Nevin Manimala

Diabetol Metab Syndr. 2025 Aug 27;17(1):355. doi: 10.1186/s13098-025-01923-1.

ABSTRACT

OBJECTIVE: The weight-adjusted waist index (WWI), an innovative indicator of central obesity, is still inadequately researched in relation to diabetic complications. This study sought to elucidate the relationship between WWI and all-cause as well as cardiovascular disease (CVD) mortality in US patients with diabetic retinopathy (DR).

METHODS: We performed a retrospective cohort research with 1247 people in the United States diagnosed with diabetic retinopathy (DR). Qualified technicians collected anthropometric data using defined techniques. Mortality data was collected from participant recruitment until December 31, 2019. Cox proportional hazards models limited cubic spline curves, and Kaplan-Meier survival analysis were employed to investigate the research aims.

RESULTS: During a median follow-up of 6.75 years, there were 446 documented deaths from all causes and 163 fatalities attributed to cardiovascular events. Multivariable-adjusted Cox regression indicated a positive association between WWI and all-cause mortality (HR = 1.35, 95%CI:1.16-1.56, P < 0.001) as well as CVD mortality (HR = 1.36, 95%CI:1.07-1.73, P = 0.011). Subgroup analyses corroborated these findings, demonstrating similar relationships across various age, sex, race, and comorbidity strata.RCS analysis revealed a linear positive connection between WWI and both all-cause and cardiovascular disease mortality (P for non-linearity > 0.05).

CONCLUSIONS: Higher WWI was significantly associated with increased risk of all-cause and CVD mortality in patients with DR, suggesting a positive correlation between WWI and mortality risk in this population.

PMID:40859292 | DOI:10.1186/s13098-025-01923-1

BMC Med Educ. 2025 Aug 26;25(1):1202. doi: 10.1186/s12909-025-07803-6.

ABSTRACT

BACKGROUND: Operational Research (OR), as part of a quality assurance program, has become a standard feature of most health institutions in most high-income countries. In contrast, in low-income settings, operational research is less common, and almost no one has asssed operational research capacity building (ORCB) as a tool to improve efficacy, efficiency and quality in these settings. This study evaluated the impact of an ORCB program on participants’ research competencies and the extent to which research findings were implemented in practice.

MATERIALS AND METHODS: This study combined quantitative and qualitative data to evaluate an ORCB intervention in eye hospitals in Nepal (3 sites) and northern India (1 site) from 2019 to 2022. A self-reported questionnaire was administered at the end of the study period, and formal interviews were conducted. The questionnaire covered knowledge improvement, practice implementation, and motivating and challenging factors. Statistical analysis included paired t-tests to compare pre- and post-training scores. Qualitative data were gathered through interviews and observations and analysed thematically.

RESULTS: The program demonstrated significant improvements in participants’ research knowledge gain. Quantitative analysis revealed substantial gains in knowledge (p-values < 0.05 for all domains). Post-training, 66.7% developed study protocols, and 60% trained other staff or students. Qualitative feedback indicated overall positive impacts, including enhanced research and operational activities. However, reported challenges such as inconsistent mentorship quality, poor internet connectivity during online sessions, and difficulty in balancing clinical work with research. Despite these challenges, there was notable improvement in research practice and internal training within hospitals, and the program’s approach was appreciated for its effectiveness.

CONCLUSION: The study highlights the need for standardized training modules, consistent mentorship, and stronger institutional support. Building operational research capacity in resource-poor settings with limited administrative staff and weak data infrastructure improves individual staff knowledge and skills. Participants learned about scientific principles of reliability and validity and their importance to efforts to improve service equity, efficiency, and effectiveness.

PMID:40859281 | DOI:10.1186/s12909-025-07803-6

World J Surg Oncol. 2025 Aug 26;23(1):319. doi: 10.1186/s12957-025-03967-z.

ABSTRACT

OBJECTIVE: Ovarian cancer is a lethal gynecological health issue, that poses a serious threat to women’s health worldwide. The objective of this study was to provide a literature overview of the application of fluorescent tracers during surgical ovarian cancer treatment.

METHODS: We systematically searched 7 electronic databases from inception to September 2024. Studies were included if they investigated the application of fluorescence-guided surgery in patients with a diagnosis of ovarian cancer. Statistical analysis was performed with Stata 14.0 software, and the pooled detection rate and measures of diagnostic accuracy were evaluated. Subgroup analyses were carried out to evaluate the types of tracers, doses, injection sites, etc. Complications and adverse events were also reported. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used for quality assessment.

RESULTS: A total of 21 studies with 681 participants were included. The overall sentinel lymph node (SLN) detection rate was 86.2% (95% CI: 69.6-97.5%; p = 0.000; I² = 82.540%) and ranged from 58.6 to 100% in individual studies. The sensitivity and specificity of SLN biopsy were 95.2% (95% CI: 71.0-100.0%; P = 0.022; I² = 73.893%) and 100.0% (95% CI: 99.9-100.0%; P = 0.810; I² = 0.000%), respectively. Four types of fluorescent materials, namely, indocyanine green (ICG), pafolacianine sodium (OLT38), 5-aminolevulinic acid (5-ALA), and folate conjugated to fluorescein isothiocyanate (EC17), were used to visualize tumor deposits and detect micrometastases. The greatest sensitivity value was noted with an EC17 of 98.2% (95% CI: 89.4-100.0%), whereas the greatest specificity and positive predictive value were noted with 5-ALA values of 96.9% (95% CI: 92.1-99.8%) and 96.9% (95% CI: 90.9-100.0%), respectively. Additionally, subgroup analysis revealed a greater SLN detection rate at an ICG dose of 0.625-1.25 mg than at an ICG dose of 0.5 mg or 2.5 mg. The incidence of adverse reactions ranged from 14.3% to 83.3%. Most events were mild or moderate in severity.

CONCLUSION: Fluorescence-guided surgery is a potentially safe and applicable technique in ovarian cancer surgery. However, considering the small number of participants and the heterogeneity, further studies are needed to better evaluate the accuracy outcomes regarding the type of tracer, dose, injection site, etc.

PMID:40859273 | DOI:10.1186/s12957-025-03967-z

BMC Health Serv Res. 2025 Aug 26;25(1):1132. doi: 10.1186/s12913-025-13254-y.

ABSTRACT

BACKGROUND: Presenteeism is when individuals despite experiencing illness or discomfort that necessitates rest and absence from work, still attend their jobs. This type of presence poses challenges for both the individual and the organization. Among the strategies for adapting to and coping with workplace challenges is resilience. The present study aims to determine presenteeism and its relationship with resilience among pre-hospital emergency technicians for the first time in Iran.

METHODS: This cross-sectional, descriptive, correlational, multicenter study was conducted between June and August 2024. The study population comprised all pre-hospital emergency technicians employed at 295 urban, road, and aerial pre-hospital emergency bases across 9 regions and 16 counties in Tehran Province, the capital of Iran. A total of 2,450 technicians were working at these bases. A proportional stratified random sampling method was used based on the number of bases and technicians in each region. Data were collected using the electronic version of the Stanford Presenteeism Scale, Emergency Medical Services Resilience Scale, and a demographic characteristics section. Data analysis was conducted using descriptive and inferential statistics with SPSS software version 28, at a significance level of P ≤ 0.05.

RESULTS: Out of 500 pre-hospital emergency technicians who received the questionnaire link, 432 completed the survey. The participants’ mean presenteeism score was 18.69 ± 4.98, indicating a moderate level. Their mean resilience score was 124.42 ± 14.02, reflecting a high level of resilience. A statistically significant positive correlation was observed between presenteeism and the dimensions of resilience. The strongest correlation was found between presenteeism and the dimension of job motivation (r = 0.435, p < 0.001). The roles of presenteeism, shift scheduling based on technician preference, and mandatory overtime were confirmed as predictors of resilience.

CONCLUSION: Most of the study participants exhibited a moderate level of presenteeism and a high level of resilience. Personnel with higher levels of resilience are likely to have greater capacity and ability to perform their duties despite experiencing illness. So, efforts should focus on enhancing staff resilience and providing organizational support during periods of illness.

PMID:40859271 | DOI:10.1186/s12913-025-13254-y

BMC Pregnancy Childbirth. 2025 Aug 26;25(1):890. doi: 10.1186/s12884-025-08059-0.

ABSTRACT

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are major contributors to maternal and neonatal mortality, particularly in low-resource settings. Pregnancy-induced hypertension accounted for 16% of maternal deaths in 2016, ranking as the second leading cause of maternal mortality in Sierra Leone. The country faces challenges of HDP management due to limited primary healthcare resources. This study investigated the admission patterns and outcomes of HDP at the Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone.

METHODS: A retrospective cross-sectional study was conducted, reviewing medical records of 572 pregnant women admitted with HDP at PCMH from January to December 2022. Hypertensive patients were classified according to established criteria for hypertensive pregnancy. Maternal and neonatal outcomes were categorised as favourable and unfavourable outcomes based on set criteria. The Chi-square Test and Fisher’s exact test were performed to determine the association between admission patterns/management with maternal and neonatal outcomes using Statistical Package for Social Sciences version 27.

RESULTS: Out of the 572 HDP patients admitted cases reviewed, preeclampsia was the most common type of HDP 446 (78%). The majority of admissions occurred in the third trimester (95.6%) with common presenting symptoms including headache 64 (11.2%) and oedema 45 (7.9%). Most patients were treated with antihypertensive medications 547 (96%), predominantly combinations of two or more antihypertensive drugs 435 (76.0%). Maternal outcomes were favourable in 488 (85.3%), while neonatal outcomes were favourable in 396(69.2%). Gestational age on admission (p < 0.001), prolonged hospitalisation ≥ 7 days (p < 0.001), and elevated diastolic BP (p < 0.001) significantly predicted adverse neonatal outcomes, while gestational age on admission (p < 0.001) and prolonged hospitalisation ≥ 7 days (p < 0.001) were significantly associated with maternal outcome.

CONCLUSION: This study underscores the substantial burden of hypertensive disorders of pregnancy in Sierra Leone, with preeclampsia as the most common presentation, largely diagnosed in the third trimester. Despite favourable maternal outcomes, neonatal outcomes remain suboptimal. These findings underscore the need for improved antenatal screening, enhanced neonatal care, and adoption of predictive tools to support early detection and targeted intervention, particularly among younger, previously overlooked at-risk populations.

PMID:40859269 | DOI:10.1186/s12884-025-08059-0

BMC Med. 2025 Aug 26;23(1):495. doi: 10.1186/s12916-025-04329-y.

ABSTRACT

BACKGROUND: Remnant cholesterol (RC) has been implicated in cardiovascular diseases (CVDs) in populations of European ancestry, yet its causal role remains underexplored in populations of East Asian ancestry, which are underrepresented in genetic studies. We sought to investigate the causal association between circulating RC levels and CVD risk in East Asian populations.

METHODS: We first conducted observational analyses of RC and multiple CVD outcomes in Chinese populations. We then conducted genome-wide association studies (GWAS) of RC in 14,939 Chinese individuals and assessed its causal associations with CVD risk using two-sample Mendelian randomization (MR) with Biobank Japan data. Replication analyses in European ancestry populations utilized summary statistics from the UK Biobank and FinnGen.

RESULTS: Circulating RC levels were significantly associated with multiple CVD outcomes in Chinese individuals. Our GWAS identified seven significant loci associated with circulating RC levels in the Chinese population. In the MR analyses, we found that genetically predicted higher RC levels were significantly associated with increased risks of aortic aneurysm (odds ratio per standard deviation increase, 1.82; 95% CI, 1.53-2.17; P = 1.17 × 10^-11) and ischemic heart diseases, such as myocardial infarction (1.22, 1.13-1.32; P = 1.81 × 10^-7) and stable angina pectoris (1.17, 1.11-1.23; P = 1.18 × 10^-8). Notably, these associations persisted after adjustment for total cholesterol, low-density and high-density lipoprotein cholesterols, Apolipoprotein A1 and Apolipoprotein B, respectively. Replication in European ancestry populations confirmed consistent causal effects for aortic aneurysm and ischemic heart diseases. A suggestive East Asian-specific association was identified between genetically predicted higher RC levels and an increased risk of peripheral artery disease, whereas a suggestive association with a higher risk of atrial flutter/fibrillation and ventricular arrhythmia was only observed in populations of European ancestry.

CONCLUSIONS: Our findings establish RC as an independent causal CVD risk factor in East Asian ancestry individuals and highlight population-specific differences in CVD risk profiles, emphasizing the need for ethnicity-tailored prevention strategies.

PMID:40859268 | DOI:10.1186/s12916-025-04329-y

Parasit Vectors. 2025 Aug 26;18(1):361. doi: 10.1186/s13071-025-06983-w.

ABSTRACT

BACKGROUND: Feline leishmaniosis (FeL) is mainly caused by Leishmania infantum in the Mediterranean Basin. In Italy, in the same epidemiological context where canine leishmaniosis (CanL) is hyperendemic, a nonpathogenic species, Leishmania tarentolae, may also occur in sympatry, infecting reptiles, dogs, and humans. Thus, this study aimed to assess L. tarentolae infection in outdoor cats along with its co-occurrence with L. infantum and to evaluate risk factors. In addition, the persistence of L. tarentolae in feline-derived peripheral blood mononuclear cells (PBMCs) was herein evaluated in vitro.

METHODS: Outdoor colony or stray cats were screened for Leishmania spp. by immunofluorescence antibody test (IFAT) using promastigotes of both L. infantum and L. tarentolae. Whole blood and buffy coat were tested by a real-time polymerase chain reaction (qPCR) and duplex real-time PCR (dqPCR), and positive samples sequenced following an ITS1 conventional PCR (cPCR). Feline-derived PMBCs were subsequently infected with promastigotes of L. tarentolae to assess the persistence of amastigotes. Viral infections caused by feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) were molecularly addressed in all enrolled cats. Statistical analysis was performed to evaluate the possible association between Leishmania spp. infection and FIV/FeLV infection by using a multivariate logistic regression model following an initial LASSO-penalized logistic regression.

RESULTS: Overall, 42 out of 194 cats (21.6%) were serologically or molecularly positive for Leishmania spp. In particular, 26 (13.4%) cats were seropositive for L. infantum and/or L. tarentolae by IFAT, with 16 (8.2%) animals positive for both species. Molecularly, 14 out of 194 cats (7.2%) were positive for L. infantum by qPCR, whereas five (2.6%) were positive for L. tarentolae by dqPCR. Cat PBMCs were successfully infected with L. tarentolae, and the infection persisted for at least 72 h. Overall, 38 out of the 194 screened cats (19.6%) were infected by FIV and/or FeLV, of which 12 were serologically or molecularly positive for Leishmania spp., with one cat positive for L. tarentolae DNA, and five for L. infantum DNA. Multivariate screening identified municipality (OR 2.206; P = 0.031; 95% CI 1.077-4.516) as a risk factor for Leishmania spp. infection, while the association between Leishmania spp. and FIV infection was not significant (OR 2.359; P = 0.08, 95% CI 0.901-6.179).

CONCLUSIONS: Colony or stray cats were herein found for the first time infected by L. tarentolae, in areas where L. infantum is endemic. Cross-reactivity using IFAT test may pose a diagnostic hindrance also in FeL. The infection with this saurian-associated Leishmania in cats was further confirmed through the persistence of this Leishmania in cat PBMCs. Further studies are needed to fully unravel the complex interactions between both species of Leishmania and the implication of the sympatric occurrence of both species in the diagnosis and control of leishmaniosis.

PMID:40859264 | DOI:10.1186/s13071-025-06983-w

Gut Pathog. 2025 Aug 26;17(1):68. doi: 10.1186/s13099-025-00741-0.

ABSTRACT

BACKGROUND: The real-world comparative effectiveness study aimed to compare the effectiveness of vonoprazan (VON)-based therapy with high-dose esomeprazole (ESO)-based therapy in the re-eradication of Helicobacter pylori.

METHODS: This real-world retrospective study analyzed patients at Nanjing First Hospital undergoing H. pylori re-eradication, who received either vonoprazan-based (VON) or high-dose esomeprazole-based (ESO) quadruple therapy. Both regimens included amoxicillin, furazolidone, and bismuth, administered twice daily for 14 days. Treatment strategies were determined by routine clinical practice, using either culture results or local epidemiological data. Patients were further classified into individualized precision (VON-P, ESO-P) or empirical (VON-E, ESO-E) groups based on real-world clinical decision-making.

RESULTS: The H. pylori re-eradication rates were 89.2% (191/214, 95% CI: 84.4-92.7%) in group ESO and 86.0% (98/114, 95% CI: 78.4-91.2%) in group VON, with no statistically significant difference between groups (P = 0.381). Among patients receiving individualized precision treatment, the re-eradication rates were 87.3% (62/71, 95%CI: 77.6-93.2%) for group ESO-P and 86.9% (53/61, 95% CI: 76.2-93.2%) for group VON-P, with no significant difference observed (P = 0.940). Similarly, for patients undergoing empirical treatment, there was no statistically significant difference in re-eradication rates between group ESO-E and group VON-E (90.2%, 129/143, 95% CI: 84.2-94.1% vs. 84.9%, 45/53, 95% CI: 72.9-92.1%; P = 0.296). Additionally, no significant difference was found between group ESO-E and group ESO-P (90.2%, 129/143, 95% CI: 84.2-94.1% vs. 87.3%, 62/71, 95% CI: 77.6-93.2%; P = 0.521), nor between group VON-E and group VON-P (84.9%, 45/53, 95% CI: 72.9-92.1% vs. 86.9%, 53/61, 76.2-93.2%; P = 0.762).

CONCLUSIONS: Both high-dose esomeprazole-containing quadruple therapy and VON-containing quadruple therapy have demonstrated effective as rescue treatments for H. pylori infection. Additionally, antibiotic selection informed by local epidemiological data demonstrated comparable effective to culture-based methods in this cohort, though future large-scale studies are needed to validate its generalizability.

PMID:40859263 | DOI:10.1186/s13099-025-00741-0

BMC Infect Dis. 2025 Aug 26;25(1):1072. doi: 10.1186/s12879-025-11368-6.

ABSTRACT

PURPOSE: ‘Post-COVID Syndrome’ (PCS), which encompasses the multifaceted sequelae of COVID-19, can be severity-graded by a previously defined score encompassing 12 different long-term symptom complexes. The PCS score was shown to have two main predictors, namely acute COVID-19 severity and individual resilience. The purpose of the present study was to verify these predictors and to assess their detailed relationship to the symptom complexes constituting the PCS score.

METHODS: The study drew upon a largely expanded dataset (n = 3,372) from COVIDOM, the cohort study underlying the original PCS score definition. Classification and Regression Tree (CART) analysis served to resolve the detailed relationship between the predictors and the constituting symptom complexes of the PCS score.

RESULTS: Among newly recruited COVIDOM participants (n = 1,930), the PCS score was again found to be associated with both its putative predictors. Of the score-constituting symptom complexes, neurological symptoms, sleep disturbance, and fatigue were predicted by individual resilience whereas the acute disease severity predicted exercise intolerance, chemosensory deficits, joint or muscle pain, signs of infection, and fatigue. These associations inspired the definition of two novel PCS scores that included the above-mentioned subsets of symptom complexes only. Similar to the original PCS score, both novel scores were found to be inversely correlated with quality of life as measured by the EQ-5D-5L index.

CONCLUSION: The two newly defined PCS scores may enable a more refined assessment of PCS severity, both in a research context and to delineate distinct PCS subdomains with possibly different therapeutic and interventional needs in clinical practise.

PMID:40859262 | DOI:10.1186/s12879-025-11368-6

BMC Pulm Med. 2025 Aug 26;25(1):405. doi: 10.1186/s12890-025-03873-w.

ABSTRACT

BACKGROUND: High-flow nasal cannula (HFNC) has recently emerged as a promising alternative to non-invasive ventilation (NIV) for patients with chronic obstructive pulmonary disease (COPD). However, direct comparative evidence on the clinical efficacy of HFNC versus NIV in acute exacerbations of COPD (AECOPD) remains limited and inconclusive.

METHODS: A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted up to January 2025 for randomized controlled trials (RCTs) comparing HFNC and NIV in AECOPD patients. Outcomes included mortality, treatment failure, intubation rates, and treatment intolerance.

RESULTS: Nine RCTs involving 786 patients were included in the meta-analysis. No significant differences were observed in mortality (I² = 0.0%, P = 0.818; RR 1.000, 95% CI 0.638 to 1.569, P = 0.999) or intubation rates (I² = 22.1%, P = 0.253; RR 1.401, 95% CI 0.790 to 2.484, P = 0.249). Although HFNC significantly reduced treatment intolerance (I² = 0.0%, P = 0.976; RR 0.145, 95% CI 0.048 to 0.438, P = 0.001), it showed a non-significant trend toward a higher treatment failure rate compared to NIV (I² = 36.2%, P = 0.180; RR 1.553, 95% CI 0.955 to 2.524, P = 0.076).

CONCLUSION: HFNC therapy showed a trend towards a higher treatment failure rate compared to NIV, though the difference was not statistically significant. No significant differences were found in mortality or intubation rates between the two groups.

PMID:40859250 | DOI:10.1186/s12890-025-03873-w