Tag: pubmed

BMC Pediatr. 2026 Jul 20. doi: 10.1186/s12887-026-07230-6. Online ahead of print.

ABSTRACT

BACKGROUND: To compare the effectiveness and safety of different phototherapy strategies in preterm infants using a network meta-analysis of randomized controlled trials, and to explore whether treatment and population-level characteristics modify the rate of bilirubin decline.

METHODS: We performed a systematic review and frequentist random-effects network meta-analysis of randomized controlled trials enrolling preterm infants (< 37 weeks’ gestation). Phototherapy interventions were grouped based on light source and delivery configuration. Prespecified network meta-regression analyses were conducted to explore potential effect modification by irradiance intensity, delivery configuration, gestational age, birth weight, and baseline bilirubin. The primary outcome was rate of total serum bilirubin decline within 24 h of treatment initiation. This network meta-analysis was prospectively registered in PROSPERO (CRD420261307223).

RESULTS: Twenty randomized trials were included. Double surface phototherapy led to increased TSB reduction (mean difference 0.17 mg/dl/h, 95% CI 0.11-0.22). Higher irradiance strategies demonstrated greater point estimates, although most pairwise comparisons did not reach statistical significance. Meta-regression did not identify statistically significant effect modification, but effect directions were consistent.

CONCLUSIONS: In preterm infants, phototherapy efficacy appears to be more closely related to irradiance intensity and exposed body surface area than to device category alone.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42477649 | DOI:10.1186/s12887-026-07230-6

BMC Cancer. 2026 Jul 20. doi: 10.1186/s12885-026-16554-6. Online ahead of print.

ABSTRACT

BACKGROUND: Gastrointestinal tract (GIT) cancers are a leading cause of cancer-related death worldwide. Chemotherapy, a cornerstone of treatment, often causes toxicities that can compromise clinical outcomes. However, evidence on the prevalence and risk factors of chemotherapy-induced toxicity among GIT cancer patients in Ethiopia remains limited. Therefore, this study aimed to assess the prevalence and associated factors of chemotherapy-induced toxicity among GIT cancer patients at two Tertiary Care Hospitals in Addis Ababa, Ethiopia.

METHODS: A hospital-based prospective observational study was conducted among patients enrolled prior to chemotherapy initiation and followed biweekly until treatment completion. Adverse drug reactions (ADRs) were collected from patient interviews and medical records, and assessed using the Naranjo algorithm, Hartwig-Siegel scale, and National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5. Data were analyzed using descriptive statistics and logistic regression in SPSS version 26, with P < 0.05 considered statistically significant.

RESULTS: The mean (± SD) age of patients was 51.59 (± 11.18) years. A total of 1499 ADRs were reported, of which 47.4% (n = 710) were hematological toxicities. Based on the Naranjo scale, 54.8% of the ADRs were classified as probable, while the Hartwig-Siegel scale severity score classified 53.7% as mild ADRs. According to NCI-CTCAE v5.0 grading score, 37.1% of the ADRs were graded ≥ 3. Poor pathological grade (AOR: 4.410, 95% CI: 1.823-10.666, p = 0.001), low baseline hemoglobin (AOR: 4.456, 95% CI: 2.021-9.824, p = 0.001) and low absolute neutrophil counts (AOR: 2.237, 95% CI: 1.061-4.717, p = 0.034) were significantly associated with severe ADRs. Granulocyte colony-stimulating factor (G-CSF) use was independently associated with lower odds of high-grade ADRs (AOR = 0.508, 95% CI: 0.260-0.995, p = 0.048).

CONCLUSION: Chemotherapy-induced toxicities were highly prevalent among GIT cancer patients, with a substantial proportion experiencing severe toxicities. Poor pathological grade, low baseline hemoglobin, and low absolute neutrophil count were significantly associated with high-grade toxicities, while G-CSF use was protective. These findings highlight the need for improved toxicity management and personalized treatment strategies in Ethiopian oncology practice.

PMID:42477648 | DOI:10.1186/s12885-026-16554-6

BMC Public Health. 2026 Jul 21. doi: 10.1186/s12889-026-28553-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Academic achievement anxiety is a common psychosocial stressor among university students and may be associated with menstrual health outcomes. However, limited research has examined the relationships between academic achievement anxiety, perceived stress, menstrual pain, and menstrual hygiene behaviors simultaneously in female university populations.

MATERIALS AND METHODS: This cross-sectional study included 307 female university students in Turkiye (mean age = 20.59 ± 2.02 years). Participants completed online self-report measures assessing academic achievement anxiety, perceived stress, menstrual pain severity and menstrual hygiene behaviors. Descriptive statistics, Pearson correlations and regression analyses were conducted to examine associations among the variables.

RESULTS: Academic achievement anxiety was positively associated with perceived stress and menstrual pain and negatively associated with genital hygiene behaviors. Multiple linear regression analyses showed that these associations remained significant after controlling for relevant covariates, including age, income level, menstrual regularity, and faculty. Academic achievement anxiety emerged as a significant predictor of perceived stress(β = 0.315, p < 0.001), menstrual pain (β = 0.211, p < 0.001), and genital hygiene behaviors (β = -0.126, p = 0.026).

CONCLUSION: Academic achievement anxiety was associated with higher perceived stress, increased menstrual pain and slightly less optimal menstrual hygiene practices among female university students. However, these associations were modest, suggesting that academic-related stress may represent one of several factors related to menstrual health outcomes. Addressing academic-related stress within a broader context that includes psychological and structural factors may support student wellbeing. Future research should further explore these relationships using more comprehensive designs.

PMID:42477642 | DOI:10.1186/s12889-026-28553-0

BMC Ophthalmol. 2026 Jul 20. doi: 10.1186/s12886-026-05147-3. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic optic neuropathy (TON) is a potentially blinding complication of craniofacial trauma with an uncertain prognosis and no established standard of care. Evidence on outcomes and prognostic factors remains limited, particularly in Southeast Asian populations.

METHODS: A retrospective observational study was conducted at a tertiary referral centre in Malaysia between September 2020 and August 2025. Patients diagnosed with TON were identified through medical record review. Visual acuity (VA) was categorised according to the World Health Organization (WHO) visual impairment classification. Visual outcomes at one-year follow-up were analysed using the Wilcoxon signed-rank test, and factors associated with visual improvement were evaluated using Fisher’s exact test.

RESULTS: Fifty-eight patients were identified, of whom 54 had complete data for visual outcome analysis. The median age was 23.5 years, and most patients were male (82.8%). Road traffic accidents were the predominant aetiology, accounting for 86.2% of TON cases. TON occurred across all traumatic brain injury severities, with comparable distribution in mild and severe cases. At presentation, 53.8% had severe visual impairment, including 13.8% with no perception of light. There was a statistically significant overall improvement in visual acuity at one-year follow-up compared with baseline (p = 0.003). However, subgroup analysis showed no significant association between treatment modality and visual improvement. Visual improvement was also not significantly associated with age, baseline severity, timing of corticosteroid initiation, or the presence of orbital or skull fractures and intracranial haemorrhage (all p > 0.05).

CONCLUSION: Visual outcomes in TON are variable and unpredictable, highlighting the importance of early neuro-ophthalmic assessment, close visual monitoring, and appropriate counselling regarding the guarded visual prognosis. Due to the relatively small sample size of this cohort, these findings may not be generalisable to broader populations.

PMID:42477640 | DOI:10.1186/s12886-026-05147-3

Int Dent J. 2026 Jul 20;76(5):109760. doi: 10.1016/j.identj.2026.109760. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to estimate the relative contributions of genetic and environmental factors on acquired tooth loss among middle-aged and older twins in Qingdao, China.

METHODS: A total of 377 complete twin pairs (240 monozygotic, 137 dizygotic) were recruited from the Qingdao Twin Registry in China, and acquired tooth loss was recorded through structured interviews. Heritability of acquired tooth loss was estimated using correlation analysis and structural equation model, adjusting for age and sex.

RESULTS: The median age of the twins was 50 years (IQR: 46-57). The polychoric correlations for monozygotic twins (0.67; 95% CI: 0.55-0.78) were more than twice as high as that for dizygotic twins (0.25; 95% CI: 0.03-0.48). Therefore, we fitted an additive, dominant, and unique environmental factors model and its nested submodels. Based on the Akaike information criterion, the additive and unique environmental factors model was selected as the preferred model. After adjusting for age and sex, the model indicated that 56.51% (95% CI: 43.21%-69.81%) of the variance in acquired tooth loss was attributable to additive genetic factors, and 43.49% (95% CI: 30.20%-56.79%) to unique environmental influences.

CONCLUSION: This study demonstrated that variation in acquired tooth loss is influenced by both additive genetic and unique environmental factors. These findings may assist in developing strategies for tooth loss prevention and oral health maintenance.

PMID:42475771 | DOI:10.1016/j.identj.2026.109760

Placenta. 2026 Jul 14;182:348-353. doi: 10.1016/j.placenta.2026.07.005. Online ahead of print.

ABSTRACT

BACKGROUND: Maternal obesity is a well-established risk factor for preeclampsia; however, whether increased maternal BMI is associated with biologically distinct subtypes of this disorder remains unknown.

OBJECTIVE: To investigate whether maternal BMI is associated with differences in placental gene expression patterns observed in preeclampsia and to identify transcriptomic signatures with potential relevance for future biomarker research.

STUDY DESIGN: This exploratory analysis used placental transcriptomic data obtained from the Gene Expression Omnibus. Differential expression within prespecified contrasts encoding preeclampsia status and maternal BMI was analyzed using a multivariable linear modeling framework with adjustment for relevant confounders. In a secondary analysis, maternal BMI was modeled continuously with an interaction term between BMI and preeclampsia status.

RESULTS: Placental transcriptomic data from 132 placentas representing a range of maternal hypertensive and normotensive states were analyzed. Genes commonly associated with preeclampsia, including FLT1, LEP, HTRA4, and FSTL3, were differentially expressed across all BMI categories. SERPINA3 demonstrated the strongest differential expression in the obese contrast, with an estimated eight-fold increase (95% CI: 3.9-16.6) in preeclamptic pregnancies complicated by obesity, whereas expression differences were smaller and not statistically significant in healthy-weight and overweight contrasts. Gene set enrichment analysis suggested heterogeneity in the underlying biology of preeclampsia across BMI strata.

CONCLUSION: Placental transcriptional patterns associated with preeclampsia differed across maternal BMI strata. These findings are consistent with previously proposed molecular subtypes of preeclampsia and highlight SERPINA3 as a candidate transcriptomic marker warranting further investigation, specifically in pregnancies complicated by obesity.

PMID:42475769 | DOI:10.1016/j.placenta.2026.07.005

J Healthc Qual Res. 2026 Jul 20;41(4):101223. doi: 10.1016/j.jhqr.2026.101223. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Inappropriate use of antimicrobial agents accelerates the emergence and spread of resistance. Antimicrobial treatment guidelines (ATG) stand between evidence and clinical practice as they are designed to guide policy decision framework for all stakeholders promoting the prudent use of antimicrobials in bedside care. The trustworthiness of these decision-making instruments relies on their methodological quality and reporting. The aim of this systematic review is to critically appraise the methodological quality and reporting of antimicrobial treatment guidelines using the AGREE II, AGREE-REX tools and the RIGHT checklist respectively.

MATERIALS AND METHODS: A systematic review was conducted. ATGs from public institutions and hospitals with over 500 beds were identified through a systematic search using the Google search engine and by consulting members of the AFinf workgroup (https://gruposdetrabajo.sefh.es/afinf/en/). Screening and data extraction were performed in duplicate. Quality and reporting were assessed using the validated checklists AGREE II, AGREE REX and RIGHT. Central tendency, dispersion, and correlations were calculated and compared using Student’s t-test. Results are de-identified. Prospective protocol: https://osf.io/cey2v RESULTS: N=22. The mean scores for AGREE II, AGREE-REX, and RIGHT were generally low: 31.0% (95% CI: 23.7%-38.3%), 20.4% (95% CI: 15.6%-25.1%), and 28.7% (95% CI: 23.4%-34.0%) respectively. Low rates were observed for development rigour (10.2%); reference existing reviews (4.6%); quality assurance (4.6%); conflict of interests disclosure (4.6%); values and preferences (1.9%) while clarity (94.8%) and implementability (37.7%) rated the highest. Strong correlations among AGREE II and AGREE-REX (corr=0.9092) and RIGHT (corr=0.9203).

CONCLUSION: There is room for improvement in the quality and reporting of current ATGs in Spain, especially at hospital level, where they have greater potential to optimize antibiotic prescribing practices.

PMID:42475767 | DOI:10.1016/j.jhqr.2026.101223

Med Image Anal. 2026 Jun 16;113:104159. doi: 10.1016/j.media.2026.104159. Online ahead of print.

ABSTRACT

Despite high performance of deep learning in medical imaging applications, the critical lack of validated computational metrics for explainable AI (XAI) impedes clinical integration. To address this gap, our study introduces a multi-level validation framework to rigorously assess seven computational evaluation metrics applied to eight widely-used post-hoc attribution methods – spanning gradient-based, input attribution, and decomposition-based families – on large-scale structural MRI datasets (UK Biobank and ADNI) with two different benchmark tasks across several deep learning architectures. At the first level, we benchmark metrics against three scales of clinical relevance: voxel-based morphometry, regional volumetric associations, and expert radiologist assessments, revealing that many widely used conventional metrics exhibit negligible correlation with clinical evidence. At the second level, we show that metrics in addition are often significantly confounded by model architecture rather than reflecting explanation quality. At the third level, we conduct a computational efficiency and stability analysis focused on practical dimensions of the metrics. Across all levels, our statistical analyses show that only one of the metrics has consistent high performance: the Robustness score – defined as the stability of explanations across random training initializations – demonstrates strong alignment with morphometry, volumetric associations, and human expert judgments, effectively isolates the quality of the XAI method from architectural bias, and possesses good computational efficiency. Our novel, multi-level framework therefore establishes Robustness as a superior, scalable proxy for clinical validity and trustworthy AI in medical imaging.

PMID:42475759 | DOI:10.1016/j.media.2026.104159

J Bras Nefrol. 2026 Oct-Dec;48(4):e20260025. doi: 10.1590/2175-8239-JBN-2026-0025en.

ABSTRACT

INTRODUCTION: Pediatric rapidly progressive glomerulonephritis (RPGN) encompasses heterogeneous serology-based subtypes, including anti-glomerular basement membrane (anti-GBM), immune-complex-associated, and ANCA-associated (pauci-immune) RPGN. Although these subtypes differ in their underlying immune mechanisms, their ability to predict early renal recovery in children remains uncertain. This study aimed to evaluate the association between serology-based RPGN subtypes and early changes in renal function and tubular injury markers.

METHODS: This prospective cohort study included 30 children with newly diagnosed RPGN treated at Dr. Soetomo General Hospital. Patients were classified into anti-GBM, immune-complex-associated, or ANCA-associated RPGN based exclusively on serologic criteria. Estimated glomerular filtration rate (eGFR) and serum kidney injury molecule-1 (KIM-1) were measured at baseline and at 3 months after induction therapy. Primary outcomes were changes in eGFR (ΔeGFR) and serum KIM-1 (ΔKIM-1). Differences among subtypes were assessed using multivariate analysis of variance.

RESULTS: Of the 30 patients, 67% had immune-complex-associated RPGN, 20% had ANCA-associated RPGN, and 13% exhibited anti-GBM disease. The median age was 15 years. No statistically significant differences in ΔeGFR or ΔKIM-1 were observed among subtypes (MANOVA, p = 0.506), although numerical improvements varied across groups.

CONCLUSION: Serology-based RPGN subtype was not associated with early improvement in glomerular filtration or reduction in tubular injury markers in pediatric RPGN. Early renal recovery may be influenced more by baseline disease severity and therapeutic responsiveness than by serologic subtype classification alone.

PMID:42475735 | DOI:10.1590/2175-8239-JBN-2026-0025en

Genet Mol Biol. 2026 Jul 20;49Suppl 1(Suppl 1):e20250248. doi: 10.1590/1678-4685-GMB-2025-0248. eCollection 2026.

ABSTRACT

Ancient DNA research has expanded dramatically in recent years, transforming reconstructions of how and when humans settled the American continent. In this review, we synthesize evidence for genetic temporal continuity and discontinuity in Native American population history using mitochondrial DNA (mtDNA) from ancient and contemporary individuals. We systematically surveyed studies indexed in PubMed, ResearchGate, and Google Scholar, extending earlier compilations with publications through October 2025. For each population, we compiled sample sizes, mtDNA haplogroup frequencies, geographic coordinates, and associated archaeological and chronological information. These data were used to map the spatial distribution of founding mtDNA lineages, examine regional trajectories of haplogroup frequencies, and characterize patterns of mitochondrial population structure. Geographic distance showed a statistically detectable but limited association with mtDNA differentiation. Time-ordered haplogroup frequency series revealed region-specific dynamics, including long-term persistence of maternal lineages as well as marked episodes of turnover, some coincident with major cultural transitions. Genetic data were obtained from 315 studies. The dataset for contemporary populations included 23,315 individuals from 322 populations, while ancient DNA data included 4,192 individuals associated with 211 archaeological populations. Together, these data provide a comprehensive synthesis of mtDNA-based temporal and spatial patterns relevant to the peopling of the American continent.

PMID:42475729 | DOI:10.1590/1678-4685-GMB-2025-0248