Nevin Manimala

Perioper Med (Lond). 2026 Jul 18. doi: 10.1186/s13741-025-00641-6. Online ahead of print.

ABSTRACT

BACKGROUND: Hip fractures significantly impact the physiological and psychological well-being of elderly patients. Post-operative delirium (POD) is a common complication after hip fractures in this population, severely affecting treatment outcomes and recovery. Effective pain management during the peri-operative period is crucial for reducing POD, yet the best analgesic approach remains debated.

METHODS: A retrospective study (from January 2015 to December 2020) included 198 elderly hip fracture patients who received preoperative (PO-) or intraoperative (IO-) fascia iliaca compartment block (FICB) with 50 mL of 0.25% ropivacaine. Over the first 3 days (assessed every 24 h), cognitive function (Mini-Mental State Examination [MMSE]), pain intensity (Visual Analog Scale [VAS]), and systemic inflammatory mediators (CRP, IL-1, IL-6, TNF-α) were evaluated. Postoperative delirium (POD) incidence was daily assessed via the Confusion Assessment Method (CAM) for 72 h by a trained surgeon. Statistical analyses included intergroup comparisons of MMSE/VAS scores and inflammatory markers; cumulative POD incidence was analyzed using Kaplan-Meier curves. Normally distributed data were compared via independent-samples t-test, and categorical data (expressed as percentages) via chi-square (χ²) test.

RESULTS: Patients were allocated to two groups: PO-FICB (n = 100) and IO-FICB (n = 98). Postoperatively, the PO-FICB group had significantly higher MMSE scores on days 1-3 (27.85 ± 1.923, 27.49 ± 2.807, 27.23 ± 1.698 vs. 25.80 ± 1.864, 25.73 ± 2.197, 22.57 ± 2.128; all P < 0.01) and lower levels of inflammatory mediators (CRP, IL-1, IL-6, TNF-α; all P < 0.05). VAS pain scores were lower in the PO-FICB group (1.58 ± 0.702, 2.26 ± 0.647, 2.40 ± 0.492 vs. 2.70 ± 0.659, 3.02 ± 0.853, 2.33 ± 0.620), with significant differences on days 1-2 (P < 0.0001) but not day 3 (P = 0.068). POD incidence was significantly lower in the PO-FICB group (5% [5/100]) than in the IO-FICB group (15.3% [15/98]; P = 0.0168). No severe complications or mortality were observed during 12-month follow-up.

CONCLUSION: Compared with IO-FICB, PO-FICB may confer more targeted analgesia and is associated with a lower incidence of POD in elderly hip fracture patients. These associations might relate to PO-FICB’s potential early effects of inhibiting inflammation and exerting putative neuroprotective-like actions, which are consistent with current multimodal perioperative management strategies and geriatric neuroprotective concepts. This finding provides preliminary support for considering PO-FICB as a viable option in perioperative regional anesthesia selection for this patient population.

PMID:42471661 | DOI:10.1186/s13741-025-00641-6

BMC Oral Health. 2026 Jul 18. doi: 10.1186/s12903-026-09340-0. Online ahead of print.

ABSTRACT

BACKGROUND: For a face to be aesthetically pleasant, it has to be well proportioned in all the three spatial planes. In addition to sagittal and vertical dimensions, transverse width of the face too needs to be addressed to ensure proper esthetics. Malocclusion in transverse dimension may not be limited to the dental arches but, it can also be associated with underlying skeletal abnormalities. So, this study aims to investigate the relation between dental arch widths, cephalic and facial indices.

METHODS: The present study was a cross-sectional, descriptive study carried out in one hundred and thirty-two students meeting the inclusion and exclusion criteria in the Department of Orthodontics, BPKIHS, Nepal. Cranial and facial measurements were performed under natural light. Dental arch widths were measured on study models obtained from the students. The data were entered and analyzed using Statistical Package for the Social Sciences (SPSS) 16. Mean and standard deviation was calculated for each variable. Correlation between the variables were determined with Pearson’s correlation test with Statistical significance set at P < 0.05.

RESULTS: Mean age of the students was 22.14 ± 3.81 years, mean cephalic index (CI) and facial index (FI) were 82.93 ± 7.72 and 90.89 ± 7.75 respectively. Brachycephalic head form (65.2%) and leptoprosopic facial form (49.2%) were more prevalent. A significant, weak negative correlation was found between CI and FI. No significant correlation was seen between CI and dental arch widths, but significant and weak negative correlation was found between FI and upper intercanine and upper intermolar width.

CONCLUSIONS: The facial index significantly correlates with the upper intercanine and intermolar widths. No correlation was seen between the facial index and lower dental arch width, between cephalic index and dental arch widths.

PMID:42471656 | DOI:10.1186/s12903-026-09340-0

Genome Biol. 2026 Jul 18. doi: 10.1186/s13059-026-04205-9. Online ahead of print.

ABSTRACT

BACKGROUND: Realizing the full potential of human genetics requires identifying causal variants and genes underlying association signals. Molecular quantitative trait locus (molQTL) analyses, such as expression QTL (eQTL) and splicing QTL (sQTL), link genetic variants to intermediate molecular phenotypes, but pinpointing causal variants and their regulatory effects remains challenging. Here, we integrate sQTL analysis with deep learning-based splicing effect annotation to identify causal genetic variants and elucidate their functional effects on human phenotypes.

RESULTS: Applying a single-cell GWAS method, scHi-HOST, across 96 lymphoblastoid cell lines with and without influenza A virus (IAV) infection, we identify approximately 43,000 sQTL SNP-junctions pairs associated with 217 genes during infection. Integrating sQTL mapping with AI based splice prediction and statistical fine-mapping, we prioritize 57 likely causal variants that affect cis-acting molecular splicing components, including 5′ donor and 3′ acceptor sites. We experimentally validate one such variant, rs2297616, in PARP2, encoding poly (ADP-ribose) polymerase 2. This variant alters the 5′ splice donor site in the second intron of PARP2, generating two protein isoforms differing by 13 amino acids. The derived A allele is associated with the longer protein isoform and increased IAV levels in lymphoblastoid cell lines. CRISPR mediated editing validates the causal effect of this variant on both protein length and IAV infection. Furthermore, these 57 putative causal sQTLs are linked to over 100 GWAS traits, including many variants associated with autoimmune diseases.

CONCLUSIONS: Our work provides a catalog of causal sQTL with direct splicing impacts, providing causal mechanistic insights from genotype to disease susceptibility.

PMID:42471654 | DOI:10.1186/s13059-026-04205-9

BMC Med. 2026 Jul 18. doi: 10.1186/s12916-026-05074-6. Online ahead of print.

ABSTRACT

BACKGROUND: Adolescent mental distress is a prevalent global public health concern. Aligning with the goals of Healthy People 2030, this study aimed to characterize the sleep duration associated with the lowest prevalence of mental distress among US high school students.

METHODS: This study pooled and examined cross-sectional data from 7 waves of the national Youth Risk Behavior Survey (YRBS) in 2011-2023. All data analyses were sex-stratified. We estimated the prevalence of mental symptoms and suicidal behaviors across sleep duration, and examined both linear and quadratic associations. We also calculated adjusted odds ratios (AORs) with 95% CIs and compared the prevalence of mental distress indicators among sleep duration categories.

RESULTS: Overall, 24.39% of adolescents reported 8-9 h of sleep (female: 22.51%; male: 26.21%). Compared with 8-9 h, insufficient sleep (< 8 h) was associated with significantly higher odds of all five mental distress indicators among female students: current bad mental health (AOR, 1.93; 95% CI, 1.61-2.30), feeling sad/hopeless (AOR, 1.59; 95% CI, 1.40-1.80), suicidal thoughts (AOR, 1.68; 95% CI, 1.49-1.91), suicide plan (AOR, 1.41; 95% CI, 1.25-1.59), and attempted suicide (AOR, 1.41; 95% CI, 1.20-1.66). Results were similar among male students. Across all five indicators in both sexes, the lowest prevalence was observed at 8-9 h; however, most comparisons at ≥ 10 h were not statistically significant.

CONCLUSIONS: The lowest prevalence of mental distress across all indicators and both sexes was observed at 8-9 h of sleep; however, most ≥ 10-hour comparisons were not significant, likely reflecting the small proportion of adolescents in this category.

PMID:42471653 | DOI:10.1186/s12916-026-05074-6

BMC Health Serv Res. 2026 Jul 18. doi: 10.1186/s12913-026-15127-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Kenya introduced the Managed Equipment Services (MES) model in 2015 as a seven-year national contract to address significant gaps in access to hemodialysis, which had previously been available in fewer than ten public hospitals. The MES aimed to expand hemodialysis capacity by centralizing procurement, standardizing equipment, and ensuring maintenance across all 47 counties. This study provides the first national evaluation of hemodialysis performance under the MES model.

METHODS: We conducted a multi-year retrospective analysis of 54 public hospitals equipped through the MES, six years after implementation, using data from the MES contract, the MES final survey, NHIF reimbursement schedules, and the 2019 Population Census. Hemodialysis system performance was assessed across four domains, including capacity, utilization, reporting accuracy, and cost efficiency, using descriptive statistics, time series trends, and discrepancy analysis.

RESULTS: A total of 54 hemodialysis centers equipped with 305 machines were established across all 47 counties, resulting in national densities of 1.14 centers and 6.41 machines per million people. Machine density varied more than 30-fold across counties. Between June 2015 and April 2021, 392,497 hemodialysis sessions were conducted, with monthly utilization increasing by 376%, from 2,100 sessions in June 2015 to 10,173 in April 2021. Time-series regression showed a significant upward trend (+75.5 sessions per month, R² = 0.721), with significant effects of year (F = 258.42, p < 0.001) and calendar month (F = 5.00, p < 0.001), and two periods of acceleration in June 2016 and January 2020. Facility throughput ranged from 217 to 79,202 sessions, and 63% of hospitals operated at less than 50% of their machine capacity. Machine-logged session counts exceeded register-based counts by more than 30% in 79% of hospitals, with a mean absolute percentage error of 180.41%. County-level utilization ranged from 89 to 4,363 sessions per million people, a 49-fold difference. The MES program reached breakeven in month 70, with a projected return on investment of 19.76% by month 84.

CONCLUSION: The MES significantly increased Kenya’s public hemodialysis capacity and supported rapid nationwide growth in service use. However, disparities in geography, facilities, and documentation persisted, with many hospitals operating below capacity and inconsistent reporting. Although the program broke even financially and had a positive return on investment, facility performance varied widely. These results show that expanding infrastructure alone was not enough to achieve equity or efficient hemodialysis service delivery, highlighting the need to improve staffing, data quality, and system coordination to make the most of future renal care investments.

PMID:42471648 | DOI:10.1186/s12913-026-15127-4

BMC Pulm Med. 2026 Jul 18. doi: 10.1186/s12890-026-04497-4. Online ahead of print.

ABSTRACT

BACKGROUND: Plasma transfusion is used in patients with severe pneumonia who develop coagulopathy or bleeding, but recipients are often sicker than non-recipients. We evaluated the association between plasma transfusion and in-hospital mortality after adjustment for available measured confounders, while recognizing that unmeasured confounding from transfusion indications and illness severity may persist.

METHODS: This single-center retrospective cohort included 156 adults with severe pneumonia admitted between January 2021 and May 2024; 62 received plasma and 94 did not. The matched mortality comparison using propensity score matching (PSM) and McNemar analysis was prespecified as the primary analysis. Supportive and exploratory analyses included Cox regression, Kaplan-Meier analysis, IPTW, overlap weighting, Fine-Gray modeling, E-value analysis, and exploratory coagulation-enhanced, logistic, microbiological/coagulation, and time-dependent exposure sensitivity analyses.

RESULTS: Before matching, mortality was higher among plasma recipients than controls (64.5% vs. 28.0%; crude odds ratio [OR] 4.69, 95% confidence interval [CI] 2.35-9.34; p < 0.001), with substantial baseline imbalance. After matching, mortality remained numerically higher in the plasma group (50.0% vs. 36.1%) but was not statistically significant (matched OR 1.62, 95% CI 0.67-3.92; McNemar p = 0.383). Cox models yielded attenuated HRs after adjustment, but the fully adjusted model violated the global proportional hazards assumption; therefore, Cox estimates were interpreted as time-weighted associations over follow-up rather than constant effects. Exploratory sensitivity estimates varied in direction across estimands: coagulation-enhanced matching yielded OR 1.50 (95% CI 0.53-4.21), full-cohort logistic regression yielded adjusted OR 3.19 (95% CI 1.12-9.11), approximate adjusted time-dependent Cox analysis yielded HR 1.73 (95% CI 0.85-3.51), and strict verified-date adjusted time-dependent Cox analysis yielded HR 2.67 (95% CI 1.38-5.16).

CONCLUSIONS: The attenuation of the crude mortality difference after propensity score matching is consistent with baseline severity and confounding by indication accounting for a substantial component of the unadjusted association; however, residual confounding cannot be excluded. Because residual confounding, immortal-time bias, related time-dependent exposure bias, and proportional-hazards violations remain important limitations, these data do not establish a definitive beneficial or harmful effect of plasma transfusion. The non-significant matched result reflects limited statistical power (approximately 25% for a paired OR of 2.0) and should not be interpreted as evidence of no effect.

PMID:42471643 | DOI:10.1186/s12890-026-04497-4

J Orthop Surg Res. 2026 Jul 18;21(1):433. doi: 10.1186/s13018-026-07124-4.

ABSTRACT

This correspondence comments on the multicenter cohort study by Audigé et al. (Journal of Orthopaedic Surgery and Research, 2026) reporting outcomes of arthroscopic repair for partial-thickness supraspinatus tears. We highlight four aspects of the study that, in our view, would benefit from further clarification or additional discussion: (1) limited information regarding the surgical indications for tear completion, which may complicate interpretation of treatment-selection effects; (2) the absence of a technique-specific analysis of adverse events, particularly postoperative stiffness; (3) the unreported methodology used for intraoperative Ellman grade determination, the primary classification variable and the only factor significantly associated with tear completion; and (4) the potential residual influence of differential concomitant acromioplasty across tear-location groups despite statistical adjustment. Addressing these issues would further strengthen the interpretation and clinical applicability of this otherwise valuable prospective multicenter dataset.

PMID:42471638 | DOI:10.1186/s13018-026-07124-4

BMC Public Health. 2026 Jul 18. doi: 10.1186/s12889-026-28390-1. Online ahead of print.

ABSTRACT

BACKGROUND: Young men who have sex with men (MSM) and transgender women (TGW) in Southern Africa experience a disproportionate burden of HIV, compounded by stigma related to HIV status and sexual orientation or gender identity (SOGI). These stigmas undermine mental health and antiretroviral therapy (ART) adherence, yet few integrated, community-informed interventions exist in low-resource settings. This study assessed the feasibility, acceptability, and preliminary impact of a peer-led pilot intervention to reduce stigma, improve mental health, and strengthen ART adherence among young MSM and TGW living with HIV in Malawi, Zambia, and Zimbabwe.

METHODS: A mixed-methods parallel design was used, combining quantitative self-administered questionnaires with qualitative in-depth interviews. Seventy-two participants aged 18-24 years were recruited through community-based organisations, with 70 completing baseline and endline assessments. The intervention was initially designed as an 8-week programme grounded in the information-motivation-behavioural skills (IMB) model, however, it was subsequently reduced to 4 weeks due to time and logistical constraints and was delivered by trained peer facilitators under clinical supervision. Quantitative outcomes included measures of HIV-related stigma, SOGI stigma, depressive symptoms (CES-D-10), alcohol use (AUDIT), and ART adherence self-efficacy. Descriptive statistics were generated, paired sample t-tests were used for continuous variables, and McNemar’s tests assessed changes in categorical outcomes. Qualitative data were analysed thematically to explore participant experiences and perceptions of the intervention.

RESULTS: Statistically significant improvements were observed from baseline to endline, including reductions in internalised HIV stigma (p = 0.01), anticipated HIV stigma (p = 0.01), healthcare-related stigma (p < 0.001), SOGI-related harassment (p = 0.02), and depressive symptoms (p = 0.01). ART adherence self-efficacy increased significantly (p < 0.001). Although changes in sexual risk behaviours were not statistically significant, trends suggested increased condom use and reduced substance use before sex. Qualitative findings indicated enhanced self-acceptance, improved coping strategies (including reduced reliance on alcohol), increased confidence around disclosure, and strong acceptability of the peer-led, group-based intervention. However, some participants reported that sessions were delivered too quickly.

CONCLUSIONS: This pilot peer-led intervention was perceived feasible, acceptable, and showed promising improvements in stigma, mental health, and ART adherence self-efficacy among young MSM and TGW in three Southern African countries. The findings support the potential value of theory-informed, peer-delivered interventions to address HIV-related stigma and SOGI-related stigma and adherence challenges in highly marginalised populations, warranting further evaluation through larger and longer-term studies.

PMID:42471635 | DOI:10.1186/s12889-026-28390-1

Cancer Med. 2026 Jul;15(7):e72025. doi: 10.1002/cam4.72025.

ABSTRACT

BACKGROUND: Clinical and epidemiological evidence has suggested a potential association between kidney dysfunction and bladder cancer (BC). One hypothesis for this comorbidity is the presence of a common genetic etiology. However, little is known about the shared genetics and causality of this association. Thus, we aimed to investigate shared genetic architecture and the causal link between kidney dysfunction and bladder cancer.

METHODS: Leveraging summary statistics from large-scale genome-wide association studies (GWASs) conducted on European-ancestry populations on eGFRcrea (N = 1,004,040), eGFRcys (N = 460,826), BUN (N = 852,678), UACR (N = 288,649), urate (N = 547,361) and BC (N _cases = 3357, N _controls = 628,027), we conducted a large-scale genome-wide cross-trait study to determine genetic overlap, to identify shared loci, and to infer causal relationships. We evaluated genetic correlation through linkage disequilibrium score regression (LDSC). Integration of single-trait GWAS was accomplished by multi-trait analysis of GWAS (MTAG), which enabled cross-trait meta-analysis to unveil overlapping genetic loci between five kidney function traits and BC. Shared genes were further validated through colocalization analysis and transcriptome-wide association analysis. Bidirectional Mendelian Randomization (MR) was conducted to determine causal inference of kidney function traits on BC.

RESULTS: We found positive correlations between both BUN and urate and BC at the genome-wide level. A total of 157 significant overlapping genetic loci (range 7 to 72) were identified across five kidney function traits and BC. Among them, PSCA was prioritized as the strongest shared gene with support from MTAG, colocalization, and TWAS, whereas ZFHX3, TTC33, and ATP2A1 were considered candidates supported only by MTAG and TWAS. MR provided the most consistent support for a potential positive causal effect of BUN on BC, limited support for UACR, and exploratory evidence for urate.

CONCLUSIONS: Our cross-trait analysis demonstrated a shared genetic basis underlying kidney function and BC, providing novel insights into the biological functions and molecular mechanisms underlying these complex traits.

PMID:42470241 | DOI:10.1002/cam4.72025