Tag: nevin manimala

Eur J Med Res. 2025 Dec 1;30(1):1196. doi: 10.1186/s40001-025-03492-5.

ABSTRACT

BACKGROUND AND AIMS: Elevated lactate dehydrogenase (LDH) has been linked to unfavorable outcomes across various diseases, yet its prognostic relevance in critically ill patients with ischemic stroke (IS) remains insufficiently defined. This study aimed to investigate whether LDH levels at admission to the intensive care unit (ICU) are independently associated with short-term mortality among IS patients requiring critical care.

METHODS: This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care (MIMIC-IV, version 3.1) database. The primary and secondary endpoints were all-cause in-hospital mortality and 30 day mortality, respectively. Associations between LDH and outcomes were evaluated using Kaplan-Meier survival curves, multivariable Cox proportional hazards models, and restricted cubic splines (RCS) analyses. Discriminative performance was assessed by time-dependent receiver operating characteristic (ROC) curves and concordance index (C-index). Incremental prognostic value beyond established clinical scores (SAPS II, APS III, OASIS, and LODS) was quantified using category-free net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

RESULTS: Of 818 patients, higher LDH was associated with worse survival (log-rank P < 0.001). After full adjustment, LDH remained independently associated with in-hospital death (36.6% vs. 7.0%; HR 2.82, 95% CI 1.46-5.46; P = 0.002) and 30 day mortality (41.0% vs. 14.8%; HR 2.07, 95% CI 1.24-3.44; P = 0.005). However, results for 30 day mortality attenuate to non-significance after full adjustment in sensitivity analysis (41.0% vs. 14.8%; HR 1.45, 95% CI 0.97-2.17; P = 0.068). RCS modeling revealed a nonlinear relationship, with mortality risk rising sharply above approximately 268 IU/L. Log-transformed LDH demonstrated modest discriminative ability for both in-hospital (AUC 0.642, 95% CI 0.583-0.701; C-index = 0.657, 95% CI 0.612-0.702) and 30 day mortality (AUC 0.668, 95% CI 0.629-0.707; C-index = 0.652, 95% CI 0.617-0.687). Incorporating LDH into conventional severity scores modestly but significantly improved discrimination (positive NRI and IDI).

CONCLUSION: Admission LDH levels are independently associated with in-hospital and 30 day mortality among critically ill IS patients and may serve as a potential adjunct to established prognostic tools for early risk stratification. External, multicenter validation is warranted to confirm these findings.

PMID:41320775 | DOI:10.1186/s40001-025-03492-5

BMC Glob Public Health. 2025 Dec 1;3(1):108. doi: 10.1186/s44263-025-00228-9.

ABSTRACT

BACKGROUND: Leprosy, or Hansen’s disease, is caused by Mycobacterium leprae and can lead to severe disabilities, social marginalisation and reduced quality of life. The disease remains a public health challenge in many low- and middle-income countries, including Pakistan. This study aimed to examine trends in leprosy cases diagnosed in Pakistan from 2001 to 2023, focusing on key epidemiological indicators such as sex, leprosy subtype, age, child cases, disability proportion and geographic distribution to reveal insights into the current situation and to inform strategies for improving case detection.

METHODS: This retrospective study analysed data from the Marie Adelaide Leprosy Centre (MALC), which operates 205 treatment centres across Pakistan. Leprosy cases diagnosed between 2001 and 2023 were examined for sociodemographic and clinical characteristics, including sex, age, and leprosy subtype. Descriptive statistics were presented for leprosy cases diagnosed during this period, and maps were created to illustrate geographic trends and distributions in leprosy incidence over four 5-year intervals between 2003 and 2022.

RESULTS: A total of 10,573 new leprosy cases were recorded with a median age of 36 years. Most cases (79.3%) were multibacillary (MB) leprosy. Until 2013, the majority of patients were male, but the proportion of female cases has steadily increased since then, rising from 40.4% in 2021 to 50.0% in 2023. The highest incidence was observed in Karachi, Sindh, and northern regions, including Khyber Pakhtunkhwa and Gilgit-Baltistan. The overall incidence of new cases declined steadily from 971 in 2001 to 236 in 2023. A decline in child cases and grade 2 disability proportions was also observed. Over the study period, 852 cases (8.1%) occurred in children under 15 years of age, while in 2023 specifically, 7.6% of new cases were in children and 17.4% presented with grade 2 disability, both key indicators for monitoring leprosy epidemiology. However, a substantial increase in the MB proportion was observed in 2023.

CONCLUSIONS: These findings indicate significant progress in leprosy control in Pakistan, but also highlight persistent transmission in specific regions. Targeted interventions in high-burden areas, along with sustained community-based case-finding and early diagnosis efforts, are essential for continued progress toward leprosy elimination in Pakistan.

PMID:41320771 | DOI:10.1186/s44263-025-00228-9

J Gambl Stud. 2025 Dec 1. doi: 10.1007/s10899-025-10459-y. Online ahead of print.

NO ABSTRACT

PMID:41320735 | DOI:10.1007/s10899-025-10459-y

Osteoporos Int. 2025 Dec 1. doi: 10.1007/s00198-025-07766-w. Online ahead of print.

ABSTRACT

Osteoporotic fractures threaten older women’s health worldwide. This nationwide study found that moderate-intensity exercise and vigorous activity performed less than six days weekly lower fracture risk, whereas overly frequent vigorous exercise may increase it. These findings provide practical guidance for balancing exercise intensity and frequency to promote safer activity in aging populations.

BACKGROUND/OBJECTIVES: Osteoporotic fractures, especially vertebral and hip fractures, pose a significant global public health burden due to their high incidence and substantial economic costs. Previous research on physical activity (PA) and fracture prevention has been limited by simplistic classifications of PA and insufficient examination of multidimensional dose-response relationships. This study aimed to elucidate detailed associations between distinct patterns of PA (type, frequency, MET-based volume) and fracture risk, hypothesizing that moderate-intensity exercise provides protective effects, whereas excessive vigorous activity paradoxically increases fracture risk.

METHODS: We conducted a retrospective cohort study using the Korean National Health Insurance Service (NHIS) database, including 541,770 women aged 66 years, with an average follow-up of 7.3 years. Baseline PA was assessed via standardized questionnaires measuring weekly frequency of vigorous (8 METs), moderate (5 METs), and walking activities (3 METs), categorized into MET quartiles. Bone mineral density (BMD) was classified as normal, osteopenia, or osteoporosis. We employed Cox proportional hazards models, adjusted for demographic and clinical covariates, to evaluate fracture risk. Kaplan-Meier curves visualized cumulative fracture incidences.

RESULTS: Regular moderate-intensity exercise (3-5 days/week) significantly reduced vertebral (HR: 0.862-0.891, all p < 0.001) and hip fracture risk (HR: 0.882-0.890, p < 0.02), especially among the osteopenia and osteoporosis groups. Vigorous activity performed at lower weekly frequencies (< 6 days/week) was also associated with reduced fracture risk, whereas excessive vigorous activity (≥ 6 days/week) paradoxically increased hip fracture risk (HR: 1.241; 95% CI, 1.010-1.525) in osteoporosis participants. Clear dose-response relationships emerged across MET quartiles, with higher activity levels consistently lowering fracture risks in osteopenia (HR Q4 vs. Q1: 0.939; 95% CI, 0.910-0.970) and osteoporosis (HR Q4 vs. Q1: 0.894; 95% CI, 0.866-0.922).

CONCLUSION: Our findings suggest that moderate-intensity exercise (3-5 days/week) appears optimal for reducing fracture risk, while excessive vigorous activity should be approached with caution, especially for older women with compromised BMD. Future studies utilizing objective PA measures and prospective designs are warranted to further validate these recommendations.

PMID:41320717 | DOI:10.1007/s00198-025-07766-w

Osteoporos Int. 2025 Dec 1. doi: 10.1007/s00198-025-07785-7. Online ahead of print.

ABSTRACT

Osteoporosis patient education has not been evaluated across Danish municipalities. In this observational study, we compared patients who had participated in osteoporosis patient education with patients who had not. We found differences both in favor of patient education and no patient education, and therefore, conclusions regarding effectiveness cannot be drawn based on this study design.

INTRODUCTION: Osteoporosis patients may benefit from patient education, including knowledge dissemination and physical exercises. We examined two primary outcomes: fractures and quality of life as well as eight secondary outcomes (self-efficacy, physical activity, balance, falls, adherence, pain management, psychological wellbeing, and daily functional capacity).

METHODS: We retrieved data from 15 Danish municipalities on citizens who had participated in osteoporosis patient education between 2016 and 2020. These were matched with citizens who had not participated (1:1) on gender, age, time of osteoporosis diagnosis, and type of previous osteoporotic fractures. A questionnaire was sent out and register data was retrieved, on average 3.7 years after participation in patient education. Participants were compared to controls using logistic or linear regression.

RESULTS: We included a total of 3132 individuals; 1660 answered the questionnaire. We found that participants had a lower score on the physical component of quality of life (difference -1.28; 95% CI -2.29, -0.28) and were more worried about falling compared to controls (OR 1.61; 95% CI 1.31, 1.99). Participants had more active spare time (OR 0.59; 95% CI 0.44, 0.81), performed more bone-specific physical activities (difference 0.50; 95% CI 0.01, 0.99), and were more adherent to medication (OR 1.74; 95% CI 1.49, 2.03). All other outcomes showed no statistically significant differences.

CONCLUSION: Our findings show that citizens who participated in patient education were more adherent to medication. Results related to quality of life, physical activity, and fear of falling were inconclusive, and therefore, we cannot draw conclusions regarding the overall effectiveness of osteoporosis patient education. Further studies should include baseline measurements and preferably conduct randomized controlled trials.

PMID:41320715 | DOI:10.1007/s00198-025-07785-7

Lasers Med Sci. 2025 Dec 1;40(1):504. doi: 10.1007/s10103-025-04764-6.

ABSTRACT

To evaluate and compare clinical outcomes, radiographic healing and regenerative biomarkers in laser-irradiated and non-irradiated groups undergoing regenerative endodontics in immature permanent teeth over a 12-month follow-up period. Twenty-eight patients with necrotic immature roots were assigned to one of two groups: a control group (n = 14) receiving standard regenerative endodontic procedure (REP) with a mock laser application, or an experimental group (n = 14) receiving standard REP with adjunctive low-level laser therapy (LLLT). Both groups underwent initial medication with double antibiotic paste. In the experimental group, a diode dental laser (810 nm, 4.5 J/cm², 0.3 W, 9 s) was applied to the apical third every 48 h for 14 days. After 21 days, intracanal bleeding was induced, and blood samples were collected for regenerative marker analysis using ELISA. Mineral trioxide aggregate was placed, followed by coronal restoration. Clinical symptoms and radiographic healing were monitored over 12 months, with statistical analysis performed using the independent t-test at a 95% confidence level. Clinically, both groups demonstrated high success rates (85.7% in the laser group vs. 78.6% in the control group; p = 0.83). No statistically significant differences were observed when pain and radiographic parameters were compared over time between the groups. Considering the biomarkers, only DSPP expression was significantly higher in the laser group (p = 0.03). For the other biomarkers (VEGF, TGF-β, MMP-8, PDGF-BB), the laser group showed numerically higher mean values, but these differences did not reach statistical significance (all p > 0.05). This study demonstrates that adjunctive low-level laser therapy (LLLT) during regenerative endodontic procedures produced comparable clinical and radiographic outcomes to standard treatment, with a significant increase in DSPP expression suggesting early molecular activation. While these findings indicate potential regenerative benefits, larger multicenter studies with extended follow-up are required to validate LLLT as an adjunct in clinical protocols. Trial registration: This trial was registered in the Clinical Trials Registry India (CTRI) under registration number CTRI/2024/01/062114 dated 31/01/2024.

PMID:41320703 | DOI:10.1007/s10103-025-04764-6

Bull Environ Contam Toxicol. 2025 Nov 30;115(6):73. doi: 10.1007/s00128-025-04142-6.

ABSTRACT

This study investigated the bioaccumulation of Zn, Pb, and Cd in the sternal feathers of house sparrows (Passer domesticus) collected from five sites in Meknes, Morocco, representing urban, industrial, and rural environments. Metal concentrations were quantified using inductively coupled plasma optical emission spectrometry (ICP-OES). The analysis revealed significant spatial differences for Pb and Cd, whereas Zn showed no marked variation among sites. Post-hoc comparisons confirmed that urban and industrial stations had considerably higher Pb and Cd levels compared to the rural reference site. No significant sex-related differences were found. Principal Component Analysis (PCA) was used as a descriptive tool to visualize correlations among metals and sampling sites, confirming spatial clustering linked to anthropogenic influence. These findings highlight P. domesticus as a reliable and non-invasive bioindicator of urban and industrial metal pollution, particularly for Pb and Cd, emphasizing its ecological relevance in monitoring environmental contamination.

PMID:41320699 | DOI:10.1007/s00128-025-04142-6

Bull Environ Contam Toxicol. 2025 Nov 30;115(6):77. doi: 10.1007/s00128-025-04152-4.

ABSTRACT

China faces escalating ozone pollution challenges, with O₃ becoming the primary pollutant in summer since 2013 and exhibiting deteriorating compliance rates (Grade I attainment plummeted from 6.9 to 0.3% during 2015-2023). Critical hotspots include the Beijing-Tianjin-Hebei region (exceeding standards by 20 µg/m³), driven by inadequate coordinated control of VOC and NO_x. Analysis of the ABaCAS-EI v2.0 dataset (2005-2021) reveals divergent precursor trends: VOC emissions shifted from residential to industrial dominance, with industrial solvents (PRSO) surging 389% during 2005-2013 and comprising 61% of national totals by 2021. Spatially, eastern provinces (e.g., Guangdong) showed transport-industrial emission profiles (TRON: 28%; PRSO: 32%), while northern regions achieved significant NO_x reductions through industrial restructuring, with Hebei’s emissions falling 46% from peak levels. Conversely, NO_x emissions peaked earlier (2011), but transportation’s share grew to 42% by 2021 (TRON: 31%). Regional disparities persist-coastal areas leveraged advanced controls, whereas western provinces struggled with expanding pollution bases. These findings underscore the imperative for spatially-explicit strategies addressing sector-region heterogeneities to mitigate ozone’s health/ecological impacts.

PMID:41320696 | DOI:10.1007/s00128-025-04152-4

Am J Biol Anthropol. 2025 Dec;188(4):e70153. doi: 10.1002/ajpa.70153.

ABSTRACT

OBJECTIVES: Energetic deficits through lack of access to resources and/or increased exposure to stressors are associated with the disadvantaged biocultural environments often afforded to individuals with lower socioeconomic status (SES). We use anthropometric and demographic data collected from 224 adult (aged 20-50 years) individuals whose computed tomography (CT) scans are housed in the New Mexico Decedent Image Database to explore how various limb proportions differ between childhood SES levels.

MATERIALS AND METHODS: Relationships between childhood SES and body proportions, calculated from standard anthropometrics measured on CT scans, were tested using ANOVA and ANCOVA.

RESULTS: Higher-SES individuals have larger dimensions for a given trunk length than lower-SES individuals across all measurements. The largest differences in individual segments are found in the lower limb segments (tibia and thigh); though total upper limb shows greater between-group differences than total lower limb. Foot length (autopod) differences do not reach statistical significance.

CONCLUSIONS: While individuals who face resource deficits in early childhood may undergo catch-up growth later in development, our study indicates the material disadvantage offered by lower- and middle-SES in New Mexico prevents catch-up growth from equalizing linear growth outcomes even in less plastic dimensions. Our study demonstrates the importance of limb segments as biomarkers of childhood biocultural environments. We highlight that SES is a socially defined category of resource allocation with clear biological impacts, which may be socially mitigated by policies supporting a more equitable division of resources.

PMID:41320675 | DOI:10.1002/ajpa.70153

Am J Hum Biol. 2025 Dec;37(12):e70173. doi: 10.1002/ajhb.70173.

ABSTRACT

BACKGROUND: Low birth weight is a critical predictor of child mortality and morbidity, contributing to both immediate health complications after birth and long-term health issues later in life. Globally, it remains a major public health challenge, particularly in low- and middle-income countries, where poor maternal nutrition, limited access to quality healthcare, and poverty exacerbate the risk. Regions such as Sub-Saharan Africa and South Asia carry the highest burden, accounting for the majority of low birth weight cases worldwide. Within this context, Pakistan stands out as one of the countries with the highest rates of child mortality and malnutrition, making the issue of low birth weight especially pressing.

METHODOLOGY: Utilizing the Demographic and Health Survey of 2017-18, multiple analytical techniques were used including logistic regression, standard, Wagestaff, Erreygers concentration index analysis and concentration curves.

RESULTS: The study indicates that low birth weight (LBW) is disproportionately concentrated among socio-economically disadvantaged groups. Negative and significant concentration indices for household wealth, maternal education, and paternal education show that children from poorer and less educated families are at higher risk of LBW. Further analysis reveals that the relationship between household wealth, parental education and LBW is nonlinear in the context of rural-urban division. Rural children from middle and higher-income families show a slightly elevated risk as compared with urban. Similarly, mother’s education seems less effective against LBW. However, father’s education might help as LBW is slightly reduced among higher educated fathers. This counterintuitive pattern may be influenced by factors such as multiple births, cesarean deliveries, antenatal care utilization, or other socio-cultural dynamics. For example rural women might have less decision-making autonomy regarding health and meeting other necessities of life.

CONCLUSION: The study finds that low birth weight (LBW) is disproportionately concentrated among socio-economically disadvantaged groups, with household wealth and parental education serving as strong protective factors. However children from middle and higher-income households, in rural areas, may also experience a slightly elevated risk of LBW as compared to urban populations Father’s education might play a more protective role against low birth weight among rural areas.

PMID:41320666 | DOI:10.1002/ajhb.70173