Tag: nevin manimala

Eur J Med Res. 2025 Sep 23;30(1):849. doi: 10.1186/s40001-025-03123-z.

ABSTRACT

BACKGROUND: Approximately 50% of the women with polycystic ovary syndrome (PCOS) are overweight or obese and obesity can significantly impair reproductive function. This study aimed to investigate the association between body mass index (BMI) and embryonical/clinical outcomes in PCOS patients undergoing ultralong gonadotrophin-releasing hormone agonist (GnRH-a) protocol and to establish evidence-based management strategies for obese women with PCOS.

METHOD: A total of 1704 PCOS patients aged 20-42 years were treated with an ultralong GnRH-a protocol during a single oocyte retrieval cycle, followed by blastocyst transfer between 2016 and 2023. Participants were stratified according to BMI criteria into four groups: underweight (n = 125), normal weight (n = 845), overweight (n = 517) and obese (n = 217). Baseline characteristic and reproductive outcomes were compared across BMI categories.

RESULTS: PCOS patients with obesity exhibited a significant reduction in both the number of retrieved oocytes and mature oocytes. In fresh blastocyst transfer cycles, no statistical differences in live birth rates were observed across the four BMI groups (p = 0.246). However, in frozen-thawed blastocyst transfer cycles, the obese group had the lowest live birth rate among all BMI categories. Multivariate logistic regression analysis identified several key predictors of live birth. The number of high-quality blastocysts transferred was a dominant favorable factor (OR = 1.480, 95% CI 1.251-1.751). Conversely, obesity independently predicted a reduced likelihood of live birth (OR = 0.437, 95% CI 0.298-0.641). Further analysis of cumulative live birth outcomes in a complete oocyte retrieval cycle confirmed that obesity remained a negative predictor (OR = 0.438, 95% CI 0.312-0.615), while the number of high-quality blastocysts transferred (OR = 1.269, 95% CI 1.132-1.423) and a shorter duration of infertility (OR = 0.927, 95% CI 0.885-0.972) were associated with improved success rates.

CONCLUSIONS: PCOS patients with obesity presented poorer embryonical and clinical outcomes. Obesity emerged as a significant independent predictor of nonlive birth in both frozen-thawed blastocyst transfer cycles and complete in vitro fertilization (IVF) cycles. This study underscores the clinical importance of incorporating pre-IVF interventions, particularly weight management strategies, for obese PCOS patients to optimize reproductive outcomes.

PMID:40988053 | DOI:10.1186/s40001-025-03123-z

BMC Med Educ. 2025 Sep 23;25(1):1255. doi: 10.1186/s12909-025-07974-2.

ABSTRACT

BACKGROUND: Educational attainment and admission tests have a longstanding history in the selection of medical students and are often used simultaneously in selection processes. Their value in the admission process is most frequently assessed by their ability to predict academic performance in medical school. However, their simultaneous use may overlook an overlap in their predictive validity. The present study aims to assess the predictive validity of both educational attainment and admission tests, as well as their incremental validities. In addition, subtest analyses are conducted to gain a more profound understanding of admission tests’ predictive power.

METHODS: A survey amongst test-takers of the German admission tests was conducted in 2022 and 2023. Self-reported preclinical performance was matched with admission test scores (i.e., TMS and HAM-Nat). Educational attainment was assessed by high-school grade point average (GPA). Based on n = 2113 medical students, hierarchical multiple regression analyses were conducted. Pearson’s correlations were used to assess the relationship of subtests with academic performance. For all analyses, the effects of range restriction were diminished using a multivariate correction formula.

RESULTS: TMS and HAM-Nat as well as high-school GPA predicted academic performance separately. However, while both admission tests demonstrate substantial incremental validity over high-school GPA, the reverse is true to a far lesser extent. High-school GPA exhibits only small predictive power whilst controlling for admission test scores. Subtests containing elements of both crystallized and fluid intelligence proved to be of moderate effect size.

CONCLUSIONS: The findings of this study suggest that both admission tests and high-school GPA are well-suited as selection criteria in the admission process. Given the growing concerns regarding high-school GPA, admission tests emerge as a compelling alternative, particularly because of their stronger predictive power. Within each examined admission test, content-rich subtests containing elements of both crystallized and fluid intelligence demonstrated the strongest association with academic performance in preclinical years, in line with the test-criterion content match hypothesis.

PMID:40988052 | DOI:10.1186/s12909-025-07974-2

Pharmacoepidemiol Drug Saf. 2025 Oct;34(10):e70213. doi: 10.1002/pds.70213.

ABSTRACT

PURPOSE: Linking claims data to electronic health record (EHR) data can improve completeness, often at a cost of decreased sample size. Quantifying information gained and differences in patient characteristics between EHR and EHR-claims linked cohorts may inform study design.

METHODS: Using ConcertAI Patient360 EHR linked to multiple closed insurance claims sources, we compared an EHR cohort of patients with incident metastatic breast cancer (mBC) to an EHR-claims subcohort (requiring ≥ 90 days claims coverage). We analyzed diagnosis coverage, patient time during lookback and follow-up, baseline characteristics, and rates of 14 adverse events (AEs). Analyses were age stratified due to insurance coverage changes at age 65.

RESULTS: For the EHR cohort (N = 6289), 1438 (23%) were in the EHR-claims subcohort. A greater proportion were aged ≥ 65 years in the EHR cohort (30%) than in the EHR-claims subcohort (17%). EHR-claims patients had longer observation periods and more unique diagnoses across both age groups. For most AEs, incidences were higher in both age groups in the EHR-claims subcohort than in the EHR cohort.

CONCLUSIONS: EHR-claims provided more diagnoses and observation time, at the cost of a reduction in sample size and underrepresentation of patients ≥ 65 years. Differing age proportions support age-stratified or standardized analyses for EHR-claims data. Results aid interpretation of differences between EHR and EHR-claims results due to shifts in age, completeness of diagnosis history, and duration of observation.

PMID:40988051 | DOI:10.1002/pds.70213

Lipids Health Dis. 2025 Sep 23;24(1):286. doi: 10.1186/s12944-025-02710-7.

ABSTRACT

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a growing public health challenge in Egypt, driven by westernized dietary patterns, urbanization, and physical inactivity. Despite lifestyle intervention being the first-line management, data on structured hypocaloric diets tailored to Egyptian patients remain limited, particularly regarding their effects on hepatic steatosis, inflammatory pathways, and oxidative stress biomarkers. This study aimed to evaluate the impact of a culturally adapted 6-month hypocaloric diet on hepatic fat reduction, metabolic parameters, inflammatory-oxidative biomarkers, and lifestyle factors in Egyptian MASLD patients, with additional exploration of weight-independent mechanisms.

METHODS: In this single-center interventional trial, 30 newly diagnosed MASLD patients received a personalized hypocaloric diet (500-1000 kcal/day deficit). Outcomes measured at baseline and post-intervention included anthropometrics, liver enzymes, metabolic profile, hepatic steatosis (CAP score), inflammatory markers (TNF-α, MDA), antioxidant enzymes (SOD, CAT), and lifestyle behaviors (physical activity, sleep). Advanced statistical analyses included effect size estimation, multivariate regression, mediation analysis, and subgroup comparisons (lean vs. obese MASLD).

RESULTS: After 6 months, patients achieved significant reductions in weight (- 10.9 kg), BMI (- 3.9 kg/m²), and CAP score (- 89.5 dB/m) (all P < 0.001). Liver enzymes improved significantly, with ALT decreasing by – 22.2 U/L and AST by – 21.3 U/L (both P < 0.001). TNF-α (- 88.2 pg/mL, baseline 166.1 pg/mL) and MDA (- 1.1 nmol/mL, baseline 2.7 nmol/mL) decreased markedly, with large effect sizes (CAP: d = 1.9; TNF-α: d = 2.1; MDA: d = 1.4). Antioxidant biomarkers improved significantly, with SOD increasing by 209% (d = 1.8) and CAT by 48.5% (d = 1.2) (both P < 0.001). Although BMI and weight loss were strongly associated with hepatic fat reduction, TNF-α reduction remained an independent predictor of CAP improvement (β = 0.31, P = 0.02), mediating 32% of the diet’s effect after adjusting for BMI. Patients achieving ≥ 5% weight loss were 4.2 times more likely to experience ≥ 10% CAP score reduction. Lean MASLD patients (n = 6) exhibited greater improvements in hepatic fat and inflammation despite less weight loss; however, these findings should be interpreted with caution due to the small subgroup size. Dietary adherence strongly correlated with CAP reduction (r = – 0.71, P < 0.001) and antioxidant gains.

CONCLUSION: A culturally tailored hypocaloric diet effectively improved hepatic steatosis, inflammatory status, and antioxidant capacity in Egyptian MASLD patients. These improvements were partially weight-independent and partially mediated by anti-inflammatory responses. These findings support hypocaloric dietary strategies as a potentially scalable therapeutic option for MASLD management in resource-limited settings, though the absence of a control group limits causal inference, and further evaluation of implementation feasibility and cost-effectiveness is warranted. Additional benefits were also observed in lifestyle behaviors such as physical activity and sleep.

PMID:40988029 | DOI:10.1186/s12944-025-02710-7

Int J Emerg Med. 2025 Sep 23;18(1):169. doi: 10.1186/s12245-025-00967-4.

ABSTRACT

BACKGROUND & AIM: Analysis of heart rate variability metrics has shown added accuracy in pre-hospital trauma triage. These metrics include heart rate variability (HRV), meaning oscillations in the time interval between heartbeats, and heart rate complexity (HRC), which assesses intricate patterns of heart rate over time. This review article evaluates current knowledge regarding HRV and HRC and prediction of a subsequent life-saving intervention (LSI), an intervention executed by trained medical personnel to prolong the life of the patient. Our primary focus was on pre-hospital patients and the utility of HRV and HRC when added to existing trauma triage scores or vital signs such as heart rate (HR).

METHODE: A literature search was carried out by searching the MEDLINE database via the PubMed website for original research published in English from 2008 to 2023. The combinations of search terms applied yielded 18 original studies of which only six met our criteria. We included another study as it contributed original research beneficial to our article.

RESULTS: The studies showed a statistically significant increase in the ∆Area Under Curve (AUC) between 0.14 and 0.40 for predicting risk of LSI when adding the two heart rate variability metrics to existing trauma triage scores or vital signs such as HR. Calculation of HRV and/or HRC could be conducted using ECG recording hardware already accessible in most emergency pre-hospital settings with less ECG noise and therefore higher quality ECG data over time.

CONCLUSION: Both HRV and HRC showed potential for increasing ∆AUC in predicting risk of LSI when added to existing risk triage scores. Calculation of HRV and HRC could potentially be conducted using a preexisting hardware in most emergency pre-hospital settings.

PMID:40988025 | DOI:10.1186/s12245-025-00967-4

Malar J. 2025 Sep 23;24(1):288. doi: 10.1186/s12936-025-05588-z.

ABSTRACT

BACKGROUND: The World Health Organization malaria burden estimates produced from incomplete clinical case reporting and often outdated household asymptomatic parasitaemia surveys in children < 5 years old, are unreliable. Surveillance target groups need to be expanded in line with the epidemiological shift in malaria-eliminating countries towards adults, and particularly men. Furthermore, new tools that can provide granular and timely data, critical to understanding geographic heterogeneity and enabling timely decision-making at the operational level, are needed. This prospective study aimed to demonstrate that blood donor malaria screening could serve as a time-sensitive complementary source of highly detailed malaria surveillance data.

METHODS: Consecutive blood donations received from 16 August 2023 to 31 August 2024 at the Ouagadougou and Bobo-Dioulasso Regional Blood Transfusion Centres in Burkina Faso, covering 5 of 13 regions, were screened for malaria using the Sysmex XN-31 automated analyser. XN-31 results, donor age, sex, place of residence, collection date, were analysed using descriptive statistics, chi-squared, and logistic regression tests. Seasonal malaria patterns were compared with publicly available rainfall data.

RESULTS: Donor malaria prevalence was 5.91% (3164/53575) overall. Key predictors of malaria identified were age ≤ 30 years (odds ratio (OR) 2.85, p < 0.001), male sex (OR 1.47, p < 0.001) and rural residency (OR 2.40, p < 0.001), with regional location having a strong influence on the latter. Strong seasonal variability, mirroring that of rainfall with a 3-month lag, was observed with different peak periods and rate of change over time at provincial level. Hot-spots were observed within both Bobo-Dioulasso and Ouagadougou. There were no age or sex-based differences in parasite density or gametocyte carriage, and both measures were directly proportional to malaria prevalence. Only males showed striking seasonal variability in gametocyte carriage (low season 1.39%, 14/1006; high season 4.42%, 66/1494; p < 0.001).

CONCLUSIONS: The large data set and spatiotemporal malaria prevalence information, not possible with episodic household malaria surveys, facilitated highly granular analysis and demonstrated the potential to provide dynamic real-time information on the malaria burden using automated XN-31 blood donor malaria screening.

PMID:40988020 | DOI:10.1186/s12936-025-05588-z

Cardiovasc Diabetol. 2025 Sep 23;24(1):365. doi: 10.1186/s12933-025-02936-w.

ABSTRACT

BACKGROUND: Combination therapy is gaining attention in type 2 diabetes management due to its potential to reach glycaemic goals within a shorter period. However, the long-term comparative cardiorenal effectiveness of fixed- versus loose-dose combinations remains unclear. This study aimed to assess whether oral antidiabetic fixed-dose combination (FDC) therapy is associated with improved cardiorenal outcomes in adults with type 2 diabetes compared with loose-dose combination (LDC) therapy. A secondary objective was to evaluate the mediating role of medication adherence in these associations.

METHODS: This population-based, new-user, active-comparator cohort study used Swedish national registers. Propensity score matching without replacement was applied. Study outcomes included acute myocardial infarction, atrial fibrillation, unstable angina, heart failure, ischaemic stroke, and eGFR < 30 ml/min/1.73m². Associations with cardiorenal outcomes were assessed using Cox regression. Adherence was defined as the proportion of days covered > 80% during the first year.

RESULTS: The median follow-up time was 4.0 years for cardiovascular outcomes and 3.8 years for kidney outcomes. In the matched cohort (mean age 62 years; 67% male), FDC users had higher treatment adherence (68.6 vs. 46.5%). FDC was associated with a lower rate of heart failure (HR = 0.88; 95% CI 0.79, 0.99), with adherence mediating 47% of this association. In people aged ≥ 65 years, FDC was associated with a lower rate of heart failure (HR = 0.79; 95% CI 0.69, 0.91). The observed association was attenuated with further matching for diabetes duration or when drugs were matched at the ATC code level. No associations between FDC use and other outcomes were identified.

CONCLUSIONS: FDC therapy in people with type 2 diabetes was associated with a lower rate of heart failure, particularly in older adults. Higher medication adherence appeared to mediate nearly half of this association.

PMID:40988019 | DOI:10.1186/s12933-025-02936-w

Cardiovasc Diabetol. 2025 Sep 23;24(1):366. doi: 10.1186/s12933-025-02921-3.

ABSTRACT

BACKGROUND: The triglyceride-glucose (TyG) index, as a measure of insulin resistance, has been confirmed to be associated with adverse clinical outcomes. The new composite indicator, TyG-A body type index (TyG-ABSI), by integrating the TyG index and the A body type index, has demonstrated superior efficacy in predicting the risk of cardiovascular death in the general population compared to traditional indicators. This study aims to deeply explore the association between TyG-ABSI and all-cause mortality and CVD mortality in the population with cardiovascular kidney-metabolic syndrome (CKM) stages 0-3. The analysis will be conducted from multiple dimensions such as the intensity of indicator correlation and potential influencing mechanisms, in order to comprehensively reveal the relationship between the two.

RESULTS: We analyzed data from 13,480 participants in the NHANES cohort (1999-2018) using Cox proportional hazards models and restricted cubic spline functions. The results indicated that elevated TyG-ABSI values were independently associated with a higher risk of all-cause mortality (HR = 1.226, 95% CI 1.104-1.361) and cardiovascular mortality (HR = 1.377, 95% CI 1.149-1.651). Time-dependent receiver operating characteristic (ROC) curves and concordance index evaluations demonstrated that TyG-ABSI yielded more accurate long-term prognostic performance than other TyG-derived metrics. The area under the curve (AUC) of this indicator reached 0.688-0.708 in the prediction of all-cause mortality risk over 5-15 years, and 0.696-0.739 in the prediction of cardiovascular mortality risk. External validation using CHARLS data confirmed the robustness of these findings in predicting all-cause mortality.

CONCLUSIONS: Among individuals with CKM stages 0-3, TyG-ABSI demonstrates a stronger association with mortality risk and superior predictive ability compared with other TyG-derived metrics. Its performance suggests a potential role in capturing variations across diverse clinical subgroups, and informing optimal timing for preventive interventions.

PMID:40988017 | DOI:10.1186/s12933-025-02921-3

BMC Oral Health. 2025 Sep 23;25(1):1417. doi: 10.1186/s12903-025-06944-w.

ABSTRACT

BACKGROUND: Pediatric dentists can play a crucial role in detecting, referring, counselling, and treating patients with obstructive sleep apnea (OSA). Understanding their knowledge and attitudes towards OSA is crucial for effective healthcare delivery.

OBJECTIVE: This study aimed to assess the knowledge, attitude, and practice of pediatric dentists in Egypt toward obstructive sleep apnea in children.

METHODS: This cross-sectional study used a web-based structured questionnaire generated via Google Forms based on a previously validated questionnaire. The link for the questionnaire was circulated to participants through emails and professional group forums. The questionnaire comprised an introductory paragraph and four sections: demographic, knowledge, attitude, and practice for data collection.

RESULTS: A total of 362 pediatric dentists participated in this online survey. Adequate knowledge was detected in 310 (85.64%) pediatric dentists, and 343 (94.75%) demonstrated a positive attitude toward OSA. In contrast, inadequate practices were observed in 274 (75.69%) pediatric dentists. Concerning the correlation between the knowledge, attitude, and practice and demographic data, a weak negative correlation with statistical significance (p-value = 0.047186) was detected between practice and age. A weak positive correlation was also detected between knowledge and years of experience, with a statistical significance (p-value = 0.011848).

CONCLUSIONS: Pediatric dentists in Egypt seem to have adequate knowledge and a positive attitude toward different domains of pediatric OSA, but their practice was inadequate. Participants’ knowledge showed a weak favourable correlation with years of experience; meanwhile, their practice has an adverse weak relationship with age.

TRIAL REGISTRATION: The current study was registered on May 6, 2025, with the identifier number NCT06970873 on clinicaltrials.gov.

PMID:40988011 | DOI:10.1186/s12903-025-06944-w

Int J Behav Med. 2025 Sep 23. doi: 10.1007/s12529-025-10397-4. Online ahead of print.

ABSTRACT

PURPOSE: Depression is the second most prevalent mental disease among adolescents, yet only a small percentage seek or receive treatment for the disease. Physical activity (PA) interventions hold promise as an alternative or adjunct to clinical treatment for depression. However, previous studies have been inconsistent regarding the relationship between PA and depressive symptoms in children and adolescents. The purpose of this study was to assess the effect of PA intervention on depressive symptoms in children and adolescents through a meta-analysis.

METHODS: Literature from 10 electronic databases and 4 registries was systematically searched. Combined estimates (standardized mean difference, SMD) and 95% CIs were calculated using a random-effects model to assess the effect of PA on depressive symptoms in adolescents. Relevant subgroup analyses and sensitivity analyses were also performed.

RESULTS: Results showed that PA improved depressive symptoms in children and adolescents (SMD = -0.707, 95% CI: -0.901 to -0.514). Subgroup analyses showed that PA improved adolescent depressive symptoms in different regions, different types of PA, moderate- to vigorous-intensity PA, different single-session time PA, different frequency PA, and different duration PA.

CONCLUSIONS: PA interventions could be used to reduce depressive symptoms in children and adolescents. A mixed program and vigorous-intensity PA intervention was the most effective in improving depressive symptoms in children and adolescents. The selection of a 4 to 8-week, no less than 4 times per week, single-session PA program of no more than 30 min may yield desirable results.

PMID:40987974 | DOI:10.1007/s12529-025-10397-4