Nevin Manimala

BMC Public Health. 2025 Mar 4;25(1):866. doi: 10.1186/s12889-025-22103-w.

ABSTRACT

BACKGROUND: COVID-19 caused a significant impact on food security; particularly among low- and middle-income countries. The objective of the current study was to assess both the direct and indirect impact of COVID-19 on individuals’ food security in the metropolitan and regional context of Ethiopia.

METHODS: This project utilized a retrospective study design with a mixed methods approach. It assessed the food insecurity experience of individuals both before and after the emergence of COVID-19 through the Food Insecurity Experience Scale (FIES). Food sellers were interviewed to identify the factors that increased post-COVID-19 emergence food insecurity. Inferential analysis using ordinal logistic regression was undertaken based on the Polytomous Universal Model (PLUM) procedure.

RESULTS: The size of the family and the type of work for income generation were statistically associated (p < 0.05) with the food security of individuals, both before and after COVID-19 emergence. Location (p = 0.002, odds = 0.37), age (p = 0.002, odds = 2.57) and educational status (p = 0.001, odds = 0.24/) of individuals had a statistically significant effect on the food security of individuals before COVID-19 emergence only. The ordinal value of all FIES indicators increased after COVID-19 emergence compared with pre-pandemic food insecurity. Overall food security of individuals was reduced by 21.5%, with the moderate and severe food insecurity of individuals increasing by 13.1% and 15.9%, respectively. The COVID-19 preventive measures that affected the individuals’ food security, in the order of their priority, were: transport bans; food price increment; lockdown measures; job loss; market bans; social distance restrictions; fear of the pandemic; movement restrictions; over-buying; food inaccessibility; and, lack of cash due to bank closure. In addition, pre-existing non-pandemic related natural and man-made disasters played a role in the food security crisis, including drought, war, and desert locust emergence.

CONCLUSION: The COVID-19 pandemic has directly and indirectly affected individuals’ food security. Learning from the experiences of COVID-19 may assist governments in preparing for future pandemics. Suggested improvements include forming impact reduction task forces and establishing disease prevention strategies that will not compromise food security.

PMID:40038640 | DOI:10.1186/s12889-025-22103-w

Cancer Epidemiol Biomarkers Prev. 2025 Mar 4. doi: 10.1158/1055-9965.EPI-24-1442. Online ahead of print.

ABSTRACT

BACKGROUND: Recent genome-wide association studies (GWAS) have identified new susceptibility loci for melanoma, but their associations with multiple primary melanoma (MPM) are unclear.

METHODS: We investigated the associations of 69 single nucleotide polymorphisms (SNPs) in 39 GWAS-identified loci with odds of MPM relative to single primary melanoma (SPM) in the international, population-based Genes, Environment, and Melanoma (GEM) study. Per-minor allele odds ratios (ORs) and 95% confidence intervals (CIs) for individuals with MPM ‘cases’ (n=1,205) relative to SPM ‘controls’ (n=2,458) were estimated using multivariable logistic regression, and polygenic risk scores (PRS) were calculated and weighted based on a 2020 GWAS meta-analysis (57 of the 68 independent GWAS SNPs available).

RESULTS: Thirteen SNPs in 11 gene regions (PARP1, CYP1B1/RMDN3, TERT, RAPGEF5, TYRP1, MTAP, CDKN2A/CDKN2B, KLF4, TYR, SOX6, ASIP) were statistically significantly associated (P<0.05) with MPM adjusting for age, sex, age-by-sex interaction, and study center. The highest vs. lowest PRS quintile was associated with a 2.81-fold higher odds of MPM (95% CI: 2.10-3.78; P=7.5×10-13); this association was attenuated but remained statistically significant after excluding SNPs individually associated with MPM (OR=1.75, 95% CI: 1.32-2.31).

CONCLUSIONS: Inherited genetic variants spanning 11 gene regions were independently associated with MPM. Non-significant SNPs were associated with MPM when aggregated into a PRS, indicating their cumulative effect may influence MPM risk despite lacking individual statistical significance in our study population.

IMPACT: Our findings provide additional evidence that these loci are associated with melanoma risk and estimate the magnitude of their genetic effect on subsequent (multiple) primary melanoma risk.

PMID:40036058 | DOI:10.1158/1055-9965.EPI-24-1442

Cancer Epidemiol Biomarkers Prev. 2025 Mar 4. doi: 10.1158/1055-9965.EPI-24-1408. Online ahead of print.

ABSTRACT

BACKGROUND: Cervical cancer is the second leading cause of cancer death among women in Addis Ababa and other parts of Ethiopia. Yet, there are limited age-eligible city-wide data on cervical cancer screening prevalence in Addis Ababa to inform public policy.

METHODS: A population-based cross-sectional study was conducted among 1881 screening eligible women aged 30-49 years who were selected from 63 enumeration areas in Addis Ababa based on multistage sampling and proportional sample size allocation. Logistic regression was used to identify barriers to screening. All statistical tests were two-sided, p<0.05.

RESULT: 30.8% (95%CI: 28.8%, 33.0%) of study participants reported receipt of screening in the past 5 years. Overall, less than half (45.7%) of women reported that they received healthcare provider recommendation for screening, and only 15% of married women reported that they had spousal support for it. In the multivariable adjusted model, the odd of being screened was considerably higher in women with healthcare provider recommendation, with spousal support, and with good cervical cancer screening awareness and knowledge of risk factors for the disease. Factors associated with not seeking screening service included feeling healthy and perception of low risk for cervical cancer.

CONCLUSION: Cervical cancer screening uptake is low in Addis Ababa, and less than half received healthcare provider recommendation. Future studies should identify barriers to provider recommendations.

IMPACT: The findings underscore the need for a coordinated effort to enhance healthcare provider recommendations for cervical cancer screening and to raise awareness about the benefits of screening in the general population.

PMID:40036054 | DOI:10.1158/1055-9965.EPI-24-1408

Clin Orthop Relat Res. 2025 Feb 25. doi: 10.1097/CORR.0000000000003427. Online ahead of print.

ABSTRACT

BACKGROUND: Many musculoskeletal symptoms arise from the natural decline of cells and tissues with age (senescence). Among patients seeking care for those conditions, symptom intensity often corresponds more with thoughts and feelings about bodily sensations than with the severity of any pathophysiology. Population studies suggest that a large percentage of people manage to live with (accommodate) symptoms from these conditions without seeking care, and that as people age, healthy attitudes toward sensations from musculoskeletal senescence may help them accommodate these kinds of symptoms; to our knowledge, however, this has not been specifically studied.

QUESTIONS/PURPOSES: In a cross-sectional study of patients presenting for musculoskeletal specialty care, we asked: (1) Are there factors associated with accommodation of aging, including mindsets measured as levels of unhelpful thoughts, feelings of distress, and intolerance of uncertainty? (2) Are there any factors associated with pain intensity, including comfort with aging and mindset measures? (3) Are there any factors associated with level of capability, including comfort with aging and mindset measures?

METHODS: One hundred fifty-six English-speaking adults (age 18 to 89 years) presenting for initial or return specialist evaluation of a musculoskeletal problem (largely an unselected sample of patients with common lower and upper extremity problems) in a single large urban city in the United States agreed to participate. Among the 98% (153) who completed the survey and were analyzed, 57% (87) were women, the mean age was 53 ± 17 years, 69% (105) were non-Hispanic White, and 47% (72) had private insurance. Participants completed an 11-point ordinal measure of pain intensity, a measure of level of capability (a person’s perception of the level of difficulty of specific activities, distinct from objective impairment or incapacity), intolerance of uncertainty (that is, a negative regard for uncertainty), unhelpful thoughts (unhealthy misinterpretations) regarding sensations, feelings of distress (worry or despair) regarding sensations, and attitudes toward aging (quantified positive or negative regard for aging), all using instruments with evidence supporting their ability to measure these constructs. Factors associated with levels of accommodation of aging, pain intensity, and incapability were analyzed using multivariable regression models, limiting the models to a single mental health variable because of concerns about collinearity and selecting the best performing model based on the Akaike information criterion. To account for known and anticipated collinearity of the mental health measures, we also performed a k-means cluster analysis to identify statistical groupings of unhelpful thoughts regarding sensations, distress regarding sensations, and intolerance of uncertainty and tested for differences in attitudes toward aging, pain intensity, and capability using analysis of variance.

RESULTS: Accounting for potential confounders such as age, marital status, income status, unhelpful thoughts regarding symptoms, feelings of distress regarding symptoms, and intolerance of uncertainty that were associated in bivariate analysis, we found a small association between lower accommodation of aging and greater feelings of distress regarding symptoms (regression coefficient [RC] -0.17 [95% confidence interval (CI) CI -0.23 to – 0.11]; p < 0.01). Higher pain intensity had a modest association with greater feelings of distress (RC 0.4 [95% CI 0.2 to 0.5]; p < 0.001) and Medicaid insurance (RC 2.2 [95% CI -0.1 to 4.5]; p = 0.04) and a small inverse association with postcollege graduate education (RC -1.7 [95% CI -3.2 to -0.3]; p = 0.02). Higher levels of capability had a large association with less distress (RC -0.8 [95% CI -1.4 to -0.1]; p = 0.001), a small association with younger age (RC -0.2 [95% CI -0.3 to -0.1]; p = 0.005), and a medium association with postcollege graduate education (RC 5.9 [95% CI 0.4 to 11]; p = 0.04). The cluster analysis identified five statistical groupings of levels of unhelpful thoughts, feelings of distress, and intolerance of uncertainty that were associated with greater levels of healthier attitudes toward aging, pain intensity, and levels of capability.

CONCLUSION: The observation that people are less accommodative of aging to the degree that they experience greater intolerance of uncertainty, feelings of distress, and unhelpful thoughts about their body’s sensations-and that these factors are also associated with greater levels of discomfort and incapability-points to the importance of cultivating and maintaining a healthy mindset as we age. To help guide patients to a healthier regard for the aging body, musculoskeletal specialists and all clinicians can transition away from concepts of inflammation (tendinitis), injury (tear), or breakdown (bone-on-bone) toward more accurate and healthful words and concepts, such as those that emphasize expected changes in people’s bodies, that even painful activities are not off limits, and the importance of evolving one’s identity to match one’s body.

LEVEL OF EVIDENCE: Level III, prognostic study.

PMID:40036052 | DOI:10.1097/CORR.0000000000003427

Clin Orthop Relat Res. 2025 Feb 25. doi: 10.1097/CORR.0000000000003421. Online ahead of print.

ABSTRACT

BACKGROUND: Fractures of the thoracic and lumbar spine are uncommon injuries in children and adolescents, but they carry substantial morbidity and a real risk of death. Compared with the adult spine, the pediatric spine has unique anatomic and biomechanical properties that yield different fracture patterns than the adult population. The mechanisms of injury and degree of skeletal maturity constitute important predictors of the outcomes of pediatric thoracic and lumbar fractures; however, there remains a paucity of meaningful epidemiologic data with specific attention to the pediatric spine.

QUESTIONS/PURPOSES: (1) What are the overall incidence and trends of all-cause pediatric thoracic and lumbar fractures in the past 20 years, and how do these differ by age and sex? (2) What are the primary mechanisms of injury responsible for all-cause pediatric thoracic and lumbar fractures, and how do these differ by age and sex? (3) What are the sex-specific incidence risks of all-cause pediatric thoracic and lumbar fractures in the past 20 years? (4) What are the age-specific incidence risks of all-cause pediatric thoracic and lumbar fractures in the past 20 years?

METHODS: The National Electronic Injury Surveillance System (NEISS) is a publicly available database from a nationally representative sample of emergency departments that offers key details on mechanisms of injury and a statistically valid calculation method of national injury estimates. The NEISS was retrospectively queried for patients ages 0 to 18 years who presented with all-cause thoracic and lumbar fractures between 2004 and 2023. Thoracic and lumbar fractures were identified from upper trunk and lower trunk fracture NEISS diagnosis codes, filtering out nonpertinent diagnoses such as rib, hip, or pelvis fractures (72% [5853 of 8131]). From relevant thoracic and lumbar fractures, only acute fractures were included after narrative review; chronic or incidental fractures or spondylolysis (0.2% [5 of 2278]) and acute fractures that did not specify an affected thoracic or lumbar region (6% [136 of 2278]) were subsequently excluded. Collected variables included age, sex, hospitalization, primary mechanism of injury, fracture level(s), and fracture type. Each NEISS case record is assigned a statistical weight, representing an estimate of such injury occurring nationally. The aggregate of these weights in patients presenting with a thoracic or lumbar fracture provides a total national estimate of these injuries. Age was subsequently classified into children (younger than 14 years) and adolescents (ages 14 to 18 years). There were 1064 case records of thoracic fractures, 988 case records of lumbar fractures, and 85 case records of thoracic and lumbar fractures between 2004 and 2023, corresponding to a national estimate of 26,732 thoracic fractures, 29,274 lumbar fractures, and 2083 thoracic and lumbar fractures after computing the aggregate statistical weights of the associated case records. Fractures affecting both the thoracic and lumbar spine were included in the separate cohorts of thoracic and lumbar fractures, totaling a final national estimate of 28,814 thoracic fractures and 31,357 lumbar fractures. Of patients with thoracic fractures, 43% (12,264 of 28,814) and 57% (16,550 of 28,814) were children and adolescents, respectively, and 64% (18,328 of 28,814) and 36% (10,486 of 28,814) were male and female, respectively. Of patients with lumbar fractures, 29% (9109 of 31,357) and 71% (22,248 of 31,357) were children and adolescents, respectively, and 61% (19,084 of 31,357) and 39% (12,273 of 31,357) were male and female, respectively. Incidence rates were calculated using provided national estimates and as incidence per population at-risk using US census data. Simple linear regression analysis characterized overall and demographic-specific trends over the 20-year period, with the beta coefficient (β) representing change in fracture national estimates per year. Incidence rate ratios were calculated to compare demographic groups with regard to overall fracture incidence, recreation-related mechanism of injury, multilevel injury, and hospitalizations.

RESULTS: The mean ± SD annual incidence rate over the 20-year study span was 19 ± 6 pediatric thoracic fractures and 20 ± 5 pediatric lumbar fractures per 1 million person-years. There were overall increasing trends in pediatric thoracic fractures by 58 fractures per year (β = 58 [95% confidence interval (CI) 30 to 86]; p < 0.001). Increases in thoracic fractures were noted among males, females, children, and adolescents, with the largest increases in males by 41 fractures per year (β = 41 [95% CI 19 to 63]; p < 0.001) and adolescents by 41 fractures per year (β = 41 [95% CI 19 to 64]; p = 0.001). There were overall increasing trends in pediatric lumbar fractures by 38 fractures per year (β = 38 [95% CI 9 to 67]; p = 0.01), most prominently in males by 30 fractures per year (β = 30 [95% CI 9 to 51]; p = 0.007). These slight yearly increases resulted in substantial total increases in thoracic and lumbar fractures over the 20-year period. Falls from height and motorsports were the most common mechanisms of injury for overall pediatric thoracic and lumbar fractures. Males primarily sustained thoracic and lumbar fractures from motorsports, football, and falls from height, whereas females primarily sustained thoracic and lumbar fractures from falls from height, horseback riding, winter sports, and playground accidents. Children primarily sustained thoracic and lumbar fractures from falls from height and playground accidents, whereas adolescents primarily sustained thoracic and lumbar fractures from motorsports, falls from height, and winter sports. Age- and sex-based differences in motorsports were especially large, with motorsports accounting for nearly fourfold as many fractures in males than in females and more than twofold as many fractures in adolescents than in children. The overall rate of thoracic and lumbar fractures was 1.82 (95% CI 1.77 to 1.86; p < 0.001) and 1.63 (95% CI 1.60 to 1.67; p < 0.001) times higher in males compared with females. The overall rate of thoracic and lumbar fractures was 3.67 (95% CI 3.58 to 3.75; p < 0.001) and 6.69 (95% CI 6.52 to 6.85; p < 0.001) times higher in adolescents compared with children.

CONCLUSION: Our findings suggest that increased public policy attention be directed toward recreational activities such as motorsports and football, which disproportionately affect adolescent males. Formal safety training, strict age requirements, and regulations on the speed and horsepower of all-terrain vehicles and dirt bikes should be considered for motorsports. Similar age limits and introduction of modified tackling and football skills development should be considered prior to full-contact football. It is the responsibility of orthopaedic surgeons to increase public attention on the fracture risk of horseback riding, which has been traditionally perceived to be low risk. Increased barrier protection on bunk beds, windows, staircases, and playground equipment may lower the rate of accidental falls for all demographics.

LEVEL OF EVIDENCE: Level III, prognostic study.

PMID:40036050 | DOI:10.1097/CORR.0000000000003421

JAMA Netw Open. 2025 Mar 3;8(3):e2462263. doi: 10.1001/jamanetworkopen.2024.62263.

ABSTRACT

IMPORTANCE: Although children across low- and middle-income countries (LMICs) are increasingly surviving, many are not fully thriving. Both stunting and off-track early child development (ECD) hinder children’s potential to thrive.

OBJECTIVES: To estimate the global prevalence of the co-occurrence of stunting and off-track ECD and explore its association with nurturing care and sociodemographic factors.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study pooled data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys (2010-2020) on 173 416 children aged 36-59 months in 41 LMICs. Statistical analysis was conducted from February to December 2024.

EXPOSURE: Risk factors pertaining to inadequate nurturing care, low socioeconomic status, and other sociodemographic characteristics.

MAIN OUTCOMES AND MEASURES: Children were classified into 4 groups with respect to thriving: children who were stunted only (height-for-age z score <-2 SD), off-track ECD only (measured using the Early Childhood Development Index), both stunted and off-track ECD (co-occurrence), or neither.

RESULTS: In the pooled sample of 173 416 children, the mean (SD) child age was 47.1 (6.8) months, and 88 242 (50.9%) were boys. Approximately 1 in 6 children (17.0% [95% CI, 16.8%-17.2%]) were both stunted and had off-track ECD, 17.1% (95% CI, 16.9%-17.3%) were stunted only, 27.8% (95% CI, 27.6%-28.0%) had off-track ECD only, and 38.1% (95% CI, 37.9%-38.4%) were neither stunted nor had off-track ECD. Socioeconomic gradients were observed, with more co-occurrence in lower-income countries (18.2% [95% CI, 17.9%-18.6%]), poorer households (22.1% [95% CI, 21.7%-22.5%] for poorest wealth quintile), mothers with lower educational levels (20.8% [95% CI, 20.6%-21.0%] for primary education or less), and rural settings (19.3% [95% CI, 19.1%-19.6%]). Various indicators of inadequate nurturing care along with low socioeconomic status were associated with co-occurrence. The top 5 factors associated with co-occurrence were poorest wealth quintile (adjusted odds ratio [AOR], 2.75; 95% CI, 2.53-2.99), no early childhood education (AOR, 2.22; 95% CI, 2.10-2.34), low maternal educational level (AOR, 1.44; 95% CI, 1.37-1.51), no toys at home (AOR, 1.43; 95% CI, 1.35-1.51), and diarrhea (AOR, 1.38; 95% CI, 1.31-1.45). The associations of poor household wealth, no birth registration, and no early childhood education with co-occurrence were significantly larger than their associations with stunting only or off-track ECD only.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of young children in LMICs suggests that a significant proportion were both stunted and had off-track ECD. These findings underscore the need for multisectoral interventions that holistically target nutrition, health, and ECD risks to ensure that all children globally can thrive, especially those facing the double burden of stunting and off-track ECD.

PMID:40036037 | DOI:10.1001/jamanetworkopen.2024.62263

Harv Rev Psychiatry. 2025 Mar-Apr 01;33(2):90-101. doi: 10.1097/HRP.0000000000000424.

ABSTRACT

LEARNING OBJECTIVE: After participating in this CME activity, the psychiatrist should be better able to:• Discuss the effects of structural racism on pregnancy and obstetric care and their contributions to maternal mental health challenges and inequitable outcomes.• Outline the current understanding of interventions initiated during pregnancy or childbirth that use reproductive justice principles to improve Black maternal perinatal and intergenerational mental health outcomes.

BACKGROUND: There are significant racial disparities in maternal outcomes for Black compared to White birthing people in the United States (US). Maternal mental health problems negatively affect mothers and their infants. Effects of structural racism during pregnancy and obstetric care may contribute to inequitable maternal mental health challenges and negative offspring outcomes. A reproductive justice framework provides a path for addressing these inequities. This systematic review examines whether pregnancy care interventions driven by reproductive justice principles have successfully improved Black maternal perinatal and intergenerational mental health outcomes.

METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies identified in November 2024 in PubMed, PsycInfo, and CINAHL. The studies included randomized clinical trials of Black birthing parents in the US and their offspring. Interventions incorporating reproductive justice principles were defined as those explicitly designed to increase autonomy, community input, racial equity, and/or cultural relevance.

RESULTS: The search revealed 619 unique records. After screening and full-text review, 12 studies were included. Of these, 7 studies reported statistically significant effects on mental health outcomes. The interventions included interpersonal therapy, culturally tailored cognitive behavioral therapy, group prenatal care, community health worker home visits, and an educational online platform. Six studies reported positive effects on maternal mental health outcomes (e.g., depressive symptoms or anxiety). One study reported positive infant mental health or developmental effects.

CONCLUSIONS: The effects of reproductive justice-driven interventions on Black maternal and offspring mental health outcomes are promising, but studies are limited. Future studies should further identify active intervention components and assess mental health-related outcomes in both generations to improve the mental health of Black mothers and prevent negative intergenerational effects.

PMID:40036027 | DOI:10.1097/HRP.0000000000000424

Prev Sci. 2025 Mar 4. doi: 10.1007/s11121-025-01791-1. Online ahead of print.

ABSTRACT

Recently, Baseline Target Moderated Mediation (BTMM) has received a lot of attention in the field of prevention science. Prevention scientists are interested in BTMM because the model goes beyond whether an intervention achieves effects but also details how and for whom the intervention is most effective. In BTMM, baseline measures are used to investigate potential baseline-by-treatment interactions. However, BTMM has some important challenges including how to incorporate multiple moderator variables when identifying subgroups that benefit the most from the intervention and how to interpret subgroup effects in the presence of multiple moderator variables. Further, with the emergence of causal mediation analysis, it is important to investigate potential treatment-by-mediator interactions which allow the posttest mediator-outcome relation to vary in magnitude across intervention groups. Few methodological developments have addressed the challenges of assessing BTMM in the presence of multiple baseline-by-treatment interactions and the treatment-by-posttest mediator interaction. If the goal is to identify subgroups of individuals who respond better/worse to the intervention, it is important to use a method that can handle the many possible interactions while capturing the heterogeneity within the subgroups of interest. There are three aims of this paper. First, we describe the methodological challenges and substantive interpretation of mediation effects in the presence of multiple moderating variables. Second, we describe two statistical methods to estimate conditional mediation effects in the presence of multiple moderating variables. Third, the methods are applied to an empirical example from the ATLAS study. Implications for BTMM are discussed.

PMID:40035988 | DOI:10.1007/s11121-025-01791-1

J Racial Ethn Health Disparities. 2025 Mar 4. doi: 10.1007/s40615-025-02348-2. Online ahead of print.

NO ABSTRACT

PMID:40035951 | DOI:10.1007/s40615-025-02348-2

J Assist Reprod Genet. 2025 Mar 4. doi: 10.1007/s10815-025-03436-2. Online ahead of print.

ABSTRACT

OBJECTIVE: Recurrent implantation failure (RIF) is a significant challenge in assisted reproductive technology (ART), affecting many women undergoing in vitro fertilization (IVF). This study aims to compare the efficacy of various intrauterine infusion treatments, including granulocyte colony-stimulating factor (G-CSF), platelet-rich plasma (PRP), human chorionic gonadotropin (HCG), and peripheral blood mononuclear cells (PBMCs), in improving clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate (MR) in women with RIF.

METHODS: A comprehensive search was conducted in multiple databases, including Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Web of Science, and China National Knowledge Internet (CNKI), to identify randomized controlled trials (RCTs) evaluating the efficacy of intrauterine infusion treatments for RIF. Data extraction and quality assessment were performed independently by two reviewers. Network meta-analysis was conducted using a random-effects model to compare the outcomes of different treatments.

RESULTS: A total of 25 RCTs involving 3035 patients were included in the network meta-analysis. The treatments involved G-CSF, PRP, HCG, PBMCs, placebo, and blank control. The results of the network meta-analysis for CPR and LBR were statistically significant among treatments, but there was no statistical significance in MR. The surface under cumulative ranking curve (SUCRA) ranking of CPR and LBR showed that intrauterine infusion treatments of G-CSF, PRP, HCG, and PBMCs were much better than placebo and blank. The SUCRA values of CPR were ranked probabilistically from high to low as follows: PRP (84.5%) > PBMCs (76.5%) > G-CSF (65.7%) > HCG (52.5%) > placebo (20.8%) > blank (0.1%). The SUCRA values of LBR were ranked probabilistically from high to low as follows: PRP (81.4%) > PBMCs (64.6%) > G-CSF (58.0%) > HCG (48.7%) > placebo (42.4%) > blank (4.9%).

CONCLUSION: All these findings confirmed that intrauterine infusions of PRP and PBMCs significantly improve pregnancy outcomes in women with RIF. PRP emerged as the most effective treatment. However, to establish the most effective approach for managing patients with RIF, future research should prioritize direct and robust comparisons between PRP and other therapeutic strategies, ensuring a comprehensive evaluation of their relative efficacy.

PMID:40035946 | DOI:10.1007/s10815-025-03436-2