based on the PRECEDE-PROCEED model, were constructed. Descriptive statistics, Chi-square or Fisher’s Exact tests, and multiple logistic regression were performed to identify associated factors.

RESULTS: The proportion of self-medication among all participants was 28.4% (n = 348), and non-adherence among migrants who took prescribed antibiotics was 67.5% (n = 249). Factors positively associated with antibiotic self-medication are; never visiting a hospital in Thailand (AOR = 3.54, 95% CI = 2.00-6.27), inability to recognize common antibiotic drugs in the photos (AOR = 2.80, 1.56-5.02), and lack of AMR information in the past year (AOR = 1.98, 1.04-3.76). Factors positively associated with non-adherence to antibiotic prescription includes alcohol drinking (AOR = 37.58, 4.55-310.63), moderate to severe legal status-related acculturative stress (AOR = 6.49, 2.10-20.05 for severe stress and AOR = 2.60, 1.20-5.68 for moderate stress), receiving information regarding antibiotic use (AOR = 2.79, 1.40-5.58), working 7 days per week (AOR = 2.36, 1.12-5.01), lack of health insurance (AOR = 2.20, 1.17-4.14) and proximity to a hospital (AOR = 2.22, 1.15-4.28).

CONCLUSION: High levels of inappropriate antibiotic use among Myanmar migrants highlight the need to integrate migrants into Thailand’s national action plan on AMR. The high prevalence of antibiotic misuse among Myanmar migrants highlights the need to include migrants in Thailand’s national plan to combat antimicrobial resistance. To improve patient understanding and adherence to treatment, healthcare professionals should provide medication guidelines and education on the risks of antimicrobial resistance. Policymakers should focus future policies and interventions on providing interpretation services and establishing institutional mechanisms to ensure migrants’ access to healthcare.

PMID:41634652 | DOI:10.1186/s12889-026-26443-z

BMC Public Health. 2026 Feb 4. doi: 10.1186/s12889-026-26469-3. Online ahead of print.

ABSTRACT

BACKGROUND: A majority of adolescents do not meet the recommended levels of physical activity, while reported levels of mental health problems are increasing, and socioeconomic disparities in academic performance are widening. Many schools are implementing physical activity in different forms, but there is inconclusive evidence on what types of interventions improve mental health, cognitive functions, and academic performance and how to implement such interventions. There is a critical need for integrated, feasible, and equitable interventions. The objective of this study is to develop an effective multi-component school-based intervention that will target both physical activity and homework support during an extended school day and evaluate its effects on mental health, cognitive function and academic performance.

METHODS: The study is designed as a cluster-randomised controlled trial with 54 schools and approximately 2,700 students in grade 8 (age 14-15). The intervention includes three weekly 60-minute sessions: (1) Different types of physical activities (2), Homework support with short activity breaks, and (3) Walking and listening to audiobooks. This study will evaluate both outcome effects and implementation process. The primary outcome is anxiety, assessed using the Spence Children’s Anxiety Scale (SCAS-S). Secondary outcomes include physical activity, sedentary time and behaviours measured by accelerometry and questionnaire, cognitive functions assessed by a computer-based test battery, mental health and sleep with questionnaires, and academic performance by grades. Process evaluation will include fidelity, dose, feasibility, acceptability and context, using structured documentation, interviews, focus groups, and observations. The effectiveness of outcomes between groups will be assessed using mixed-effects regression analysis, adjusting for relevant covariates. Process data will be analysed using descriptive statistics and content, and thematic analysis.

DISCUSSION: This study addresses key knowledge gaps in school-based health promotion by integrating physical activity and homework support within the school structure. The results will yield insights into both effectiveness and implementation, informing future policy and practice in schools to promote health and facilitate students’ learning. The intervention targets youth in diverse socioeconomic contexts and is expected to contribute to reducing health and education inequalities.

TRIAL REGISTRATION: The trial was retrospectively registered on April 27, 2021. ISRCTN78666212.

PMID:41634640 | DOI:10.1186/s12889-026-26469-3

BMC Surg. 2026 Feb 3. doi: 10.1186/s12893-026-03494-y. Online ahead of print.

ABSTRACT

OBJECTIVES: This retrospective cross-sectional study aimed to investigate the differences and influencing factors between the headache patients who achieved complete remission or significant reduction in headache frequency postoperatively and those whose frequency remained unchanged.

METHODS: The study was conducted on 386 patients who underwent bariatric surgery at the four university hospitals between January 2018 and June 2024. Patients were divided two groups as with or without headache and then patients with headache were divided into migraine and tension-type headache groups.

RESULTS: Headache duration, HIT-6 and VAS scores were also significantly reduced after operation. Bariatric surgery was significantly and negatively correlated with headache duration (r=-0.170; p < 0.05), HIT-6 (r=-0.353; p < 0.01) and VAS (r=-0.408; p < 0.01). Bariatric surgery had significant effect on HIT-6 (OR: 7.120; p < 0.01), headache frequency (OR: 13.634; p < 0.01) and VAS (OR: 2.024; p < 0.01). In migraine group; duration, HIT 6 and VAS levels were significantly decreased after operation (p < 0.05). In tension type group; only VAS level was significantly decreased after operation (p < 0.05).

CONCLUSION: After bariatric surgery, a statistically significant decrease in headache in terms of impact and severity was observed. This situation reveals that bariatric surgery has a direct and significant effect on headache. In patients with a BMI value on the borderline for bariatric surgery, these values ​​can be lowered slightly in case of severe headache.

PMID:41634636 | DOI:10.1186/s12893-026-03494-y