Tag: nevin manimala

BMC Surg. 2026 Jan 16. doi: 10.1186/s12893-026-03500-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Firearm injuries continue to be a major cause of trauma-related morbidity and mortality worldwide. Abdominal firearm injuries are particularly critical due to the high risk of organ damage, hemorrhage, and sepsis. In trauma management, time to surgical intervention is considered one of the most decisive factors affecting survival. However, the evidence regarding the relationship between operating room (OR) access time and mortality remains inconsistent in the current literature.

AIM: This study aimed to evaluate the effect of the time to emergency surgery on mortality in patients presenting with isolated intra-abdominal firearm injuries. Additionally, it sought to identify clinical, hemodynamic, and organ-specific factors associated with early mortality.

METHODS: This retrospective study included 121 adult patients who presented to the Emergency Department of Adana City Training and Research Hospital between January 1, 2018, and July 31, 2024, with isolated intra-abdominal gunshot injuries and underwent emergency surgery. Demographics, comorbidities, vital signs, laboratory parameters, imaging findings, organ injuries, OR access times, and clinical outcomes were analyzed. Statistical comparisons were performed using appropriate parametric and non-parametric tests, with a significance threshold of p < 0.05.

RESULTS: Of the patients, 93.4% were male, and the median age was 34 years. The overall mortality rate was 6.6%. Mortality was significantly associated with chronic ischemic heart disease, colonic injury, and intra-abdominal vascular injury (p < 0.05). Non-survivors exhibited significantly lower blood pressure, hemoglobin, hematocrit, oxygen saturation, and pH levels and significantly higher heart rate, lactate, shock index, modified shock index, CK-MB, and hs-Troponin-I values (p < 0.05). Interestingly, time to the operating room was shorter in non-survivors (p = 0.002), reflecting more severe initial clinical presentation rather than improved outcomes.

CONCLUSION: In intra-abdominal firearm injuries, mortality is influenced more by the severity of organ damage and the patient’s hemodynamic condition at presentation than by OR access time alone. Early recognition of critical injuries, rapid resuscitation, and timely surgical intervention remain essential for improving survival outcomes. Clinical indicators such as lactate level, shock index, and hemodynamic parameters may serve as valuable predictors of early mortality.

PMID:41546051 | DOI:10.1186/s12893-026-03500-3

BMC Oral Health. 2026 Jan 17. doi: 10.1186/s12903-026-07660-9. Online ahead of print.

ABSTRACT

BACKGROUND: There has been a notable increase in artificial intelligence (AI) studies in dentistry. However, the inadequate use of proper validation methods has led to overly optimistic performance metrics of machine learning (ML) models. External validation provides evidence of a ML model’s performance with independent datasets and is crucial for generalizability.

METHODS: We developed Extreme Gradient Boosting (XGBoost) models to detect dental caries using easy-to-collect questionnaire data. ML model training was conducted using cross-validation nested resampling with a holdout test set, utilizing NHANES datasets (n = 6070). Performance of the trained model was tested using external data from the Northern Finland Birth Cohorts (NFBC1966 and NFBC1986; n = 3616). To enhance interpretability, beeswarm plots were constructed to visualize variable importance.

RESULTS: The ML model demonstrated acceptable performance in predicting dental caries on the internal dataset, with an area under the operating characteristics curve (AUC) of 0.785 (95% CI 0.756-0.813). However, the model encountered difficulties in identifying participants with dental caries, as shown by its poor sensitivity of 0.391, despite achieving a high specificity of 0.919. When applied to the external dataset, the ML model encountered significant challenges, with the AUC dropping to 0.550 (95% CI 0.532-0.569), sensitivity decreasing to 0.053, and specificity slightly improving to 0.974. Important variables identified by the model were self-rated condition of teeth and gums, presence of missing teeth, financial status, and time since last dental visit.

CONCLUSION: The performance of our ML model during external validation degraded notably compared to the internal validation. However, the XAI methodology exhibited great potential to be used in the future for individualized dental caries risk assessment.

PMID:41546040 | DOI:10.1186/s12903-026-07660-9

Biomed Eng Online. 2026 Jan 16. doi: 10.1186/s12938-025-01494-2. Online ahead of print.

ABSTRACT

BACKGROUND: Diabetic foot (DF) is a severe complication of type 2 diabetes mellitus (T2DM), contributing to significant morbidity and healthcare costs globally. Early prediction and intervention are critical for preventing amputations and improving patient outcomes. However, traditional statistical methods lack the capacity to handle high-dimensional clinical data and identify optimal predictive features. This study aimed to develop and validate machine learning models for DF risk prediction using feature selection strategies based on binary logistic regression and information theory.

METHODS: A retrospective cohort of 1,179 patients (95 DF cases, 1,084 T2DM controls) was analyzed using clinical and biochemical data from 2019 to 2025. Three data sets were constructed: (1) original features; (2) features selected via binary logistic regression (F1); and (3) features selected via information-theoretic global learning (F2). Six models-extreme learning machine (ELM), kernel extreme learning machine (KELM), and their variants trained on the three data sets-were evaluated using fivefold cross-validation. Performance metrics included area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and computational efficiency.

RESULTS: Age, blood-urea-nitrogen (BUN), homocysteine (Hcy), albumin (ALB), and fasting blood glucose (FBG) were identified as independent DF risk factors. The information theory-based KELM (IT-KELM) model achieved the highest AUC of 0.799 (sensitivity: 0.792 and specificity: 0.710) on F2, outperforming other models. Feature selection improved predictive accuracy while reducing computational time, with IT-KELM requiring 0.138 s for training and 0.0023 s for testing. The SHAP summary dot plot and bar chart revealed that the top five features contributing to the model were TP, RBC, ALB, BMI and HB.

CONCLUSIONS: Integrating information theory with KELM enhances DF risk prediction by optimizing feature subsets and leveraging nonlinear kernel mapping. The IT-KELM model demonstrates robust diagnostic performance and clinical feasibility for early DF screening. Future multi-center studies are needed to validate generalizability and refine model interpretability in real-world settings. This approach provides a cost-effective tool for precision medicine in diabetes care.

PMID:41546000 | DOI:10.1186/s12938-025-01494-2

Head Face Med. 2026 Jan 16. doi: 10.1186/s13005-026-00587-0. Online ahead of print.

NO ABSTRACT

PMID:41545992 | DOI:10.1186/s13005-026-00587-0

BMC Nephrol. 2026 Jan 16. doi: 10.1186/s12882-025-04690-3. Online ahead of print.

ABSTRACT

BACKGROUND: Abnormal serum potassium levels are common among peritoneal dialysis (PD) patients. Many studies have shown hypokalemia as a risk factor for peritonitis, but most were cross-sectional and observational. We intended to analyze the longitudinal association between serum potassium levels and peritonitis in those undergoing PD.

METHODS: We included 1,288 patients undergoing regular PD at our institution. The endpoint event was peritonitis. Patients were divided into peritonitis and non-peritonitis groups. The relationship between baseline data and the emergence of peritonitis was analyzed through Cox regression analysis. Mixed-effects model was used to analyze the correlation between longitudinal serum potassium and other lab characteristics with peritonitis. Kaplan-Meier survival analysis estimated the median time to peritonitis.Independent samples t-test was used in subgroup analysis to explore the relationship between serum potassium and different pathogenic bacteria. Spearman correlation analysis and scatter plot were used to evaluate the correlation between serum potassium and magnesium. Cochran-Armitage trend chi-square test assessed the trend of peritonitis incidence.

RESULTS: COX regression analysis found higher baseline lymphocyte count and female gender were associated with lower peritonitis risk, while older age and higher baseline uric acid levels were linked to higher risk. A mixed-effects model indicated that the peritonitis group’s serum potassium decreased more rapidly and remained low longer. Kaplan-Meier curves estimated the median time to peritonitis to be 4.09 years. The analysis of subgroups found no significant difference in serum potassium levels between the gram-positive and gram-negative bacteria groups. Spearman correlation analysis showed a very weak positive correlation between potassium and magnesium with poor trend consistency but statistical significance. Peritonitis incidence showed a significant linear downward trend from 2011 to 2023.

CONCLUSIONS: Rapid declines and long-term low levels of serum potassium after PD initiation increase peritonitis risk. Long-term potassium management in PD patients is crucial in clinic practice, with intensified monitoring advised around 4 years into PD treatment.

TRIAL REGISTRATION: 2023BA0125_GC; 2023-10-20.

PMID:41545970 | DOI:10.1186/s12882-025-04690-3

BMC Endocr Disord. 2026 Jan 16. doi: 10.1186/s12902-025-02132-7. Online ahead of print.

NO ABSTRACT

PMID:41545963 | DOI:10.1186/s12902-025-02132-7

BMC Neurol. 2026 Jan 16. doi: 10.1186/s12883-026-04636-8. Online ahead of print.

NO ABSTRACT

PMID:41545942 | DOI:10.1186/s12883-026-04636-8

BMC Anesthesiol. 2026 Jan 17. doi: 10.1186/s12871-026-03628-y. Online ahead of print.

ABSTRACT

BACKGROUND: Intranasal dexmedetomidine is commonly used preoperatively in pediatric anesthesia to reduce agitation and emergence delirium. Esketamine, with sedative and analgesic ef-fects and minimal respiratory depression at clinical doses, is also widely used in chil-dren. However, current evidence remains limited regarding the efficacy and safety of combining intranasal esketamine with dexmedetomidine versus dexmedetomidine alone in improving cooperation during anesthesia induction and reducing postoperative complications.

METHODS: This meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD420251084757). A systematic search of PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials.gov, and Wanfang was conducted up to May 25, 2025. The primary outcome included the incidence of emergence delirium, emergence time, mask acceptance score (MAS), parental separation anxiety score (PSAS), and the incidence of adverse events, with pooled effect estimate reported as proportions and relative risk (RR) with 95% confidence intervals (CIs). Sensitivity analysis were performed to assess the robustness of the results and to identify sources of heterogeneity.

RESULTS: Six studies involving a total of 515 pediatric patients were included. Compared with dexmedetomidine alone, intranasal esketamine combined with dexmedetomidine significantly reduces the incidence of emergence delirium (RR = 0.27, 95% CI: [0.17-0.44], P < 0.00001, I² = 0%). The incidence of bradycardia is also significantly lower in the combination group (RR = 0.24, 95% CI: [0.08-0.72], P = 0.01). No statistically significant differences are observed between the two groups in terms of emergence time or the incidence of nausea and vomiting. The combination group shows lower parental separation anxiety scores and better mask acceptance scores, indicating improved cooperation during anesthesia induction.

CONCLUSION: Preoperative intranasal administration of esketamine combined with dexmedetomidine significantly reduces the incidence of emergence delirium and bradycardia compared with dexmedetomidine alone.Improved cooperation during anesthesia induction further supports the potential of this combination as a safe and effective alternative to dexmedetomidine monotherapy in pediatric anesthesia.

TRIAL REGISTRATION: Not applicable.

PMID:41545910 | DOI:10.1186/s12871-026-03628-y

J Health Popul Nutr. 2026 Jan 16. doi: 10.1186/s41043-025-01229-y. Online ahead of print.

ABSTRACT

BACKGROUND: Tobacco exposure is a major public health concern and has been implicated in accelerated female reproductive aging. However, most evidence relies on self-reported smoking history, which may introduce bias. Cotinine, a reliable biomarker of nicotine exposure, provides an objective measure to clarify the association between tobacco exposure and reproductive lifespan (RLS).

METHODS: We analyzed 11,944 women from two nationally representative cohorts: NHANES (n = 6,081, U.S., 1999-2018) and KNHANES (n = 5,863, Korea, 2014-2020). Serum cotinine (NHANES) and urinary cotinine (KNHANES) were quantified using standardized laboratory assays. Multivariable linear regression and restricted cubic spline (RCS) models were employed to assess the relationship between cotinine levels and age at menopause, menarche, and RLS, adjusting for demographic, socioeconomic, and metabolic covariates. Subgroup analyses were conducted to explore effect modification.

RESULTS: Higher cotinine levels were significantly associated with earlier menopause (NHANES β = -0.23; KNHANES β = -0.10) and shorter RLS (NHANES β = -0.22; KNHANES β = -0.08). RCS models confirmed linear dose-response associations in both cohorts, with threshold effects observed at higher exposure levels (NHANES ln-cotinine > – 3.47: β = -0.303, 95% CI: -0.386 to – 0.220, P < 0.001). Subgroup analyses indicated stronger associations among younger women, non-diabetic individuals, and lower-income groups, with pronounced differences across racial and educational strata.

CONCLUSIONS: Cotinine, as an objective biomarker of tobacco exposure, was robustly associated with shortened reproductive lifespan across two national cohorts. The associations were linear, with stronger reproductive toxicity at higher exposure levels, particularly among U.S. women. These findings highlight the reproductive risks of smoking and underscore the importance of biomarker-based assessments in reproductive aging research.

PMID:41545908 | DOI:10.1186/s41043-025-01229-y

Acta Obstet Gynecol Scand. 2026 Jan 16. doi: 10.1111/aogs.70141. Online ahead of print.

ABSTRACT

INTRODUCTION: Somatization disorders belong to a category of psychiatric conditions in which psychological distress and impairment are manifested as physical symptoms. Affected patients tend to utilize specialist healthcare services more frequently and have more emergency visits than those without somatization. From a gynecological perspective, it is of relevance to investigate whether any specific somatic symptoms are linked to previous experience of physical, psychological, or sexual violence. The study aimed to explore whether any specific symptoms could be associated with level of somatization among women consulting a gynecologist; whether experience of physical, psychological, or sexual violence could be associated with level of somatization; and whether experience of violence is associated with self-rated state of health.

MATERIAL AND METHODS: A cross-sectional survey was conducted at three gynecological clinics in western Sweden between February and May 2024. A project-specific questionnaire was distributed to women who consulted the clinic and completed in the waiting room. The survey consisted of 13 items, including sociodemographic variables, reasons for the current gynecological consultation, self-rated health, history of physical, psychological or sexual violence, discomfort during gynecological examination, and somatic symptom severity. Data were analyzed using descriptive statistics, chi-square tests, ANOVA, and multivariable linear regression analyses.

RESULTS: Of 2000 questionnaires distributed, 1766 were completed (response rate 88.3%). Among participants, 21.8% reported experience of sexual violence, 16.8% psychological violence, and 13.6% physical violence. Among those reporting any form of violence (n = 653), overlap was common: 236/653 (36.1%) had experienced only sexual violence, while 191/653 (29.2%) had experienced all three types. Somatic symptom severity was significantly associated with both sexual and psychological violence, but not physical violence. Clinical predictors of somatization included abdominal pain, dysmenorrhea, and multiple symptoms including pain. High somatic symptom severity was strongly associated with worse self-rated health. Somatic symptoms and specific consultation reasons, but not violence experiences, were significantly associated with self-rated health.

CONCLUSIONS: Somatization is common among women seeking gynecological care and is associated with a history of sexual and psychological violence. The findings underscore the importance of assessing underlying symptom patterns and the value of trauma-informed assessment to optimize patient management.

PMID:41545902 | DOI:10.1111/aogs.70141