Nevin Manimala

Lipids Health Dis. 2025 Oct 6;24(1):309. doi: 10.1186/s12944-025-02732-1.

ABSTRACT

BACKGROUND: The triglyceride-glucose index (TyG) and C-reactive protein (CRP) are key biomarkers on clinical diagnosis, each related to lung dysfunction. However, the relationship of both indexes with the risk of chronic obstructive pulmonary disease (COPD) is still unclear. This study purposes to focus on the individual and joint associations of TyG and CRP levels with COPD risk.

METHODS: This cohort study utilized baseline TyG and CRP data from the UK Biobank. Hazard ratios (HRs) and 95% confidence intervals (CIs) for COPD risk associated with TyG and CRP levels were calculated through Cox regression models. Receiver operating characteristic (ROC) curves were conducted to determine the optimal cut-off values for TyG and CRP, which were combined into a joint variable. Kaplan-Meier (KM) method was utilized to analyze cumulative hazard, while joint analysis was employed for evaluating the joint risk. Stratified and sensitivity analyses were also performed to assess the associations within subgroups, and mediation effect of TyG on COPD risk via CRP levels was assessed.

RESULTS: This study enrolled 385,523 individuals, with 10,515 COPD cases were recorded in follow-up. Compared to the lowest quintile, individuals with higher TyG and CRP had increased risk of COPD (all HRs > 1.00). The optimal cut-off values of TyG and CRP were 7.14 and 1.88 mg/L, and we found that the simultaneous elevation of both TyG and CRP significantly increased the risk of COPD. Moreover, the joint effect was stronger in participants younger than 60 years old, males, smokers or passive smokers, those with body mass index (BMI) < 25.0 kg/m², and those without baseline diabetes, asthma, or a family history of respiratory diseases (P _{for interaction} < 0.05). Moreover, the effect of TyG on COPD was significantly mediated by CRP, explaining almost 15.6% of this influence.

CONCLUSIONS: These results underscored the individual and joint effects of TyG and CRP upon COPD risk, indicating their usefulness as biomarkers for early risk assessment.

PMID:41053749 | DOI:10.1186/s12944-025-02732-1

BMC Health Serv Res. 2025 Oct 6;25(1):1308. doi: 10.1186/s12913-025-13151-4.

ABSTRACT

BACKGROUND: This study describes and compares the utilisation rates of specialist mental health and addiction (MH) services between different refugee groups and the New Zealand (NZ) resident population.

METHODS: Using linked data in Statistics NZ’s Integrated Data Infrastructure, we identified 23,709 individuals with an asylum seeker or refugee visa who stayed in NZ for at least 6 months. Logistic regression models compared the use of MH services between different refugee groups (quota refugees, convention refugees, family reunification, and asylum seekers). We conducted cox regression hazard models to investigate the time to the first service use between refugee groups and a sample of NZ resident population, including NZ-born and overseas-born individuals.

RESULTS: Adjusting for age, sex, ethnicity, neighbourhood deprivation, and time spent in NZ, we found that asylum seekers, family, and convention refugees were less likely to utilise MH services than quota refugees. The following groups had higher odds of utilising MH services: females compared with males (OR = 1.46, 95%CI = 1.35, 1.59) and those living in more deprived neighbourhoods compared with less deprived areas (OR = 1.27; 95%CI = 1.18, 1.38). Quota refuges were more likely to use MH services compared to the NZ-born group (HR = 1.94, 95%CI = 1.86, 2.03). Convention, family and asylum seekers were less likely to utilise MH services than the NZ-born population (HR = 0.82; [95% CI = 0.76, 0.89], HR = 0.54; [95% CI = 0.46, 0.64], and HR = 0.71, [95%=0.59, 0.86], respectively). We found that quota refugees’ primary source of MH service use was NGOs whereas for other refugee sub-groups, it has been District Health Boards.

CONCLUSION: The use of MH services differed between refugee groups. Quota refugees were more likely to utilise services, mainly from NGOs, with women and those who lived in the most deprived areas more likely to use MH services. These results have policy implications, such as improving early service accessibility for all refugee sub-groups.

PMID:41053745 | DOI:10.1186/s12913-025-13151-4

BMC Surg. 2025 Oct 6;25(1):453. doi: 10.1186/s12893-025-03201-3.

ABSTRACT

BACKGROUND: This study aims to evaluate the feasibility and safety of two intestinal fecal diversion methods using novel stents to prevent anastomotic leakage after surgery for middle and lower rectal cancer, and to compare their advantages and disadvantages for clinical application.

METHODS: A retrospective analysis was conducted on 101 patients who underwent laparoscopic radical resection(LAR) for rectal cancer at Yongchuan Hospital from June 2021 to March 2024. Patients were divided into three groups: 26 in the ileum group (using terminal ileal stents) ,54 in the in situ group (using rectal in situ covered stents) and 21 in the control group. Preoperative, surgical, and postoperative data were compared among the three groups.

RESULTS: No significant differences were found in baseline characteristics, surgical data, or the occurrence of postoperative anastomotic leakage or other complications. The in situ group showed no statistically significant differences from the control group in the postoperative hospital stay(12.6 ± 3.7 vs. 11.4 ± 2.9days, p > 0.05 ), total cost of hospitalization (48903.58 ± 7094.14 vs. 82205.77 ± 12222.41yuan, p > 0.05). Moreover, the ileum group in these comparisons performed worse than the control group. After incorporating data related to stoma closure surgery, the in situ group and ileum group showed significant advantages in overall hospitalization costs(59085.88 ± 7460.79 vs. 48903.58 ± 7094.14 vs. 81418.32 ± 11186.78yuan, p < 0.05), and the in-situ group also had shorter overall hospital stay(17.6 ± 5.0 vs. 22.2 ± 4.0days, p < 0.05).

CONCLUSIONS: Both fecal diversion methods showed acceptable rates of postoperative anastomotic leakage and can avoid a second stoma closure surgery. The in situ covered stent method seemed better as it not only saved hospitalization time and costs but also made postoperative management simpler and more efficient.

PMID:41053739 | DOI:10.1186/s12893-025-03201-3

Cardiovasc Diabetol. 2025 Oct 6;24(1):385. doi: 10.1186/s12933-025-02915-1.

ABSTRACT

BACKGROUND: Cardiovascular outcome trials have shown that glucagon-like peptide 1 receptor agonists (GLP1-RAs) reduce cardiovascular event rates more effectively than placebo and in patients with type 2 diabetes at increased cardiovascular risk. However, the generalizability of these findings to real-world settings remains uncertain.

AIM: This study aimed to evaluate the real-world cardiovascular effectiveness of sustained GLP1-RA use compared to dipeptidyl peptidase 4 inhibitor (DPP-4i) over 3.5 years.

METHODS: Using Danish nationwide registries, we emulated a target trial to assess the real-world effectiveness of GLP1-RAs in a population of individuals with type 2 diabetes mirroring the inclusion and exclusion criteria from the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial. The study period was 2012-2022. Outcomes included the composite of myocardial infarction, stroke, and cardiovascular mortality (3P-MACE), as well as each component individually, alongside all-cause mortality, heart failure, angina pectoris, and revascularization. Longitudinal Targeted Minimum Loss-based Estimation, a method that adjusts for both baseline and time-varying confounding, was used to estimate absolute risks of cardiovascular outcomes under sustained use of GLP1-RA and DPP 4i (active comparator), adjusting for baseline and time-varying confounding.

RESULTS: We included 6,681 people initiating GLP1-RA and 19,072 initiating DPP-4i. Accounting for baseline and time-varying confounding, sustained GLP1-RA use showed a 2.5% (95% CI 0.8-4.1%) risk reduction of 3P-MACEover 3.5 years. Risk reductions for cardiovascular mortality, all-cause mortality, heart failure, and unstable angina pectoris were 2.3% (95% CI 1.4-3.1%), 2.5% (95% CI 0.7-4.3%), 0.9% (95% CI 0.01-1.8%), and 0.7% (95% CI 0.01-1.3%), respectively. No significant differences were observed for myocardial infarction, stroke, or revascularization with risk differences of 0.1% (95% CI -1.0 to 0.8%), 0.8% (95% CI -0.2 to 1.7%), and 0.2% (95% CI -0.7-1.1%), respectively.

CONCLUSIONS: This real-world study confirms the cardiovascular benefits of GLP1-RAs over DPP-4is, particularly for reducing cardiovascular and all-cause mortality under continuous treatment exposure in patients with type 2 diabetes at increased cardiovascular risk.

PMID:41053738 | DOI:10.1186/s12933-025-02915-1

BMC Pulm Med. 2025 Oct 6;25(1):454. doi: 10.1186/s12890-025-03921-5.

ABSTRACT

BACKGROUND: Lung cancer is a leading cause of cancer-related mortality worldwide. Accurate staging of mediastinal lymph nodes is a crucial step in determining appropriate treatment approaches. Current noninvasive diagnostic methods do not provide sufficient accuracy to confidently decide on surgery without histological confirmation. Our study aimed to develop a artificial intelligence model for the precise prediction of N2 lymph node metastasis.

METHODS: We retrospectively analyzed 1489 patients who underwent standard cervical mediastinoscopy at our department, including 472 patients diagnosed with non-small cell lung cancer. We developed three distinct prediction models for N2 lymph node station metastasis: one using standard statistical analysis, another utilizing an image processing deep learning algorithm with thoracic CT, and the third employing various machine learning methods with clinicopathological and radiological data. We compared diagnostic accuracy, area under the curve (AUC), sensitivity, and specificity rates, as well as the F1-score of all models.

RESULTS: Linear discriminant analysis, quadratic discriminant analysis, Gaussian naive Bayes, and artificial neural networks all surpassed 90% accuracy. The linear support vector machine demonstrated the highest performance, with an accuracy of 95.7%, an AUC of 93.5%, and an F1-score of 92%, respectively and outperformed the logistic regression-based statistical model, which reached an accuracy of 90.6% and an AUC of 85.7%.

CONCLUSION: Machine learning models outperformed standard statistical analysis models in predicting N2 lymph node metastasis. Implementing these machine learning prediction models might greatly improve the accuracy of mediastinal lymph node metastasis detection, thereby enhancing clinical decision making and patient outcomes.

PMID:41053734 | DOI:10.1186/s12890-025-03921-5

Reprod Health. 2025 Oct 7;22(1):187. doi: 10.1186/s12978-025-02162-3.

ABSTRACT

BACKGROUND: Maternal and child mortality remains a global public health challenge. Thus, countries, including Tanzania, have adopted different cost-effective models, especially antenatal care (ANC) to improve maternal and child health (MCH). Despite the early timing of ANC visits having a great implication for ensuring improved MCH services, Tanzania has disproportionately experienced late ANC visits among pregnant women. This has entailed conducting an institutional-based study in Western Tanzania, Kasulu Town Council (KTC) to ascertain whether demographic socio-economic and maternal characteristics imply the persistence of late ANC visits using robust methods.

METHODS: An institutional cross-sectional study design was conducted in KTC, Kigoma Region using an embedded mixed-method approach from March-April 2020. Quantitative data was collected from 320 women with children aged 0-6 months attending postnatal services. A total of 40 participants were involved in the qualitative study through in-depth interviews with healthcare providers and focus group discussions held with pregnant women and women with children aged 0-6 months. Descriptive statistics and multivariate binary logistic regression were used to determine the characteristics associated with the timing of ANC visits among pregnant women. Furthermore, thematic analysis was used to generate themes triangulated with quantitative results.

RESULTS: Findings revealed that 32.2% of pregnant women attended ANC visits in the first trimester. Early ANC was associated with maternal age (AOR = 1.839, 95% Cl: 1.023, 3.303), being accompanied by a partner (AOR = 2.165, 95% Cl: 1.256, 3.733), and awareness of the danger signs (AOR = 2.079, 95% Cl: 1.172, 3.687) and parity (AOR = 2.164, 95% Cl: 1.091, 4.291). Little association was noted in the knowledge of ANC timing (AOR = 0.564, 95% Cl: 0.320, 994) and household income (AOR = 0.529, 95% Cl: 0.281, 0.995). Qualitative data indicated that low rate of early ANC initiation was attributed to a lack of support from partners and accompanied to ANC visits, insufficient knowledge of the timing of early ANC visits, and socio-cultural beliefs.

CONCLUSION: Results confirmed that early ANC visit in KTC is low. Revealed associated factors act as a bridge to improve maternal and newborn health and contribute to achieving Sustainable Development Goal no 3, which targets maternal mortality of less than 70 deaths per 100,000 live births and neonatal mortality of 12 per 1000 live births by 2030. Proposed integrated interventions can potentially ensure that women, regardless of pregnancy status, are encouraged to receive early ANC utilisation during the first trimester to receive antenatal care before delivery to improve maternal and newborn health.

PMID:41053705 | DOI:10.1186/s12978-025-02162-3

BMC Public Health. 2025 Oct 6;25(1):3344. doi: 10.1186/s12889-025-24189-8.

ABSTRACT

BACKGROUND: Prisoners are considered a vulnerable group in terms of health risks and limited access to health services. This study aimed to determine the health perceptions and health-promoting behaviors of Turkish prisoners, examine the relationship between these factors, and identify the predictors of health perceptions and health-promoting behaviors as a cross-sectional design.

METHODS: This cross-sectional study was conducted between November 2023 and January 2024 with 234 prisoners convicted of criminal offenses in two open penal institutions in Eskişehir, Turkey. Data were collected using a sociodemographic information form, the Health Perception Scale, and the Healthy Lifestyle Behaviors Scale II. Statistical analyses included Independent Samples t-test, One-way ANOVA, Pearson correlation analysis, and multiple linear regression analysis to identify the predictors of health perceptions and health-promoting behaviors.

RESULTS: The mean score of health perception among the prisoners was 51.43 ± 7.66, and the mean score of healthy lifestyle behaviors was 130.41 ± 26.90. A positive but weak correlation was found between health perception and healthy lifestyle behaviors (r = .319; p < .001).

CONCLUSIONS: The findings highlight the importance of evaluating prisoners’ health perceptions and health-related behaviors. Prison nurses are recommended to routinely assess these factors and implement targeted interventions to support healthy lifestyle changes in prison populations.

PMID:41053702 | DOI:10.1186/s12889-025-24189-8

BMC Cancer. 2025 Oct 6;25(1):1517. doi: 10.1186/s12885-025-14891-6.

ABSTRACT

BACKGROUND: High sodium intake is a recognized risk factor for increased gastric cancer mortality. This study examines the trends and distribution of stomach cancer burden associated with high sodium intake from 1990 to 2021, with a focus on its relationship with age, period, and birth cohort.

METHODS: Utilizing data from the 2021 Global Burden of Disease study, we applied an age-period-cohort model to conduct statistical analysis. We calculated age, period, and cohort effects, as well as net drift (overall annual percentage change), for gastric cancer deaths and disability-adjusted life years (DALYs) associated with high sodium intake across 204 countries and regions.

RESULTS: In 2021, 7.93% of global gastric cancer deaths and 7.92% of DALYs were linked to high sodium intake. Populations in East Asia and those with a high-middle Sociodemographic Index (SDI) bore the heaviest burden. Over the 32-year period, the global age-standardized mortality rate [Net drift = -2.33(95%CI:-2.37 to -2.28)] and age-standardized DALYs rate [Net drift = -2.56(95%CI:-2.65 to -2.47)] generally demonstrated a declining trend, particularly in high SDI regions [Net drift =-2.91 (95%CI: -3.02 to -2.81)]. China, as a representative country, exhibited unfavorable age, period, and cohort effects. Future projections suggest further declines in mortality and DALYs numbers, along with corresponding age-standardized rates.

CONCLUSION: Despite ongoing global efforts to reduce sodium intake, gastric cancer remains a significant public health challenge, especially in East Asia. The findings underscore the necessity of developing targeted prevention strategies for high-risk groups, such as the elderly and males, to mitigate the global burden of gastric cancer.

PMID:41053684 | DOI:10.1186/s12885-025-14891-6

BMC Oral Health. 2025 Oct 6;25(1):1536. doi: 10.1186/s12903-025-06912-4.

ABSTRACT

BACKGROUNDS: Psychological stress plays a role in the development of periodontal disease by influencing immune function and behavioral responses. Chromogranin A (CgA), a glycoprotein released due to activation of the sympathetic-adrenomedullary system, shows potential as a salivary biomarker for stress-related immune changes. This study aimed to assess salivary CgA levels in individuals with healthy and diseased periodontal conditions while investigating its correlation with clinical periodontal parameters and psychological stress.

METHODS: This cross-sectional study involved 56 systemically healthy participants classified into groups based on their periodontal condition: periodontal health, gingivitis, Stage II, and Stage III periodontitis. Clinical periodontal parameters were assessed. Psychological stress levels were measured using the Beck Depression Inventory (BDI). Unstimulated saliva samples were collected and analyzed for CgA mRNA expression. Statistical analyses comprised ANOVA, Spearman’s correlation, and chi-square tests.

RESULTS: Salivary CgA levels were significantly higher in individuals with Stage III periodontitis compared to those with periodontal health, gingivitis, or Stage II periodontitis (p < 0.01). No significant correlation was observed between salivary CgA levels and BDI scores.

DISCUSSION: Although salivary CgA levels were significantly elevated in patients with advanced periodontal disease, no direct associations were observed between CgA levels and individual clinical or psychological stress measures. These findings suggest that CgA may reflect systemic stress-related changes associated with disease severity rather than individual psychological status.

PMID:41053683 | DOI:10.1186/s12903-025-06912-4

BMC Pediatr. 2025 Oct 6;25(1):773. doi: 10.1186/s12887-025-06053-1.

ABSTRACT

BACKGROUND: Growth retardation is common in glycogen storage disease (GSD), though the relative contributions of hormonal and metabolic factors remain unclear. We compared clinical and biochemical features between GSD I and non-GSD I patients and identified independent predictors of height standard deviation score (SDS).

METHODS: Thirty-eight children with GSD (24 with GSD I; 14 with GSD III/VI/IX; mean age: 7.5 years) underwent evaluation of height SDS, BMI SDS, IGF1 SDS, and metabolic parameters. After excluding three patients with inflammatory bowel disease (final n = 35), multiple regression was used to identify factors associated with height SDS. In GSD I (n = 24), Lasso regression selected variables, and 1,000 bootstrap resamples assessed coefficient stability.

RESULTS: GSD I patients had lower height SDS (-2.30 vs. – 1.17; p = 0.021) and higher lactate (3.94 vs. 1.48 mmol/L; p < 0.001), uric acid (431.04 vs. 283.79µmol/L; p < 0.001) and triglyceride levels (2.38 vs. 1.29 mmol/L, p = 0.002) compared to non-GSD I. In combined-cohort regression, lactate was the only independent negative predictor of height SDS (p = 0.011); glucose levels and IGF1 SDS did not reach statistical significance. In GSD I, Lasso retained lactate (β = – 0.682), glucose (β = – 0.625), and IGF1 SDS (β = 0.524), and bootstrap validation showed only IGF1 SDS remained consistently significant.

CONCLUSIONS: Hyperlactatemia is significant predictor of growth impairment in GSD, while IGF1 is a stable predictor in GSD I. These findings highlight metabolic and hormonal targets for future hypothesis-driven research in this population.

PMID:41053679 | DOI:10.1186/s12887-025-06053-1