Tag: nevin manimala

J Int Assoc Provid AIDS Care. 2026 Jan-Dec;25:23259582261460521. doi: 10.1177/23259582261460521. Epub 2026 Jun 16.

ABSTRACT

BackgroundCervical cancer remains a major global health challenge, disproportionately affecting low- and middle-income countries. Women living with HIV are at increased risk due to weakened immunity. This study assessed cervical cancer screening utilization and associated factors among HIV-positive women attending antiretroviral therapy (ART) clinics in Gondar town, Northwest Ethiopia.MethodsA multicenter institution-based cross-sectional study was conducted from November 1 to 30, 2025, using systematic random sampling. Data were collected through structured interviewer-administered questionnaires and analyzed using STATA 14. Bivariable and multivariable logistic regression analyses were performed, with P < .05 considered statistically significant.ResultsScreening utilization was 30.2%. Good knowledge (AOR = 3.44; 95% CI: 2.22-5.16), favorable attitude (AOR = 2.81; 95% CI: 2.28-6.61), and history of sexually transmitted infections (AOR = 2.22; 95% CI: 1.83-4.13) were significantly associated.ConclusionScreening utilization was low. Strengthening health education, improving ART counseling, and integrating screening into routine HIV care are recommended.

PMID:42299655 | DOI:10.1177/23259582261460521

Eur Heart J Cardiovasc Pharmacother. 2026 Jun 16:pvag040. doi: 10.1093/ehjcvp/pvag040. Online ahead of print.

ABSTRACT

AIMS: Current guidelines recommend considering long-term oral anticoagulation in patients with new-onset postoperative atrial fibrillation (POAF) after cardiac surgery, balancing stroke and bleeding risk. However, no specific approach to bleeding risk assessment is provided. We explored in a proof-of-concept study whether a bleeding risk score can identify patients with POAF after coronary artery bypass grafting (CABG) with increased risk of post-discharge major bleeding.

METHODS AND RESULTS: This observational cohort study included 4436 patients with POAF after CABG in 2009-2020 without oral anticoagulation. The four-item PRECISE-DAPT score (based on age, creatinine clearance, preoperative hemoglobin concentration, and previous bleeding) was calculated for all patients. Bleeding risk was defined as high (≥25 points), medium (16-24 points), or low (≤15 points). Associations between bleeding risk and major bleeding events during the first postoperative year were assessed by Cox regression. Discrimination was evaluated with C-statistics, and calibration by comparing expected and observed bleeding rates. Major bleeding occurred in 2.1% of patients during the first year. The score classified 36.0% of patients as high bleeding risk. The hazard ratio for high versus low bleeding risk was 4.81 (95% CI 2.59-8.96). The area under the receiver operating characteristic curve was 0.68 (95% CI 0.63-0.73). Calibration showed good agreement between expected and observed bleeding events in patients with an annual bleeding risk up to 7%.

CONCLUSIONS: A bleeding risk score can be used to stratify patients with POAF after CABG into groups with different post-discharge bleeding risk. Further studies are necessary to identify the optimal risk score and its role in OAC decision pathway to improve clinical outcomes.

PMID:42299626 | DOI:10.1093/ehjcvp/pvag040

Medicine (Baltimore). 2026 Jun 12;105(24):e49308. doi: 10.1097/MD.0000000000049308.

ABSTRACT

Diabetic nephropathy (DN) is a common, life-threatening complication of diabetes, contributing to the global disease burden. With the advent of video platforms, health information is being more widely disseminated. However, the quality of such content varies widely, which may influence the public’s perception. This study aimed to evaluate the upload sources, content, and characteristics of DN-related videos on TikTok and Bilibili and to explore descriptive associations between video quality scores and selected video characteristics. This cross-sectional content analysis included 166 DN-related videos. Video quality was assessed using the Global Quality Scale (GQS), modified DISCERN (mDISCERN), and Journal of the American Medical Association (JAMA) benchmark criteria. Descriptive subgroup and correlation analyses were performed to examine cross-sectional associations between video quality scores and selected video attributes. No multivariable adjustment was performed. In unadjusted cross-sectional comparisons, TikTok videos showed higher observed engagement counts at the time of data collection than Bilibili videos, whereas no statistically significant differences were observed in video duration or quality indicators after correction for multiple comparisons. In unadjusted descriptive subgroup comparisons, videos uploaded by experts showed more favorable results in selected quality-related measures, particularly GQS and JAMA, than videos uploaded by individual users. No clear association was observed between video quality and snapshot engagement metrics recorded at the time of retrieval. This study identified descriptive differences in the presentation and dissemination patterns of DN-related health information across TikTok and Bilibili. Because the analyses were observational, cross-sectional, and unadjusted for potential confounders such as video length and content type, the observed differences between platforms and uploader types should be interpreted as descriptive associations only rather than independent effects.

PMID:42299601 | DOI:10.1097/MD.0000000000049308

Medicine (Baltimore). 2026 Jun 12;105(24):e49278. doi: 10.1097/MD.0000000000049278.

ABSTRACT

Insulin resistance is closely associated with mild cognitive impairment (MCI) and sarcopenia. The predictive utility of the metabolic score for insulin resistance (METS-IR) for MCI across different sarcopenia strata and its potential as a substitute for life’s essential 8 (LE-8) remains unclear. This prospective cohort study used data from the China Health and Retirement Longitudinal Study. Participants aged ≥45 years without baseline MCI or memory-related disease and with biomarker and cognitive data were included. METS-IR was calculated from fasting blood glucose, triglycerides, high-density lipoprotein cholesterol, and body mass index. LE-8 was scored using an adapted American Heart Association framework. Associations between METS-IR and incident MCI stratified by sarcopenia status were assessed using Cox proportional hazards models and restricted cubic splines. Machine-learning analyses using 11 classifiers and stratified 10-fold cross-validation evaluated the incremental and substitutional value of METS-IR within LE-8-based prediction models. A total of 4980 participants were included. Higher METS-IR was associated with a less favorable cardiometabolic profile. In multivariable-adjusted Cox models, compared with the lowest quartile of METS-IR, hazard ratios for incident MCI were 0.94 (95% confidence interval [CI]: 0.79-1.11) for quartile 2, 0.65 (95% CI: 0.53-0.78) for quartile 3, and 0.72 (95% CI: 0.59-0.87) for quartile 4. Restricted cubic spline analyses showed a significant nonlinear association between METS-IR and incident MCI in the overall sample (P for overall < .001, P for nonlinear = .017). A significant overall association was also observed in the possible sarcopenia subgroup, although nonlinearity was not statistically significant. No significant nonlinear or overall association was observed in the nonsarcopenia or confirmed sarcopenia subgroups. In prediction analyses, LE-8-based models achieved moderate discrimination (area under curve, AUC: 0.525-0.696). Adding METS-IR yielded a modest but statistically significant improvement only in AdaBoost (ΔAUC = +0.00487, P < .05). When selected biochemical LE-8 components were substituted by METS-IR, discrimination improved in several algorithms in multiple models, particularly in multilayer perceptron (P < .01). METS-IR showed a significant nonlinear association with incident MCI, with the lowest risk observed at intermediate-to-higher METS-IR levels. The incremental and substitutional value beyond LE-8 was limited, model-dependent, and requires external validation.

PMID:42299594 | DOI:10.1097/MD.0000000000049278

Medicine (Baltimore). 2026 Jun 12;105(24):e49163. doi: 10.1097/MD.0000000000049163.

ABSTRACT

This ecological study was based on secondary, population-level data from the Global Burden of Disease 2021 study. We systematically assessed the burden of Guillain-Barré syndrome (GBS) from 1990 to 2021 at global, regional, and national levels, and projected trends through 2041. Temporal trends were evaluated using joinpoint regression to calculate the average annual percentage change. Future trends up to 2041 were projected using autoregressive integrated moving average models. In 2021, the global number of prevalent GBS cases reached 471,850, with an age-standardized prevalence rate of 5.91 per 100,000, a 229% increase since 1990 (average annual percentage change: 3.34). Substantial regional disparities were observed, and frontier analysis indicated an inverse correlation between the sociodemographic index (SDI) and age-standardized rates. The disease burden was higher in males than in females, with peak prevalence occurring among children aged 5 to 9 years. The coronavirus disease 2019 pandemic was temporally associated with a marked increase in GBS burden in 2021, coinciding with a shift in the burden toward low-SDI regions. Projections suggest that the age-standardized prevalence rate will continue to rise through 2041, disproportionately affecting resource-limited areas. The global burden of GBS increased markedly from 1990 to 2021, with a notable rise after 2019 that was temporally associated with the coronavirus disease 2019 pandemic. Addressing this growing burden will warrant targeted interventions, strengthened surveillance, and equitable allocation of resources, particularly in low-SDI populations.

PMID:42299592 | DOI:10.1097/MD.0000000000049163

Medicine (Baltimore). 2026 Jun 12;105(24):e49203. doi: 10.1097/MD.0000000000049203.

ABSTRACT

Erectile dysfunction (ED) is a prevalent health condition with significant psychosocial impacts, yet the causal role of age at first sexual intercourse (AFS) remains unclear. This study investigated the causal effect of AFS on the risk of ED using Mendelian randomization (MR) and Bayesian methods. Five traditional 2-sample MR analyses and 5 Bayesian MR analyses were performed using genome-wide association studies summary statistics from European populations. Sensitivity analyses included MR Egger regression, MR-pleiotropy residual sum and outlier, and Cochran Q-test. In mixed-sex cohorts (Groups 1 and 2), inverse variance weighted results demonstrated significant protective effects: odds ratio (OR) = 0.626, θ = -0.469, P = 2.73 × 10-6 for Group 1 and OR = 0.617, θ = -0.483, P = 3.56 × 10-5 for Group 2. The analyses for male-specific cohorts (Groups 3-10) showed weaker but consistent effects. For Group 3, OR = 0.643, θ = -0.442, P = .010. For Group 4, some instrumental variables associated with confounders were removed. The result became statistically insignificant: OR = 0.680, θ = -0.385, P = .064. For Group 5, the instrument selection criteria were relaxed and significance was retained: OR = 0.695, θ = -0.364, P = .016. For Groups 6 to 10, Bayesian MR was used to strengthen the inferences. In particular, for Group 8, which has a strongly informed prior, a posterior mean θ = -0.358 and a 95% credible interval (-0.575, -0.136) were obtained. This study provides evidence supporting a causal protective effect of later AFS on ED risk. While traditional MR analyses in male-specific cohorts yielded suggestive results, Bayesian MR analyses, which allow for the integration of prior evidence, provided more precise estimates and strengthened the causal inference. These findings may inform future sexual health policies. Strengths include the use of male-specific cohorts and Bayesian enhancement for weak instruments. Limitations include reliance on European-ancestry data and inability to stratify ED subtypes.

PMID:42299590 | DOI:10.1097/MD.0000000000049203

Medicine (Baltimore). 2026 Jun 12;105(24):e49213. doi: 10.1097/MD.0000000000049213.

ABSTRACT

Patients with end-stage renal disease (ESRD) who are on maintenance hemodialysis (HD) often experience chronic, low-level inflammation, which is closely linked to complications such as anemia, poor nutritional status, and cardiovascular issues. The purpose of this study was to assess the average level of the systemic immune-inflammation index (SII) among individuals receiving regular HD due to ESRD and to explore the clinical and laboratory variables associated with ongoing inflammatory conditions, as indicated by the SII. This descriptive cross-sectional study involved 116 patients diagnosed with ESRD who were receiving maintenance HD. Blood samples were collected and tested for complete blood count, serum albumin, lipid profile (including cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol, and triglycerides), and high-sensitivity C-reactive protein (hs-CRP). Several inflammatory markers were derived from the complete blood count results, including the neutrophil-to-lymphocyte ratio, SII, systemic inflammation response index, and pan-immune-inflammation value. Among the 116 HD patients included in the analysis, the median SII was 498.22 (363.85-749.52). Elevated hs-CRP levels (≥3 mg/L) were observed in 35.34% of patients and were associated with clinical and laboratory characteristics such as gender, body mass index, hemoglobin, triglycerides, albumin, HDL-C, and inflammatory indices such as SII, neutrophil-to-lymphocyte ratio, systemic inflammation response index, and pan-immune-inflammation value (P < .05). hs-CRP showed a moderate positive correlation with SII (r = 0.32, P < .001) and an association with anemia, hypoalbuminemia, and dyslipidemia. Receiver operating characteristic analysis demonstrated that SII had the highest area under the curve (0.673), and the combination of high SII and low albumin significantly increased the odds of elevated hs-CRP (OR = 6.50, 95% confidence interval: 1.73-24.39, P < .05). The median SII in HD patients was 498.22, and it showed a moderate correlation with hs-CRP. The high-inflammation group (hs-CRP ≥ 3 mg/L) showed a statistically significant association with hemoglobin, albumin, triglycerides, and HDL-C (P < .05). The combination of SII and albumin improved the identification of patients at high inflammatory risk. These findings suggest that SII and the SII-albumin combination may serve as practical surrogate markers of systemic inflammation in routine dialysis care.

PMID:42299587 | DOI:10.1097/MD.0000000000049213

Medicine (Baltimore). 2026 Jun 12;105(24):e48840. doi: 10.1097/MD.0000000000048840.

ABSTRACT

This study used a two-sample Mendelian randomization (MR) method to explore the potential causal relationship between air quality, cholelithiasis, and its related risk factor, blood lipids. This study used MR in European and East Asian groups, utilizing publicly available genome-wide association study data. The main method was inverse-variance weighting, with additional quality checks including weighted median, MR-Egger, simple, and weighted models. The Cochran Q test assessed heterogeneity. MR-Egger regression and MR-PRESSO checked for gene pleiotropy, with sensitivity tests using leave-one-out analysis. No statistically significant association was observed between air pollution and cholelithiasis in both European and East Asian populations for all pollutants analyzed, including PM2.5 (European: P = .745, East Asian: P = .209), PM2.5 to 10 (European: P = .737), PM10 (European: P = .258, East Asian: P = .977), nitrogen dioxide (European: P = .986, East Asian: P = .893), and nitrogen oxides (European: P = .902, East Asian: P = .843). However, significant correlations between air pollution and blood lipids were identified. In European populations, PM2.5 was significantly correlated with triglycerides (β = 0.428, odds ratio = 1.534, 95% confidence interval = 1.058-2.225; P = .024). In East Asian populations, PM2.5 showed a significant association with low-density lipoprotein (LDL) cholesterol (β = 0.050, odds ratio = 1.051, 95% confidence interval = 1.006-1.098; P = .026). Importantly, no evidence of heterogeneity or pleiotropy was detected in these associations, bolstering the credibility of our findings. Our study found no clear causal link between air pollution and cholelithiasis. However, we observed significant correlations between PM2.5 and triglycerides in Europeans, and between PM2.5 and LDL cholesterol in East Asians. These results suggest that PM2.5 might affect triglyceride and LDL cholesterol metabolism differently in various populations, potentially raising the risk of cholelithiasis indirectly.

PMID:42299586 | DOI:10.1097/MD.0000000000048840

Medicine (Baltimore). 2026 Jun 12;105(24):e49298. doi: 10.1097/MD.0000000000049298.

ABSTRACT

This study aimed to explore the diagnostic value of combining serologic indexes with the Gleason score (GS) in identifying prostate cancer bone metastasis. We included 108 patients diagnosed with prostate cancer at the Third Hospital of Mianyang from December 2019 to December 2021. Clinical data were collected, and patients were divided into 2 groups: 44 cases with prostate cancer bone metastasis and 64 cases without bone metastasis. We compared age, serum total prostate-specific antigen (TPSA), free prostate-specific antigen (FPSA), fibrinogen (FIB), alkaline phosphatase (ALP), serum albumin (ALB), and GS between the 2 groups. Logistic regression analysis was used to assess the correlation between serologic indexes and prostate cancer bone metastasis. The diagnostic value of combining multiple indexes versus single indexes was evaluated using receiver operating characteristic curves. The serum TPSA, FPSA, FIB, ALP and GS levels of patients in the prostate cancer bone metastasis group were higher than those of patients in the prostate cancer without bone metastasis group, while the ALB level in the bone metastasis group was lower than that in the non-bone metastasis group. The differences in each index were statistically significant when compared between the 2 groups (P < .05). The univariate logistic analysis revealed that TPSA (OR:0.984, P < .001), FPSA (OR:0.899, P < .001), ALP (OR:0.986, P < .05), and GS (OR:0.569, P < .05) were positively correlated with prostate cancer bone metastasis. Multivariate analysis showed that ALP (OR = 0.991, P < .05) was an independent risk factor for bone metastasis in prostate cancer after adjusting for Age, ALB, and FIB. The area under the receiver operating characteristic curve (AUC) of serum ALP and the combined assay were 0.738 and 0.792, respectively. Serum TPSA, FPSA, FIB, ALB, ALP and GS have significant diagnostic value in identifying prostate cancer bone metastasis. ALP is an independent risk factor for bone metastasis in prostate cancer. Combining these indicators can enhance diagnostic efficacy.

PMID:42299585 | DOI:10.1097/MD.0000000000049298

Medicine (Baltimore). 2026 Jun 12;105(24):e49296. doi: 10.1097/MD.0000000000049296.

ABSTRACT

Previous studies have confirmed that the ZJU index is effective in capturing trends in metabolic disorders and disease risk. However, no study has statistically analyzed the relationship between the ZJU Index and depression. This study included data from 16,008 participants sourced from the National Health and Nutrition Examination Survey 2005-2018. Weighted multivariable logistic regression and generalized additive models were used to explore the independent and nonlinear relationships between the ZJU index and depression. A 2-piece linear regression model was used to estimate threshold effects, along with subgroup analyses and interaction tests. To account for multiple testing in subgroup analyses, P values for interaction were additionally adjusted using the Benjamini-Hochberg false discovery rate procedure. A total of 16,008 participants were included, with 7.42% classified as having depression. The prevalence of depression initially decreased and then increased across the ZJU index quartiles (Q1: 6.35%; Q2: 5.38%; Q3: 6.83%; Q4: 11.32%; P < .0001). Both unadjusted and adjusted models demonstrated that higher ZJU index levels were associated with increased depression risk. In Model III, each unit increase in the ZJU index was associated with a 1.4% higher likelihood of depression (Model III: odds ratio (OR) = 1.014, 95% confidence interval (CI): 1.006, 1.022). Curve fitting indicated a J-shaped association between the ZJU index and depression, with a breakpoint (K) of 35.386. To the left of this breakpoint, the ZJU index showed a negative association with depression (OR = 0.948, 95% CI: 0.917-0.980), while to the right, a positive association was observed (OR = 1.022, 95% CI: 1.013-1.032). Subgroup analyses and interaction tests revealed that the association between the ZJU index and depression was dependent on drinking status and diabetes presence (P < .05). Among individuals who consumed alcohol or had diabetes, a positive association between the ZJU index and depression was observed, whereas no significant association was found among nondrinkers or those without diabetes, where the ZJU index and depression showed a nonlinear relationship. There is a J-shaped association between the ZJU index and depression, suggesting that a higher ZJU index may be linked to an increased risk of depression.

PMID:42299580 | DOI:10.1097/MD.0000000000049296