Tag: nevin manimala

Cureus. 2025 Dec 11;17(12):e99013. doi: 10.7759/cureus.99013. eCollection 2025 Dec.

ABSTRACT

Coronary artery bypass grafting (CABG) is one of the most common surgical procedures, contributing to improved long-term survival and quality of life for patients with coronary artery disease (CAD). However, surgical site infections (SSIs) remain a serious complication, increasing mortality, morbidity, and hospital length of stay.

BACKGROUND/OBJECTIVES: The study aimed to determine the incidence of SSIs and to identify factors associated with their development in patients at intermediate- to high-risk of infection undergoing CABG. It also aimed to provide context-specific evidence to inform targeted preventive strategies.

METHODS: The study included 51 patients (39 (76.5%) men, 12 (23.5%) women; mean age 67.2 ± eight years) who underwent CABG via median sternotomy. Patients were preoperatively stratified for SSI risk using the Brompton Harefield Infection Score (BHIS), and only those classified as intermediate or high risk were included. The occurrence of SSIs was evaluated postoperatively using the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, and Stay as inpatient prolonged over 14 days (ASEPSIS) scoring system. Data were analyzed using SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA).

RESULTS: Infections were observed in 17 (33%) patients. The occurrence of SSIs was positively associated with prolonged hospital stay (ρ = 0.512, p < 0.001) and obesity (f = 0.348, p = 0.013). Age, gender, smoking, diabetes mellitus, and ejection fraction were not statistically significantly associated with infection occurrence.

CONCLUSIONS: Obesity and prolonged hospital stay were significantly associated with higher SSI rates in patients after CABG. The high incidence of SSIs highlights the urgent need for targeted interventions in patients at increased risk. Early identification and proactive management of patients at increased risk may help reduce infection rates, improving postoperative outcomes and patient quality of life. The small sample size of this study, the data collection from a single cardiothoracic surgery center, and the limited number of examined variables are limitations that indicate the need for further research.

PMID:41527653 | PMC:PMC12790610 | DOI:10.7759/cureus.99013

Cureus. 2025 Dec 12;17(12):e99020. doi: 10.7759/cureus.99020. eCollection 2025 Dec.

ABSTRACT

Total laparoscopic hysterectomy (TLH) is a widely accepted minimally invasive procedure for benign gynecologic diseases. Transvaginal retrieval avoids additional abdominal incisions but may be technically challenging in nulliparous women because of narrower vaginal dimensions and less distensible tissues, particularly in cases with a large uterus. We retrospectively analyzed 368 nulliparous patients who underwent TLH at our institution between February 2021 and August 2025. Among them, 267 underwent transvaginal retrieval and 101 underwent transabdominal retrieval, with all cases performed using contained in-bag morcellation. In the high-difficulty subgroup defined as uterine weight ≥500 g (n = 147), 62 underwent transvaginal and 85 underwent transabdominal retrieval. No conversion from transvaginal to transabdominal extraction was required. Compared with the abdominal route, transvaginal retrieval was associated with significantly shorter operative time (median 203.5 vs. 207.0 minutes, p = 0.016) and retrieval time (28.5 vs. 34.0 minutes, p = 0.024), while blood loss did not differ significantly (25 vs. 25 ml, p = 0.142). Retrieval efficiency (uterine weight ÷ retrieval time) tended to be higher in the transabdominal group (median 25.69 vs. 24.14 g/min, p = 0.083), but the difference was not statistically significant. No major complications occurred, and only minor events such as vaginal wall lacerations and vaginal cuff infections were observed (vaginal wall laceration: 1/62 [1.6%] vs. 2/85 [2.4%]; vaginal cuff infection: 1/62 [1.6%] vs. 1/85 [1.2%] in the transvaginal and transabdominal groups, respectively); all were managed conservatively or with simple intraoperative repair. These findings suggest that even in nulliparous women with large uteri, transvaginal retrieval during TLH using contained in-bag morcellation can be considered a safe and effective first-line option for specimen removal when intraoperative conditions permit, potentially providing superior cosmetic results and reducing surgical morbidity without increasing perioperative risks. Prospective, multicenter studies are warranted to validate these results.

PMID:41527651 | PMC:PMC12790631 | DOI:10.7759/cureus.99020

Cureus. 2025 Dec 12;17(12):e99061. doi: 10.7759/cureus.99061. eCollection 2025 Dec.

ABSTRACT

Background Right ventricular (RV) strain detected via transthoracic echocardiography (TTE) has emerged as a potential prognostic marker in patients with COVID-19, given the virus’s cardiovascular implications. However, data on the prognostic utility of point-of-care ultrasound (POCUS) in this context remains limited. This study evaluated whether RV strain identified through limited POCUS TTE at emergency department (ED) presentation correlates with adverse clinical outcomes or mortality in SARS-CoV-2 positive patients without pre-existing cardiovascular disease. Methods This study followed 29 patients at a medical center in the United States, in a prospective cohort design. Participants included patients who tested positive for COVID-19 via polymerase chain reaction (PCR) and had no history of myocardial infarction, congestive heart failure, percutaneous coronary intervention, pulmonary embolism, or atrial fibrillation. Each underwent bedside POCUS TTE to assess for RV strain. Follow-up was conducted via structured phone surveys at 30, 60, and 90 days using a four-question instrument developed by the study team. The study was conducted from initial enrollment through the final 90-day follow-up period, with data collected between September 2020 and August 2021. We used chi-square tests to examine the relationship between echocardiographic findings and clinical outcomes. Results Among those with RV strain (D Sign positive), 60% experienced adverse outcomes, compared to 73.7% in those without RV strain. This difference was not statistically significant (p = 0.7). Mortality was also lower in the RV strain group (10%) compared to those without RV strain (31.6%), though this difference did not reach statistical significance (p = 0.2). Conclusion In this preliminary cohort, RV strain identified via limited POCUS TTE was not significantly associated with adverse outcomes or mortality in COVID-19 patients without prior cardiovascular disease. To better understand whether bedside echocardiography can predict clinical outcomes for this group, more extensive research is necessary.

PMID:41527650 | PMC:PMC12790843 | DOI:10.7759/cureus.99061

Cureus. 2025 Dec 12;17(12):e99058. doi: 10.7759/cureus.99058. eCollection 2025 Dec.

ABSTRACT

Objective The main objective of this study is to assess the frequency and management of thoracic complications following supracostal mini-percutaneous nephrolithotomy (mini-PCNL) in pediatric patients. Methods This retrospective cross-sectional study was conducted in the Department of Urology, Institute of Kidney Diseases, Peshawar, Pakistan, from June 2017 to December 2019. A total of 80 pediatric patients (52 males, 65%, and 28 females, 35%) who underwent supracostal mini-PCNL were included. Patients were categorized according to the level of puncture: Group 1 (between the 11th and 12th ribs; n = 62, 77.5%), Group 2 (between the 10th and 11th ribs; n = 15, 18.75%), and Group 3 (between the 9th and 10th ribs; n = 3, 3.75%). Postoperative thoracic complications, including hydrothorax and hemothorax, were documented and managed either conservatively, by needle aspiration, or by intercostal chest tube insertion. Results Among the 80 patients, 12 (15%) developed hydrothorax. Although thoracic complications were observed in 6/62 (9.6%) in Group 1, 3/15 (20%) in Group 2, and 3/3 (100%) in Group 3, the interpretation of the 100% complication rate in Group 3 should be made with caution, because this group contained only three patients, limiting the statistical power despite the anatomical plausibility of higher complications at higher intercostal levels. Of the affected patients, six (50%) were managed conservatively, four (33.3%) required needle aspiration, and two (16.6%) underwent intercostal chest tube insertion. The mean hospital stay among patients with thoracic complications was 2.3 days. Conclusion The likelihood of thoracic complications following supracostal mini-PCNL in pediatric patients increases with higher intercostal access. While punctures above the 10th rib carry a 100% risk of hydrothorax, most cases can be managed conservatively through timely recognition and multidisciplinary collaboration among urologists, anesthetists, and pulmonologists. A meticulous surgical approach and careful perioperative monitoring significantly reduce morbidity.

PMID:41527648 | PMC:PMC12790831 | DOI:10.7759/cureus.99058

BMC Med Imaging. 2026 Jan 12;26(1):17. doi: 10.1186/s12880-025-02073-6.

ABSTRACT

OBJECTIVES: Metabolic syndrome (MetS) presents significant health risks, but studies on individual component of MetS or its combined impact on bone mass have shown conflicting results. Therefore, this study aimed to analyze the relationship between abdominal fat and bone mineral density (BMD) in women with MetS using gemstone spectral imaging (GSI).

METHODS: A retrospective study was performed on 76 women with MetS scheduled for sleeve gastrectomy between June and November 2021. Based on cluster analysis of BMD parameters, the patients were categorized into the high (54) and low (22) BMD groups. Clinical, BMD, and body composition metrics were analyzed separately. Univariate and multivariate logistic regression analyses were used to evaluate patients’ clinical and body composition parameters. Receiver operating characteristic (ROC) curves were generated to determine the optimal diagnostic thresholds of various parameters for diagnosing the high and low BMD groups. Furthermore, taking lumbar vertebral BMD as the dependent variable, multiple linear regression analysis was performed.

RESULTS: Significant differences in body composition were observed between the high and low BMD groups, with lower abdominal fat in patients in the high BMD group. The ROC curves showed a total abdominal fat volume threshold of 4733.2mL for predicting BMD (P = 0.008). Furthermore, using multiple linear regression adjusted for age, a statistically significant negative correlation was observed between the lumbar vertebral BMD and abdominal fat volume.

CONCLUSION: Abdominal fat volume influenced the GSI-BMD in women with MetS. As the abdominal fat increased, the patients’ GSI-BMD in the lumbar spine also decreased.

PMID:41527041 | DOI:10.1186/s12880-025-02073-6

BMC Neurol. 2026 Jan 12. doi: 10.1186/s12883-025-04621-7. Online ahead of print.

ABSTRACT

BACKGROUND: Post-stroke spasticity affects a significant proportion of stroke survivors and impairs quality of life. Repeated intramuscular injections of OnabotulinumtoxinA are widely used for spasticity management; however, long-term real-world outcomes remain underreported. This study aimed to evaluate the long-term safety and treatment continuation patterns, and to identify predictors of treatment discontinuation associated with repeated onabotulinumtoxinA treatment.

METHODS: This retrospective, single-center study included 224 post-stroke patients treated with OnabotulinumtoxinA between 2012 and 2023. Inclusion criteria were a diagnosis of post-stroke spasticity, initiation of treatment before 2021, and at least three years of follow-up. Outcomes assessed included treatment continuation rates, reasons for discontinuation, dose trends, and predictors of treatment discontinuation. Logistic regression and repeated measures ANOVA were used for statistical analyses.

RESULTS: Of the 224 patients, 94 (42%) continued treatment as of December 2023. Reasons for discontinuation included improvement and completion (n = 59, 45.4%), unknown reason (n = 39, 30.0%), Change of doctor or relocation (n = 13, 10.0%), insufficient efficacy (n = 13, 10.0%), switch to other treatment (n = 4, 3.1%), and adverse events (n = 2, 1.5%). Long-term treatment was associated with progressive dose escalation (p < 0.05).Logistic regression analysis showed that cerebral infarction was significantly associated with treatment completion due to improvement(p = 0.004), while a lower initial dose demonstrated a non-significant trend toward treatment completion (p = 0.051).

CONCLUSIONS: Repeated onabotulinumtoxinA injections were not associated with unexpected safety concerns over long-term follow-up. Approximately 25% of patients discontinued treatment during the observation period, including cases documented as treatment completion due to clinical improvement. Stroke type was associated with treatment discontinuation patterns, supporting the importance of individualized long-term treatment planning.

PMID:41527032 | DOI:10.1186/s12883-025-04621-7

Alzheimers Res Ther. 2026 Jan 13. doi: 10.1186/s13195-025-01941-1. Online ahead of print.

ABSTRACT

BACKGROUND: The oral microbiota has been associated with Alzheimer’s disease (AD). However, earlier studies provided conflicting results using varying sampling methods, sequencing techniques, and statistics, as well as independent subjects.

METHODS: To robustly identify disease-associated microbial features, we recruited patients and their healthy life partners from the same households sharing a more similar microbiota compared to independent individuals increasing statistical power via paired design and combined three different sequencing methods – including metagenomics-and several bioinformatic pipelines. We recruited 26 AD-patients and their life partners. Salivary and supragingival samples were collected and a clinical examination of the mouth was performed.

RESULTS: Both groups showed comparable oral health. By focusing primarily on recurrently identified species across the different datasets we were able to identify a Core dysbiosis. This Core dysbiosis surprisingly spares the most central of oral diseases pathogens, namely Porphyromonas gingivalis. However, it includes numerous other species commonly associated with oral pathologies such as Prevotella nigrescens, Streptococcus anginosus, Dialister invisus, Anaeroglobus geminatus, Olsenella uli and Mogibacterium timidum. In contrast, more host-compatible species such as Prevotella melaninogenica or Streptococcus parasanguinis are identified in controls.

CONCLUSIONS: This is the first study using a combined sequencing approach and a paired study design to identify robust features of the oral microbiota of AD-patients. Although promising, the results should nevertheless be interpreted with caution, as the cross-sectional study design limits the possibilities of interpretation, and larger, longitudinal data are necessary for causal conclusions. However, this combined approach on multiple processing levels to identify intra-partnership differences still offers the possibility to better identify disease-associated microbial features potentially involved in AD-pathogenesis.

TRIAL REGISTRATION: This study was prospectively registered at the German Clinical Trials Register (DRKS00023456) at the 30th of November 2020.

PMID:41527012 | DOI:10.1186/s13195-025-01941-1

BMC Res Notes. 2026 Jan 12. doi: 10.1186/s13104-026-07632-w. Online ahead of print.

NO ABSTRACT

PMID:41527010 | DOI:10.1186/s13104-026-07632-w

Infect Dis Poverty. 2026 Jan 12;15(1):8. doi: 10.1186/s40249-025-01410-9.

ABSTRACT

BACKGROUND: Schistosomiasis is a parasitic worm infection that affects an estimated 250 million people. In Côte d’Ivoire, schistosomiasis remains a public health problem despite control efforts that have been mounted since the new millennium. The aim of this study was to assess the pooled prevalence of human schistosomiasis, to determine trends over the past 50 years and to identify risk factors for schistosomiasis.

METHODS: We systematically searched Google Scholar, PubMed, Scopus and Web of Science Core Collection without language restriction for papers published from January 1, 1974 to December 31, 2023. We adhered to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. We performed random effect models for meta-analysis and generated forest plots. Pooled schistosomiasis prevalences and corresponding 95% confidence intervals (CIs) were determined. Heterogeneity among studies were evaluated using Cochran’s Q test and I² statistic test. Publication bias was assessed with funnel plot and Egger’s test.

RESULTS: Overall, 326 articles involving 279,340 participants were included, comprising 254,954 school-aged children and 520 preschool-aged children. The pooled prevalence of schistosomiasis was 26.1%. The prevalence decreased from 66.5% in 1994-2003 to 15.0% in 2014-2023. The highest pooled prevalence of schistosomiasis was observed in Tonkpi regional health directorate. The main risk factors for schistosomiasis were sex [male: odds ratio (OR) = 1.24, 95% CI: 1.13-1.35], age group (> 15 years: OR = 2.45, 95% CI: 1.82-3.08, compared to children aged 6-10 years), and altitude (< 400 m, OR = 4.76, 95% CI: 4.00-5.88).

CONCLUSION: Our findings revealed that the prevalence of schistosomiasis in Côte d’Ivoire has considerably declined over the past decades. However, the disease remains a public health problem, and hence, surveillance should be tightened up and control efforts targeted to high-risk communities.

PMID:41526998 | DOI:10.1186/s40249-025-01410-9

Eur J Med Res. 2026 Jan 12. doi: 10.1186/s40001-026-03879-y. Online ahead of print.

ABSTRACT

BACKGROUND: Traditional adiposity indices like the cardiometabolic index (CMI) assess central adiposity and lipid metabolism but do not directly reflect insulin resistance (IR). The modified cardiometabolic index (MCMI), incorporating fasting plasma glucose, may better reflect IR-related metabolic dysfunction relevant to skeletal muscle health. Muscle mass is a basic and objective component of sarcopenia, and relative muscle loss has been used as a proxy indicator for the low muscle mass dimension of sarcopenia-related phenotypes in some studies. This study evaluates the cross-sectional relationship between MCMI and relative muscle loss, comparing its discrimination ability with other indices (BMI, CMI, LAP, TyG, TyG-WC).

METHODS: We conducted a cross-sectional analysis using data from 3559 U.S. participants aged 20-59 years, derived from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 cycles. Relative muscle loss was defined by the Foundation for the National Institutes of Health (FNIH) as characterized by appendicular lean mass (ALM) adjusted by BMI (ALM/BMI) < 0.512 for women and < 0.789 for men. Weighted analyses assessed the relationship between MCMI and the odds of relative muscle loss. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated through multivariable logistic regression analysis. Bonferroni-adjusted P values for MCMI quartiles and tests for linear trend were calculated to account for multiple comparisons. We applied restricted cubic spline (RCS) models and threshold effect analyses to assess non-linear trends and detect possible cutoff values. In addition, subgroup analyses were carried out to examine potential effect modification by age, sex, and other important covariates. The discriminatory ability of MCMI was compared with BMI, CMI, LAP, TyG, and TyG-WC using receiver operating characteristic (ROC) curve analysis. Key predictors of relative muscle loss were identified using LASSO regression with a 70/30 training-validation split and incorporated into an exploratory multivariable classification model for internal assessment. Model discrimination and calibration were examined using ROC curves, calibration plots, and decision curve analysis (DCA), and a nomogram was developed to visualize the odds of relative muscle loss.

RESULTS: In survey-weighted analyses, higher MCMI was strongly associated with greater odds of relative muscle loss (per 1-unit increase: OR = 2.68, 95% CI 2.21-3.25); participants in the highest MCMI quartile had markedly higher odds than those in the lowest quartile (OR = 21.31, 95% CI 10.16-44.70), and all quartile-based associations and the overall trend remained statistically significant after Bonferroni correction for multiple comparisons. Restricted cubic spline and threshold analyses suggested a non-linear association with an inflection point around MCMI 4.61: below this level, each 1-unit increase in MCMI was associated with substantially higher odds of relative muscle loss (OR = 3.52, 95% CI 2.78-4.45), whereas above the threshold the association appeared attenuated and statistically non‑significant (OR = 1.10, 95% CI 0.67-1.82). Associations were generally consistent across subgroups and appeared stronger in men (P for interaction = 0.002). In ROC analyses, MCMI showed the highest discrimination for prevalent relative muscle loss (AUC = 0.776) compared with BMI (0.727), CMI (0.690), LAP (0.708), TyG (0.661), and TyG-WC (0.718); a multivariable model that additionally included MCMI and selected sociodemographic and clinical covariates achieved an AUC of 0.828 in the training dataset, representing a modest improvement in statistical discrimination over MCMI alone, and the nomogram is provided as an exploratory communication tool for visualizing cross-sectional probability estimates derived from this model.

CONCLUSIONS: In this cross-sectional NHANES 2011-2018 analysis, higher MCMI was associated with greater odds of relative muscle loss and showed better cross-sectional discrimination than with widely used metabolic indices (BMI, CMI, LAP, TyG, TyG-WC). Prospective studies are needed to assess temporality and clinical utility.

PMID:41526991 | DOI:10.1186/s40001-026-03879-y