Tag: nevin manimala

BMC Neurol. 2026 May 15. doi: 10.1186/s12883-026-04961-y. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple Sclerosis (MS) is a chronic neurological disorder affecting 2.8 million individuals worldwide, characterized by motor dysfunction and cognitive impairment that remain poorly addressed by pharmacological interventions alone. Transcranial Direct Current Stimulation (tDCS) has emerged as a promising non-invasive neuromodulation technique for symptom management in MS patients.

OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the efficacy of tDCS in improving motor and cognitive functions in patients with MS, and to assess its safety profile.

METHODS: A comprehensive literature search was conducted across PubMed, Scopus, EMBASE, Wiley Online Library, and Google Scholar databases. Studies were selected based on PICOS criteria, including randomized controlled trials and quasi-experimental studies involving adults (≥ 18 years) with all types of MS receiving tDCS interventions. Methodological quality was assessed using RoB 2.0 and ROBINS-I. Meta-analyses were performed using RevMan 5.4.1 with random-effects models for outcomes with substantial heterogeneity and fixed-effects models where I² = 0%. Additionally, the protocol was prospectively registered with the Open Science Framework.

RESULTS: Twenty-two studies published between 2015 and 2025 were included in this review. Meta-analysis revealed that tDCS significantly improved information processing speed (SDMT: MD = 7.71, 95% CI: 1.60-13.82, p = 0.01) and functional mobility (TUG: MD = -1.03 s, 95% CI: -2.08-0.02, p = 0.05). While individual studies showed improvements in gait speed and balance, pooled analyses for these outcomes did not reach statistical significance (gait speed: MD = 0.16 m/s, 95% CI: -0.07-0.38, p = 0.18; Berg Balance Scale: MD = 1.18, 95% CI: -2.03-4.39, p = 0.47). Qualitative analysis revealed consistent improvements in manual dexterity, working memory, executive function, and complex attention. Additionally, no serious adverse events were reported across studies; mild and transient side effects (e.g., tingling, itching) were noted, and completion rates were high (98% in studies that reported them).

CONCLUSION: This systematic review provides preliminary evidence supporting tDCS as a potentially beneficial adjunctive intervention for MS patients, particularly for cognitive processing speed enhancement based on two small studies. While individual studies reported motor improvements, pooled meta-analyses for gait speed and balance failed to demonstrate statistical significance, indicating insufficient evidence for definitive motor benefits despite positive signals in individual trials. The substantial limitation of small study numbers per meta-analysis (2-6 studies), combined with limited MS subtype-specific data in most studies, significantly constrains confidence in these findings and limits assessment of external validity across different MS populations. Larger, standardized, multi-center randomized controlled trials with adequate subgroup representation and extended follow-up periods are essential to establish clinical significance and treatment durability.

PMID:42141416 | DOI:10.1186/s12883-026-04961-y

BMC Oral Health. 2026 May 15. doi: 10.1186/s12903-026-08518-w. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to assess the impact of silver and titanium dioxide nano-coatings on stainless steel and nickel titanium arch wires concerning friction, surface roughness and the release of nickel, silver, and titanium ions.

METHODS: A total of 168 arch wires measuring 17.8 cm in length were divided into two groups based on the type of the orthodontic arch wire material: 84 stainless steel (SS) wires and 84 nickel titanium (NiTi) wires. Each group of these wire materials was evenly divided into three subgroups according to the nano coating material: non-coated group (control), titanium dioxide nanoparticles (TiO₂NPs) and silver nanoparticles (Ag-NPs). Static friction on a specially designed acrylic plate was measured using a universal testing machine. Surface roughness data was then gathered using a profilometer machine, and inductively coupled plasma-optical emission spectroscopy (ICP-OES) was used to determine the ion release of Ni, Ag and Ti ions. The collected data were compared using a two-way ANOVA and the Bonferroni test for repeated pairwise comparisons. In the ion release test all samples had been incubated in 10 milliliters of artificial saliva and the data was collected at intervals of after 48 h, one week and two weeks, respectively. Then compared using a three-way mixed ANOVA.

RESULTS: The nano-coating effect on arch wires static frictional resistance was statistically significantly higher in the nanocoated wires especially in nanocoated SS arch wires (p < .001). The surface roughness of both arch wires is significantly impacted by the nanocoating as it became lower in nanocoated arch wires especially Ag-NPs coated SS arch wires (p < .001). Ni ion release significantly decreased in SS arch wires coated with TiO₂NPs in comparison to SS wires coated with Ag-NPs and to NiTi arch wires coated with Ag-NPs and TiO₂NPs (p < .001).

CONCLUSIONS: Ag-NPs and TiO₂NPs coatings are suitable for decreasing static friction in arch wires and improving surface roughness. Nano coating can improve surface roughness, static friction resistance especially for SS arch wires. Ion release of Ag and Ti ions in NiTi and SS coated arch wires is in safety concerns associated with nanoparticle dimensions. Ni ion release decreased in nano-coatings so, nano-coatings slightly improved the corrosion resistance especially in SS arch wires coated with TiO₂NPs.

PMID:42141410 | DOI:10.1186/s12903-026-08518-w

BMC Pregnancy Childbirth. 2026 May 15. doi: 10.1186/s12884-026-09214-x. Online ahead of print.

ABSTRACT

BACKGROUND: Placenta accreta spectrum (PAS) is a severe obstetric condition associated with substantial maternal and neonatal morbidity. This study aimed to evaluate a five-year experience of PAS management in a tertiary referral center and compare outcomes with those from a preceding five-year period.

METHOD: this retrospective cohort study was conducted at hospitals affiliated with Shiraz University of Medical Sciences, a tertiary referral center in southern Iran. Pregnant women diagnosed with PAS between January 2020 and December 2024, compared with a historical cohort from January 2015 to December 2019. Clinical and operative data of PAS cases were reviewed. Maternal morbidity and mortality were defined as primary outcomes, while operative characteristics, intraoperative complications, and neonatal outcomes were secondary outcomes. Statistical analyses were performed using SPSS software, with Mann-Whitney and Chi-square tests applied for inter-period comparisons. Maternal morbidity and mortality, operative blood loss, intraoperative complications, gestational age at diagnosis and delivery, and neonatal outcomes were assessed.

RESULTS: Of 325 PAS cases, 300 women underwent hysterectomy and were included in the analysis. The mean gestational age at operation was 31.16 ± 6.16 weeks, and 97% had a prior cesarean section. PAS was diagnosed before 14 weeks in 5%, between 14 and 28 weeks in 41%, and after 28 weeks in 54% of cases. Emergency surgery was required in 18.3%. Mean intraoperative blood loss was 2119.76 ± 1612.93 mL and was significantly higher in placenta percreta (p < 0.001). Bladder injury occurred in 23%, and 79% required packed cell transfusion. Neonatal survival was 83.7%, with 74.7% admitted to the NICU. Compared with the earlier cohort, gestational age at diagnosis was significantly earlier, hospital stay was shorter, and fifth-minute Apgar scores were higher (all p < 0.001).

CONCLUSIONS: Enhanced prenatal diagnosis and multidisciplinary management have improved maternal and neonatal outcomes in PAS over recent years.

PMID:42141408 | DOI:10.1186/s12884-026-09214-x

BMC Cardiovasc Disord. 2026 May 16. doi: 10.1186/s12872-026-05931-5. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have become an important therapeutic option for patients with dyslipidemia. Evolocumab and alirocumab are monoclonal antibodies targeting circulating PCSK9, whereas inclisiran is a small interfering RNA (siRNA) agent that suppresses hepatic PCSK9 synthesis and requires only twice-yearly dosing. Although these agents are proven effective in clinical trials, direct real-world comparative evidence on lipid-lowering efficacy, apolipoprotein B (apoB) reduction, safety, and adherence remains limited.

METHODS: This was a real-world, retrospective study conducted at a single center. A total of 198 patients were consecutively enrolled and assigned to three groups (n = 66 per group): inclisiran, evolocumab, or alirocumab. Baseline characteristics, including age, sex, and familial hypercholesterolemia (FH) status (assessed by DLCN criteria), were well-balanced across cohorts. All lipid parameters were analyzed using standardized automated biochemical analyzers at a centralized laboratory to ensure measurement consistency.

RESULTS: At 180 days, all three agents achieved robust and significant reductions in LDL-C from baseline (p < 0.001), with no significant differences observed between the groups. Notably, inclisiran demonstrated a numerical advantage in the reduction of apolipoprotein B (apoB) compared with evolocumab and alirocumab at 180 days (0.650 g/Lvs.0.774 g/L and 0.752 g/L, respectively), although these between-group differences did not reach formal statistical significance (p > 0.05). Treatment persistence was highest in the inclisiran group (69.7%), followed by evolocumab (56.1%) and alirocumab (50.0%). All therapies were well-tolerated with no new safety signals.

CONCLUSIONS: In this real-world study, Inclisiran, evolocumab, and alirocumab are all highly effective in lowering LDL-C in a real-world setting. Inclisiran may offer additional clinical value through superior treatment persistence and a favorable numerical trend toward enhanced apoB suppression.

PMID:42141407 | DOI:10.1186/s12872-026-05931-5

BMC Cardiovasc Disord. 2026 May 15. doi: 10.1186/s12872-026-05968-6. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiovascular diseases (CVD) continue to be the leading cause of global mortality. Despite the alarming statistics, effective prevention of CVD remains a significant challenge in practice. The available risk stratification tools have critical limitations in the early detection of CVD. To address these gaps, it is crucial to integrate additional risk detection methods for more accurate identification of at-risk patients.

OBJECTIVES: This article addresses the limitations of conventional CVD risk factors and emphasizes the need for individualized risk evaluation. Additionally, it evaluates the role of imaging techniques in the early detection of CVD and the personalized use of aspirin therapy when subclinical atherosclerosis becomes advanced.

METHODS: This article is based on an expert literature review and reflects the outcomes of a medical advisory board meeting that was held in the Middle East (ME) region. A multidisciplinary group of experts discussed the “cardiac risk continuum” concept and the importance of advanced subclinical atherosclerosis detection beyond traditional binary CVD classification. Experts evaluated the clinical feasibility of utilizing carotid ultrasound and coronary artery calcium (CAC) scoring, and assessed the role of aspirin in primary prevention for at-risk patients.

RESULTS: The need for tailored risk assessment strategies and individualized preventive measures was highlighted. The experts agreed on the practical use of CAC scoring and/or carotid ultrasound to identify at-risk patients and quantify subclinical atherosclerosis. Data suggest that aspirin estimated benefit increases proportionally with atherosclerosis burden and becomes a net-positive at CAC > 100 or carotid plaque score above 2.

CONCLUSIONS: The experts emphasized the importance of individualized screening strategies tailored to the Middle Eastern population, considering the challenges and resource limitations in the region. They recommended selective use of CAC and carotid ultrasound to improve risk stratification and to guide a more personalized approach to managing CVD. The experts stressed the need for standardized protocols, healthcare providers’ education, and infrastructure development to ensure the effective implementation of these approaches.

PMID:42141396 | DOI:10.1186/s12872-026-05968-6

BMC Geriatr. 2026 May 15. doi: 10.1186/s12877-026-07616-2. Online ahead of print.

ABSTRACT

BACKGROUND: Caregivers of individuals with vascular dementia (VaD) face various physical and psychological burdens in their daily caregiving responsibilities. This role is challenging, demanding, and often stressful due to the symptoms characteristic of this condition. The aim of this study was to assess the level of burden experienced by caregivers of individuals diagnosed with vascular dementia.

METHODS: The study included a total of 351 participants. The research was conducted anonymously and voluntarily among informal caregivers of individuals with dementia. A survey questionnaire and the Caregiver Burden Scale (CB Scale) were employed. Statistical analysis was conducted using the χ² independence test, t-test for independent samples, Mann-Whitney test, Kruskal-Wallis test, Spearman’s rank correlation coefficient, Wilcoxon signed-rank test, and Kolmogorov-Smirnov test.

RESULTS: High caregiving burden was most commonly observed in the domains of General Burden (63.2%), Disappointment (59.8%), and Social Isolation (58.1%). A significantly lower percentage of caregivers reported high burden levels in the domains of Environmental Factors (36.8%) and Emotional Engagement (34.2%).

CONCLUSIONS: Our study demonstrates that caregivers of individuals with VaD experience particularly high levels of overall burden, social isolation, and a sense of disappointment. The findings highlight the need for early interventions focused on psychosocial support, as well as preventive programs aimed at reducing caregiver strain. In the broader perspective, these results may serve as a starting point for developing comprehensive models of home care and public health targeted at caregivers of individuals with VaD.

PMID:42141395 | DOI:10.1186/s12877-026-07616-2

BMC Infect Dis. 2026 May 15. doi: 10.1186/s12879-026-13582-2. Online ahead of print.

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19), first identified in Wuhan, China, in December 2019, rapidly evolved into a global pandemic with substantial morbidity and mortality. Severe COVID-19 cases, particularly those with pneumonia requiring intensive care unit (ICU) admission, posed significant challenges for healthcare systems. This study aimed to evaluate and compare healthcare-associated infections (HAIs) developing in the ICU during the pre-pandemic and pandemic periods.

METHODS: This retrospective observational study was conducted at Sakarya Yenikent State Hospital, a secondary-care hospital with 50 ICU beds. Active surveillance data collected by the infection control team were analyzed for two periods: pre-pandemic (May 2018-February 2020) and pandemic (March 2020-December 2021). The number of ICU patients, patient-days, HAI rates, causative microorganisms, antimicrobial resistance patterns, and mortality rates were compared between periods. Statistical analyses were performed using Epi Info™ version 7.2.5.0, with p < 0.05 considered statistically significant.

RESULTS: A total of 1,840 patients (16,572 patient-days) in the pre-pandemic period and 2,119 patients (12,460 patient-days) in the pandemic period were followed. Mortality significantly increased during the pandemic period compared to the pre-pandemic period (40.96% vs. 24.94%, p = 0.00001). Although the overall HAI rate did not differ significantly between periods (3.26% vs. 2.73%, p = 0.333), Although the overall HAI rate did not differ significantly between periods (3.26% vs. 2.73%, p = 0.333), HAI density was higher during the pandemic. Notably, Acinetobacter baumannii-related HAIs increased significantly during the pandemic period (58.89% vs. 35.00%, p = 0.016), while distributions of other pathogens remained similar. Antimicrobial resistance patterns were more pronounced during the pandemic period.

CONCLUSION: Despite similar HAIs rates, in-hospital mortality increased during the pandemic. This was accompanied by higher disease severity, reflected by increased cardiopulmonary resuscitation rates, and a shift toward Acinetobacter baumannii infections. Although mortality was high among COVID-19-positive patients, COVID-19 status was not an independent predictor. Overall, worse outcomes during the pandemic were associated with increased disease severity and pathogen distribution rather than changes in HAI incidence.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42141392 | DOI:10.1186/s12879-026-13582-2

BMC Med Imaging. 2026 May 15. doi: 10.1186/s12880-026-02413-0. Online ahead of print.

ABSTRACT

OBJECTIVE: The cartilaginous endplate (CEP) exhibits an intrinsically short [Formula: see text] model based on ultrashort echo time (UTE) sequence, and to explore the diagnostic utility of bi-exponential [Formula: see text]-derived parameters and monoexponential UTE-[Formula: see text] mapping values in grading CEP damage. METHODS: This study retrospectively collected 46 patients who underwent lumber UTE MRI, of whom 43 met the inclusion criteria. CEP was graded into three groups according to morphological features on multiple MRI sequences: healthy (structurally intact), mild damage (localized thinning or concavity with preserved continuity), and moderately damage (defects < 50% with disrupted continuity). Multiple quantities were evaluated using the UTE sequence on the CEP manually drawn by an experienced radiologist. One-way Kruskal-Wallis test was used to inspect the distribution differences among groups. Logistic regression and support vector machine models were applied to predict the level of degeneration with a considerably good precision, and receiver operating characteristic curves suggests a distinguishable performance among those models.

RESULTS: [Formula: see text] values showed significant differences among the groups (p < 0.05), with Tukey’s test indicating the most significant difference between the moderately damaged group and the healthy controls. [Formula: see text] values were non-normally distributed but statistically different between the moderate and mild damage groups (p < 0.05), a trend also observed in monoexponential UTE-[Formula: see text] mapping values (p < 0.05). The logistic regression and SVM models performed well in identifying moderate damage (AUC of 0.878 and 0.858, respectively), but had limited ability to detect mild damage (AUC of 0.718 and 0.729). CONCLUSION: The UTE bi-exponential [Formula: see text] model enable effective separation and quantification of distinct water components within the CEP. Both [Formula: see text] and UTE-[Formula: see text] mapping show promise as imaging biomarkers for grading CEP degeneration even in the early stage of CEP degeneration.

PMID:42141391 | DOI:10.1186/s12880-026-02413-0

BMC Musculoskelet Disord. 2026 May 16. doi: 10.1186/s12891-026-09965-w. Online ahead of print.

ABSTRACT

BACKGROUND: Charcot neuroarthropathy (CN) is a debilitating joint disorder that predominantly affects patients with neuropathy, particularly those with diabetic peripheral neuropathy (DPN). CN causes painless, rapid joint destruction and often leads to foot deformity, ulceration, osteomyelitis, and, in severe cases, amputation. Its pathogenesis involves repetitive microtrauma due to loss of protective sensation, triggering an inflammatory cascade that activates osteoclasts (OCs) disproportionately relative to osteoblasts (OBs) via the RANKL-RANK-OPG pathway, resulting in progressive bone loss and joint destruction. This systematic review and meta-analysis evaluated the efficacy of anti-resorptive agents in promoting bone remodeling and alleviating clinical symptoms in patients with active or stable CN.

METHODS: Following Cochrane Collaboration guidelines, we searched MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) comparing anti-resorptive agents, such as bisphosphonates, denosumab, calcitonin, and parathyroid hormone analogues, with placebo or no treatment in patients with Charcot neuroarthropathy. Two independent reviewers performed data extraction and risk-of-bias assessment using the Cochrane RoB 2 tool. Primary outcomes were bone mineral density (BMD), bone turnover markers (BTMs), time to remission, change in foot temperature, and adverse events. Statistical analyses were conducted using Stata 18, with random-effects models used to pool results.

RESULTS: We identified 936 records and nine reports describing seven RCTs met the inclusion criteria. The meta-analysis showed no significant difference in BMD between anti-resorptive agents and control groups. However, anti-resorptive therapy significantly reduced bone resorption markers. Clinical outcomes, including foot temperature change and time to remission, did not differ significantly between groups. Adverse events were similar between the intervention and control groups.

CONCLUSIONS: Although anti-resorptive agents reduce bone resorption markers in patients with Charcot neuroarthropathy, current evidence does not support their efficacy in improving BMD or providing clinically meaningful symptom relief beyond standard offloading. High-quality clinical trials and mechanistic studies are needed to define the role of these agents in CN management.

PMID:42141385 | DOI:10.1186/s12891-026-09965-w

J Racial Ethn Health Disparities. 2026 May 15. doi: 10.1007/s40615-026-03005-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Social Determinants of Health (SDoH) profoundly influence cancer outcomes, yet their distribution among racially diverse gastrointestinal (GI) cancer patients remains understudied. This study examines racial differences in SDoH between non-Hispanic White (NHW) and Non-White (including Asian, African American, and Hispanic) patients with gastrointestinal (GI) cancers using data from the All of Us Research Program.

METHODS: A total of 6,620 participants with GI cancer were identified using ICD-10 and SNOMED codes, of whom 1,831 completed the SDoH survey and were included in the analysis. Descriptive statistics summarized SDoH constructs such as social cohesion, support, and neighborhood disorder. Variables were categorized using validated scoring tools or grouped into tertiles. Group comparisons used chi-square, t-tests, or Wilcoxon rank-sum tests.

RESULTS: Among the 1,831 participants included in the overall cohort, 80.7% (n = 1,478) identified as non-Hispanic White and 13.9% (n = 255) as Non-White, including Black or African American (6.2%), Hispanic or Latino (6.4%), and Asian (1.4%). NHW participants were older (71.0 vs. 64.2 years) and reported greater social cohesion (3.9 vs. 3.6, p < 0.001) and support (3.9 vs. 3.7, p < 0.001). Non-White patients reported higher perceived discrimination (1.7 vs. 1.5, p = 0.016), daily spiritual experience (4.5 vs. 3.7, p < 0.001), neighborhood disorder (2.2 vs. 2.1, p < 0.001), food insecurity (23.6% vs. 5.8%, p < 0.001), and housing issues (41.8% vs. 21.8%, p < 0.001). Delayed care (47.1% vs. 26.8%, p < 0.001) and unaffordability of care (9.9% vs. 3.4%, p < 0.001) were also more common.

CONCLUSION: Significant racial disparities in SDoH were observed among GI cancer patients. Non-White individuals faced greater economic hardship, environmental disadvantage, and barriers to healthcare access.

KEY MESSAGES: WHAT IS KNOWN ON THIS TOPIC: Racial disparities in gastrointestinal cancer outcomes persist, but the social and structural factors underlying these differences are not routinely captured in oncology research. Many cancer datasets emphasize clinical characteristics while underrepresenting patient-reported social, economic, and neighborhood conditions. Addressing social determinants of health is increasingly recognized as necessary to advance equity in cancer care delivery.

WHAT THIS STUDY ADDS: This study provides a comprehensive, patient-reported assessment of social determinants of health among GI cancer patients in the All of Us Research Program. Non-White patients experience a higher burden of economic instability, neighborhood disadvantage, perceived stress,and barriers to accessing healthcare services. These findings identify concrete social risk domains that can inform equity-focused screening, care navigation, and policy interventions within oncology practice.

PMID:42141357 | DOI:10.1007/s40615-026-03005-y