Nevin Manimala

Malar J. 2025 Jul 4;24(1):218. doi: 10.1186/s12936-025-05464-w.

ABSTRACT

BACKGROUND: Zoonotic malaria is a growing public health concern in Southeast Asia, with Malaysia and Thailand accounting for 95.2% of the 3290 global cases reported in 2023. It is caused by Plasmodium species primarily adapted to long- and pig-tailed macaques, transmitted to humans via certain Anopheles mosquitoes. This meta-analysis quantifies its prevalence and risk factors in the Greater Mekong Subregion and Malaysia.

METHODS: This meta-analysis was conducted following the PRISMA (Preferred Reporting Items for Systematic) guidelines. A comprehensive literature search was conducted in PubMed and Scopus databases (2000-2024) to identify studies on zoonotic malaria infection in humans and monkeys. Backward search was done using Google Scholar. Inclusion criteria were defined using the CoCoPop (Condition, Context, and Population) framework. Two reviewers independently extracted data, and study quality was assessed using appropriate risk-of-bias tools. A random-effects meta-analysis was conducted using the metafor package in R programme, with heterogeneity assessed via I² statistics and subgroup analyses. Meta-regression using a linear mixed-effects models estimated unadjusted odds ratios for transmission determinants.

RESULTS: The overall pooled prevalence of malaria infection was 8.6% in humans and 35.0% in monkeys. The pooled prevalence was higher in Malaysia (22.8%) than GMS (1.2%). In GMS, Myanmar with a pooled prevalence of 4.9% contributes a higher burden of human zoonotic malaria than Thailand (1.8%). Significantly high heterogeneity between studies was recorded for both human (I² = 99.7%, P < 0.0001) and monkey (I² = 98.7%, P < 0.0001) infections. The major risk factors assessed were gender (males: OR = 4.3), age (adults 21-40 years: OR = 5.6), mobility, misdiagnosis, and Plasmodium knowlesi infection. Most cases (4773; 89.6%) were initially misdiagnosed by microscopy as non-zoonotic. Prevalence in monkeys was highest in Macaca nemestrina (63.3%) followed by Macaca fascicularis (31.4%) with Plasmodium inui and Plasmodium cynomolgi as the most frequent parasites.

CONCLUSIONS: This study contributes to the understanding of the transmission complexities of zoonotic malaria in the GMS countries and Malaysia, highlighting critical knowledge gaps and the need for a multidisciplinary approach to managing its further spread.

PMID:40616123 | DOI:10.1186/s12936-025-05464-w

Diabetol Metab Syndr. 2025 Jul 4;17(1):256. doi: 10.1186/s13098-025-01812-7.

ABSTRACT

BACKGROUND: The relationship between triglyceride glucose (TyG) index and long-term prognosis in individuals with heart failure (HF) remains unclear. This study aimed to explore the relationship between the TyG index and both all-cause and cardiovascular mortality in patients with HF.

METHODS: A total of 709 participants with HF were included from the National Health and Nutrition Examination Survey (1999-2018). The primary endpoints were all-cause mortality and cardiovascular mortality. Participants were classified into three groups (T1, T2, and T3) based on the tertiles of the TyG index, with T1 representing the group having the lowest values, T2 the middle-value group, and T3 the group with the highest values. Multivariate Cox proportional hazards regression model was used to investigate the associations between the TyG index and both all-cause mortality and cardiovascular mortality. The restricted cubic spline (RCS) analysis was used to examine the non-linear associations between TyG index and the endpoint events, and a two-piecewise Cox hazards model was constructed.

RESULTS: During a median follow-up period of 74 months, a total of 355 deaths were recorded, with 128 of them attributed to cardiovascular causes. Multivariate Cox regression models showed that compared to the T1 group, the T2 group exhibited a significantly lower risk of cardiovascular mortality (model 1 h: 0.51, 95%CI: 0.28-0.94; model 2 h: 0.55, 95%CI: 0.30-1.00). The RCS analysis revealed a nonlinear relationship between TyG index and all-cause mortality (p-non-linear: 0.014) as well as the cardiovascular mortality (p-non-linear: 0.049) among patients with HF. The inflection points were identified as 8.89 for all-cause mortality and 8.86 for cardiovascular mortality. The risk of all-cause mortality and cardiovascular mortality demonstrated a significantly increase when the TyG index exceeded the corresponding inflection points.

CONCLUSIONS: J-shaped associations were observed between TyG index and both all-cause mortality and cardiovascular mortality in patients with HF. TyG index exhibited significant predictive value in this population.

PMID:40616121 | DOI:10.1186/s13098-025-01812-7

Trials. 2025 Jul 4;26(1):239. doi: 10.1186/s13063-025-08949-w.

ABSTRACT

BACKGROUND: Pregnant people are often excluded from clinical trials, primarily due to safety concerns. However, exclusion causes population-level harms as well as sometimes providing individual protection. Harms caused to pregnant people by exclusion from clinical trials have been clearly evidenced and highlighted during the COVID pandemic. The National Institute for Health and Care Research (NIHR) has since provided guidance on improving inclusion of under-served groups, which includes pregnant people, in clinical research. Appropriate inclusion and active facilitation to participate are required to provide equitable evidence-based healthcare during pregnancy and to comply with ethical principles for research.

METHODS: We carried out an exploratory, online, cross-sectional survey of trialists to assess whether, why, and how pregnant people are included or excluded from clinical trials funded by the NIHR Health Technology Assessment (HTA) Programme, with awards starting in 2022-2023. Trialists were the respondents, with trials the primary focus of this survey. Invitations were sent to trialists between October 2023 and March 2024. Summary statistics were calculated to describe the characteristics of the trials and respondents, to describe eligibility of pregnant people, reasons for this, and how this eligibility is documented and implemented.

RESULTS: We identified 120 trials of which 88 were eligible for this survey. Responses were received for 81 trials. Pregnant people are excluded from 34 of these 81 trials. Pregnant people are eligible for inclusion in 40 of the 81 trials, including four which partially exclude people during pregnancy. Eligibility is unclear for seven trials. Exclusions are mostly for safety reasons. Sponsors and regulatory authorities are unnecessary barriers to inclusion in some trials. Eight trials of 40 trials make explicit or deliberate attempts to include people during pregnancy.

CONCLUSIONS: A minority of the 120 trials include people during pregnancy. Most trials for which pregnant people are eligible do not report explicitly including people during pregnancy or facilitating their inclusion. A small number of trials, different in setting, clinical area, and intervention type, are intentionally designed and conducted in a way that include people during pregnancy. There are clear opportunities to improve the inclusion of pregnant people in clinical trials in the NIHR HTA Programme.

PMID:40616110 | DOI:10.1186/s13063-025-08949-w

Respir Res. 2025 Jul 4;26(1):236. doi: 10.1186/s12931-025-03312-8.

ABSTRACT

BACKGROUND: Pulmonary emphysema occurs frequently in older adults, often without airflow limitation. Its presence predicts symptoms, respiratory hospitalizations and deaths, and all-cause mortality. Proteomics may provide further insights into emphysema pathogenesis and inform therapeutic targets.

OBJECTIVE: We performed a proteomic discovery analysis of percent emphysema on computed tomography (CT) in a population-based, multiethnic sample from the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study. Replication was performed in two chronic obstructive pulmonary disease (COPD)-based studies, the SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) and the Genetic Epidemiology of COPD (COPDGene) Study.

METHODS: MESA recruited participants from the general population in 2000-02. The MESA Lung Study performed full-lung CT scans in 2010-12. Percent emphysema was defined as the percentage of lung voxels < -950 Hounsfield units. Over 7,200 plasma aptamers were measured via SomaScan. Cross-sectional linear and least absolute shrinkage and selection operator (LASSO) regression models were adjusted for demographics, anthropometrics, smoking, renal function, and scanner parameters. Statistical significance was defined as a false discovery rate p-value < 0.05. Gene Ontology (GO)/Reactome enrichment analyses were performed. LASSO-selected proteins’ predictive performance was evaluated.

RESULTS: Among 2,504 participants in the MESA Lung Study, mean age was 69.4 years, 1,291 had ever smoked, and median percent emphysema-like lung was 1.4%. In total, 1,234 aptamers were significantly associated with percent emphysema in the MESA Lung Study, and 35 replicated in the SPIROMICS and COPDGene Studies. Novel associations included protein family with sequence similarity (FAM) 177A1, syntenin-2, ubiquitin carboxyl-terminal hydrolase 25, and uncharacterized protein C20orf173. Previously identified emphysema-associated proteins included soluble advanced glycosylation end product-specific receptor (sRAGE), protein S100-A12, high mobility group protein B1, and roundabout homolog 2. Enrichment analyses identified 40 GO biological processes, including chemokine production and regulation and cell-cell adhesion and regulation, and two Reactome pathways, including RAGE signaling. In tenfold cross-validation, novel proteins were largely retained by LASSO (R² = 5.4%), improved overall model performance (R² = 24.8%), and uniquely explained greater variance in percent emphysema.

CONCLUSIONS: This analysis in a general population sample identified novel and previously characterized proteins whose functional roles were validated by GO/Reactome enriched pathways, offering new insights into emphysema pathophysiology and therapeutics.

PMID:40616090 | DOI:10.1186/s12931-025-03312-8

BMC Vet Res. 2025 Jul 4;21(1):436. doi: 10.1186/s12917-025-04906-6.

ABSTRACT

BACKGROUND: Myiasis is the infestation of tissues and organs in vertebrates, including humans and animals, by the larvae of dipteran flies that occurs in subtropical and tropical areas.

METHODS: This study assessed the knowledge, attitudes, and practices of livestock farmers across 12 counties in Ardabil province regarding myiasis in 2024, employing ANOVA and T-tests to analyze the relationships with various variables.

RESULTS: The study found a statistically significant difference in knowledge, attitude, and practice mean scores among individuals influenced by education level, residency, livestock contact, disease history, and animal interactions. In this study, a significant direct correlation was found between knowledge and attitude (r = 0.12, p < 0.001), knowledge and practice (r = 0.08, p < 0.001), as well as attitude and practice (r = 0.34, p < 0.001).

CONCLUSION: Research in Ardabil province shows that increasing awareness and training for youth on disease prevention and control can significantly enhance livestock disease management. The county health network should develop a strong educational initiative for livestock farmers and their families to raise awareness about myiasis and encourage proactive measures over time.

PMID:40616085 | DOI:10.1186/s12917-025-04906-6

BMC Musculoskelet Disord. 2025 Jul 4;26(1):650. doi: 10.1186/s12891-025-08897-1.

ABSTRACT

BACKGROUND: Although glucocorticoid therapy has been used in patients with lumbar radiculopathy for many years, the results of studies in literature are inconsistent. The aim of the study was to evaluate the effects of intramuscular betamethasone injection on pain, disability, quality of life and electroneuromyography (ENMG) findings in patients with lumbar radicular pain (LRP).

METHODS: Patients with LRP (n = 98) were evaluated between July 2022 and June 2023. Sixty patients who met the inclusion criteria were randomized into two groups. Glucocorticoid group (GC) received intramuscular injection of betamethasone and Placebo group (PB) received isotonic sodium chloride. Visual analog scale (VAS), Oswestry disability index (ODI), Nottingham health profile (NHP) and ENMG were applied to both groups. Patients were evaluated before treatment and after first week, first month and third month of treatment.

RESULTS: Significant improvements were seen in all clinical parameters in GC group. At the end of third month, VAS and NHP-Pain subscale scores improved significantly in both groups (p < 0.001) but the change of these values over time was statistically significant in favor of GC group (p = 0.03 and p = 0.044, respectively). The significant improvements observed in ODI, Energy and Physical Mobility subscales and Total scores of NHP in both groups (p < 0.05) revealed no significant difference between the groups over time. The ENMG data revealed no significant difference within the groups except the fibrillation potentials, which disappeared in both groups.

CONCLUSION: Intramuscular glucocorticoid administration provided improvements on pain, disability and quality of life of patients with LRP. Especially the effects on pain scores were superior to placebo. No superiority over placebo on ENMG findings has been demonstrated and further studies are needed in this regard.

CLINICAL TRIAL REGISTRATION: The study protocol was registered to Clinicaltrials.gov with the number NCT05571046 (retrospectively registered on 30/09/2022).

PMID:40616084 | DOI:10.1186/s12891-025-08897-1

BMC Endocr Disord. 2025 Jul 4;25(1):166. doi: 10.1186/s12902-025-01989-y.

NO ABSTRACT

PMID:40616082 | DOI:10.1186/s12902-025-01989-y

BMC Med Educ. 2025 Jul 4;25(1):1003. doi: 10.1186/s12909-025-07584-y.

ABSTRACT

BACKGROUND: The appropriate management of traumatic dental injuries (TDIs) in immature permanent teeth is critical for predicting prognosis and preserving injured teeth. However, providing accurate treatment is always challenging for dental students due to their limited knowledge of TDIs. This study aimed to assess TDIs in immature permanent teeth in terms of knowledge, attitudes, and clinical practice among Chinese dental undergraduates and residents.

METHODS: Dental undergraduates (in 3rd -, 4th -, and 5th -years) and residents (in 1st -, 2nd -, and 3rd -years) at the School of Stomatology, Wuhan University (763 in total, from May to June 2024), were distributed with a structured electronic questionnaire containing 22 items. The obtained data was statistically analyzed via the Chi-square (χ²) test (p < 0.05) using SPSS.

RESULTS: Participants from various academic levels completed 502 questionnaires, with a response rate of 65.79%. Approximately half of the participants (58.6%) were familiar with TDIs, chiefly through traditional classroom learning (90.0%). Participants had limited knowledge on correct emergency treatment for TDIs, including tooth replantation timing (51.6%), fixation method (43.8%), and time (25.5%), with 3rd -year undergraduates reporting the lowest percentage (10.2%) (p < 0.05). Most participants agreed that vital pulp preservation (95.0%) and additional examination (91.0%) are essential for TDI management. Besides, only 29.9% of participants had ever treated a clinical TDI case independently. The majority of participants expressed a strong desire to gain comprehensive knowledge of TDIs (90.0%) and additional training (96.4%).

CONCLUSIONS: Dental students at the undergraduate and postgraduate levels lacked sufficient knowledge and practice with TDIs but had a positive attitude toward TDI management. Thus, it would be enormously beneficial for dental students to gain a better understanding of TDIs through improved dental education, including multiple teaching methodologies and more clinical practice.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40616076 | DOI:10.1186/s12909-025-07584-y

BMC Surg. 2025 Jul 4;25(1):288. doi: 10.1186/s12893-025-02989-4.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of preoperative 3D reconstruction combined with intraoperative augmented reality fluorescence guidance system in laparoscopic liver surgery by establishing a retrospective cohort study.

METHODS: A retrospective cohort study was conducted from March 2023 to December 2024, with patients’ data from the medical record system. Patients were divided into two groups according to their surgical protocols: 46 cases in the control group (conventional laparoscopic liver surgery) and 50 cases in the observation group (preoperative 3D reconstruction combined with intraoperative augmented-reality fluorescence guiding system in laparoscopic liver surgery). We compared perioperative indexes (operation time, intraoperative bleeding, time to first flatus, drainage tube removal time, hospitalization time), preoperative and postoperative liver function indexes [alanine aminotransferase (ALT), albumin (ALB), total bilirubin (TBIL)], stress indexes [angiotensin II (AT II), norepinephrine (NE), epinephrine (AD)], and complication rates between the two groups.

RESULTS: The operation time of patients in the observation group was shorter than that of patients in the control group (110.75 ± 20.56 vs. 122.35 ± 20.48 min, 95% CI of difference: 2.52-20.68 min, p = 0.013), and the amount of intraoperative bleeding was less (300.80 ± 32.70 vs. 320.76 ± 35.84 mL, 95% CI of difference: 7.62-32.30 mL, p = 0.002). There was no statistically significant difference in the comparison of time to first flatus, drain removal time, hospitalization time and complication rate between the two groups (p > 0.05). Preoperatively, the comparison of ALT, ALB, TBIL, AT II, NE, AD levels of patients in the two groups were not statistically significant (p > 0.05); postoperatively, the AT II, NE, AD levels of patients in the observation group were lower than those of patients in the control group, with statistically significant differences (p < 0.001), while the differences in ALT, ALB, TBIL levels were not statistically significant (p > 0.05). For malignant cases, the R0 resection rate was similar between groups (92.3% vs. 89.5%, p = 0.724).

CONCLUSION: Preoperative 3D reconstruction combined with intraoperative augmented reality fluorescence guidance system is potentially beneficial for laparoscopic liver surgery, which can modestly shorten the operation time, reduce intraoperative bleeding, and alleviate postoperative stress reactions.

PMID:40616072 | DOI:10.1186/s12893-025-02989-4

BMC Surg. 2025 Jul 4;25(1):290. doi: 10.1186/s12893-025-03007-3.

ABSTRACT

BACKGROUND: Acute appendicitis is one of the most common surgical emergencies, predominantly affecting young adults who form the backbone of the workforce. While its diagnosis and treatment are well-studied, limited research exists on the perioperative factors affecting post-operative outcomes and health-related quality of life in resource-limited settings like Palestine. Understanding these factors is essential to enhance patient care and recovery.

METHODS: This prospective, single-center observational study was conducted at Secondary Surgical Hospital, Nablus, Palestine, from April 2021 to February 2022. Patients aged ≥ 18 years diagnosed with acute appendicitis and treated surgically were included. Data were collected using structured forms covering preoperative (sociodemographics, clinical characteristics, imaging, and laboratory findings), intraoperative (timing, technique, and surgical findings), and postoperative (pain using Visual Analogue Scale), complications, and Health-Related Quality of Life using European Quality of Life-5 Dimensions-3 Levels variables. Follow-ups were conducted at discharge, one week, and two weeks post-surgery. Statistical analyses were performed using SPSS, with p < 0.05 considered significant.

RESULTS: Ninety-three patients participated, with a mean age of 31.14 years (63.4% ≤ 31 years, 65.6% male). Sociodemographic factors, including smoking (41.9%), educational level (76.4% grade 12 or less), and COVID-19 history (18.3%), were significantly associated with post-operative outcomes. Complicated appendicitis was observed in 43.3% of cases, particularly in older patients and those with delayed presentation (> 48 h, 16.3%). Pain was assessed postoperatively with scores that were significantly higher in females (VAS > 7, p < 0.001) and showed gradual improvement within 24 h post-surgery. Health-Related Quality of Life improved significantly over two weeks, with the European Quality of Life-5 Dimensions-3 Levels index rising from 0.569 at discharge to 0.827 at two weeks. Gender, age, and delayed presentation were strongly associated with worse outcomes, including increased anxiety, reduced mobility, and prolonged recovery.

CONCLUSION: Perioperative factors such as age, gender, smoking, educational level, and pre-hospital delay significantly impact pain and HRQoL after appendectomy. Females and older patients experienced worse outcomes, highlighting the need for tailored care. These findings underscore the importance of addressing sociodemographic disparities and optimizing perioperative management. Tailored surgical planning should prioritize early intervention in high-risk groups such as females, older adults, and patients with delayed presentation to reduce complications and improve recovery. Furthermore, the significant role of anxiety and depression in post-operative outcomes suggests that stress-reduction strategies and mental health support should be integrated into patient care. Future research should aim for longer follow-up and broader populations to establish more comprehensive post-appendectomy care guidelines.

PMID:40616063 | DOI:10.1186/s12893-025-03007-3