Tag: nevin manimala

BMC Infect Dis. 2025 Aug 26;25(1):1072. doi: 10.1186/s12879-025-11368-6.

ABSTRACT

PURPOSE: ‘Post-COVID Syndrome’ (PCS), which encompasses the multifaceted sequelae of COVID-19, can be severity-graded by a previously defined score encompassing 12 different long-term symptom complexes. The PCS score was shown to have two main predictors, namely acute COVID-19 severity and individual resilience. The purpose of the present study was to verify these predictors and to assess their detailed relationship to the symptom complexes constituting the PCS score.

METHODS: The study drew upon a largely expanded dataset (n = 3,372) from COVIDOM, the cohort study underlying the original PCS score definition. Classification and Regression Tree (CART) analysis served to resolve the detailed relationship between the predictors and the constituting symptom complexes of the PCS score.

RESULTS: Among newly recruited COVIDOM participants (n = 1,930), the PCS score was again found to be associated with both its putative predictors. Of the score-constituting symptom complexes, neurological symptoms, sleep disturbance, and fatigue were predicted by individual resilience whereas the acute disease severity predicted exercise intolerance, chemosensory deficits, joint or muscle pain, signs of infection, and fatigue. These associations inspired the definition of two novel PCS scores that included the above-mentioned subsets of symptom complexes only. Similar to the original PCS score, both novel scores were found to be inversely correlated with quality of life as measured by the EQ-5D-5L index.

CONCLUSION: The two newly defined PCS scores may enable a more refined assessment of PCS severity, both in a research context and to delineate distinct PCS subdomains with possibly different therapeutic and interventional needs in clinical practise.

PMID:40859262 | DOI:10.1186/s12879-025-11368-6

BMC Pulm Med. 2025 Aug 26;25(1):405. doi: 10.1186/s12890-025-03873-w.

ABSTRACT

BACKGROUND: High-flow nasal cannula (HFNC) has recently emerged as a promising alternative to non-invasive ventilation (NIV) for patients with chronic obstructive pulmonary disease (COPD). However, direct comparative evidence on the clinical efficacy of HFNC versus NIV in acute exacerbations of COPD (AECOPD) remains limited and inconclusive.

METHODS: A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted up to January 2025 for randomized controlled trials (RCTs) comparing HFNC and NIV in AECOPD patients. Outcomes included mortality, treatment failure, intubation rates, and treatment intolerance.

RESULTS: Nine RCTs involving 786 patients were included in the meta-analysis. No significant differences were observed in mortality (I² = 0.0%, P = 0.818; RR 1.000, 95% CI 0.638 to 1.569, P = 0.999) or intubation rates (I² = 22.1%, P = 0.253; RR 1.401, 95% CI 0.790 to 2.484, P = 0.249). Although HFNC significantly reduced treatment intolerance (I² = 0.0%, P = 0.976; RR 0.145, 95% CI 0.048 to 0.438, P = 0.001), it showed a non-significant trend toward a higher treatment failure rate compared to NIV (I² = 36.2%, P = 0.180; RR 1.553, 95% CI 0.955 to 2.524, P = 0.076).

CONCLUSION: HFNC therapy showed a trend towards a higher treatment failure rate compared to NIV, though the difference was not statistically significant. No significant differences were found in mortality or intubation rates between the two groups.

PMID:40859250 | DOI:10.1186/s12890-025-03873-w

BMC Public Health. 2025 Aug 26;25(1):2919. doi: 10.1186/s12889-025-24403-7.

ABSTRACT

BACKGROUND: Community engagement is essential during crises such as the COVID-19 pandemic. However, the effectiveness of community engagement during this pandemic, especially in low- and middle-income countries, has not been seriously investigated.

OBJECTIVE: The effectiveness of a comprehensive intervention program in managing COVID-19 in Iran emphasizes community involvement and multifaceted strategies.

PARTICIPANTS: All individuals who were admitted to hospitals and outpatient clinics across the country with suspected COVID-19 symptoms.

METHODS: A quasi-experimental study was conducted on the implementation of interventions (supportive, caring, and supervisory) by neighborhood-based teams during the COVID-19 epidemic in Iran. The evaluation took place four months later. Data from various inpatient and mortality sources was used, along with statistical-epidemiological analyses such as logistic regression analysis, and odds ratio.

RESULTS: Deaths per day declined from 479 to 75 within the study period. R₀ decreased from 1.26 to 0.86. PCR tests reached from 661 to 1601 /100,000. The incidence rate of the disease reached 0.2 per hundred thousand people to 0.05 per hundred thousand people. The number of hospitalizations from COVID-19 decreased from 3044 to 417 before and after the community-based interventions.

CONCLUSION: Epidemic management when combined with community participation can be very effective in crisis situations. Strengthening the disease care system and more supervision in the implementation of the strategy and having an effective relationship with the doctors of the private sector to comply with the national protocol, an effective step will be taken towards the control of this disease and finally its elimination.

PMID:40859243 | DOI:10.1186/s12889-025-24403-7

Health Qual Life Outcomes. 2025 Aug 26;23(1):80. doi: 10.1186/s12955-025-02412-9.

ABSTRACT

BACKGROUND: Arthritis is a prevalent chronic disease substantially impacting patients’ quality of life (QoL). While identifying key determinants associated with arthritis is critical for targeted interventions, traditional statistical methods often struggle with complex interactions, and existing machine learning (ML) approaches frequently lack the interpretability needed to guide clinical decisions. This study integrates a comprehensive, explainable machine learning (XAI) workflow to identify and interpret key QoL-related predictors of arthritis status in a large national cohort.

METHODS: Data were obtained from 15,011 participants aged > 45 years in the 2020 China Health and Retirement Longitudinal Study (CHARLS). We initially selected 55 potential QoL-related predictors spanning demographic, functional, pain, psychosocial, and lifestyle domains. Feature engineering was performed to create aggregate scores, indicators, and binned variables. Missing data were handled using imputation combined with missing indicator variables. A LightGBM-based feature selection process identified 68 key predictors. Nine ML models (including Logistic Regression, RandomForest, GradientBoosting, LightGBM, CatBoost, XGBoost, DecisionTree, NaiveBayes, KNN) were developed using SMOTE-resampled training data, with hyperparameters optimized via Optuna targeting recall. Performance was evaluated on a held-out test set using Area Under the ROC Curve (AUC), Average Precision (AP), Recall, Specificity, Precison, and F1-score. SHapley Additive exPlanations (SHAP) analysis was applied to the best-performing model (GradientBoosting) for interpretation.

RESULTS: Several models achieved strong predictive performance, with GradientBoosting yielding the highest AUC (0.767, 95% CI: 0.752-0.782) and high AP (0.678, 95% CI: 0.655-0.702). SHAP analysis identified multi-site pain burden (particularly knee/leg pain and pain location count), age, self-rated health, sleep quality, functional limitations (ADL counts/scores), and negative affect as the most influential predictors driving arthritis status prediction.

CONCLUSIONS: This study successfully applied an XAI pipeline to identify and rank key QoL-related factors predictive of arthritis status in a large Chinese cohort, achieving robust model performance. Pain burden, age, subjective health, sleep, functional status, and psychological well-being are critical determinants. These interpretable findings can inform risk stratification and guide targeted interventions focusing on these key areas to potentially improve arthritis management.

PMID:40859240 | DOI:10.1186/s12955-025-02412-9

BMC Psychiatry. 2025 Aug 26;25(1):811. doi: 10.1186/s12888-025-07230-3.

ABSTRACT

BACKGROUND: Patients with psychiatric disorders have high levels of self-oriented empathy, but dampened other-oriented empathy. Empathy characteristics in individuals who attempt suicide, and their relationships with psychopathology are not clear.

METHODS: Altogether 62 suicide attempters, 64 non-suicidal psychiatric inpatients and 138 healthy controls filled-in self-reported questionnaires on empathy and psychopathology. The relationships between each empathy subscale, levels of psychopathology, and case-control groups were tested via linear regression models and in group-stratified analyses.

RESULTS: Cases had significantly higher Fantasy (FS) and Personal Distress (PD) scores than healthy controls. Higher levels of psychological distress were associated with higher scores of FS (2.10, 1.08‒3.13) and PD (2.90, 1.87‒3.93), irrespective of the group. With increasing psychopathology levels, scores of Perspective Taking decreased significantly in suicide attempters (-1.81, -3.55‒ -0.08), non-significantly in non-suicidal psychiatric inpatients (-1.11, -2.94‒0.73) and increased in healthy controls (0.79, -1.05‒2.64); conversely, PD increased significantly in healthy controls (4.91, 2.86‒6.96) and in psychiatric controls (2.89, 0.95‒4.82), but non-significantly among cases (1.60, -0.13‒3.33).

CONCLUSIONS: Empathy does not differ between suicidal and non-suicidal psychiatric patients. Psychopathology is related to empathic PD and FS. The relation is stronger in individuals with no psychiatric conditions than in psychiatric patients or suicide attempters. Emotional and self-oriented dimensions of empathy could contribute to the identification of people at risk of suicidal behavior.

PMID:40859237 | DOI:10.1186/s12888-025-07230-3

BMC Surg. 2025 Aug 26;25(1):394. doi: 10.1186/s12893-025-02973-y.

ABSTRACT

OBJECTIVE: This study aims to explore the effects of prehabilitation strategies on the psychological state and glucose metabolism markers in patients undergoing laparoscopic sleeve gastrectomy (LSG).

METHODS: A total of 120 eligible patients undergoing elective LSG between January 2024 and December 2024 were enrolled in the study. They were randomly assigned to either the control group or the observation group, with 60 patients in each group. The control group received routine care interventions, while the observation group received prehabilitation strategies. The outcomes were compared between the two groups, including body mass index (BMI), body fat percentage (PBF), visceral fat area (VFA), waist-to-hip ratio (WHR), basal metabolic rate (BMR), glucose metabolism markers, psychological state, and incidence of postoperative complications, measured both one day before and six months after the intervention.

RESULTS: One day before the intervention, there were no significant differences between the two groups in BMI, PBF, VFA, WHR, and BMR (P > 0.05). However, six months after the intervention, the observation group showed significantly lower BMI, PBF, VFA, WHR, and BMR compared to the control group (P < 0.05). Furthermore, at six months post-surgery, the observation group had significantly lower HbA1c levels compared to the control group (P < 0.05), while the difference in fasting blood glucose (FBG) was not statistically significant (P > 0.05). Regarding psychological state, the observation group showed significantly lower scores on the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) six months after the intervention (P < 0.05). Additionally, the incidence of postoperative minor complications was significantly lower in the observation group compared to the control group (P < 0.05).

CONCLUSION: Prehabilitation strategies can effectively improve the psychological state, reduce glycated hemoglobin levels, promote weight loss, and reduce the incidence of minor postoperative minor complications in patients undergoing laparoscopic sleeve gastrectomy. These strategies appear to be safe and effective, and could be considered for wider clinical adoption.

CLINICAL REGISTRATION NUMBER: Not applicable.

PMID:40859236 | DOI:10.1186/s12893-025-02973-y

BMC Gastroenterol. 2025 Aug 26;25(1):619. doi: 10.1186/s12876-025-04199-x.

ABSTRACT

BACKGROUND: Over the past few decades, the global incidence of cholangiocarcinoma has risen overall. In particular, the incidence of intrahepatic cholangiocarcinoma increased by 109% over a ten-year period, rising from 0.67 per 100,000 in 2007 to 1.40 per 100,000 in 2016¹. Epidemiological studies have suggested that cholecystitis may increase the risk of hepatobiliary cancers. However, whether this association indicates an independent causal relationship remains unclear. Given that observational studies are prone to residual confounding and bias, limiting the strength of causal inference. Our study aimed to evaluate whether cholecystitis is an independent risk factor for cholangiocarcinoma.

METHODS: Instrumental variables were identified as independent single nucleotide polymorphisms highly associated with cholecystitis (n = 25). The entire dataset from the Integrative Epidemiology Unit (IEU) publicly available genome-wide association studies (GWAS) was utilized to obtain cholangiocarcinoma outcome data (n = 25). In this study, five MR statistical techniques (Inverse Variance Weighted, MR Egger, Weighted Median, Simple Mode, and Weighted mode) were used. The MR Egger intercept test, leave-one-out analysis, and the funnel plot were all utilized in sensitivity analyses.

RESULTS: Results of the Inverse Variance Weighted (IVW) method genetically predicted cholecystitis was associated with higher risk of cholangiocarcinoma, with an odds ratio of 2.915 (95% CI = 1.122-7.575, P = 0.038). Weighted Median Method also demonstrated consistent direction of effect (P = 0.016). However, MR-Egger, Simple Mode, and Weighted Mode all showed no statistical significance (P > 0.05). Both funnel plots and MR Egger intercepts indicated the absence of any directional pleiotropic effects between cholecystitis and cholangiocarcinoma.

CONCLUSION: We found evidence supporting a causal effect between cholecystitis and cholangiocarcinoma, indicating an increased likelihood of cholangiocarcinoma in patients with cholecystitis through MR analysis.These findings may help inform clinical strategies for the management of cholecystitis, with the aim of potentially reducing the risk of cholangiocarcinoma.

PMID:40859233 | DOI:10.1186/s12876-025-04199-x

BMC Public Health. 2025 Aug 26;25(1):2920. doi: 10.1186/s12889-025-22909-8.

ABSTRACT

BACKGROUND: Healthcare accessibility remains a critical challenge in many low-and middle-income countries, where disparities between rural and urban areas persist. This study, conducted in Dodoma region, Tanzania, models the determinants of healthcare accessibility, aiming to generate evidence that informs policy interventions for equitable healthcare service delivery in underserved populations.

METHODS: A cross-sectional survey design was adopted. Data were collected from 1,009 households (urban 556; rural 453) across four selected districts withing Dodoma region, Tanzania, using a structured questionnaire digitized and implemented through KoboToolbox. The bivariate analysis and binary logistics regression were used to assess the determinants of healthcare accessibility. Fairlie decomposition was also used to assess and explain the healthcare accessibility disparity between urban and rural areas.

RESULTS: Among the 1,009 households surveyed, 45% had access to healthcare services, with urban households having higher access compared to rural households. Significant determinants of healthcare accessibility included healthcare insurance cover [(AOR = 72.006 p < 0.001), CI:19.573 – 264.895], household size [(AOR = 0.713, p < 0.05), CI: 0.536 – 0.947], age of the head of household [(AOR = 0.830 p < 0.001), CI:0.785 – 0.878], and Out-of-pocket costs used for the last illness episodes [(AOR = 0.404 p < 0.01), CI:0.139 -1.167]. Additionally, decision-making authority within households, payment methods, and the presence of chronic illness showed significant or partial influence on accessibility. Fairlie’s decomposition revealed that health insurance and the age of the head of household account for the largest (93.4%) share of the disparity in healthcare accessibility between urban and rural households. These findings underscore the complexity of healthcare access, providing actionable insights for policy interventions to address rural-urban disparities.

CONCLUSION: The study highlights the importance of health insurance coverage in improving healthcare access, emphasizing the need for targeted policy interventions to address rural-urban disparities and improve health outcomes, considering unique rural household needs.

PMID:40859226 | DOI:10.1186/s12889-025-22909-8

Eur J Heart Fail. 2025 Aug 26. doi: 10.1002/ejhf.3799. Online ahead of print.

ABSTRACT

AIMS: End-stage cancer may resemble a heart failure (HF)-like phenotype marked by cardiac wasting, dysfunction, and symptoms such as dyspnoea, congestion, and impaired physical function. The EMPATICC (EMPower the heArt of patients with TermInal Cancer using Cardiac medicines) trial evaluates the safety and efficacy of optimized HF therapy in patients with advanced cancer to improve self-care ability.

METHODS: EMPATICC is a multicentre, investigator-initiated, randomized, double-blind, controlled, proof-of-concept trial employing a joint cardio-oncology care approach. Patients were randomized 1:1 to optimized HF therapy (sacubitril/valsartan, empagliflozin, ivabradine, ferric carboxymaltose) plus usual care, or usual care alone, for 30 days, followed by a 30-day open-label extension. Eligible patients had stage IV solid tumours (per Union for International Cancer Control), were receiving palliative care, had a 1-6 month life expectancy, and were on optimized analgesia. At baseline, first patients had to meet ≥2 criteria of the following indicating cardiovascular risk: heart rate ≥70 bpm, N-terminal pro-B-type natriuretic peptide ≥600 pg/ml, elevated high-sensitivity troponin, left ventricular ejection fraction <55%, left ventricular mass loss >15%, transferrin saturation <20%, or moderate/high likelihood of HF with preserved ejection fraction (based on the HFA-PEFF score); and they had to meet at least one criterion of the following indicating functional limitation: ≥6 s to walk 4 m, inability to wash ≥3 days of the last 7 days, or symptoms of dyspnoea at rest. Enrolment ended 30 January 2025; 93 patients completed randomization. The primary endpoint is a hierarchical composite (analysed by win ratio): (1) days alive and able to wash, (2) 4 m walking ability, and (3) patient global assessment of well-being.

CONCLUSIONS: EMPATICC evaluates whether HF therapy can improve function and well-being in advanced cancer, potentially reshaping care in this population.

PMID:40857084 | DOI:10.1002/ejhf.3799

J Acquir Immune Defic Syndr. 2025 Aug 26. doi: 10.1097/QAI.0000000000003752. Online ahead of print.

ABSTRACT

BACKGROUND: The Veterans Aging Cohort Study (VACS) Index 2.0 accurately predicts mortality using age and clinical biomarkers, but adding behavioral and psychosocial factors that are common among sexual minority men (SMM) may improve its predictive accuracy. We examined whether adding these factors would improve mortality prediction among SMM living with HIV.

METHODS: We included 1,438 SMM in the Multicenter AIDS Cohort Study (MACS) who initiated highly active antiretroviral therapy (HAART) for at least one year between January 1996 and September 2022. We divided the sample into development (70%) and validation (30%) sets. We used Cox proportional hazards models to develop new indices in the development set by adding binary behavioral and psychosocial factors (depression, cigarette smoking, heavy alcohol use, polydrug use) or the total number of these factors in the VACS Index 2.0 and estimated mortality using Weibull survival models. We compared accuracy using C-statistics and calibration curves in the validation set and within subgroups (age, race, CD4 count, and viral suppression).

RESULTS: Among the 1,438 SMM, 83 (5.8%) died within 5 years of follow-up. Depression significantly predicted 5-year mortality after adjusting for the VACS Index 2.0 and resulted in a 70% increased risk of death (aHR=1.70, 95% CI=1.10-2.63) compared to men without depression. The addition of depression improved C-statistics from 0.818 to 0.851 in the development set. Results were robust in all subgroups.

CONCLUSIONS: Including depression improved the VACS Index 2.0 in predicting mortality. Screening and treating depression could improve health and reduce mortality among SMM living with HIV.

PMID:40857055 | DOI:10.1097/QAI.0000000000003752