Tag: nevin manimala

JMIR Med Inform. 2026 Aug 14;14:e92838. doi: 10.2196/92838.

ABSTRACT

BACKGROUND: Sepsis-associated acute kidney injury (SA-AKI) is a frequent and life-threatening complication of sepsis. While the static lactate-to-albumin ratio (LAR) has prognostic value, its dynamic temporal evolution during early resuscitation and its utility for guiding clinical risk stratification remain underexplored.

OBJECTIVE: The aim of the study is to identify distinct dynamic trajectories of LAR, evaluate their independent associations with adverse clinical outcomes, and construct a practical prognostic nomogram for patients with SA-AKI.

METHODS: Data were extracted from the Medical Information Mart for Intensive Care IV database, including adult patients with SA-AKI and ≥ 3 lactate and albumin measurements within the first 72 hours of intensive care unit admission. A multicenter external validation cohort was assembled from 5 tertiary hospitals in Beijing, China. Group-based trajectory modeling identified distinct LAR trajectories. The primary outcome was 28-day mortality; secondary outcomes included 90-day mortality and continuous renal replacement therapy initiation. Trajectory-outcome associations were assessed using multivariable Cox and logistic regression models. Robustness was examined using restricted cubic splines, inverse probability of treatment weighting, weight truncation, doubly robust estimation, and subgroup analyses. Incremental predictive value beyond single baseline LAR was quantified, and a trajectory-integrated nomogram was developed and externally validated.

RESULTS: Among the 615 patients in the primary cohort, 3 LAR trajectories were identified: trajectory 1 (low-stable type), trajectory 2 (rapid-clearance type), and trajectory 3 (delayed-clearance type). In adjusted multivariable models, trajectory 3 (vs trajectory 1) was independently associated with increased 28-day mortality risk (hazard ratio 1.63, 95% CI 1.00-2.64; P=.0496), 90-day mortality (hazard ratio 1.72, 95% CI 1.14-2.60; P=.01), and continuous renal replacement therapy initiation (odds ratio 3.40, 95% CI 1.64-7.15; P=.001). Conversely, the mortality risk for trajectory 2 did not differ significantly from trajectory 1. Sensitivity analyses supported these findings, although trajectory 3 associations attenuated in inverse probability of treatment weighting-weighted analyses. Incorporating trajectories improved predictive accuracy over single baseline LAR (continuous net reclassification improvement 0.170, integrated discrimination improvement 0.023; both P=.01). In the external validation cohort (n=508), 3 analogous trajectories were identified. Trajectory 3 consistently conferred a higher mortality risk across both cohorts, whereas trajectory 2 was significantly associated with 28-day mortality only in validation. The nomogram exhibited modest discrimination in the external cohort (concordance index=0.612), acceptable calibration, and potential utility as a supplementary bedside risk stratification tool.

CONCLUSIONS: Dynamic LAR trajectories are independently associated with 28- and 90-day mortality in SA-AKI. The delayed-clearance trajectory identifies a specific high-risk phenotype, suggesting that longitudinal LAR monitoring and the constructed nomogram may support early risk stratification and inform clinical decision-making.

PMID:42605517 | DOI:10.2196/92838

Glob Health Epidemiol Genom. 2026;2026(1):e6687660. doi: 10.1155/ghe3/6687660.

ABSTRACT

BACKGROUND: Regular blood donation has been associated with lower cardiovascular risk in some studies, possibly through mechanisms involving reduced iron stores and oxidative stress.

OBJECTIVE: The study investigated the association between blood donation frequency and cardiovascular risk factors among voluntary blood donors.

METHODS: The cross-sectional study examined blood donors classified into regular donors and occasional donors. Blood pressure, body mass index (BMI), fasting blood glucose, and total cholesterol levels were measured. Standard clinical criteria were used to determine the cardiovascular risk factors. Independent t-tests and chi-square tests were analyzed to compare the two groups. Multivariate logistic regression was applied to control for possible confounding variables.

RESULTS: Regular donors demonstrated lower blood pressure measurements, which included systolic blood pressure of 118 ± 12 mmHg and diastolic blood pressure of 77 ± 8 mmHg. Donors who donated regularly demonstrated a lower BMI of 24.5 ± 3.1 kg/m² compared to donors who donated occasionally. Regular donors showed lower rates of hypertension, 22% compared to 39%, and elevated cholesterol, 21% compared to 35%, with a statistical significance of p = 0.04. The study found no differences between the groups regarding their fasting glucose levels or diabetes rates. Regular donors had lower odds of hypertension (OR = 0.52, 95% CI: 0.30-0.89) and elevated cholesterol (OR = 0.56, 95% CI: 0.33-0.95), while the association with overweight/obesity did not reach statistical significance.

CONCLUSION: Regular blood donation was associated with more favorable cardiovascular risk profiles among donors in this study.

PMID:42605499 | DOI:10.1155/ghe3/6687660

Spine Surg Relat Res. 2026 Feb 16;10(4):585-591. doi: 10.22603/ssrr.2025-0396. eCollection 2026 Jul 27.

ABSTRACT

INTRODUCTION: Although follow-up is recommended for 2 years after lumbar spinal stenosis (LSS) surgery, some patients fail to complete all follow-up visits. In recent years, the treatment burden on older adults has attracted increasing attention, with particular emphasis on outpatient visits. Thus, we aimed to clarify the clinical characteristics of older adults who discontinued postoperative follow-up between 1 and 2 years after LSS surgery.

METHODS: This retrospective study included consecutive patients aged ≥65 years who had undergone surgery for LSS at a single center between April 2020 and June 2023. At follow-up assessments scheduled 1 and 2 years after surgery, patients completed the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and the Zurich Claudication Questionnaire (ZCQ). The preoperative and 1-year postoperative JOABPEQ and ZCQ scores were statistically compared between patients who did and did not complete follow-up and were adjusted using analysis of covariance or the Poisson regression model.

RESULTS: Among the 330 patients who attended the 1-year follow-up visit, 252 (76.4%) attended the 2-year visit, whereas the remaining 78 (23.6%) did not. Patients who did not complete follow-up exhibited significantly higher rates of dyslipidemia (p=0.022), cardiovascular disease (p=0.005), and frailty (p=0.014), and a lower prevalence of spondylolisthesis (p<0.001) and fusion surgery (p<0.001), than those who completed the follow-up. Furthermore, patients who did not complete follow-up had worse scores in the psychological disorder domain of the JOABPEQ both preoperatively and at 1 year, and worse 1-year scores across all ZCQ domains than those who completed the follow-up.

CONCLUSIONS: Several factors were associated with the likelihood of discontinuing postoperative follow-up among older adults with LSS, and their postoperative outcomes were poorer. Therefore, when analyzing data from older adults with LSS at 2 years postoperatively, considering the characteristics of patients who discontinued follow-up is essential.

PMID:42605476 | PMC:PMC13477750 | DOI:10.22603/ssrr.2025-0396

Niger Med J. 2026 Jul 10;67(3):1014-1022. eCollection 2026 May-Jun.

ABSTRACT

BACKGROUND: Chronic rhinosinusitis (CRS) interferes with daily functioning and well-being. Though not life-threatening, the severity of CRS can affect quality of life (QoL), turning everyday moments into persistent struggles. Despite its high prevalence, little research has assessed its relationship with patients’ specific QoL. This study aimed to assess the relationship between disease severity and quality of life in CRS patients.

METHODOLOGY: This was a cross-sectional survey conducted among patients with CRS. Severity of disease was determined using the Sino-Nasal Outcome Test-22 (SNOT-22), while the QoL was assessed using the World Health Organization Quality of Life Instrument (WHOQoL-BREF) and the Rhinosinusitis Disability Index (RSDI) questionnaires. RSDI was interpreted as a higher score indicated poor QoL. While for WHOQoL, a higher score indicated good QoL. The data was compared using Spearman’s rank correlation test.

RESULTS: There were 114 participants, with 58 (50.9%) males and 56 (49.1%) females. Their age ranged between 18 – 70 years, with a mean of 37.60 ±13.03 years. The Spearman’s test revealed a statistically significant moderate negative correlation between SNOT-22 scores and various WHOQoL domains: physical health (r_s = -0.291, p = 0.002), psychological well-being (rs = -0.279, p = 0.003), social relationships (r_s = -0.179, p = 0.005), and environmental health (r_s = -0.274, p = 0.001) domains. The comparison of disease severity and RSDI showed a positive moderate correlation (r_s = 0.50, p = 0.000) that is statistically significant. The relation between disease severity and RSDI showed a positive correlation because higher RSDI indicated poor QoL, while the relationship between disease severity and WHOQoL showed a negative correlation because higher WHOQoL indicated good QoL.

CONCLUSION: The SNOT-22 scores were statistically significant and moderately correlated with all four WHOQoL domains, indicating that higher disease severity scores are consistently associated with poorer quality of life across physical health, psychological well-being, social relationships, and environmental health domains.

PMID:42605465 | PMC:PMC13477699

Niger Med J. 2026 Jul 10;67(3):988-995. eCollection 2026 May-Jun.

ABSTRACT

BACKGROUND: One of the concerns after transcervical resection of endometrial polyps (TCRP) is the recurrence of polyps post-surgery. Some studies have shown that hormone therapy with progesterone may reduce the risk of recurrence. This clinical trial aimed to investigate the effect of progesterone treatment after hysteroscopic polypectomy.

METHODOLOGY: In this clinical trial, 40 patients diagnosed with endometrial polyps were randomly and equally assigned to two groups: intervention and control. TCRP surgery was performed for both groups. In the intervention group, medroxyprogesterone was administered one week after surgery at a dose of 10 mg twice daily from the 5th day of the menstrual cycle for 21 days, over four cycles. The recurrence rate at 3 and 6 months post-surgery, endometrial thickness, hemoglobin levels, and menstrual status before and six months after surgery were compared between the two groups.

RESULTS: None of the patients had a recurrence of endometrial polyps in the first three months, while three patients in the control group had a recurrence six months post-surgery (Relative Risk (RR) = 7.0, CI: 0.38-12.73). Regarding menstrual disorders, one patient in the control group had a menstrual disorder in the first three months (RR = 3.0, CI: 0.12-69.51), while six months post-surgery, 11 patients in the control group and one patient in the intervention group had menstrual disorders (RR = 11.55, CI: 1.63-81.45). Endometrial thickness six months post-surgery was significantly lower in the intervention group (5.5 ± 1.2 mm vs. 8.0 ± 2.5 mm, P = 0.001). The mean hemoglobin level six months post-surgery was higher in the intervention group, but it was not statistically significant.

CONCLUSION: Progesterone administration after TCRP surgery may be effective due to improved menstrual status, reduced endometrial thickness, and possibly lower recurrence rates of endometrial polyps.

PMID:42605458 | PMC:PMC13477703

Niger Med J. 2026 Jul 10;67(3):1039-1050. eCollection 2026 May-Jun.

ABSTRACT

BACKGROUND: Varicocele is the commonest cause of male infertility, and varicocelectomy is the commonest surgery performed for such men. Although many studies have reported improvements in semen parameters following varicocelectomy, their adequacy in relation to WHO standards has received less attention. There are patients who, after undergoing varicocelectomy, still do not naturally cause pregnancy, sometimes due to inadequate improvements in these parameters. This oftentimes influences their acceptance of the procedure. This is a prospective interventional study aimed at determining the adequacy of improvements in semen parameters following varicocelectomy at UCTH in one year.

METHODOLOGY: Clinical varicoceles patients with subnormal seminograms, who met certain inclusion criteria and consented, were recruited. Participants underwent varicocelectomy, and their pre- and post-surgical seminograms were compared with the current WHO standards. A proforma was designed to record patients’ data. Data were analyzed using SPSS version 25. Frequencies, percentages, means, and standard deviations were used to summarize data. Relevant tests of significance (Fisher’s exact, Chi-square (X2), t-tests) were conducted at a confidence interval of 95 percent and p-value <0.05. Data were presented in charts and tables.

RESULTS: Sixty-six percent were aged 31-40 years (mean of 35.14±8.76). The study revealed that there was improvement in mean sperm count from 15.2±1.6×10⁶ to 38.2±3.3×10⁶/ejaculate (p<0.001) and percentage motility from 23.4±1.7 to 37.9±1.8 (p<0.001) 3-6 months following varicocelectomy. There was also a significant decrease in the mean percentage of non-motile sperms from 56.4±2.1 to 42.1±1.7 (p<0.001). Although there were corresponding improvements in the mean morphology and sluggishly motile sperm, these changes were not statistically significant.

CONCLUSION: The study demonstrated that varicocelectomy improves seminogram adequately (in clinical varicocele patients) as recommended by the WHO.

PMID:42605456 | PMC:PMC13477695

Iran J Pathol. 2026 Sep 1;21(4):560-570. doi: 10.22034/ijp.2026.2087485.3651. Epub 2026 Aug 1.

ABSTRACT

BACKGROUND & OBJECTIVE: Ankylosing spondylitis (AS) is a systemic inflammatory disorder where the HLA-B27 allele significantly influences disease severity. This study evaluated the molecular profiles of integrins CD29 and CD49b in peripheral blood mononuclear cells (PBMCs) to identify potential biomarkers associated with HLA-B27 status.

METHODS: In this cross-sectional study of an Iraqi cohort, 130 participants were recruited: 50 HLA-B27-positive (HLA+) radiographic AS patients, 50 HLA-B27-negative (HLA-) radiographic AS patients, and 30 healthy controls. Transcriptomic and proteomic expressions of CD29 and CD49b were quantified using qPCR and flow cytometry (mean fluorescence intensity, MFI). Hematological and biochemical profiles were also assessed.

RESULTS: CD29 mRNA was significantly upregulated in both patient groups, with a more pronounced median elevation in the HLA+ group (11-fold; P < 0.0001) than in the HLA- group (3-fold; P < 0.001). Surface CD29 protein significantly increased only in the HLA+ cohort (mean MFI approximately 3000; P < 0.0001). Conversely, CD49b mRNA was substantially suppressed, particularly in the HLA+ group (P < 0.0001). Correspondingly, a marked reduction in CD49b surface protein occurred in the HLA+ cohort (mean MFI approximately 300; P < 0.0001), whereas the HLA- group remained statistically comparable to controls. Additionally, the HLA- phenotype was characterized by significant granulocytosis (85%-90%) and more pronounced elevations in urea and ALT levels.

CONCLUSION: These findings suggest a divergent regulation of CD29 and CD49b integrins associated with HLA-B27 status in Iraqi AS patients. While these integrins may serve as molecular indicators for disease stratification, longitudinal validation is required to confirm their clinical utility as diagnostic or therapeutic targets.

PMID:42605454 | PMC:PMC13477783 | DOI:10.22034/ijp.2026.2087485.3651

Niger Med J. 2026 Jul 10;67(3):1140-1149. eCollection 2026 May-Jun.

ABSTRACT

BACKGROUND: Breast cancer is a leading cause of mortality, with critically low (0.2% in urban areas per NFHS-5) screening rates in India. This study aimed to evaluate the effect of an educational intervention based on the Health Belief Model (HBM) on breast cancer knowledge and screening perceptions among Women of Reproductive Age (WRA) in West Bengal.

METHODOLOGY: A quasi-experimental, single-group pre-test/post-test study was conducted among 435 WRA in the urban slums of Burdwan. Participants (median age 30 years) received four teaching sessions, the intervention per se, each lasting 45-60 minutes. Data on sociodemographic profile, breast cancer knowledge, and HBM domains (susceptibility, severity, benefits, barriers, cues to action, and self-efficacy) were collected at baseline, one month, and six months post-intervention. Data was analyzed using descriptive statistics, repeated measure ANOVA and multivariable logistic regression.

RESULT: The educational intervention led to statistically significant improvements across all HBM domains (p<0.001). Multivariable logistic regression showed that women aged ≤ 30 years had significantly higher odds of satisfactory ‘cues to action’ [aOR= 4.731] and ‘perceived benefits’ [aOR=10.745], while those > 30 years had lower odds of ‘perceived susceptibility’ [aOR= 0.052]. Living in a nuclear family was associated with both satisfactory ‘susceptibility’ [aOR=3.099] and higher ‘perceived barriers’ [aOR= 2.626]. Higher family income (> Rs.7000/-) was a significant predictor for satisfactory ‘self-efficacy’ [aOR= 2.684].

CONCLUSION: The HBM-based intervention significantly improved perceptions regarding breast cancer. The findings confirm that sociodemographic factors like age, family type and income are key determinants of health beliefs, providing crucial information for developing tailored interventions to overcome specific barriers.

PMID:42605448 | PMC:PMC13477700

Iran J Pathol. 2026 Sep 1;21(4):543-551. doi: 10.22034/ijp.2026.2087169.3640. Epub 2026 Aug 1.

ABSTRACT

BACKGROUND & OBJECTIVE: Breast cancer is a major global health concern, with tumor heterogeneity and tumor microenvironment (TME) dynamics limiting the predictive value of conventional prognostic markers such as age, tumor size, grade, nodal status, lymphovascular invasion (LVI), and ER/PR/HER2 status. Stromal CD10, a zinc-dependent metalloproteinase expressed by fibroblasts and myoepithelial cells, promotes tumor invasion through extracellular matrix remodeling and is associated with aggressive tumor features. This study evaluates stromal CD10 expression in invasive breast carcinoma and its correlation with clinicopathological and immunohistochemical parameters.

METHODS: A prospective study of 73 modified radical mastectomy specimens of invasive ductal carcinoma was conducted between April 2024 and December 2025. Histopathological diagnosis and grading were confirmed using H&E staining. Immunohistochemistry assessed ER, PR, HER2, stromal CD10 expression, and molecular subtypes. Nottingham Prognostic Index (NPI) was calculated for risk stratification.

RESULTS: Most patients were female, with predominance of T2 tumors (61.6%), IDC-NST (86.3%), and grade 2 tumors (79.5%). ER, PR, and HER2 positivity were observed in 52.1%, 37%, and 30.1% of cases. Basal-like and luminal B subtypes were most common (30.1% each). Stromal CD10 showed strong positivity in 49.3%, weak positivity in 30.1%, and negativity in 20.5%. CD10 expression showed a higher frequency among cases with T2 tumors, grade 2 histology, lymphovascular invasion, lymph node involvement, ER/PR negativity, HER2 positivity, and basal-like/HER2-enriched subtypes; however, these associations did not reach statistical significance.

CONCLUSION: In low-resource settings, Stromal CD10 may have potential as an adjunct marker of tumor aggressiveness; however, in the present study, its associations with adverse clinicopathological parameters were not statistically significant. Larger multicentric studies with survival data are required for validation. Validation requires larger multicentric investigations with survival data.

PMID:42605446 | PMC:PMC13477775 | DOI:10.22034/ijp.2026.2087169.3640

Niger Med J. 2026 Jul 10;67(3):1104-1115. eCollection 2026 May-Jun.

ABSTRACT

BACKGROUND: Preimplantation genetic testing (PGT) is increasingly integrated into in-vitro fertilization (IVF) to detect chromosomal abnormalities and monogenic disorders before embryo transfer. Although its use is primarily intended to prevent genetic disease and improve reproductive outcomes, PGT is also applied for non-medical indications such as elective sex selection in some settings. The objective of this study is to characterize the sociodemographic profile of couples undergoing PGT, the clinical indications for testing, and patterns of maternal and paternal age, parity, and geographic distribution in a Nigerian fertility centre.

METHODOLOGY: A Retrospective study conducted at a tertiary fertility and preimplantation genetic testing centre in Lagos, Nigeria, between January 2018 and December 2024 was reviewed. Sociodemographic characteristics, reproductive history, type of PGT performed (PGT-A, PGT-M, or combined), and clinical indications for testing were extracted from anonymized medical records. Descriptive statistics were used to summarize participant characteristics and indications for PGT.

RESULTS: The mean maternal age was 39.7 ± 6.1 years, while the mean paternal age was 46.3 ± 6.9 years. Most women had parity 2-3 (51.6%), and 86.3% had 1-4 living children. Participants resided predominantly in Nigeria (61.5%), with a substantial proportion from the United Kingdom (17.3%) and Canada (8.8%), reflecting cross-border utilization of fertility services. The most common indication for PGT was elective sex selection/family balancing (89.7%). Among clinical indications, PGT-M for haemoglobin S (HBS) genotype screening accounted for 5.4%. A small proportion of cycles involved combined PGT-A/PGT-M, mainly for women with previous children with oculocutaneous albinism (1.0%, n = 4) and Duchenne Muscular Dystrophy (0.5%, n = 2) and severe male-factor infertility (0.5%).

CONCLUSIONS: In this cohort of Nigerian couples undergoing IVF with PGT, elective sex selection was the predominant indication, highlighting the influence of sociocultural factors on the use of reproductive genetic technologies.

PMID:42605444 | PMC:PMC13477692