Tag: nevin manimala

J Int Med Res. 2026 Jun;54(6):3000605261452559. doi: 10.1177/03000605261452559. Epub 2026 Jun 6.

ABSTRACT

ObjectiveThis study aimed to systematically investigate the independent predictive value of the platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio for 28-day all-cause mortality in patients with sepsis and to further evaluate their incremental discriminatory capacity when added to conventional prognostic scoring models.MethodsThis single-center retrospective cohort study involved 287 adult patients diagnosed with sepsis according to the Sepsis-3 criteria. Patients were stratified into high- and low-level groups based on the median values of platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio, and baseline characteristics, and clinical outcomes were compared between groups. Univariate and multivariate Cox proportional hazards regression models were used to assess the independent associations of platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio with 28-day mortality risk. To evaluate predictive performance, multiple models were constructed and compared, including Sequential Organ Failure Assessment score alone, Acute Physiology and Chronic Health Evaluation II score alone, each combined separately with platelet-to-neutrophil ratio or platelet-to-lymphocyte ratio, and a composite model integrating Acute Physiology and Chronic Health Evaluation II, day-3 lactate level, platelet-to-neutrophil ratio, and platelet-to-lymphocyte ratio. Model performance was rigorously assessed using receiver operating characteristic curves, calibration plots, decision curve analysis, integrated discrimination improvement, and net reclassification improvement, enabling a comprehensive evaluation of discrimination, calibration, clinical utility, and the incremental value of novel biomarkers.ResultsMultivariate Cox regression analysis revealed that lower platelet-to-neutrophil ratio (hazard ratio = 0.97, 95% confidence interval: 0.95-0.99, p = 0.012) and higher platelet-to-lymphocyte ratio (hazard ratio = 1.01, 95% confidence interval: 1.01-1.01, p = 0.043) were independently associated with increased 28-day all-cause mortality. Kaplan-Meier survival analysis confirmed significantly higher cumulative mortality in the low-platelet-to-neutrophil ratio and high-platelet-to-lymphocyte ratio groups (log-rank p < 0.05). The composite model incorporating Acute Physiology and Chronic Health Evaluation II, day-3 lactate level, platelet-to-neutrophil ratio, and platelet-to-lymphocyte ratio demonstrated superior predictive accuracy, with an area under the receiver operating characteristic curve (area under the curve) of 0.824 (95% confidence interval: 0.778-0.871), significantly outperforming both the Acute Physiology and Chronic Health Evaluation II only model (area under the curve: 0.746, p < 0.001) and the Sequential Organ Failure Assessment only model (area under the curve: 0.667, p < 0.001). Decision curve analysis showed that this model provided greater clinical net benefit across a broad range of threshold probabilities. Furthermore, both integrated discrimination improvement and net reclassification improvement analyses confirmed statistically significant improvements in discrimination and reclassification accuracy after the inclusion of platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio (both p < 0.001).ConclusionPlatelet-to-neutrophil ratio and platelet-to-lymphocyte ratio are independent predictors of 28-day mortality in patients with sepsis. Incorporating these readily available and cost-effective inflammatory markers into traditional prognostic systems-such as Acute Physiology and Chronic Health Evaluation II-and combining them with dynamic lactate monitoring substantially enhances the discrimination, calibration, and clinical utility of risk prediction models. These findings provide robust evidence supporting the use of platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio for early risk stratification and individualized prognostic assessment in clinical practice.

PMID:42251504 | DOI:10.1177/03000605261452559

Proc Inst Mech Eng H. 2026 Jun 6:9544119261456916. doi: 10.1177/09544119261456916. Online ahead of print.

ABSTRACT

Smash landings in badminton carry high injury risk, worsened by fatigue. Assess how fatigue and task predictability shape lower-limb biomechanics in elite male players and identify fatigue markers via explainable ML. Fourteen elites performed anticipated and unanticipated smash-landings before and after fatigue. Synchronous 3-D kinematics/kinetics were analyzed with a 2 × 2 repeated-measures ANOVA. XGBoost models based on anticipated-task trials were used to classify fatigue status; SHAP ranked feature importance. Fatigue and unpredictability independently affected peak coronal-plane knee moment (fatigue p = 0.033; task p = 0.016). Significant ankle-moment effects were also observed in the transverse plane. Statistical parametric mapping highlighted time-specific effects of fatigue and task on knee/ankle sagittal moments, with an interaction for knee sagittal ROM (p = 0.0395). XGBoost showed high accuracy, identifying peak ankle plantar-flexion moment as the foremost fatigue discriminator. Fatigue and unanticipated tasks were associated with reduced lower-limb control during smash landings. Knee moment and vertical ground-reaction force may serve as biomechanical indicators of fatigue-related movement alterations. Training strategies that combine fatigue exposure with decision-making demands may help improve motor control under high-demand task conditions.

PMID:42251489 | DOI:10.1177/09544119261456916

Trop Med Health. 2026 Jun 6. doi: 10.1186/s41182-026-00994-8. Online ahead of print.

ABSTRACT

BACKGROUND: The potential re-emergence of Mpox poses an increasing public health concern in the Horn of Africa, particularly in Ethiopia. This study examined perceptions of preparedness among surveyed surveillance professionals in Ethiopia regarding the disease surveillance system’s ability to detect and respond to a potential Mpox outbreak.

METHODS: A descriptive cross-sectional survey design was employed, utilizing a structured 58-item questionnaire that assessed preparedness across five domains: general awareness and understanding, surveillance infrastructure and resources, coordination and communication, preparedness and response, and policy, training, and equity. The survey was distributed to disease surveillance professionals at both federal and regional levels through purposive sampling. The data were analyzed using descriptive statistics, Mann-Whitney U tests, Cramér’s V, and content analysis.

RESULTS: Among the 42 surveyed surveillance professionals, 45.3% believed that the surveillance system could effectively respond to an Mpox outbreak, while 54.7% disagreed, reflecting divided perceptions within the sample. Respondents identified several perceived gaps, including limited awareness of Mpox-specific protocols, insufficient training, inadequate diagnostic capacity, and fragmented coordination across sectors. A substantial proportion of respondents reported system-related challenges, with 83.3% perceiving laboratory facilities as inadequate and 78.6% noting the absence of contingency plans. In addition, 57.1% indicated that their organizations lacked staff trained on Mpox, and 59.5% reported no stockpiles of personal protective equipment. Overall, the surveyed professionals expressed mixed perceptions of preparedness, with notable concerns regarding resource allocation, infrastructure, and policy implementation.

CONCLUSIONS: The study identifies perceived gaps among the 42 surveyed surveillance professionals regarding Mpox preparedness in Ethiopia, highlighting the need for enhanced training, strengthened infrastructure, improved coordination, and more equitable resource distribution. Addressing these gaps through targeted interventions may help strengthen disease surveillance capacity and improve the ability to detect, respond to, and manage emerging health threats such as Mpox.

PMID:42251460 | DOI:10.1186/s41182-026-00994-8

J Pharm Health Care Sci. 2026 Jun 6. doi: 10.1186/s40780-026-00592-0. Online ahead of print.

ABSTRACT

BACKGROUND: Antibiotic resistance has emerged largely due to the improper use of antibiotics in clinical practice, although most acute diarrheal diseases resolve without antibiotic treatment and should be reserved for cases of invasive bacterial or dysenteric diarrhea. This study aimed to assess the patterns of antibiotic use for acute diarrheal diseases at Nigist Elleni Mohammed Memorial Teaching Hospital (NEMMTH) in Central Ethiopia.

METHODS: A retrospective cross-sectional study was conducted to assess patients treated for diarrhea between January 1 and June 30, 2023. The appropriateness of antibiotic prescriptions for diarrhea was evaluated according to the Ethiopian Standard Treatment Guidelines. Data were collected using a structured abstraction form, and patient charts were selected through systematic random sampling. The analysis was performed using the Statistical Package for Social Sciences version 25.

RESULTS: Among 302 patients evaluated, 53.3% were female and 46.4% were children under five years old. Of the 302 patients, 57.6% had watery diarrhea. A total of 74.5% of patients received at least one antibiotic, of whom 73.5% received a single antibiotic during the treatment of acute diarrheal cases. The most commonly prescribed antibiotics were metronidazole (18.2%), cotrimoxazole (17.5%), and ciprofloxacin (11.6%). The proportion of inappropriate antibiotic prescribing was 77.1%.

CONCLUSIONS: This study found a high level of inappropriate antibiotic use for acute diarrheal disease at NEMMTH. Metronidazole and cotrimoxazole are the most commonly prescribed antibiotics. Ensuring proper management by adhering to the standard treatment guidelines is crucial.

PMID:42251448 | DOI:10.1186/s40780-026-00592-0

AIDS Res Ther. 2026 Jun 6. doi: 10.1186/s12981-026-00895-0. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence on COVID-19 among people living with HIV (PLWH) remains mixed and context-dependent.

METHODS: We prospectively followed 64 PLWH receiving antiretroviral therapy at a tertiary university hospital in Martin, Slovakia (September 2020-September 2021). SARS-CoV-2 infection was confirmed by RT-PCR.

RESULT: COVID-19 was diagnosed in 54 of 64 participants (84.4%) and was generally mild; none required intensive care, and no deaths were reported. There were no statistically significant differences between PLWH who did and did not develop COVID-19 with respect to age, duration of HIV infection, CD4 cell count, or viral suppression. Participants who developed COVID-19 were more likely to have at least one documented comorbidity; however, this did not appear to translate into severe outcomes in this small cohort. Among those with COVID-19, exploratory comparisons showed no clear differences in short-term outcomes according to mRNA vaccination status.

CONCLUSIONS: In this small exploratory cohort of ART-treated individuals in Slovakia, we did not identify clear clinical or HIV-related predictors of COVID-19 outcomes; however, the study was underpowered and the findings should be interpreted cautiously.

PMID:42251430 | DOI:10.1186/s12981-026-00895-0

AIDS Res Ther. 2026 Jun 6. doi: 10.1186/s12981-026-00893-2. Online ahead of print.

ABSTRACT

We assessed the association between dolutegravir (DTG)-based antiretroviral therapy and kidney abnormalities among young people living with HIV in Kampala, Uganda. Cross-sectional albumin-creatinine ratio (ACR), proteinuria, and estimated glomerular filtration rate (eGFR) were measured. Among 483 participants, the mean serum creatinine was higher (0.68 vs. 0.59) and creatinine-based eGFR lower (118.8 vs. 113.9), among those on TDF/DTG. Cystatin C-based eGFR, prevalences of elevated ACR (9.6% vs. 13.0%), proteinuria (28.3% vs. 30.2%), and eGFR < 90 ml/min/1.73 m² (40.1% vs. 46.9%) were similar. Kidney abnormalities were not associated with regimen, supporting the need for longitudinal studies to clarify progression risk.

PMID:42251428 | DOI:10.1186/s12981-026-00893-2

J Cardiothorac Surg. 2026 Jun 6. doi: 10.1186/s13019-026-04309-0. Online ahead of print.

ABSTRACT

BACKGROUND: Preoperative intravenous iron has become increasingly popular as a strategy to optimize hemoglobin before major surgery. However, its potential benefit in non-anaemic patients undergoing cardiac surgery remains unclear. To address this uncertainty, we conducted a systematic review and meta-analysis to investigate whether preoperative IV iron reduces red blood cell transfusion requirements and improves hematologic and clinical outcomes in adults with normal baseline hemoglobin undergoing cardiac surgery.

METHODS: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library until October 2025 for randomized controlled trials. Eligible studies compared preoperative IV iron to a control (placebo, saline, or standard care) in non-anaemic (per WHO definition) adult patients (≥ 18 years) undergoing cardiac surgery. The primary outcomes were the incidence of postoperative RBC transfusion and the number of units transfused. Secondary outcomes included postoperative hemoglobin level, Postoperative iron indices, length of ICU stay, length of hospital stay (LOS), overall postoperative infection, All-cause mortality, and adverse events possibly related to IV iron (hypersensitivity, anaphylaxis). We used the Cochrane ROB 2 tool for bias assessment and for evidence certainty. Pooled Risk ratios, odds ratios, mean difference, and standardized mean difference with 95% confidence intervals were calculated using random-effects models, with the fixed-effects model applied when heterogeneity was absent or low (I² < 10%).

RESULTS: From 529 initial records, 3 RCTs met the inclusion criteria, encompassing 338 patients. The overall risk of bias was low to moderate. Preoperative IV iron significantly reduced the incidence of postoperative RBC transfusion compared to the control group (Risk Ratio [RR] = 0.62; 95% CI 0.43-0.88; p = 0.008; I² = 0%), representing a 38% relative risk reduction. Furthermore, IV iron significantly decreased the mean number of RBC units transfused (Mean Difference [MD] = – 1.08 units; 95% CI – 1.61 to – 0.54; I² = 0%). While no significant difference was observed in hemoglobin levels at 48 h or one week postoperatively, the IV iron group showed significantly higher hemoglobin at 4-6 weeks (MD = 0.84 g/dL; 95% CI 0.41-1.26; p = 0.0001). IV iron also significantly increased postoperative serum ferritin and transferrin saturation. There were no statistically significant differences in overall postoperative infection rates (RR = 1.16; 95% CI 0.64-2.08) or all-cause mortality (Risk Difference = – 0.00; 95% CI – 0.03 to 0.03). The GRADE certainty of evidence for the primary outcome was moderate.

CONCLUSION: In non-anaemic adult patients undergoing cardiac surgery, preoperative IV iron administration significantly reduces the incidence of postoperative RBC transfusion and the total volume of blood transfused. This intervention also improves hemoglobin levels during the 4-6 week recovery period without an increased risk of infection or mortality. The moderate-certainty evidence suggests this is a beneficial strategy, though further adequately powered RCTs are warranted to strengthen these findings.

PROSPERO REGISTRY REFERENCE: CRD420251161421.

PMID:42251415 | DOI:10.1186/s13019-026-04309-0

BMC Palliat Care. 2026 Jun 6. doi: 10.1186/s12904-026-02184-z. Online ahead of print.

ABSTRACT

BACKGROUND: Advance care planning (ACP) is important in cancer care, but discussions are often delayed or inconsistently implemented. Online ACP decision aid programmes may support ACP participation, although their effects in adults with cancer remain unclear.

METHODS: A systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, the Cochrane Library, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and supplementary sources was conducted from inception to 10 March 2026. Quantitative studies evaluating online ACP decision aid programmes for adults with cancer were included. Risk of bias was assessed using appropriate tools according to study design. Meta-analyses were performed using fixed- or random-effects models.

RESULTS: Twelve studies met the eligibility criteria, including 10 randomised controlled trials, 1 pre-post study, and 1 single-arm quantitative evaluation study. Most studies were conducted in the USA. Pooled evidence showed that online ACP decision aid programmes significantly improved ACP documentation (OR = 2.06, 95% CI 1.29 to 3.27, p = 0.002) and ACP engagement (MD = 0.28, 95% CI 0.15 to 0.40, p < 0.0001). No statistically significant effects were found for AD completion (OR = 1.37, 95% CI 0.54 to 3.45, p = 0.50), satisfaction (MD = 0.15, 95% CI -0.25 to 0.55, p = 0.47), decisional conflict (MD=-0.72, 95% CI -5.87 to 4.43, p = 0.78), or anxiety (MD=-0.76, 95% CI -1.67 to 0.16, p = 0.11). Sensitivity analyses suggested that the findings for ACP documentation and ACP engagement were relatively robust, whereas the results for satisfaction and anxiety were less stable.

CONCLUSIONS: Online ACP decision aid programmes may support ACP in adults with cancer, particularly by improving ACP engagement and ACP documentation. However, evidence for benefits beyond ACP process outcomes remains limited or inconsistent. Further rigorous studies are needed to identify effective programme features and implementation strategies.

PMID:42251411 | DOI:10.1186/s12904-026-02184-z

J Orthop Surg Res. 2026 Jun 6. doi: 10.1186/s13018-026-06965-3. Online ahead of print.

ABSTRACT

BACKGROUND: The rapid adoption of electric bicycles (EB) has led to a significant increase in related injuries, posing a growing public health challenge. In Anhui Province, China, EB-related orthopedic injuries represent a major component of traffic trauma burden. However, systematic data on injury patterns, anatomical distribution, and demographic variations remain limited, hindering optimized clinical management. This study aims to characterize the clinical spectrum of orthopedic injuries associated with EB that necessitate surgical management.

METHODS: This single-center retrospective cohort study analyzed data from the Hospital Information System (HIS) for patients with EB-related orthopedic injuries between January, 2020, and December, 2025. Among 3,412 vehicle-related injuries, 1,735 cases met inclusion criteria. Injury types were classified into six categories (e.g., fractures, dislocations), and anatomical sites were categorized into 16 regions. Statistical analyses included descriptive statistics and chi-square tests to identify factors associated with severe injuries.

RESULTS: The study included 1,735 patients (59.20% male; mean age 48.65 ± 15.73 years), with a bimodal age distribution peaking in the 31-44 and 45-59 groups. Fractures predominated (85.01% of cases), followed by combined injuries such as open fractures with soft tissue damage (4.67%). The most frequent anatomical sites were the clavicle, tibiofibula, and hand/foot. Female patients were significantly older than males (95% CI: 3.44, 6.38; p < 0.001), and young males had higher injury rates.

CONCLUSIONS: EB-related orthopedic injuries predominantly affect middle-aged and elderly populations (1,735 patients; mean age 48.65 ± 15.73 years, bimodal peaks at 34.65 ± 9.41 years and 57.28 ± 6.72 years), with fractures accounting for 85.01% of cases and combined trauma (e.g., open fractures with soft tissue damage) representing 4.67%. The clavicle, tibiofibula, and hand/foot are the most commonly injured sites. These findings provide foundational insights for orthopedic clinical practice pertaining to EB-related injuries, suggesting that age-stratified triage protocols and prioritized evaluation of high-risk anatomical sites (clavicle, lower limbs) warrant further investigation to optimize resource allocation and patient outcomes in clinical settings. However, this study has several limitations, including its single-center retrospective design, absence of severity validation scores, and insufficient data on protective measures/devices/follow-up and so on. Therefore, prospective multicenter studies are warranted to validate and optimize clinical practice.

PMID:42251405 | DOI:10.1186/s13018-026-06965-3

BMC Psychol. 2026 Jun 6. doi: 10.1186/s40359-026-04940-5. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Amid increasing social pressures, the importance of psychological resilience as a key resource for stress coping has become prominent. Although exercise is considered a potential means to enhance resilience, a systematic quantitative assessment of moderating factors influencing its effect is lacking. This meta-analysis aimed to systematically evaluate the effect of exercise interventions on enhancing psychological resilience and explore the moderating roles of intervention duration, age, and study design.

METHODS: Following PRISMA guidelines, relevant databases were searched up to January 2026. Randomized controlled trials or quasi-experimental studies were included. Study quality was assessed using standardized tools. Analyses were conducted using a random-effects model, subgroup analyses, and heterogeneity tests.

RESULTS: Ten studies were included. Exercise intervention had a significant positive effect on psychological resilience (pooled SMD = 0.49, 95% CI: 0.33-0.65). Intervention duration was a statistically significant moderator (p = 0.01) that survived Bonferroni correction for multiple subgroup tests (α < sub > adjusted < /sub > = 0.017), with long-term interventions (> 8 weeks, SMD = 0.64) yielding significantly larger effects than short-term interventions (≤ 8 weeks, SMD = 0.30). The intervention was effective across all age groups. Randomized controlled trials yielded a numerically larger effect size (SMD = 0.56) than non-randomized studies (SMD = 0.35), but the subgroup difference was not statistically significant (p = 0.21). No publication bias was detected.

CONCLUSION: Exercise intervention is an effective approach to enhancing psychological resilience. Subgroup analyses confirmed that intervention duration is a statistically significant moderator, with long-term interventions yielding significantly greater benefits. This provides an empirical basis for designing personalized, long-term exercise programs for different populations.

PMID:42251398 | DOI:10.1186/s40359-026-04940-5