Tag: nevin manimala

BMC Neurol. 2026 May 25. doi: 10.1186/s12883-026-05010-4. Online ahead of print.

ABSTRACT

BACKGROUND: Intracerebral hemorrhage (ICH) is associated with poor prognosis, characterized by high acute mortality and long-term disability. Real-time risk stratification using dynamic biomarkers is urgently needed to improve patient outcomes. This study aimed to explore the association between temporal changes in the hemoglobin-to-red blood cell distribution width ratio (HRR) and in-hospital all-cause mortality in patients with ICH.

METHODS: We retrospectively analyzed 2,447 ICH patients from MIMIC-IV and externally validated findings in 3,142 patients from eICU. Cox regression analyzed the association between HRR (baseline and daily dynamic values) and in-hospital mortality. Restricted cubic spline (RCS) models assessed the non-linear relationship between baseline HRR and in-hospital mortality. An optimal baseline HRR cutoff for risk stratification was identified using the maximally selected log-rank statistic and subsequently externally validated. Pearson correlation analysis was applied to evaluate associations between daily HRR and in-hospital mortality, and receiver operating characteristic (ROC) curves were used to examine the time-specific predictive performance of serial HRR values.

RESULTS: HRR exhibited a consistent inverse association with in-hospital all-cause mortality in both cohorts. In fully adjusted Cox models, continuous baseline HRR was associated with lower mortality risk (HR approximately 0.51 in both cohorts), and the highest HRR quartile was associated with a reduced mortality risk compared with the lowest quartile. Both survivors and non-survivors showed progressive HRR declines during 14-day hospitalization. Non-survivors had more pronounced declines (daily reduction approximately 0.017 vs. 0.014 in MIMIC-IV; P for trend difference < 0.001) and consistently lower HRR levels at all time points. Daily HRR was inversely correlated with mortality throughout hospitalization (adjusted HRs < 1.0, P < 0.05), with the strength of this inverse association increasing notably from Day 1 (r = -0.141) to Day 4 (r = -0.225). HRR demonstrated predictive performance comparable to Hb and RDW across time points. In the MIMIC-IV test set, all indicators presented a temporal upward trend within the initial few days, with AUCs reaching 0.631 (HRR), 0.594 (Hb) and 0.630 (RDW) at Day 1, and 0.663, 0.632 and 0.645 at Day 3, respectively. Calibration curves revealed poor predictive performance with overestimation of mortality risk. A baseline HRR cutoff of ≤ 0.74 identified high-risk patients, who had significantly higher mortality (25.14% vs. 12.93% in MIMIC-IV; 17.64% vs. 12.72% in eICU, all P < 0.001).

CONCLUSIONS: This study preliminarily suggests that temporal changes in HRR are associated with in-hospital all-cause mortality in ICH patients. HRR may serve as a complementary dynamic prognostic marker with predictive performance comparable to Hb and RDW, though its utility is limited by poor calibration. Further prospective validation in dedicated ICH cohorts with severity and imaging data is warranted, and future studies should consider underlying diseases and inflammatory status.

PMID:42178542 | DOI:10.1186/s12883-026-05010-4

BMC Pregnancy Childbirth. 2026 May 25. doi: 10.1186/s12884-026-09333-5. Online ahead of print.

ABSTRACT

BACKGROUND: The placenta and umbilical cord play a crucial role in fetal growth, development, and neonatal survival. Although extensively studied in developed countries, quantitative data on placental and umbilical cord morphology in preeclampsia are scarce in Ghana. This study aimed to assess the gross morphometry of preeclamptic placentae and umbilical cords and their relationship with neonatal indices.

METHOD: A cross-sectional study was conducted on 152 freshly delivered placentae (100 normotensive; 52 preeclamptic) at the Holy Family Hospital, Berekum, Ghana. Maternal data collected included age, parity, blood pressure, and occupation. Standard anthropometric techniques were used for placental and umbilical cord measurements after they were fixed with 10% neutral buffered formalin. Statistical analyses included t-test, Chi-square, and Spearman correlation, with significance set at p < 0.05.

RESULTS: Placental and umbilical cord indices differed significantly between preeclamptic and normotensive groups, except for cord length. Moderate to strong correlations were observed between placental and cord indices and neonatal outcomes, but not with neonatal length. Placentae were more often oval, and cords were eccentrically inserted in preeclamptic births compared to normotensive births.

CONCLUSIONS: Preeclampsia is associated with altered placental and umbilical cord morphology and reduced neonatal growth indices. These findings provide baseline data to support multidisciplinary strategies for improved management and pregnancy outcomes in Ghana.

PMID:42178540 | DOI:10.1186/s12884-026-09333-5

BMC Med Educ. 2026 May 25. doi: 10.1186/s12909-026-09437-8. Online ahead of print.

ABSTRACT

BACKGROUND: The dental pulp is a vital tissue integral to tooth vitality and endodontic health. However, awareness and comprehension of pulpal functions among preclinical dental students remain inadequately characterized. Understanding baseline knowledge and attitudes in early dental education can inform pedagogical improvements in oral histology and foundational endodontic instruction. The study evaluates the awareness, knowledge, attitudes, and learning practices related to dental pulp and its functions among preclinical undergraduate dental students.

METHODS: A descriptive cross-sectional study was conducted among 225 preclinical (first and second-year) undergraduate dental students from multiple dental institutions. A validated 20-item structured questionnaire comprising four sections; demographics, knowledge assessment with 6 multiple-choice items, attitude evaluation using 5-point Likert scale with 6 items, and learning practice assessment with 5 items was administered via Google Forms. Data were analyzed using descriptive statistics, frequency distributions, percentages, and comparative analysis between academic years using chi-square and independent t-tests.

RESULTS: Second-year students demonstrated significantly higher knowledge accuracy (61.8%) compared to first-year students (38.2%, p < 0.05). The majority of students (92.4%) correctly identified mastication as a non-function of pulp, and 67.6% recognized A-delta fibers as responsible for sharp, localized pain. However, knowledge gaps were identified: 29.3% of students incorrectly attributed odontoblast function to enamel formation, and only 61.9% understood the physiological constraints limiting pulpal healing capacity. Attitude assessment revealed strong positive perception (mean Likert scores 3.16-4.37), with highest endorsement for understanding pulp structure (4.37) and learning pulp for endodontics (4.25). Exam-driven learning behavior was predominant (57.3%), while visual learning modalities were preferred (33.3% favored videos/3D models and 32.9% preferred textbook reading).

CONCLUSIONS: While preclinical students demonstrate commendable foundational understanding of pulpal anatomy and core functions, specific knowledge gaps and exam-centric learning patterns point the need for enhanced pedagogical approaches. Integration of visual aids, clinically relevant case-based learning, active learning modalities, and structured early clinical correlation could strengthen conceptual understanding and foster deeper engagement with pulp biology, ultimately enhancing preparedness for clinical endodontic practice.

PMID:42178531 | DOI:10.1186/s12909-026-09437-8

BMC Cardiovasc Disord. 2026 May 25. doi: 10.1186/s12872-026-06026-x. Online ahead of print.

ABSTRACT

BACKGROUND: There is a limited body of research examining the association between long COVID and major adverse cardiovascular events (MACE) as well as all-cause mortality. This study aimed to investigate the association between long COVID and both MACE and mortality.

METHODS: This retrospective cohort study utilized multicenter real-world data from the TriNetX research network platform, which contains electronic health records from multiple healthcare organizations. Patients aged 18 years and older who were diagnosed with COVID-19 between 2020 and 2023 were included. The exposure group comprised individuals diagnosed with long-COVID within 3 to 6 months after their initial COVID-19 diagnosis, while the comparison group included COVID-19 patients without a diagnosis of long-COVID. The primary outcomes were the risk of major adverse cardiovascular events (MACE) and all-cause mortality. Follow-up commenced 90 days after the index date and continued until the occurrence of the study outcome or the date of the last available medical record.

RESULTS: The risk of MACE was markedly higher in the long-COVID cohort compared to the non-long-COVID cohort. The overall hazard ratio (HR) for MACE was 4.48 (95% CI: 3.95-5.07). Specific conditions such as coronary artery disease and stroke exhibited particularly high HRs, at 6.48 (5.29-7.95) and 3.46 (2.96-4.04) respectively. Mortality was significantly higher in the long-COVID group, with an HR of 1.53 (1.38-1.69).

CONCLUSIONS: Compared to patients without long COVID, patients with long COVID had a higher risk of developing MACE.

PMID:42178526 | DOI:10.1186/s12872-026-06026-x

BMC Cardiovasc Disord. 2026 May 25. doi: 10.1186/s12872-026-06001-6. Online ahead of print.

ABSTRACT

BACKGROUND: Recurrence after first radiofrequency catheter ablation remains common in patients with non-valvular persistent atrial fibrillation. Cardiovascular-kidney-metabolic burden may contribute to atrial remodeling and adverse ablation outcomes, but its relationship with post-ablation recurrence and downstream atrial substrate markers remains incompletely understood.

METHODS: We retrospectively enrolled 730 patients with non-valvular persistent atrial fibrillation who underwent first-time radiofrequency catheter ablation. Cardiac, kidney, and metabolic domains were integrated into a weighted cardiovascular-kidney-metabolic burden score, and patients were stratified by tertiles. Sequential Cox regression models were constructed to evaluate the association between burden and recurrence after adjustment for clinical characteristics and downstream atrial substrate markers, including left atrial diameter, log(BNP), and fine f-wave. Model discrimination was assessed using Harrell’s C-index and time-dependent receiver operating characteristic analysis.

RESULTS: During follow-up, 228 patients (31.2%) developed recurrence. Compared with the low-burden tertile, intermediate- and high-burden tertiles were associated with a significantly higher risk of recurrence in the primary adjusted model (intermediate vs. low: HR = 1.49, 95% CI 1.05-2.11; high vs. low: HR = 1.60, 95% CI 1.13-2.27). Further adjustment for left atrial diameter, log(BNP), and fine f-wave attenuated these associations, suggesting partial statistical overlap between upstream multisystem burden and downstream atrial substrate abnormalities. In continuous analyses, each 1-standard deviation increase in weighted burden remained associated with recurrence risk. Addition of substrate markers improved model discrimination.

CONCLUSION: Higher cardiovascular-kidney-metabolic burden was associated with recurrence after first ablation in patients with non-valvular persistent atrial fibrillation, suggesting partial statistical overlap between upstream multisystem burden and downstream atrial substrate abnormalities.

PMID:42178525 | DOI:10.1186/s12872-026-06001-6

BMC Gastroenterol. 2026 May 25. doi: 10.1186/s12876-026-04917-z. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the decreasing incidence of gastric cancer in the United States, cancers of the stomach remain one of the leading causes of cancer related death in globally. Most patients are asymptomatic and have advanced disease when diagnosed. Studies have shown similar prognosis for proximal and distal tumors, although most studies exclude lesions in the cardia given overlap with esophageal cancers. Distal tumors involving the pylorus often leads to symptoms, such as gastric outlet obstruction presenting with nausea and emesis, which may lead to earlier diagnosis; therefore, we compared the adjusted survival with gastric adenocarcinomas based on location.

METHODS: Using SEER*Stat software, we performed a retrospective cohort study by extracting U.S. survival data from the Surveillance, Epidemiology and End Results Database for all gastric adenocarcinomas based on location (antrum, body, fundus, pylorus) for the period between 1975 and 2016 for individuals aged > 30 years of age. Survival was compared by calculating relative hazard ratios (HRs) for cancer-specific death in the 5-year period following diagnosis with Cox proportional hazards models, adjusted for covariates, with significance set at p < 0.05. Data were analyzed using SAS 9.4 software and R.

RESULTS: Survival analysis included 31,158 patients and showed no survival benefit comparing adenocarcinomas of the pylorus with those in the antrum (HR 1.02, 95% CI 0.97-1.07), body (HR 1.03, 95% CI 0.97-1.09). However, lower survival was seen for those in the fundus (HR 1.19, 95% CI 1.12-1.27). Male sex (HR 1.13, 95% CI 1.10-1.27), older age (HR 1.26, 95% CI 1.21-1.30), lack of chemotherapy (HR 1.06, 95% CI 1.02-1.10) and absence of surgery (HR 1.45, 95% CI 1.38-1.53) were associated with higher mortality. There were also statistically significant differences across higher stage and grade tumors, racial groups, and marital status.

CONCLUSONS: Despite early presentation of symptoms, our study corroborated data suggesting no difference in prognosis between pyloric gastric adenocarcinomas and proximal tumors, except those in the fundus. While involvement of the pylorus often leads to clear clinical manifestations including weight loss, early satiety, nausea, and emesis, earlier identification of malignancy compared to adenocarcinomas in more indolent locations does not necessarily improve survival outcomes.

PMID:42178521 | DOI:10.1186/s12876-026-04917-z

BMC Microbiol. 2026 May 25. doi: 10.1186/s12866-026-05200-7. Online ahead of print.

ABSTRACT

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are major healthcare-associated infections driven by indwelling devices that facilitate microbial adhesion. This study investigated the distribution of uropathogens in paired urine and catheter samples and evaluated the associations between extended-spectrum beta-lactamase (ESBL) production and clinical factors.

METHODS: A total of 100 paired urine and catheter samples (n = 100 per sample type) were analyzed using a convenience sampling approach. Clinical criteria for CAUTI diagnosis followed standardized protocols. Statistical significance was set at p < 0.05; however, a formal power calculation was not performed.

RESULTS: Catheter-derived specimens demonstrated a higher bacterial yield compared to urine samples Klebsiella spp and Escherichia coli were the predominant isolates. Opportunistic pathogens like Pseudomonas spp were primarily recovered from catheter surfaces. ESBL production was higher among catheter isolates (42/88 isolates; 47.72%) compared to urine isolates (13/51 isolates; 25.4%). A significant association was observed between catheter-derived isolates and ESBL positivity (OR = 2.66, 95% CI: 1.25-5.67, p < 0.05). Advanced age, prolonged catheterization, and chronic diseases were associated with increased bacterial growth; however, these correlations are unadjusted and may be influenced by confounding factors.

CONCLUSION: Urinary catheters serve as reservoirs for MDR uropathogens. While associations were found between device duration and resistance, the use of convenience sampling limits the generalizability of these findings.

PMID:42178517 | DOI:10.1186/s12866-026-05200-7

BMC Prim Care. 2026 May 25. doi: 10.1186/s12875-026-03399-y. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to evaluate the hemoglobin, albumin, lymphocyte, and platelet (HALP) score as an exploratory adjunctive marker associated with reduced bone density, particularly in resource-limited settings.

METHODS: This cross-sectional study was conducted between October 2022 and October 2023 at the Physical Therapy and Rehabilitation Hospital in Trabzon, Türkiye. This study included 267 patients who had not been previously diagnosed with osteopenia or osteoporosis and had undergone a dual-energy X-ray absorptiometry (DEXA) scan within the previous year. The participants were categorized into the normal, osteopenic, and osteoporotic groups according to their DEXA results. Statistical analysis included receiver operating characteristic (ROC) curve assessment, sensitivity and specificity calculations, and multiple logistic regression analysis to evaluate the discriminative performance of the HALP score and its adjusted association with reduced bone density.

RESULTS: Patients with reduced bone density (osteopenia or osteoporosis) had substantially lower HALP scores than those with a normal bone density. The area under the curve (AUC) for the HALP score was 0.625, indicating a limited discriminative ability. The HALP score exhibited a sensitivity of 65.36% and a specificity of 55.26% for identifying reduced bone density. In multivariable analysis, higher HALP remained associated with lower odds of osteopenia/osteoporosis after adjustment (OR = 0.757, 95% CI 0.624-0.917, p = 0.004).

CONCLUSION: Given its limited discriminative ability, HALP should not be interpreted as a stand-alone screening test. At most, it may represent a low-cost exploratory adjunctive signal that could help support consideration of confirmatory DEXA in resource-limited settings, pending external validation.

TRIAL REGISTRATION: Not applicable.

PMID:42178515 | DOI:10.1186/s12875-026-03399-y

J Appl Clin Med Phys. 2026 May;27(5):e70635. doi: 10.1002/acm2.70635.

ABSTRACT

BACKGROUND: Conformity evaluation is essential for assessing radiotherapy plan quality, yet widely used indices such as the ICRU and Paddick Conformity Index do not distinguish between target underdosage and peripheral overdose. As clinical protocols differ in their target coverage definitions ICRU 50/62, ICRU 83, and RTOG/NRG direct comparisons of plan conformity across protocols remain challenging. Recently proposed metrics the Universal Conformity Index (CI) and Unconformity Indices (UCIu for underdose and UCIo for overdose) provide a decomposed, interpretable assessment of dose target relationships. However, protocol-specific optimal ranges for these indices and their clinical achievability have not been systematically established for pelvic radiotherapy.

PURPOSE: To determine protocol-specific optimal (p10-p90) ranges for CI, UCIu, and UCIo across pelvic sites under ICRU 50/62, ICRU 83, and RTOG/NRG frameworks, and to verify whether these optimal values are clinically achievable using modern IMRT plans.

METHODS: This study analyzed 40 anonymized pelvic cancer cases (20 prostate, 10 rectum, 10 endometrium). All cases were replanned under standardized dose prescriptions following ICRU 50/62, ICRU 83, and RTOG/NRG protocols. Two geometric configurations were evaluated: Target 1 (strict) and Target 2 (conservative). Stage 1: Using protocol-specific V95(%) definitions, theoretical optimal CI, UCIu, and UCIo bands (p10-p90) were calculated separately for each site and protocol under Target 1 and Target 2. Stage 2: All 40 cases were combined into a pooled pelvic dataset to derive region-wide optimal ranges and assess generalizability across sites. Stage 3: Clinical IMRT plans satisfying ICRU, RTOG, and QUANTEC constraints were generated for all patients, and clinical CI, UCIu, and UCIo values were compared against theoretical optimal bands. Statistical analysis included percentile bands, 95% Confidence Interval, p value, and effect size (η²).

RESULTS: Across all pelvic sites, CI values decreased progressively from ICRU 50/62 to ICRU 83 and RTOG/NRG (p < 0.001), while UCIu and UCIo increased systematically, reflecting protocol-driven differences in coverage tolerance. Margin expansion from Target 1 to Target 2 further reduced CI and increased UCIo. Pooled pelvic optimal ranges showed tight reproducibility with narrow 95% confidence intervals (± 0.006-0.016). Strong protocol effects were observed for CI (η² = 0.259-0.519), UCIu (η² = 0.997), and UCIo (η² up to 0.182). Clinically generated IMRT plans demonstrated high-quality target coverage (V95% ≥ 98.9%) and acceptable OAR doses. Clinical CI, UCIu, and UCIo values closely matched the optimal p10-p90 bands. Prostate and rectum plans aligned fully with all protocol-specific optimal ranges, while endometrium plans matched RTOG/NRG and Target-2 thresholds, with minor deviations under strict Target-1 geometry.

CONCLUSIONS: This study provides the protocol-specific and clinically achievable optimal ranges for CI, UCIu, and UCIo for pelvic radiotherapy across ICRU 50/62, ICRU 83, and RTOG/NRG frameworks. The combined theoretical, pooled, and clinical validation approach demonstrates that these decomposed conformity indices are robust, reproducible, and directly applicable to routine IMRT plan evaluation. The resulting optimal bands offer standardized benchmarks for assessing dose conformity and dose spill, improving cross-protocol comparability and supporting future development of quantitative conformity-based guidelines in radiotherapy.

PMID:42178514 | DOI:10.1002/acm2.70635

Head Neck. 2026 May 24. doi: 10.1002/hed.70327. Online ahead of print.

ABSTRACT

Squamous cell carcinoma of the head and neck (HNSCC) is a global public health issue. Traditionally diagnosed in individuals over 60 years old, there has been a rising incidence among young patients (< 45 years). This retrospective and descriptive study analyzes the epidemiological, clinical, and biochemical profiles of young patients diagnosed with HNSCC between 2015 and 2022 at the Cancer Hospital of Muriaé, Minas Gerais, Brazil. A comparative analysis between young and older patients revealed significant differences in inflammatory profiles and disease progression. Young patients showed higher counts of leukocytes, monocytes, and neutrophils compared to older patients, suggesting an exacerbated inflammatory response. The 60-month survival rate was 41.5% among young patients and 38.1% among older ones, with no statistically significant difference. A strong association between poor oral hygiene and HNSCC was observed, with 61.43% of young patients presenting poor hygiene-a factor that may contribute to increased local inflammation and tumor progression. These findings underscore the need for preventive strategies and early diagnosis.

PMID:42178490 | DOI:10.1002/hed.70327