Nevin Manimala

JACC Adv. 2026 Mar 19;5(4):102678. doi: 10.1016/j.jacadv.2026.102678. Online ahead of print.

ABSTRACT

BACKGROUND: Limited evidence exists on the relationship between socioeconomic disparities and cardiovascular disease in resource-limited settings, particularly in Latin America.

OBJECTIVES: The objective of the study was to assess the association between educational attainment, socioeconomic status (SES), and cardiovascular risk among Peruvian adults.

METHODS: We performed a cross-sectional analysis using data from 24,048 adults included in the 2023 Peruvian Demographic and Family Health Survey. Educational attainment was categorized as none, primary, secondary, or superior education, and SES was divided into 5 quintiles. Ten-year cardiovascular risk was estimated using the 2019 World Health Organization risk charts and dichotomized as high (≥10%) or nonhigh (<10%). Logistic regression models were used to estimate ORs and 95% CIs for cardiovascular risk.

RESULTS: Overall, 4.7% of adults were found to have a high cardiovascular risk, with substantial variation across education levels and socioeconomic status. In adjusted analyses, secondary and higher educational attainment were associated with substantially lower odds of high cardiovascular risk compared with no education (secondary: OR: 0.42; 95% CI: 0.25-0.71; superior: OR: 0.47; 95% CI: 0.30-0.73). These inverse associations were more pronounced among men, whereas among women the estimates were directionally similar but not statistically significant. In contrast, SES quintiles showed no independent association with high cardiovascular risk after adjustment for covariates.

CONCLUSIONS: Higher educational attainment was independently associated with lower 10-year cardiovascular risk, whereas SES quintiles showed no association.

PMID:41863208 | DOI:10.1016/j.jacadv.2026.102678

JACC Adv. 2026 Mar 19;5(4):102688. doi: 10.1016/j.jacadv.2026.102688. Online ahead of print.

ABSTRACT

BACKGROUND: Type 2 myocardial infarction (MI) (T2MI) is common and associated with adverse outcomes.

OBJECTIVES: The objective of the study was to evaluate the prevalence of coronary artery disease (CAD) in patients with T2MI and myocardial injury and its impact on outcomes.

METHODS: Observational U.S. cohort study of emergency department patients undergoing high-sensitivity cardiac troponin T measurement. Cases with >1 high-sensitivity cardiac troponin T increase >99th percentile were adjudicated following the Fourth Universal Definition of MI. CAD was defined as a prior CAD, MI, or coronary revascularization or newly diagnosed CAD during index hospitalization. Two-year major adverse cardiovascular outcomes including all-cause, cardiovascular, and noncardiovascular death, acute MI, heart failure hospitalization, and coronary revascularization were compared between patients with T2MI or myocardial injury and CAD vs type 1 MI (T1MI).

RESULTS: Among 858 patients, 64 (7.5%) had T1MI, 91 (11%) had T2MI, and 703 (82%) had myocardial injury. Patients with T2MI and CAD (n = 31; 34% of T2MI) had higher major adverse cardiovascular outcomes than T1MI (65% vs 39%; adjusted HR [aHR]: 1.95; 95% CI: 1.2-3.6), driven by higher all-cause death (52% vs 20%; aHR: 2.2; 95% CI: 1.0-4.5), noncardiovascular death (26% vs 5%; aHR: 5.04; 95% CI: 1.3-19.3), acute MI (13% vs 2%; aHR: 9.2; 95% CI: 1.01-84.2), and heart failure hospitalization (32% vs 8%; aHR: 4.6; 95% CI: 1.6-13.7). Patients with myocardial injury and CAD (n = 245) demonstrated similar trends, although differences were not statistically significant after adjustment.

CONCLUSIONS: CAD is common among patients with T2MI and myocardial injury and is associated with poor long-term outcomes. Its presence may facilitate risk-stratification and represent a potential therapeutic target.

PMID:41863201 | DOI:10.1016/j.jacadv.2026.102688

Knee. 2026 Mar 19;61:104426. doi: 10.1016/j.knee.2026.104426. Online ahead of print.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) is a prevalent orthopaedic procedure often accompanied by significant postoperative pain. Central sensitization, marked by increased nervous system reactivity, may influence opioid consumption variability after TKA. Investigating central sensitization, particularly regarding sex differences, could enhance postoperative care and opioid prescribing practices for TKA patients.

METHODS: Patients scheduled for TKA were assessed preoperatively and at 2 and 6 weeks postoperatively. Data collected included demographics, PROMIS-29, Brief Pain Inventory (BPI), Pain Catastrophizing Scale, Central Sensitization Inventory (CSI), and quantitative sensory testing. Participants recorded opioid use in home diaries over 6 weeks, measured in morphine milligram equivalents (MME) and days of use. Analyses involved descriptive statistics, sex differences, correlations, and regression models.

RESULTS: Thirty-nine participants (59% females) were enrolled. CSI scores indicated sub-clinical central sensitization in a majority of patients. No sex differences were observed in patient-reported outcomes, but males consumed significantly more opioids than females (median MME: 248 vs 519, p = 0.023), with similar durations of use (median days: 18 vs 16, p = 0.50). Pain levels correlated with opioid use duration (rs = 0.50, p = 0.001), stronger in males (rs = 0.69) than females (rs = 0.33). Central sensitization correlated with opioid use duration in males (rs = 0.81, p < 0.001), unlike females (rs = -0.11, p = 0.64).

CONCLUSION: Central sensitization significantly impacts opioid use in males post-TKA, challenging existing beliefs. Males with preoperative CSI scores indicating central sensitization showed sustained opioid use above norms, suggesting CSI as a predictive tool for postoperative opioid consumption. Recognizing sex-specific differences in central sensitization could improve pain management and opioid prescribing in TKA.

PMID:41863198 | DOI:10.1016/j.knee.2026.104426

Curr Med Chem. 2026 Mar 16. doi: 10.2174/0109298673445152260120111510. Online ahead of print.

ABSTRACT

INTRODUCTION: Dual inhibitors of AROM and STS (DASIs), through their synergistic action, hold the potential to suppress estrogen biosynthesis at multiple points. It also overcomes limitations associated with single-enzyme inhibition and reduces the risk of resistance development. In order to potentially improve the clinical outcomes in hormone-dependent breast cancers, 1,2,4-triazole derivatives having similar structural characteristics to third-generation Aromatase Inhibitors (AIs), including exemestane, letrozole, and anastrozole, were subjected to ligand-based screening. This research study comparatively analyzes the drug candidates as DASIs that aim at the development of advanced therapeutic strategies for breast cancer treatment.

MATERIALS AND METHODS: In this study, a set of 172 biphenyl 1,2,4-triazole derivatives with defined biological activity against AROM and STS enzymes was subjected to 3DQSAR modelling, followed by ADMET, molecular docking, and dynamics.

RESULTS: Through 3D-QSAR, significant statistical parameters of aromatase (q2 = 0.8429, r2 = 0.8874, r2pred = 0.8252) and steroidal sulfatase (q2 = 0.8877, r2 = 0.9402, r2pred = 0.9376) indicated the accuracy and reliability, and the good prediction power of the model. The external validation set further demonstrated its predictive capability. Furthermore, molecular docking, along with molecular dynamics at a time period of 100 ns, elucidated the stability of the docked complexes and found that Compound 109 emerged as the most promising dual inhibitor, exhibiting high binding affinities of -9.94 kcal/mol for Aromatase (AROM) and -9.41 kcal/mol for Steroid Sulfatase (STS). These values reflect a strong potential for dual enzyme inhibition.

DISCUSSION: The structural features of triazole derivatives through QSAR modelling established a statistical correlation, establishing a relationship between functional groups and their biological activity. They are found to have dual inhibition efficiency in a target-based approach, accelerating for synthetic accessibility.

CONCLUSION: The study highlights the potential of triazole derivatives and provides a multi-targeted therapeutic avenue for hormone-dependent breast cancers. It shows strong reliability and predictive power through molecular docking and a dynamic approach. Compound 109 emerged as the lead candidate due to its strong binding affinities and stable dual interactions.

PMID:41863173 | DOI:10.2174/0109298673445152260120111510

Curr Med Chem. 2026 Mar 19. doi: 10.2174/0109298673408383251203080930. Online ahead of print.

ABSTRACT

BACKGROUND: The sarcopenia index (SI) was recommended as a surrogate marker of sarcopenia based on the serum creatinine-to-cystatin C ratio, given its accessibility and effectiveness. However, the impact of SI on chronic heart failure (HF) has not been addressed.

METHODS: A total of 1209 chronic HF patients from a retrospective cohort study were included. Cox regression and inverse probability of treatment weighting (IPTW) were used to analyze the impact of the SI on all-cause death and hospitalization. The C-index, net reclassification improvement (NRI), and discrimination improvement (IDI) were used to assess the predictive ability for all-cause death after the addition of SI.

RESULTS: By IPTW analysis, chronic HF patients with a high SI (SI> 62.5) demonstrated a decreasing trend of 28-day hospital death (HR=0.44, 95% CI = 0.06, 3.27, p=0.422), 3-month death (HR=0.45, 95% CI = 0.06, 3.42, p=0.441) and 6-month death (HR=0.44, 95% CI = 0.06, 3.27, p=0.422) compared with a low SI group (SI≤62.5). The subsequent meta-analysis revealed that a low SI was significantly associated with all-cause mortality (OR 0.42, 95% CI = 0.28, 0.62, I2 = 0, p < 0.0001) in patients with chronic HF. Finally, the SI significantly improved the predictive performance of 6-month allcause mortality in chronic HF patients via the integrated IDI (0.002, 95% CI= 0.00-0.120, p=0.033) but not the C-index (Z statistic=0.116) or NRI (0.114, 95% CI= -0.301–0.263).

DISCUSSION: Heart failure and sarcopenia share common pathogenetic pathways, including hormonal changes, malnutrition, inflammation and oxidative stress.

CONCLUSION: A low SI may indicate a poorer prognosis in patients with chronic heart failure. These findings should be validated in larger, prospective studies.

PMID:41863167 | DOI:10.2174/0109298673408383251203080930

Perspect Sex Reprod Health. 2026 Mar 21. doi: 10.1111/psrh.70060. Online ahead of print.

ABSTRACT

PURPOSE: We sought to understand the relationship between Kentucky medical students’ personal beliefs and values about the state’s restrictive abortion climate and their considerations for residency training and/or post-residency practice in Kentucky.

METHODS: We surveyed medical school students enrolled in two medical schools in Kentucky about their personal beliefs and values regarding the state’s abortion climate and whether they were considering residency training and/or staying post-residency in Kentucky. We used descriptive statistics to examine differences in responses, stratified by consideration for residency training and staying. We further examined these relationships among the subset of students who were considering a residency in obstetrics and gynecology (OBGYN).

RESULTS: The survey response rate was 17.9%. Overall, 77.8% (n = 210) of respondents indicated that the current anti-abortion climate in Kentucky did not align with their personal beliefs and values. Among all medical students, 51.1% (n = 138) indicated they were considering staying in Kentucky post-residency, including 29% of those considering an OBGYN residency. Among those considering an OBGYN residency (n = 74), 51.4% (n = 38) reported that they were considering staying in Kentucky for residency, compared with 48.6% (n = 69) of those who were not considering an OBGYN residency.

CONCLUSIONS: While most responding medical students reported their personal beliefs and values do not align with the state’s anti-abortion climate, the majority are considering staying in Kentucky for residency and post-residency practice, regardless of their interest in an OBGYN residency. This suggests that opinions about the anti-abortion climate may not factor prominently in students’ decisions about residency training and practice location.

PMID:41863155 | DOI:10.1111/psrh.70060

J Vet Diagn Invest. 2026 Mar 21:10406387261432653. doi: 10.1177/10406387261432653. Online ahead of print.

ABSTRACT

Digital microscopy is increasingly used in veterinary diagnostic pathology. However, limited independent research has been published on its use, especially for the purpose of evaluating blood films. Hence, determining the potential limits of blood film assessments obtained via digital microscopy is needed. We compared the agreement of digital and optical cytology for the detection of common cellular morphology changes and abnormalities in veterinary blood films. Twenty-two veterinary clinical pathologists and residents evaluated canine, feline, and equine blood films on glass slides via optical microscopy and digitized blood film slides, with a ≥8-wk washout period between evaluations. One of the equine cases was a patient experimentally infected with Theileria haneyi. Using a standardized rubric, 16 erythrocyte features, 2 platelet features, and 2 leukocyte features were scored from absent to 4+. Additional comments at pathologist discretion were recorded. Changes in erythrocyte shape, platelets, and leukocytes were readily identified on both digital and glass slides. T. haneyi organisms were identified on significantly fewer digitized blood film slides than glass slides. Additionally, intra-observer consistency was low between digitized blood film slide and glass slide evaluation. Relative to glass slides, digitized blood film slides appear generally adequate for identifying erythrocyte, leukocyte, and platelet morphology changes, but may be inadequate for identifying intracellular T. haneyi organisms; however, more studies are needed. Clinicians should exercise caution when interpreting results from digitized blood film slides in which blood-borne infectious disease may be present.

PMID:41863154 | DOI:10.1177/10406387261432653

Acta Anaesthesiol Scand. 2026 Apr;70(4):e70225. doi: 10.1111/aas.70225.

ABSTRACT

PURPOSE: Pre-admission functional status affects patients’ ability to overcome the deteriorating effects of acute critical illness. We aimed to develop a clinical prediction model for 90-day and 1-year mortality based on pre-admission data, including functional status, in adult delirious ICU patients.

METHODS: We included participants randomized to the three highest-enrolling hospitals in the Agents Intervening against Delirium in the Intensive Care Unit (AID-ICU) trial, with pre-admission data on the Clinical Frailty Scale, Comorbidity-Polypharmacy Score, and Barthel-20 score. Ten candidate models were evaluated using multiple modeling approaches. Final models were chosen based on the hyperparameter setting maximizing the Cox-Snell pseudo R². All baseline variables and trial allocation were included. Final models were retrained on the full dataset, with internal validation performed using bootstrapping validation adjusting for optimism.

RESULTS: Of 1000 participants in AID-ICU, 632 were included: 630 provided data on 90-day mortality, and 610 on 1-year mortality. The elastic net regression models demonstrated stable, robust performance. The optimism-adjusted areas under the receiver operating characteristic curves were 0.74 (95% confidence interval [CI]: 0.70-0.78) and 0.74 (95% CI: 0.70-0.77) for the 90-day and 1-year mortality models, respectively. Calibration was good across the risk spectrum. Frailty, age, the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU), advanced cancer, and surgical admission contributed most to the prediction models.

CONCLUSIONS: We developed models to predict 90-day and 1-year mortality at ICU admission in patients enrolled in the AID-ICU trial, using baseline variables, including functional status measures. The models showed fair discrimination and good calibration, with frailty, age, SMS-ICU, advanced cancer, and surgical admission as key predictors. Future studies are needed to test whether the model is valid in other ICU settings and whether its performance is sufficient to have clinical value.

EDITORIAL COMMENT: This article presents mortality prediction models for ICU patients with delirium that incorporate pre-admission functional status and apply several modern statistical learning approaches, providing an instructive and transparent example of contemporary prediction modeling. The resulting elastic net regression models showed fair discrimination and good calibration for predicting 90-day and 1-year mortality, with frailty, age, and illness severity emerging as the strongest predictors. However, such models should be interpreted cautiously at the individual patient level and may be most useful for identifying patients at increased risk who may benefit from careful clinical assessment, individualized treatment, and close follow-up.

PMID:41863137 | DOI:10.1111/aas.70225

Psychogeriatrics. 2026 May;26(3):e70158. doi: 10.1111/psyg.70158.

ABSTRACT

BACKGROUND: With the advent of disease-modifying therapies for Alzheimer’s disease, there is a growing demand for more cost-effective methods that predict amyloid PET positivity. In Japan, the combination of structural brain MRI and regional cerebral blood flow (rCBF) single-photon emission computed tomography (rCBF SPECT) is routinely used in clinical practice for neuroimaging. The present study investigated the utility of this imaging approach for amyloid PET positivity in real-world clinical settings.

METHODS: A retrospective analysis of 101 patients who visited the Memory Clinic at Juntendo University Hospital between April 2019 and September 2023 was performed. All patients had undergone amyloid PET imaging at their own expense, in addition to a neuropsychological assessment, structural brain MRI and rCBF SPECT. Among 58 cases that underwent a voxel-based specific regional analysis system for Alzheimer’s disease (VSRAD), volumetric differences between the amyloid-positive and -negative groups were assessed using Statistical Parametric Mapping (SPM) version 12.

RESULTS: Among the 101 patients analysed, 68 were positive and 33 were negative for amyloid. Twenty-nine patients had a change in clinical diagnosis after amyloid PET imaging, which affected subsequent management. Using VSRAD, VOI severity (continuous value) was set to 0.95 based on Youden’s index and AUC (95% CI) was 0.72 (0.572-0.867), with a sensitivity of 90%, specificity of 52% and accuracy of 78%. In the visual assessment, MRI and rCBF SPECT were combined, and AUC (95% CI) was 0.767 (0.629-0.905), with a sensitivity decrease to 21% and specificity increase to 95%. The SPM12 analysis revealed clusters in the right medial temporal lobe at an uncorrected threshold (p < 0.001). However, no voxels survived family-wise error (FWE) correction (p < 0.05).

CONCLUSION: A VSRAD analysis of brain MRI has moderate discriminatory ability as a screening tool for predicting amyloid PET positivity. The addition of SPECT to MRI was not associated with a statistically significant improvement compared with MRI alone. SPECT may contribute to the differential diagnosis of non-Alzheimer’s disease. MRI alone could be considered an option to increase the pre-test probability of amyloid PET positivity.

PMID:41863136 | DOI:10.1111/psyg.70158

Curr Med Imaging. 2026 Mar 16. doi: 10.2174/0115734056429704251125042910. Online ahead of print.

ABSTRACT

BACKGROUND: Although fetal MRI has been increasingly widely used in clinical and research settings, quantitative studies specifically targeting the ossification centers of the atlas and axis remain scarce. This study aims to quantitatively assess the ossification centers of the atlas and axis in fetuses using Magnetic Resonance Imaging (MRI) and establish standardized reference data for prenatal evaluation.

MATERIALS AND METHODS: This study included 41 human fetuses (24 males and 17 females) at 17 to 42 weeks of gestation, collected after spontaneous abortion or preterm birth that met ethical standards. High-resolution imaging was obtained by an MRI scanner. Three-dimensional volumetric data of the ossification centers were obtained and analyzed using the 3D Slicer software. Morphometric parameters, which included the 3D maximum diameter, projection surface area, and volume, were measured. Statistical analysis was conducted with SPSS 23, and growth dynamics were evaluated by regression models.

RESULTS: Analysis shows that the ossification centers of the atlas and axis increase proportionally with gestational age, and there is a significant correlation between age and measurement parameters. The average 3D maximum diameter, projected surface area, and volume show consistent growth patterns, with no significant differences between genders. The linear regression model is the best at describing developmental dynamics, with high coefficients of determination for all parameters (R 2>0.70).

DISCUSSION: This study indicates that the ossification centers of the fetal atlas and axis increase proportionally with gestational age, and a high correlation is observed in all morphological measurement parameters. Compared with ultrasound or CT, MRI has been proven to be a superior non-invasive imaging method that can provide high-resolution three-dimensional data for detailed evaluation of the fetal cervical spine without radiation exposure. The lack of gender-based differences supports the use of a unified growth model. These normative data provide valuable benchmarks for detecting cervical dysplasia. Although the sample size and cross-sectional design are relatively limited, this study provides clinically applicable growth references that may aid in the early diagnosis of congenital spinal abnormalities.

CONCLUSION: This study provides standardized morphometric data for the main ossification centers of the atlas and axis in human fetuses. These findings contribute to a better understanding of fetal cervical spine development and establish a reference framework for early detection of congenital abnormalities. In addition, the research findings emphasize that MRI is a reliable and non-invasive tool for the detailed assessment of fetal skeletal maturity.

PMID:41863132 | DOI:10.2174/0115734056429704251125042910