Nevin Manimala

J Robot Surg. 2025 May 24;19(1):232. doi: 10.1007/s11701-025-02379-1.

ABSTRACT

OBJECTIVE: This analysis aims to compare the outcomes of robotic cystectomy in patients with bladder cancer who are under 80 years of age versus those who are 80 years or older.

MATERIALS AND METHODS: A thorough search was conducted across key databases, including Google Scholar, Cochrane Library, PubMed, EMBASE, and Web of Science, with the most recent search conducted in July 2024. Data analysis was performed using Stata 18, applying a random-effects meta-analysis model. Weighted mean differences were calculated for continuous data, and odds ratios for categorical variables, accompanied by 95% confidence intervals.

RESULTS: Four studies were included in the meta-analysis. The baseline data revealed significant differences in age, sex distribution, BMI, ASA scores (≥ 3), and cT2 staging between the two age groups. Patients aged 80 and above had significantly longer surgical durations and a greater number of lymph nodes removed compared to those under 80. Marked heterogeneity was observed in the younger cohort, which showed higher rates of urinary diversion to the neobladder and pelvic lymph node dissection. Blood loss, hospitalization duration, total complications, minor complications, and major complications did not differ notably between the age groups.

CONCLUSION: This study suggests that robot-assisted radical cystectomy (RARC) is a viable and safe procedure for carefully selected elderly patients when performed in high-volume specialized centers. However, the small sample size, intermediate follow-up period, and potential for selection bias warrant caution in interpreting long-term outcomes. Future multi-center studies with longer follow-ups are needed to confirm these findings and establish standardized criteria for patient selection.

PMID:40411671 | DOI:10.1007/s11701-025-02379-1

Appl Health Econ Health Policy. 2025 May 24. doi: 10.1007/s40258-025-00977-6. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the decreased risk of cardiovascular disease (CVD) with statins, there remains an unfulfilled clinical need to prevent CVD events and premature mortality through further cholesterol-modifying interventions. In people with established CVD taking a statin, lipid therapy escalation to reduce low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C) levels may lower the risk of CVD hospital admissions and improve survival. However, the cost-effectiveness of different cholesterol treatment escalation thresholds is uncertain.

OBJECTIVE: This study aimed to identify the most cost-effective cholesterol threshold for escalating lipid therapy in people with established CVD who are taking a statin, to support the 2023 update of the NICE guideline on CVD in England.

METHODS: A cohort Markov model with a yearly cycle length was developed to compare the lifetime costs and quality-adjusted life years (QALYs) of various LDL-C treatment escalation thresholds (0-4.0 mmol/L), using a combination of treatment effects from an original network meta-analysis of randomised controlled trials (RCTs), real-world data for estimating baseline cholesterol levels and CVD event rates from a published meta-analysis of statin RCTs. The model used the following CVD events: ischaemic stroke; transient ischaemic attack; peripheral artery disease; myocardial infarction; unstable angina; coronary revascularisation; and mortality. The model also used evidence-based estimates of resource use and costs, and published quality of life data. Baseline LDL-C levels and CVD hospital admission rates were estimated through a bespoke analysis of the English primary care data from Clinical Practice Research Datalink (CPRD), linked to Hospital Episode Statistics Admitted Patient Care (HES) and Office for National Statistics (ONS) death registrations.

RESULTS: Data from 590,917 adult individuals (61.7% men) with CVD on a statin in primary care between 1 January 2013 and 28 February 2020 were included in the CPRD-HES-ONS analysis. The most cost-effective threshold for lipid therapy escalation was an LDL-C of 2.2 mmol/L (or equivalent non-HDL-C of 2.9 mmol/L) at NICE’s lower cost per QALY of £20,000. An LDL-C of 2.0 mmol/L (or equivalent non-HDL-C of 2.6 mmol/L) was the most cost-effective treatment escalation threshold in a significant proportion (38%) of probabilistic simulations and produced more health. At this threshold, the model predicted that 42% of people with CVD would require combination therapy with ezetimibe while 19% would require an injectable drug such as inclisiran. At NICE’s upper cost per QALY of £30,000, the most cost-effective LDL-C treatment escalation threshold was 1.7 mmol/L (or equivalent non-HDL-C of 2.2 mmol/L).

CONCLUSIONS: The results demonstrate the importance of establishing evidence of cost-effectiveness for cholesterol treatment escalation thresholds. The study’s findings support the updated NICE guideline recommending a threshold of 2.0 mmol/L LDL-C (or equivalent non-HDL-C of 2.6 mmol/L) for secondary prevention of CVD.

PMID:40411656 | DOI:10.1007/s40258-025-00977-6

Clin Oral Investig. 2025 May 24;29(6):309. doi: 10.1007/s00784-025-06387-1.

ABSTRACT

OBJECTIVES: To evaluate the cleaning efficacy of different irrigation activation techniques in removing smear layers from root canals.

MATERIALS AND METHODS: Ninety lower premolars with straight root canals were assigned to six experimental groups (n = 15 each): control group, conventional irrigation, passive ultrasonic activation (PUI), distilled water laser-activated irrigation (LAI), PulpSucker irrigation, and iVac irrigation. Each canal was shaped to size 30/04 and irrigated with 5% NaOCl. The final rinse was performed according to the experimental group. After chemo-mechanical procedures, the teeth were split longitudinally and subjected to scanning electron microscopic (SEM) analysis for each root canal third (coronal, middle, and apical). The presence of smear layer was evaluated using a 5-grade scoring system at 500× and 1000× magnification. Following the Shapiro-Wilk test, data were statistically analyzed using the nonparametric Kruskal-Wallis test, followed by the post-hoc Dunn test with Bonferroni correction (α = 5%), to compare the effectiveness of smear layer removal. The Friedman test and post-hoc Wilcoxon signed-rank test with Bonferroni correction (α = 5%) were performed to assess significant differences in smear layer removal among the different tooth thirds.

RESULTS: Activated irrigation techniques significantly outperformed conventional irrigation (p <.05), with the iVac technique demonstrating the best results in smear layer removal in the apical third. LAI and PUI showed comparable results across all tooth thirds. Significant differences in cleaning efficacy were observed among the different tooth thirds within each experimental group, with the apical third exhibiting the highest presence of smear layer.

CONCLUSION: Within the limitations of the study, irrigant activation demonstrated higher efficiency in smear layer removal from root canal systems compared to conventional irrigation techniques. iVac showed the best cleaning performance in each third, particularly in the apical third.

CLINICAL RELEVANCE: iVac technology offers significant potential for improving clinical outcomes.

PMID:40411649 | DOI:10.1007/s00784-025-06387-1

Arch Public Health. 2025 May 23;83(1):135. doi: 10.1186/s13690-025-01629-w.

ABSTRACT

BACKGROUND: In Tanzania, cervical cancer is the fourth leading cause of cancer-related deaths and the foremost type of cancer affecting women of reproductive age (15-49 years) and beyond. Cervical cancer is preventable and treatable, which underscores the importance of early screening. This study aimed to determine the prevalence and determinants of cervical cancer screening(CCS) among women of reproductive age (15-49) in Tanzania.

METHODS: In this study we analysed secondary data of 15,254 women drawn from the 2022 Tanzanian Demographic and Health Survey (TDHS). Data were weighted using the individual weight for women (v005/1,000,000) according to DHS guidelines. The dependent variable was CCS status, while independent variables included demographic characteristics, socio-economic factors, and health system factors. Descriptive analysis was used to show the distribution of respondents in terms of frequency and percentage. Weighted binary logistic regression model was used to determine associations between the variables. In addition, multivariable logistic model was used to control confounders and assess possibility of interaction. A significance threshold of p-value < 0.05 at 95% confidence interval(CI) was applied to assess the significance of each variable.

RESULTS: The prevalence of women aged 15-49 years who have ever undergone CCS in Tanzania was 7% (95% CI: 6.58, 7.93). Despite the low proportion of women who have ever received screening, cervical screening was significantly more common among women aged 30-49 years (adjusted Odds Ratio (aOR) = 3.56, 95% CI = 2.75, 4.60), married (aOR = 1.44, 95% CI = 1.11, 1.87), separated individuals (aOR = 1.64, 95% CI = 1.20, 2.24), smokers (aOR = 11.75, 95% CI = 1.93, 71.60), living with HIV (aOR = 5.72, 95% CI = 4.33, 7.56), and those who listened to the radio at least once a week (aOR = 1.46, 95% CI = 1.20, 1.78). Conversely, women who were less likely to be screened for CCS were typically characterised by residing in rural areas (aOR = 0.66, 95% CI = 0.53, 0.82), having informal education (aOR = 0.43, 95% CI = 0.30, 0.60), from low economic backgrounds (aOR = 0.49, 95% CI = 0.37, 0.66), unemployed (aOR = 0.78, 95% CI = 0.65, 0.952), never using contraception (aOR = 0.82, 95% CI = 0.70, 0.97), never covered by health insurance (aOR = 0.58, 95% CI = 0.45, 0.74). These factors were significantly associated with the uptake of CCS services among women aged 15-49 years in Tanzania.

CONCLUSION: The study highlight that women aged 15-49 years who have ever undergone CCS in Tanzania is generally low at 7%, compared to the WHO recommendation of 70%. Women with no formal education or primary education, belonging to the poor wealth quintile, and having no access of listening to the radio at least once per week; had lower possibility of undergoing CCS compared to their counterparts. Tailored programs aimed at increasing cervical cancer screening should target all women in order to attain the WHO recommendation. Additionally, there is a need to enhance education and health insurance coverage among community members to increase women’s accessibility to CCS services.

PMID:40410900 | DOI:10.1186/s13690-025-01629-w

J Orthop Surg Res. 2025 May 24;20(1):512. doi: 10.1186/s13018-025-05941-7.

ABSTRACT

Objective Enhanced recovery after surgery protocols have been increasingly adopted to optimize postoperative functional restoration. This propensity score-matched cohort study quantified the impact of the direct anterior approach during THA on ERAS efficacy in patients with femoral neck fractures and analyzed outcomes such as functional recovery acceleration and perioperative complications. Methods The consecutive cohort comprised 231 patients who underwent primary arthroplasty for femoral neck fractures and were stratified by surgical approach: direct anterior (DAA, n = 59) versus posterolateral (PLA, n = 172). The clinical outcomes, such as patient statistics, details of perioperative management, length of stay, pain, Harris hip score, and in-hospital complications, were recorded. This retrospective observational study mitigated the risk of confounding bias by applying propensity score matching. Results With PSM, 51 pairs of well-matched patients were generated for comparison between the DAA group and the PLA group. The incision length decreased to 10.7 ± 1.4 cm in the DAA group, whereas it was 13.1 ± 1.3 cm in the PLA group. Compared with the PLA cohort, the DAA cohort had a significantly shorter postoperative length of stay (P = 0.001) but superior limb-length discrepancy control (P < 0.001). Compared with the PLA group, the DAA group demonstrated superior early pain control (VAS score reduction: 3/7/14 days, P < 0.05) and accelerated functional gains (HHS improvement: 7/14 days/1 month, P < 0.05), although the 6-month outcomes were similar between groups (P = 0.675). The DAA group exhibited superior 1-month outcomes in terms of pain control, device independence, and ambulation (P < 0.05), but there were similar complication profiles between the groups. Conclusions Compared with the posterolateral approach, DAA enhances early recovery outcomes in THA among elderly patients with femoral neck fractures undergoing ERAS protocols. DAA demonstrated superior short-term functional gains and similar long-term outcomes compared with the posterolateral approach. These findings support the strategic use of DAA for optimizing early recovery for this patient population.

PMID:40410877 | DOI:10.1186/s13018-025-05941-7

Microbiome. 2025 May 23;13(1):134. doi: 10.1186/s40168-025-02119-5.

ABSTRACT

One Health seeks to integrate and balance the health of humans, animals, and environmental systems, which are intricately linked through microbiomes. These microbial communities exchange microbes and genes, influencing not only human and animal health but also key environmental, agricultural, and biotechnological processes. Preventing the emergence of pathogens as well as monitoring and controlling the composition of microbiomes through microbial effectors including virulence factors, toxins, antibiotics, non-ribosomal peptides, and viruses holds transformative potential. However, the mechanisms by which these microbial effectors shape microbiomes and their broader functional consequences for host and ecosystem health remain poorly understood. Metaproteomics offers a novel methodological framework as it provides insights into microbial dynamics by quantifying microbial biomass composition, metabolic functions, and detecting effectors like viruses, antimicrobial resistance proteins, and non-ribosomal peptides. Here, we highlight the potential of metaproteomics in elucidating microbial effectors and their impact on microbiomes and discuss their potential for modulating microbiomes to foster desired functions.

PMID:40410872 | DOI:10.1186/s40168-025-02119-5

Hum Genomics. 2025 May 24;19(1):61. doi: 10.1186/s40246-025-00756-3.

ABSTRACT

BACKGROUND: The interplay between diet and healthspan is a topic of great interest in biomedical research. Toward this end, consumption of marine omega-3 fatty acids is of particular significance, as reports suggest that diets focused on seafood can prolong the disease-free portion of the human lifespan. Fish consumption has also been linked to reduced biological aging as measured by epigenetic clocks, but there is no conclusive evidence of a causal relationship. Moreover, fish oils reduce triglycerides, and may affect other lipid profiles, as well as systemic inflammation. To investigate further, we used two-sample Mendelian randomization to investigate potential causality between fish intake and healthspan markers.

METHODS: Bidirectional Mendelian randomization was performed in the two-sample setting with publicly available GWAS summary statistics. GWAS data from the UK Biobank for oily fish consumption (n = 460,443) and fish oil supplementation (n = 461,384) were used as the primary exposures. First-generation epigenetic clocks Hannum age and intrinsic epigenetic age acceleration (IEAA), as well as second-generation clocks GrimAge and PhenoAge were collected from an independent dataset of individuals of European ancestry (n = [34,449-34,667]). Finally, data from the Integrative Epidemiology Unit database was used for serum proxies of lipidemia and systemic inflammation (n = [61,308-78,700]). Additional sensitivity analyses, such as reverse causation testing and the Cochran’s Q test were performed for exposure-outcome pairs where the inverse variance weighted (IVW) method was significant (p-value < 0.05), and where the MR Egger method indicated an effect in the same direction as the IVW result.

RESULTS: We report that oily fish consumption appears to decrease PhenoAge acceleration (p < 0.0086), whereas fish oil supplementation appears to decrease GrimAge (p = 0.037). Both omega-3 exposures modify the epigenetic clocks in the expected negative, or age-decelerating, direction. For the serum biomarkers, we find evidence that fish oil consumption leads to a reduction in triglycerides (p = 0.004), although HDL and LDL were not significantly modified. Finally, we also detected a suggestive inverse relationship between oily fish consumption and hsCRP (p = 0.064).

CONCLUSIONS: Our analysis shows that consuming fish oil, whether through whole food or as a supplement, can have a rejuvenating impact as measured by PhenoAge and GrimAge acceleration. We have also provided evidence further linking fish oil intake and lower triglyceride levels. These results, based on robust MR-based analyses, emphasize the effectiveness of dietary choices in modifying emerging measures of healthspan.

PMID:40410862 | DOI:10.1186/s40246-025-00756-3

BMC Oral Health. 2025 May 23;25(1):775. doi: 10.1186/s12903-025-06148-2.

ABSTRACT

BACKGROUND: E-cigs(E-cigs) use is increasing worldwide. Recent studies suggest that E-cigs contain harmful elements that could lead to adverse oral health outcomes. Therefore, the aim of this study was to evaluate the impact of E-cigs smoking on periodontal health among current male smokers in Al-Kharj city in Saudi Arabia by assessing periodontal parameters and proinflammatory cytokine levels.

METHODS: Fifty-three male individuals (25 E-smokers and 28 non-smokers) participated in the study. This study compared periodontal parameters, including the plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment loss (CAL), and marginal bone loss (MBL), as well as levels of unstimulated whole saliva (UWS), interleukin IL-1B, and IL-6, between E-smokers and non-smokers.

RESULTS: The E-cigs users consumed approximately 432.6 ± 425.22 puffs on average daily, with a nicotine content of approximately 45.2 ± 11.23 mg on average. There was no statistically significant difference between the groups in terms of BOP and PI. A statistically significant difference was detected in PPD and CAL (p < 0.05) between the two groups, in which the PPD (4.10 ± 1.87) and CAL (2.72 ± 0.89) were greater in E-smokers. The mean MBL was also higher among E-smokers, which was statistically significant (p < 0.05). The mean cytokine IL-1B level was found to be (640.75 ± 138.78) among non-smokers and (889.05 ± 540.56) among E-smokers, and this difference was statistically significant (p < 0.05). However, while IL-1B had shown a significant difference between groups in the bivariate analysis (t-test), its association with E-cigs use became non-significant in the multivariate model (OR = 1.01, 95% CI: 1.00-1.02, p = 0.194). The mean IL-6 level among non-smokers was (19.49 ± 11.90) and among E-smokers, it was (17.07 ± 8.21). And, this difference was not statistically significant (p > 0.05).

CONCLUSIONS: This study revealed that E-cigs smoking had a negative effect on periodontal status (especially PPD, CAL and MBL). These results may contribute to the pathogenesis of periodontal diseases and tissue destruction. Efforts must be made to educate and create awareness among patients and the general community regarding the risks associated with E-cigs usage especially in young populations.

PMID:40410855 | DOI:10.1186/s12903-025-06148-2

BMC Oral Health. 2025 May 23;25(1):778. doi: 10.1186/s12903-025-06164-2.

ABSTRACT

BACKGROUND: The underlying cause of poor oral health in women of reproductive age remains unclear. This study aimed to explore the association between caries experience and reproductive history, focusing on age at menarche, age at menopause, and number of pregnancies.

METHODS: This cross-sectional study analyzed women from the baseline phase of the Ravansar Non-Communicable Disease (RaNCD) cohort. Data on reproductive history, including age at menarche, number of pregnancies, age at first pregnancy, and breastfeeding duration, were collected via questionnaire. The Decayed, Missing, and Filled Teeth (DMFT) index was assessed using dental examinations conducted with standard instruments. Reproductive history was considered the exposure variable, while caries experience was the outcome. Statistical analyses, including t-tests, One-way ANOVA, and linear regression, were conducted to examine associations between reproductive history and oral health.

RESULTS: A total of 5,151 women were assessed, with a mean age of 47.56 ± 8.46 years. Of these 42.46% lived in rural areas. The mean DMFT score in the overall population was 16.47 ± 9.19. Women who used dental floss had a significantly lower median DMFT than those who did not (16 vs. 12, P < 0.001). In the adjusted model, DMFT increased significantly by 0.30 for each additional pregnancy (β = 0.30,95%CI:0.04,0.56). However, no significant associations were observed between age at menstruation, frequency of abortion, age at first pregnancy, or age at menopause and DMFT.

CONCLUSIONS: The findings indicate that the number of pregnancies is significantly associated with caries experience. Further, longitudinal studies are needed to replicate this study findings.

PMID:40410853 | DOI:10.1186/s12903-025-06164-2

Ital J Pediatr. 2025 May 23;51(1):154. doi: 10.1186/s13052-025-01947-3.

ABSTRACT

House dust mite (HDM) is the most common cause of perennial allergy worldwide, causing allergic rhinitis with or without conjunctivitis (AR/C). HDM-related clinical manifestations can be treated with allergy pharmacotherapy or allergen immunotherapy (AIT) in selected cases. AIT is acknowledged as the only therapeutic approach capable of modifying the course of allergic diseases. SQ HDM-SLIT tablets (Accarizax; Merck & Co, Kenilworth, NJ/ALK-Abellò, Hørsholm, Denmark) ensures a constant potency ratio of major HDM allergens of the Dermatophagoides pteronyssinus (DERM_PT) and Dermatophagoides farinae (DERM_FA) HDM species and has demonstrated beneficial effects on allergic rhinoconjunctivitis outcomes. In Italy, rhinoconjunctivitis affects up to as many as 40% of adolescents, but no studies on HDM AIT quality of life (QoL) regarding this exclusive cohort of patients have been specifically conducted. The aim of this study is to evaluate SQ HDM SLIT tablets’ performance in improving QoL in Italian adolescents. To assess the treatment at T0, T1, and T2, we employed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ(s)), a standardized self-administered questionnaire designed for Italian patients aged 12 and above. RQLQ(s) median values at T2 and T1 were significantly lower than those at T0 (p-values equal to 0.0018 and 0.0051 for T0 vs. T2 and T0 vs. T1, respectively). Our findings suggest that the QoL of SQ HDM SLIT tablet is highly promising, demonstrating substantial potential in alleviating signs and symptoms. Our data suggest that QoL significantly improved with SQ-HDM SLIT, highlighting the potential importance of introducing this therapy for selected cases.

PMID:40410848 | DOI:10.1186/s13052-025-01947-3