Nevin Manimala

BMC Health Serv Res. 2026 Jun 6. doi: 10.1186/s12913-026-14902-7. Online ahead of print.

ABSTRACT

BACKGROUND: Screening and referral for type 2 diabetes mellitus (T2DM) during dental care visits has the potential for expanding preventive care. Using the consolidated framework for implementation research (CFIR) and the theoretical domains framework (TDF), we examined the barriers and facilitators at pre-implementation of a community-driven T2DM screening program in an urban dental clinic serving Alaska Native and American Indian (AN/AI) adults.

METHODS: This convergent mixed-methods parallel study was informed by the updated CFIR. Data were collected in 2023 through a 13-item survey of adult AN/AI potential recipients of the T2DM screening innovation/intervention, and individual in-person interviews with dental and primary care providers, staff, and operational leaders who were from the population of potential innovation deliverers. Univariate statistics and differences between strata were analyzed using R software. Interview transcripts were coded onto CFIR and TDF domains using template analysis then thematically analyzed. A convergent analysis identified areas of convergence, divergence, or complementarity.

RESULTS: Two hundred and fifty potential innovation recipients provided survey responses. The majority of survey respondents agreed that the dental clinic is a good place to get T2DM screening, thought screening would be helpful, and had no concerns about the setting. Some respondents had concerns about T2DM screening in the dental setting or by dental staff due to T2DM screening not usually occurring in a dental visit. However, most survey respondents thought the dental clinic as a good place to get screened for diabetes and had low levels of concern about T2DM screening in dental settings. Primary care providers did not see the need for T2DM screening in dental settings; however, about half of potential innovation recipients thought the T2DM screening information would be helpful for their doctor and would be a good way to find if they were at risk for or currently had T2DM.

CONCLUSIONS: Using CFIR and TDF, we identified barriers and facilitators to inform the design of a pilot process, development of pilot materials, and selection of innovation deliverers.

PMID:42251385 | DOI:10.1186/s12913-026-14902-7

BMC Vet Res. 2026 Jun 6. doi: 10.1186/s12917-026-05612-7. Online ahead of print.

ABSTRACT

Canine distemper (CD), caused by Morbilivirus canis of Paramyxoviridae family, is a contagious and potentially fatal viral disease affecting a wide range of domestic and wild canid species. This study aimed to determine the seroprevalence of Canine Distemper Virus (CDV) and associated risk factors among free-roaming dogs in the buffer zone of Bardiya National Park (BNP), Nepal. A total of 91 serum samples were collected from free-roaming dogs and tested for CDV-specific IgG antibodies using an iELISA kit. The apparent seroprevalence was found to be 52.75% (95% CI: 42.5-63.0%), while the Rogan-Gladen adjusted true prevalence was 53.28% (95% CI: 42.92-63.64%). Among seropositive samples, 29.17% had high, 31.25% medium, and 39.58% low antibody titers, indicating mixed stages of exposure. Although older dogs (> 72 months) showed higher seropositivity (80%), no statistically significant association was observed between CDV seropositivity and age, sex, body condition score, and location (p > 0.05). The findings suggest that CDV is enzootic in the free-roaming dog population around BNP, representing a potential reservoir for viral spillover to vulnerable wildlife species such as leopards and tigers.

PMID:42251375 | DOI:10.1186/s12917-026-05612-7

BMC Health Serv Res. 2026 Jun 6. doi: 10.1186/s12913-026-14908-1. Online ahead of print.

ABSTRACT

BACKGROUND: Diagnosis-related groups (DRGs) are a key instrument in health insurance payment reform. However, for DRG groups with substantial heterogeneity in disease severity and surgical complexity, uniform payment standards may lead to a mismatch between reimbursement and actual costs. The ureteral surgery group (LC19) under the China Healthcare Security Diagnosis-Related Groups (CHS-DRG) system shows marked variation in resource utilization and is therefore at high risk of systematic financial loss. This study aimed to identify factors influencing hospitalization costs in the LC19 group from a DRG profit-loss perspective, providing evidence to support the optimization of payment mechanisms.

METHODS: A retrospective cross-sectional study was conducted using data from two tertiary general hospitals in Hunan Province, China. A total of 2,568 inpatient cases classified under the CHS-DRG LC19 group between July 2023 and December 2024 were included. Total hospitalization cost was set as the dependent variable. Independent variables covered patient demographics, disease and treatment characteristics, surgical characteristics, and inpatient management factors. Univariate analyses and multivariate linear regression were performed, followed by comparisons of DRG profit-loss status and cost structures across key influencing factors.

RESULTS: Multivariate linear regression analysis showed that pyonephrosis (βt = 0.31), length of stay ≥ 7 days (βt = 0.22), and level IV surgery (βt = 0.21) were major factors associated with increased hospitalization costs, whereas day surgery was significantly associated with lower costs (βt = – 0.09). DRG profit-loss analysis indicated that cases involving procedure code 56.41, level IV surgery, or length of stay ≥ 7 days had deficit rates exceeding 80%. Cost structure analysis revealed that level IV surgery was associated with significantly higher expenditures across all cost components, while day surgery demonstrated clear advantages in laboratory test and diagnostic examination costs.

CONCLUSIONS: Hospitalization costs and DRG financial performance in the LC19 group are mainly driven by disease severity, surgical complexity, and inpatient management patterns. Refining grouping criteria, establishing dynamic stratified payment standards, and expanding day surgery pathways may improve payment accuracy and healthcare efficiency.

PMID:42251371 | DOI:10.1186/s12913-026-14908-1

J Transl Med. 2026 Jun 6. doi: 10.1186/s12967-026-08394-6. Online ahead of print.

ABSTRACT

BACKGROUND: Chimeric antigen receptor T (CAR-T) cell therapy has demonstrated remarkable efficacy in relapsed/refractory large B-cell lymphoma (R/R LBCL), yet nearly 40-60% of patients fail to achieve durable responses. The mechanisms underlying interpatient variability in CAR-T expansion and persistence remain incompletely understood. In this exploratory study, we preliminarily investigated the associations between baseline peripheral blood immune subsets, CAR-T expansion kinetics, and clinical outcomes.

METHODS: We retrospectively analyzed 33 patients with R/R LBCL who received CD19/CD22 bispecific chimeric antigen receptor T-cell therapy (CAR2219) at our center. Peripheral blood samples were analyzed by flow cytometry. CAR-T cell expansion was monitored longitudinally, and group-based trajectory modeling (GBTM) classified patients into expansion patterns. Associations with progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier analysis and Cox regression. Twenty-two patients received tislelizumab (a PD-1 inhibitor) as maintenance therapy (200 mg intravenously every 3 weeks) starting on day 28 after CAR-T infusion. This regimen was not used as prior therapy, bridging therapy, or co-infusion, rather, it was designed to potentially enhance CAR-T persistence after the initial expansion phase. Given the small sample size (n = 33) and the exploratory nature of the analyses, all findings are hypothesis-generating only and require validation in large prospective cohorts.

RESULTS: Two distinct CAR-T expansion trajectories were identified: a low-expansion group (Group 1, n = 18) and a high-expansion group (Group 2, n = 15). Compared to Group 1, Group 2 exhibited higher peak expansion (Cmax, p < 0.001), greater total exposure (area under the curve (AUC), p < 0.001), and delayed time to peak (Tmax, 14 days vs. 10 days). Group 2 had higher baseline naive T cells (FDR-adjusted p = 0.024), helper T cells (FDR-adjusted p = 0.006), and CD4/CD8 ratio (FDR-adjusted p = 0.049), and fewer activated regulatory T cells (Tregs) (FDR-adjusted p = 0.018). Higher CD4/CD8 ratio associated with longer PFS (HR 0.41, 95% CI 0.17-0.73, p = 0.047). In exploratory subgroup analyses, a directional trend toward longer PFS was noted among patients with high baseline PD-1 expression who received PD-1 inhibitor maintenance therapy, whereas no such trend was observed in those without maintenance. These hypothesis-generating observations require validation in larger prospective cohorts.

CONCLUSION: Baseline immune cell composition may associate with CAR-T expansion and outcomes in R/R LBCL. Exploratory subgroup analyses suggested that the direction of association between baseline PD-1 expression and PFS may differ according to receipt of PD-1 inhibitor maintenance therapy (initiated on day 28 post-infusion), though no statistical significance was reached in either subgroup. Current evidence does not support the clinical use of baseline PD-1 expression as a predictive biomarker, and further validation in prospective studies is warranted.

PMID:42251370 | DOI:10.1186/s12967-026-08394-6

BMC Endocr Disord. 2026 Jun 6. doi: 10.1186/s12902-026-02347-2. Online ahead of print.

ABSTRACT

BACKGROUND: Hypertension (HTN) increasingly originates in childhood and adolescence, with obesity and smoking as modifiable risk factors. However, longitudinal evidence on their independent and joint effects on HTN risk into early adulthood remains limited in non-Western populations.

METHODS: Using data from the Tehran Lipid and Glucose Study (TLGS), we followed 985 adolescents (mean age 15.01 years) for a median of 15.05 years. Adolescent overweight/obesity was defined using national BMI percentiles, and smoking status was self-reported. Incident adulthood HTN was defined as blood pressure ≥ 140/90 mmHg or use of antihypertensive medication. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders.

RESULTS: Over follow-up, 95 participants developed HTN. In adjusted analyses, adolescent overweight/obesity was independently associated with higher adulthood HTN risk (HR: 1.73; 95% CI: 1.11-2.71). Adolescent smoking was not independently associated with adulthood HTN after adjustment (HR: 1.15; 95% CI: 0.63-2.09). In joint exposure analyses, overweight/obese non-smokers had a higher risk than normal-weight non-smokers (HR: 1.77; 95% CI: 1.10-2.84), whereas smokers did not show statistically significant excess risk regardless of weight status. The obesity-smoking interaction suggested a possible synergistic effect on HTN risk in adulthood.

CONCLUSIONS: Adolescent overweight/obesity is an independent predictor of adulthood HTN. Although smoking was not independently associated after adjustment, the potential interaction between obesity and smoking merits further study. Prevention efforts should prioritize adolescent weight management to reduce long-term cardiovascular risk.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42251360 | DOI:10.1186/s12902-026-02347-2

Pediatr Rheumatol Online J. 2026 Jun 6. doi: 10.1186/s12969-026-01234-3. Online ahead of print.

ABSTRACT

OBJECTIVES: This study sought to evaluate the clinical implications of thrombocytopenia in pediatric patients diagnosed with systemic lupus erythematosus (SLE) and to explore its relationship with various disease features. Furthermore, the research aimed to identify risk factors that affect the occurrence of SLE-associated thrombocytopenia.

METHODS: A single-center retrospective study was conducted involving 236 pediatric patients diagnosed with SLE at Children’s Hospital of Fudan University from January 2020 and December 2025. Clinical information and laboratory parameters, such as complement levels, autoantibody profiles, and platelet counts, were systematically collected. Participants were divided into two groups and those without, based on their platelet counts at the time they were diagnosed with SLE. The presence of thrombocytopenia was determined at diagnosis, and further subgroup analyses were carried out based on the severity of the condition. All statistical analyses, such as logistic regression and one-way ANOVA, were conducted using SPSS version 26.0.

RESULTS: Thrombocytopenia was observed in 19.5% (46 out of 236) of the patients. In comparison to the cohort without thrombocytopenia, the thrombocytopenia group demonstrated significantly increased incidences of leukopenia, leukocyte reduction, and positivity for antiphospholipid antibody IgM, anti-β2-glycoprotein-1 antibody, and lupus anticoagulant (P < 0.05). Furthermore, severe thrombocytopenia (defined as a platelet count below 50 × 10⁹/L) was correlated with a markedly higher prevalence of lupus anticoagulant positivity relative to the mild-to-moderate thrombocytopenia subgroup. Logistic regression analysis revealed that leukopenia, elevated erythrocyte sedimentation rate (ESR), positivity for Anti-β2 glycoprotein 1 antibodies, high lupus anticoagulant, and neuropsychiatric manifestations were significantly associated with the presence of thrombocytopenia.

CONCLUSION: Thrombocytopenia frequently occurs in pediatric patients with SLE and demonstrates a significant correlation with leukopenia, the presence of antiphospholipid antibodies, and involvement of major organs. Additionally, further multicenter prospective investigations are necessary to clarify the contribution of platelets to the pathogenesis of SLE. In clinical practice, when thrombocytopenia is identified in pediatric SLE patients, thorough evaluation for antiphospholipid antibodies and neuropsychiatric systemic lupus erythematosus (NPSLE) is warranted.

PMID:42251347 | DOI:10.1186/s12969-026-01234-3

BMC Pediatr. 2026 Jun 6. doi: 10.1186/s12887-026-07103-y. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to investigate the clinical utility of the C-reactive protein/albumin ratio (CAR) and the neutrophil/lymphocyte ratio (NLR) in evaluating the severity of sepsis in pediatric patients.

METHODS: A retrospective cohort study was conducted involving 174 pediatric patients hospitalized between June 2022 and November 2025. Sepsis and septic shock were defined according to the 2024 Phoenix criteria. Patients were stratified into a sepsis group (n = 123) and a septic shock group (n = 51). CAR and NLR were calculated from blood samples collected within 24 h of admission. A two-sided p < 0.05 was considered statistically significant. Independent associated factors for septic shock were identified using binary logistic regression analysis. Receiver operating characteristic (ROC) curves were constructed, and the area under the curve (AUC) was calculated to evaluate the diagnostic performance of CAR, NLR, and other relevant biomarkers.The study was conducted in accordance with the STROBE guidelines.

RESULTS: Univariate analysis revealed significantly elevated white blood cell (WBC) count, CAR, and NLR levels in the septic shock group compared to the sepsis group (all p < 0.05). Binary logistic regression analysis confirmed that elevated CAR (OR = 2.893, p < 0.001) and NLR (OR = 1.232, p < 0.001) were independent associated factors for progression to septic shock. ROC curve analysis demonstrated that a model combining CAR and NLR exhibited superior discriminative performance compared to either biomarker alone, with a higher AUC (0.802), sensitivity (74.50%), and specificity (74.80%).

CONCLUSION: CAR and NLR appear to be significant independent biomarkers for assessing severity and predicting septic shock in children with sepsis. The combination of CAR and NLR provides improved predictive accuracy compared with either marker alone, suggesting its potential utility in guiding early clinical decisions.

PMID:42251342 | DOI:10.1186/s12887-026-07103-y

BMC Oral Health. 2026 Jun 6. doi: 10.1186/s12903-026-08766-w. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to evaluate patients’ knowledge-related responses, attitudes, anxiety levels, and radiation risk perceptions regarding dental radiographic imaging methods.

MATERIALS AND METHODS: A structured 30-item questionnaire was administered face-to-face to 410 participants. Anxiety and radiation risk perception were assessed using a 5-point Likert scale, while knowledge-related responses were evaluated using categorical responses. Constructs were analyzed separately as anxiety (emotional response to radiographic procedures), risk perception (radiation-related concerns), and knowledge-related responses (factual awareness of radiation).

RESULTS: A total of 410 participants were included (mean age: 32.98 ± 12.66 years; 58.8% female). Overall anxiety levels regarding radiographic procedures were low; however, increased anxiety was observed in situations involving radiation exposure and absence of protective aprons. Radiation risk perception was generally at a moderate level; however, the tendency to refuse or postpone radiographic examinations recommended by the dentist was low. Female participants had higher radiation risk perception scores; however, this difference was not statistically significant. Regarding knowledge-related responses, participants demonstrated higher awareness of computed tomography (CT) and natural background radiation, while uncertainty was prominent regarding magnetic resonance imaging (MRI) and panoramic radiography (PR) dose.

CONCLUSION: Although patients generally tolerate dental radiographic procedures with low anxiety, uncertainties regarding radiation exposure contribute to increased perceived risk. These findings highlight the need for structured, evidence-based patient information strategies to improve radiation literacy and support informed acceptance of dental imaging procedures.

PMID:42251337 | DOI:10.1186/s12903-026-08766-w

BMC Med Educ. 2026 Jun 6. doi: 10.1186/s12909-026-09543-7. Online ahead of print.

ABSTRACT

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) is considered a reference standard for diagnosing hypertension and is recommended for out-of-office blood pressure assessment, yet internal medicine residents receive limited training in its interpretation. We conducted a needs assessment to identify gaps in hypertension and ABPM education and developed an asynchronous e-learning module to address these deficiencies. We then evaluated its impact on residents’ self-reported confidence and preparedness in outpatient hypertension management.

METHODS: We conducted a single-center quality improvement study among internal medicine residents (PGY1-4) at the University of Toronto between July 2024 and January 2026. A baseline needs assessment evaluated prior exposure to ABPM, confidence in interpretation, and preparedness to diagnose hypertension. An e-learning module was developed, consisting of a structured “Five Steps of ABPM Interpretation” framework and case-based learning. A post-intervention survey assessed self-reported confidence, preparedness, and educational value. Descriptive statistics were used to summarize outcomes. Between-group comparisons of categorical outcomes were performed using chi-square tests.

RESULTS: Sixty-two residents completed the baseline survey, and 26 completed the module and post-intervention survey [1]. At baseline, 56.5% (35/62) reported no prior exposure to ABPM interpretation. Only 22.6% (14/62) felt comfortable interpreting ABPM reports, and 32.3% (20/62) felt prepared to diagnose outpatient hypertension. Following the intervention, 84.6% (22/26) of residents reported feeling comfortable or very comfortable interpreting ABPM, and 92.3% (24/26) reported feeling prepared or very prepared to diagnose hypertension. Learner satisfaction was high, with over 90% of participants reporting that the module was educationally valuable, easy to use, and effective.

CONCLUSIONS: An asynchronous, case-based e-learning module was feasible, well-received, and associated with higher self-reported confidence and preparedness in ABPM interpretation among internal medicine residents. The observational nature and potential for both response and selection bias limits generalizability of the study.

PMID:42251329 | DOI:10.1186/s12909-026-09543-7

BMC Pregnancy Childbirth. 2026 Jun 6. doi: 10.1186/s12884-026-09443-0. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of our study is to compare the markers and parameters obtained from complete blood count between patients diagnosed with missed abortion in the first trimester and a healthy pregnant control group.

MATERIALS AND METHODS: This descriptive, retrospective, case-control study included 166 patients diagnosed with missed abortion according to ultrasound criteria, and an equal number of healthy pregnant controls, who visited the Gynecology and Obstetrics Clinic at a Training and Research Hospital from January 1, 2018, to July 1, 2023. Participants, with 5 to 14 weeks of gestation, were selected using simple random sampling. Data on age, gravida, parity, gestational week, and hemogram results were retrieved from medical records and compared. Statistical significance was set at p < 0.05.

RESULTS: No significant differences were observed between the case and control groups in terms of gravida, parity, age, or gestational week (p > 0.05). Likewise, comparisons of hemogram parameters and derived values, did not show statistically significant differences (p > 0.05). However, the multivariate logistic regression analysis revealed that each unit increase in lymphocyte count was linked to a 2.075 times higher risk of missed abortion (p = 0.040).

CONCLUSION: Our study found no significant differences in complete blood count parameters between the missed abortion and healthy pregnant groups. Although lymphocyte count was significant in the multivariate model, this association should be interpreted with caution, as complete blood count values were obtained at the time of diagnosis. Therefore, it does not indicate predictive value, and prospective studies are needed to determine whether lymphocyte count may serve as a pre-diagnostic marker.

PMID:42251326 | DOI:10.1186/s12884-026-09443-0