Nevin Manimala

Neuromuscul Disord. 2026 May 22;64:106463. doi: 10.1016/j.nmd.2026.106463. Online ahead of print.

ABSTRACT

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder primarily affecting motor neurons; however, non-motor symptoms, including sensory and autonomic disturbances, are increasingly recognized. This retrospective cross-sectional study evaluated the frequency of sensory and entrapment neuropathies in 114 patients with ALS using electrodiagnostic (EDX) studies. Demographic characteristics, comorbidities, and sensory and autonomic symptoms were documented. Electrophysiological evidence of sensory neuropathy was identified in 20 patients overall (20/114, 17.5%), including 10 patients without diabetes mellitus (DM), whereas entrapment neuropathy was detected in 28 patients overall (28/114, 24.6%), including 16 of those without DM or hypothyroidism. Sensory neuropathy was significantly associated with both DM and a history of chronic disease. In contrast, these comorbid conditions were not significantly associated with entrapment neuropathy. Furthermore, patient-reported symptoms showed no correlation with electrophysiological evidence of sensory involvement on EDX. Sensory neuropathy was more frequent in patients with spinal-onset than bulbar-onset disease, although the difference was not statistically significant. This study confirms that sensory involvement is not uncommon in ALS. Although clinical symptoms are poor predictors, electrophysiological abnormalities consistent with sensory and entrapment neuropathies are common. A significant proportion of these abnormalities are idiopathic and may directly reflect the disease process itself, particularly in spinal-onset cases.

PMID:42263370 | DOI:10.1016/j.nmd.2026.106463

Int J Pediatr Otorhinolaryngol. 2026 May 30;207:112876. doi: 10.1016/j.ijporl.2026.112876. Online ahead of print.

ABSTRACT

BACKGROUND: Congenital laryngeal webs are rare laryngeal anomalies resulting from incomplete re-canalization of the primitive larynx. They present a significant therapeutic challenge, requiring a delicate balance between establishing a patent airway and preserving vocal function. This study details a ten-year, single-surgeon experience at a tertiary care centre to evaluate the efficacy of a graded management protocol and long-term outcomes.

METHODS: A retrospective chart review was conducted for 23 pediatric patients managed for congenital laryngeal webs between 2015 and 2025. Data regarding demographics, Cohen’s classification, presenting symptoms, surgical management, and postoperative outcomes were analyzed. Treatment choice was dictated by web severity: endoscopic release for thin webs, open web release with keel placement for thick webs without subglottic extension and open reconstruction for thick webs with subglottic extension.

RESULTS: The cohort included 23 patients (10 males, 13 females) with a mean age of 4.5 years. The study population presented with severe pathology; Type III webs were the most prevalent (65.2%). Consequently, respiratory symptoms (82.6%) were more common than isolated voice abnormalities (78.2%). Management strategies included endoscopic web release (17.4%), endoscopic web release and keel placement (21.7%), open web release with keel placement (8.7%) and open laryngotracheal reconstruction (LTR) (34.8%). Post-operative airway patency was achieved in all tracheostomized patients, yielding a 100% decannulation rate (8/8). Revision surgery was required in 2 patients (1 in Type III and 1in Type IV), (8.7%). Perceptual voice analysis yielded a mean GRBAS score of G2R1B1A1S1.

CONCLUSIONS: Congenital laryngeal webs are rare but clinically significant airway anomalies that may present with a wide spectrum of respiratory and phonatory symptoms. A tailored algorithm-reserving endoscopic techniques for thin webs and open LTR for thick webs-results in excellent decannulation rates. Overall, a multidisciplinary approach with careful surgical technique and long-term follow-up is essential to optimize both airway stability and voice outcomes in children with congenital laryngeal webs.

PMID:42263361 | DOI:10.1016/j.ijporl.2026.112876

Horm Behav. 2026 Jun 9;183:105954. doi: 10.1016/j.yhbeh.2026.105954. Online ahead of print.

ABSTRACT

Poor sleep hygiene is reported to impair subjective sleep and disrupt circadian system, yet the association between sleep hygiene and objective alterations in sleep continuity is scarcely studied. Moreover, the role of gender differences is largely neglected. In this pilot study, sixty-five adults (66% females) completed a psychometric assessment including the Sleep Hygiene Index (SHI) and wore an actigraph for one week for the assessment of sleep. No statistically significant gender differences on sleep hygiene practices were found. Bedtime and waketime were later in males than females. Males showed longer sleep onset latency (SOL), and wake after sleep onset (WASO), and lower sleep efficiency compared to females. General linear analyses showed that poorer sleep hygiene was associated with shorter SOL and longer WASO in males but not in females. Age, habitual insomnia and psychological distress did not influence the results. Current findings suggest a differential impact of sleep hygiene behaviors on objective alternations in males. While future research is needed to investigate the role of specific sleep promoting and sleep inhibiting behaviors on objective sleep, current results highlight the importance of considering gender differences in sleep hygiene research. Gender differences in homeostatic, circadian, and neuroendocrine factors related to sleep hygiene should be further investigated in mechanistic studies also considering non-binary participants.

PMID:42263358 | DOI:10.1016/j.yhbeh.2026.105954

Arch Med Res. 2026 Jun 9;57(6):103446. doi: 10.1016/j.arcmed.2026.103446. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: This study aimed to evaluate whether preoperative nutritional risk, as measured by the NRS-2002 score, predicts hepatic regeneration after ALPPS in patients with HBV-related HCC.

METHODS: Among the 54 patients who completed both ALPPS stages, intervals to adequate regeneration were dichotomized (≤14 vs. >14 d). Logistic regression identified predictors of prolonged intervals, and a nomogram was developed.

RESULTS: Univariable and multivariable logistic analyses revealed that the NRS-2002 score (≥3), resected-side portal vein thrombosis (PVT), and decreased prealbumin (pre-ALB) levels were independently identified as preoperative risk factors for prolonged intervals. The nomogram showed exploratory accuracy in estimating the prolonged interval, with an AUC of 0.905 (95% CI:0.828-0.981). It should be noted that the wide confidence intervals for the predictor odds ratios (e.g., NRS-2002 ≥3: OR = 11.406, 95% CI: 1.481-87.841) reflect the uncertainty inherent to the sample size, and the model may be susceptible to overfitting. However, the relatively wide confidence intervals for key predictors and the modest sample size warrant caution against overfitting, and external validation is required before clinical application. Correlation analysis revealed a statistically significant positive association was observed between standard future liver remnant (sFLR)/standard liver volume (SLV) before stage 1 and sFLR/SLV before stage 2. Patients with lower NRS-2002 scores had better survival outcomes than those with higher scores.

CONCLUSIONS: Preoperative NRS-2002 score, prealbumin, and portal vein thrombosis may help identify patients with HBV-related HCC at risk for delayed regeneration after ALPPS. However, these findings require validation in intention-to-treat cohorts.

PMID:42263344 | DOI:10.1016/j.arcmed.2026.103446

Nutrition. 2026 May 5;150:113264. doi: 10.1016/j.nut.2026.113264. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze differences in taste preferences and dietary characteristics in early childhood according to genetic polymorphisms in taste receptor genes.

METHODS: This study is a secondary analysis of a randomized clinical trial (ReBEC: RBR-229SCM; U1111-1226-9516) that enrolled infants at 5.5 mo of age and allocated them to different complementary feeding methods in Porto Alegre, Brazil. At 12 mo old, the Food Preferences Questionnaire (FPQ) was applied, and data on dietary characteristics were obtained. Between 12 and 35 mo of age, the Taste Acceptance Test (TAT) was conducted, and oral mucosa samples were collected for the analysis of polymorphisms in sweet and bitter taste receptor genes. Pearson’s chi-square test, Fisher’s exact test, and Kruskal-Wallis test were used in data analysis.

RESULTS: A total of 96 infants with available data for exposures and outcomes were included in the analysis. The duration of exclusive breastfeeding was associated with TAS1R3(rs35744813) (P = 0.039), TAS1R2(rs9701796) (P = 0.022), and the number of sweet taste-related polymorphisms (P = 0.013). In the FPQ, TAS1R3(rs35744813) was associated with a preference for sour-tasting foods (P = 0.040), and TAS2R16(rs846672) with a preference for umami-flavored foods (P = 0.042). In the TAT, bitter taste reactions were associated with TAS1R2(rs9701796) (P = 0.021), TAS1R3(rs307355) (P = 0.008), and the number of sweet taste-related polymorphisms (P = 0.037). In contrast, sour taste reactions were associated with the number of bitter taste-related polymorphisms (P = 0.048).

CONCLUSIONS: The study found that genetic polymorphisms were associated with infant food acceptance, leading to differences in food preferences. Future longitudinal and experimental studies are needed to elucidate the mechanisms by which genetic polymorphisms influence infant food acceptance.

PMID:42263342 | DOI:10.1016/j.nut.2026.113264

Am J Emerg Med. 2026 Jun 2;108:26-34. doi: 10.1016/j.ajem.2026.06.002. Online ahead of print.

ABSTRACT

INTRODUCTION: The need for alternative analgesia to opioids in the emergency department (ED) has become increasingly urgent due to the opioid epidemic. Ketamine, traditionally used for sedation, has emerged as a promising alternative for pain control in the acute care setting. This scoping review evaluates the use of intranasal (IN) ketamine compared with intravenous (IV) opioids for analgesic efficacy in treating acute pain in the ED.

METHODS: A search of PubMed, CINAHL and PRIMO databases was conducted for randomized controlled trials (RCTs) published between 2015 and 2025. A total of 561 records were identified, and 8 RCTs evaluating analgesic efficacy as the primary outcome were included in this review. This review was conducted in accordance with the PRISMA-ScR reporting guidelines.

RESULTS: Eight RCTs including 846 patients were included (2016-2025), all conducted in Iran, Israel, or Thailand. IN ketamine (0.3-1.5 mg/kg) was most commonly compared with IV morphine (0.1 mg/kg). Across studies, IN ketamine demonstrated comparable reductions in pain scores to IV morphine, with several trials reporting no statistically significant differences at measured time points, although IV morphine was generally associated with faster onset of analgesia. In one study, IV fentanyl produced greater pain reduction than IN ketamine. Adverse effects were generally mild and transient with IN ketamine associated with fewer adverse events compared to IV morphine.

CONCLUSION: IN ketamine may be useful for acute pain management in the ED. However, further research is needed to determine optimal dosing, compare its efficacy with more potent opioids, and evaluate long-term outcomes associated with its use.

PMID:42263334 | DOI:10.1016/j.ajem.2026.06.002

Foot (Edinb). 2026 Jun 4;68:102268. doi: 10.1016/j.foot.2026.102268. Online ahead of print.

ABSTRACT

BACKGROUND: Falls in older adults remain a major clinical concern. Although the Enhanced Paper Grip Test (EPGT), provides an objective measure of lower limb strength and has shown promise in controlled settings, its use in routine podiatric practice has not been described.

AIM: To audit the implementation of the EPGT in routine private podiatric practice and to explore whether EPGT measures are associated with self-reported recent falls in older adults.

METHODS: The EPGT was introduced on a trial basis in three independent private UK podiatry clinics for six months. People (aged ≥60 y) were tested when the treating podiatrist considered the assessment clinically appropriate. Anonymised routine clinical data were extracted retrospectively at the end of the audit period, including EPGT outcomes, age, sex, and self-reported history of an unexplained fall in the previous twelve months.

RESULTS: Seventy-eight participants (mean age 72 ± 7 years) were assessed; 17 reported a fall. Median EPGT force was statistically significantly lower in fallers (11.9 N) than in non-fallers (21.4 N), U= 283,z = -3.554,p < .0005. Differences remained significant after adjustment for age and sex and were robust to outlier exclusion. Hallux-related pathology was not associated with EPGT outcomes.

CONCLUSIONS: In this pragmatic private practice audit, the EPGT could be incorporated into routine podiatric assessment and lower EPGT values were associated with self-reported recent falls. These findings support the EPGT as a potentially useful adjunct to falls risk screening that could be offered as part of routine podiatry care. Prospective studies are needed before predictive use or clinical thresholds can be established.

PMID:42263330 | DOI:10.1016/j.foot.2026.102268

Pain Physician. 2026 May;29(3):281-287.

ABSTRACT

BACKGROUND: Trans-sacral canalplasty (TSCP) is a minimally invasive epidural adhesiolysis technique positioned between conventional block therapy and open surgery. However, the relationship among MRI-defined levels of stenosis, epidurographic block patterns, and clinical effectiveness remains unclear.

OBJECTIVES: To investigate the clinical significance of mismatch between MRI-defined levels of stenosis and epidurographic block as well as to evaluate the short-term outcomes and feasibility of adhesiolysis in patients undergoing TSCP.

STUDY DESIGN: A retrospective observational study.

SETTING: A university hospital in Japan and an affiliated institution.

METHODS: We reviewed all patients who underwent TSCP between October 2024 and August 2025. Baseline characteristics, diagnosis, surgical history, and minimum dural sac area at L3/4, L4/5, and L5/S (measured on MRI using ImageJ2) were assessed. Epidurography was performed to identify block levels, and cases were categorized as concordant (MRI-defined level of stenosis = block level) or discordant (mismatch). Discordant cases were subclassified into a “tail-stop” type (in which contrast stopped in a position caudal to the MRI-defined level of stenosis) and a “pass-through” type (in which these levels differed). Clinical effectiveness was defined as an improvement in low back pain or leg pain at one week after the procedure. Feasibility of adhesiolysis was also evaluated.

RESULTS: Twenty-eight patients underwent TSCP during the study period. Nine (32.1%) showed concordance between MRI-defined levels of stenosis and epidurographic block sites, and 19 patients (67.9%) showed discordance (tail-stop, n = 11; pass-through, n = 8). Overall, 23 patients (82.1%) experienced clinical improvement. The effectiveness rate was 66.7% (6/9) in the concordance group and 89.5% (17/19) in the discordance group; however, the difference was not statistically significant (P = 0.290). In the discordance group, there was a significant difference in gender distribution between subgroups, with men predominating in the tail-stop subtype and women in the pass-through subtype (P = 0.024), but not in age, diagnosis, surgical history, or minimum dural sac area. Epidural dissection was successful in 21 patients (75.0%), with no significant difference between the effective and noneffective groups (73.9% vs 80.0%, P > 0.999).

LIMITATIONS: A single-center retrospective design, small sample size, and short-term follow-up of only one week.

CONCLUSIONS: TSCP demonstrated favorable short-term clinical effectiveness, even in cases with mismatches between MRI and epidurographic findings. The feasibility of adhesiolysis may contribute to the clinical success of TSCP. Epidurographic mismatch should not be considered a contraindication for TSCP, and our findings support its role as a minimally invasive option for patients with degenerative disorders of the lumbar spine who are unsuitable for open surgery.

PMID:42263314

Pain Physician. 2026 May;29(3):269-279.

ABSTRACT

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) affects approximately 50% of patients who receive chemotherapy. CIPN often results in dose reductions, therapy discontinuation, and long-term neurological impairment. Despite existing studies, identifying high-risk populations remains challenging, particularly in patients with diabetes, diabetic neuropathy, and those undergoing corticosteroid therapy.

OBJECTIVES: We sought to evaluate the key risk factors associated with CIPN by analyzing patient demographics, comorbidities, and chemotherapy regimens, with a specific focus on diabetes-related variables in order to inform early identification and prevention strategies.

STUDY DESIGN: Retrospective, single-center, observational cohort study.

SETTING: Academic tertiary care cancer center.

METHODS: Adult patients who received chemotherapy between January 2016 and December 2023 were identified through electronic medical records. Patients with CIPN were defined by the International Classification of Disease, Tenth Revision G62.0 diagnosis code (drug-induced polyneuropathy) and an associated diagnosis of “painful peripheral neuropathy.” Extracted data included demographics (age, body mass index [kg/m2], race/ethnicity), clinical variables (alcohol use, corticosteroid use, diabetes-related factors), and chemotherapy regimen details. Descriptive statistics, Wilcoxon rank sum, c2/Fisher’s exact tests, and multivariable logistic regression were performed. Institutional review board (IRB) approval was obtained (IRB exemption #2024-0139).

RESULTS: Among 36,949 patients, significant CIPN risk factors included older age (40-80 years, P < 0.0001), women (odds ratio [OR] 1.89; P < 0.0001), non-Hispanic/non-Latino ethnicity (OR 1.29; P < 0.0001), and corticosteroid use (OR 2.01; P < 0.0001). African American patients had lower odds of CIPN than White patients (OR 0.78; P < 0.0001). Diabetic neuropathy was strongly associated with increased CIPN risk (OR 5.35; P < 0.0001). Alcohol use was inversely associated with CIPN (OR 0.75; P < 0.0001). Several chemotherapy agents also showed significant associations.

LIMITATIONS: Our study is limited by its retrospective design, potential misclassification bias in CIPN diagnosis, and reliance on electronic medical records. Alcohol use data were frequently missing or unspecified, limiting interpretation.

CONCLUSIONS: Key CIPN risk factors include age, race/ethnicity, corticosteroid use, and diabetic neuropathy. Alcohol use appeared inversely associated with CIPN, though causality remains unclear. Individualized patient assessments and proactive management strategies may help reduce CIPN incidence and improve outcomes in patients with cancer who are receiving chemotherapy.

PMID:42263313

Pain Physician. 2026 May;29(3):E217-E227.

ABSTRACT

BACKGROUND: Degenerative disc disease is a leading cause of low back pain. Conservative treatments like pain medication and exercise therapy have shown mixed results, while procedures like fusion surgery carry risks such as adjacent segment disorder and surgical morbidity. Therefore, there is a critical need for treatments that bridge the gap between conservative care and surgery.

OBJECTIVE: To assess the efficacy of intradiscal hydrogel implantation compared with sham treatment of intradiscal injection of saline in patients with chronic discogenic low back pain.

STUDY DESIGN: Prospective, double-blind, randomized, controlled, multicenter trial.

SETTING: Two tertiary interventional pain care centers in Switzerland and in the Netherlands.

METHODS: Forty-nine patients with chronic discogenic low back pain unresponsive to conservative treatment were randomized to receive either intradiscal hydrogel implantation or a sham treatment. Control Group patients could cross over to hydrogel treatment after 6 months. The primary outcome was pain improvement at 6 months. Secondary outcomes included disability, quality of life, employment status, Patient Global Impression of Change score, analgesic use, disc space height, and disc degeneration. Adverse events were continually assessed.

RESULTS: At 6 months postprocedure, the Hydrogel Group patients had improved pain scores compared to Control Group patients, though not statistically significant (P = 0.070). Six out of 24 patients in the Hydrogel Group reported much improvement on their Patient Global Impression of Change scores, compared to 0 out of 25 in the Control Group (P = 0.008). Within-group disability improvements were statistically significant in the Hydrogel Group but not in the Control Group. No significant differences were found between groups in disability, quality of life, or employment status. Only one serious adverse event was reported-a patient from the Hydrogel Group was hospitalized due to a possible exacerbation of low back pain 6 days postprocedure.

LIMITATIONS: This trial’s limitations include strict eligibility criteria and questions about the validity of intradiscal saline as a placebo.

CONCLUSIONS: This trial suggests that percutaneous intradiscal hydrogel implantation may reduce chronic discogenic pain and disability, with significant Patient Global Impression of Change improvements, though larger trials are needed to confirm efficacy.

PMID:42263312