Nevin Manimala

Am J Sports Med. 2026 Mar 28:3635465261429493. doi: 10.1177/03635465261429493. Online ahead of print.

ABSTRACT

BACKGROUND: Horizontal cleavage tears (HCTs) comprise one-quarter of all diagnosed meniscal pathologies. Despite several static/quasi-static cadaveric studies showing that HCTs and their repairs do not change contact mechanics while leaflet resections do, it is unclear if these conclusions hold during activities of daily living.

HYPOTHESIS/PURPOSE: The purpose of this study was to quantify the comparative biomechanical effects of meniscal HCT, HCT repair, and leaflet resection on joint contact forces throughout simulated gait. It was hypothesized that HCT repair would not change contact mechanics relative to the intact meniscus, while inferior meniscal leaflet resection would lead to increased contact stress and decrease contact areas throughout simulated gait.

STUDY DESIGN: Controlled laboratory study.

METHODS: Six human cadaveric knees were placed on a multidirectional dynamic simulator. Electronic pressure sensors were inserted across the medial tibial plateau, and contact forces throughout simulated gait were quantified. Contact stress, contact area, and percent meniscal loading were quantified for intact, HCT, HCT repair, and inferior leaflet conditions.

RESULTS: No significant differences in contact mechanics occurred between the intact meniscus and HCT or between the intact meniscus and HCT repair. Inferior leaflet resection resulted in a statistically significant decrease in contact area during the early, mid-, and late stance of the simulated gait cycle; a significant decrease in percent meniscal loading between 8% and 60% of simulated gait; and a small but significant increase in peak contact stress during the midstance phase of the simulated gait cycle between 19% and 30% of simulated gait.

CONCLUSION: The authors failed to reject the null hypothesis as there was no significant difference observed between meniscal HCT repair and the intact meniscus, while resection of the inferior leaflet was associated with a small but statistically significant increased peak contact stress, decreased contact area, and decreased percent meniscal loading during simulated gait. Taken together, these results support that when an HCR tear is symptomatic, meniscal preservation is preferable over inferior leaflet resection in the biomechanical management of horizontal cleavage meniscal tears.

CLINICAL RELEVANCE: These cadaveric tests suggest that horizontal cleavage meniscal tears of the medial meniscus posterior horn are not biomechanically detrimental to joint contact forces during simulated gait. If they must be surgically treated for symptomatic reasons, meniscal repair is biomechanically favorable over inferior leaflet resection.

PMID:41902557 | DOI:10.1177/03635465261429493

J Diabetes Investig. 2026 Mar 28. doi: 10.1111/jdi.70293. Online ahead of print.

ABSTRACT

OBJECTIVE: To systematically evaluate and compare the efficacy and safety of three fixed-ratio combination products-insulin degludec/liraglutide (IDegLira), insulin glargine/lixisenatide (iGlarLixi), and insulin degludec/insulin aspart (IDegAsp)-in patients with type 2 diabetes.

METHODS: We systematically searched PubMed, Embase, Cochrane Library, CNKI, Wanfang, and VIP up to July 2025 for randomized controlled trials (RCTs) comparing the three combinations of primary interest (IDegLira, iGlarLixi, IDegAsp) and their individual components (insulin degludec, insulin glargine, liraglutide, and lixisenatide). Inclusion of the individual components enabled indirect comparisons. Data extraction, risk-of-bias assessment, and GRADE evaluation were performed. Network meta-analysis was conducted using Stata 14.0, with treatments ranked by the surface under the cumulative ranking curve (SUCRA).

RESULTS: Twenty-one RCTs involving 12,815 patients were included. Both IDegLira (OR = 1.69, 95% CI: 1.08-2.65) and iGlarLixi (OR = 1.67, 95% CI: 1.17-2.37) had a higher incidence of treatment-emergent adverse events (TEAEs) than IDegAsp; no other significant pairwise differences were observed. Based on SUCRA values, which provide a probabilistic ranking (indicating the likelihood of being the best rather than direct statistical superiority), IDegLira had the highest probability of being optimal for reducing HbA1c (89.4%), fasting plasma glucose (81.8%), and incidence of hypoglycemic events (57.6%), while IDegAsp ranked highest regarding the incidence of TEAEs (97.9%). Inconsistency in the hypoglycemia network, likely due to varied definitions, warrants cautious interpretation.

CONCLUSIONS: Among the three fixed-ratio combination products, IDegLira appears most effective for glycemic control (in terms of HbA1c and FPG reduction), whereas IDegAsp demonstrates the best safety profile regarding incidence of TEAEs.

PMID:41902544 | DOI:10.1111/jdi.70293

J Vestib Res. 2026 May;36(3):172-182. doi: 10.1177/09574271251385900. Epub 2025 Oct 14.

ABSTRACT

ObjectivesThis work aims to evaluate the psychometric properties of the Vertigo Handicap Questionnaire (VHQ) in a Spanish-speaking population.MethodsA total of 150 patients were included. Exploratory Factorial Analysis (EFA), Cronbach’s alpha, weighted kappa, Spearman correlation with respect to the Dizziness Handicap Inventory (DHI) and Activities Balance Confidence Scale (ABC), Kruskal-Wallis test and receiver operating characteristics (ROC) curve analysis were performed.ResultsInternal consistency analysis found eight items uncorrelated with the total score, after whose elimination a 17-item VHQ version was generated. The EFA did not find clear factorization but did find a 7-item VHQ subscale that correlated strongly with VHQ_17 and VHQ_25. The Kappa was 0.993, 0.979 and 0.996 for VHQ_25, VHQ_17 and VHQ_7, respectively. Standard Error of Measurement (SEM) was 1.57, 2.11 and 0.60 points, and Minimum Detectable Change (MDC) was 3.08, 4.13 and 1.17 points for the three scales. VHQ_25, VHQ_17 and VHQ_7 strongly correlated with ABC-16 (Rho = -0.716, -0.787 -0.603, respectively) and DHI (Rho = 0.708, 0.696 0.721, respectively). VHQ_7 score was statistically different for different health conditions. The cut-off point >57 in VHQ_25 and >14 in VHQ_7 had 100% sensitivity, while a cut-off point >41 in VHQ_17 had 100% specificity in predicting severe disability due to vertigo.ConclusionsThe Spanish version of the VHQ_25 is a valid and reliable instrument for measuring disability, handicap and psychological distress related to vertigo. However, the VHQ_17 and VHQ_7 versions may be viable options, especially the last, which has excellent psychometric properties and may be easier to implement.

PMID:41902518 | DOI:10.1177/09574271251385900

J Empir Res Hum Res Ethics. 2026 Mar 28:15562646261434107. doi: 10.1177/15562646261434107. Online ahead of print.

ABSTRACT

Including diverse populations in clinical research is essential for generalizable findings. Prior studies show lower consent rates among vulnerable populations in higher-risk studies, but whether these trends apply to minimal-risk studies has not been explored. This study investigated factors influencing consent to a musculoskeletal ultrasound study for extremity injuries in the emergency department. Demographic characteristics, injury severity, interpreter use, and researcher-patient racial concordance were compared between those who consented and declined. Patients were more likely to decline if they were admitted to the hospital (p = 0.002) or had a displaced fracture (displaced-nondisplaced: p = 0.032; displaced-no fracture: p = 0.009). Younger patients (<45 years) most often declined due to pain, while older patients (>45 years) primarily cited lack of interest (p = 0.04). Although not statistically significant, Black and Hispanic patients most often declined for lack of interest. Older adults’ lower interest highlights the need to increase research participation in this underrepresented population.

PMID:41902511 | DOI:10.1177/15562646261434107

JPEN J Parenter Enteral Nutr. 2026 Mar 28. doi: 10.1002/jpen.70087. Online ahead of print.

ABSTRACT

BACKGROUND: Parenteral nutrition is a high-alert medication with the potential for errors that result in patient harm. The American Society for Parenteral and Enteral Nutrition has published guidance to support safe parenteral nutrition practices; however, the current implementation of this guidance or improvement in clinical practice over time remains unknown.

METHODS: A cross-sectional survey on current parenteral nutrition practice was distributed to US-based clinicians. Survey items addressed multiple steps in the parenteral nutrition use process. Descriptive statistics were performed and presented as number and percentage of respondents.

RESULTS: A total of 1160 participants were included. Critical safety gaps included: prescribing practices that lack standardization and do not align with guidance; inadequate storage practices between compounding and administration; lack of adherence to specific filter type guidance; lack of adherence to the maximum hang time of separate lipid injectable emulsion infusions; limited oversight; minimal quality improvement activities; inadequate evaluation of errors; and pervasive unawareness of key institutional parenteral nutrition practices. Practice improvements included greater adoption of safety technologies and an increased use of filters during administration.

CONCLUSION: This survey of current parenteral nutrition practice reveals some improvements in clinical practice; however, it highlights several critical gaps in the adoption of guidance with ongoing unsafe practices, which can result in patient harm.

PMID:41902507 | DOI:10.1002/jpen.70087

Disabil Rehabil. 2026 Mar 28:1-18. doi: 10.1080/09638288.2026.2647648. Online ahead of print.

ABSTRACT

PURPOSE: To assess participation levels of fathers and siblings in home-based rehabilitation for children with neuro-developmental delay (NDD) in Bulawayo, Zimbabwe, and identify facilitators and barriers.

MATERIALS AND METHODS: A concurrent mixed-methods cross-sectional design with a dominant quantitative component and a supplementary qualitative component was used. Data were collected from 196 fathers of children with NDD at two hospitals using a questionnaire. Quantitative data were analysed using descriptive statistics and logistic regression (α = 0.05) in Stata 17.0, while open-ended responses were thematically analysed in NVivo 12 using a deductive approach informed by the Social Ecological Model.

RESULTS: Only 35 (17.9%) fathers and 20 (10.2%) siblings consistently participated. Fathers with tertiary education participated more (AOR = 6.4; 95% CI: 1.9-22.1; p = 0.003), as did fathers of male children (AOR = 2.8; 95% CI: 1.3-6.1; p = 0.009). Facilitators included ability to manage disability-related challenges and access to information. Barriers included emotional strain, work demands, and exclusion from sessions. Sibling participation was facilitated by parental supervision, play-based activities, and professional support, while barriers included school obligations and cultural norms.

CONCLUSIONS: Modifiable factors affect father and sibling participation, highlighting the need for inclusive family-centred rehabilitation policies and practices.

PMID:41902491 | DOI:10.1080/09638288.2026.2647648

J Cachexia Sarcopenia Muscle. 2026 Apr;17(2):e70263. doi: 10.1002/jcsm.70263.

ABSTRACT

BACKGROUND: Diabetes increases susceptibility to infectious respiratory diseases, but the impact of underweight status on mortality from these conditions remains unclear. We evaluated the association between low body mass index (BMI) and respiratory infection-related mortality in a large nationwide cohort of individuals with diabetes.

METHODS: We conducted a population-based cohort study using linked Korean national health and mortality data, including 2 508 409 adults with type 2 diabetes. Participants were stratified by BMI and followed for cause-specific mortality from influenza/pneumonia, tuberculosis and COVID-19. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs), accounting for demographics, lifestyle factors, comorbidities and competing risks.

RESULTS: Over a median follow-up of 6 years, 18 024 (0.72%) participants died due to respiratory infections. Compared to individuals with BMI ≥ 18.5 kg/m², the aHRs for respiratory mortality were 7.27 (95% CI, 6.31-8.38), 4.79 (4.25-5.41) and 3.15 (2.93-3.38) for BMI < 16, 16-16.9 and 17-18.4 kg/m², respectively (all p < 0.001) with a progressive risk gradient. Underweight status amplified the risk of tuberculosis-related mortality most markedly (aHR, 9.93 for BMI < 16 kg/m², p < 0.001). Mortality risks in underweight individuals exceeded those for BMI ≥ 35 kg/m² relative to the reference group (25-29.9 kg/m²). Associations were more pronounced in individuals under 65 years and those without cardiovascular or kidney disease.

CONCLUSIONS: Underweight status is a strong, independent predictor of respiratory infection-related mortality in individuals with diabetes. Recognition of low BMI as a marker of vulnerability may improve targeted preventive strategies in diabetes care.

PMID:41902484 | DOI:10.1002/jcsm.70263

Ideggyogy Sz. 2026 Mar 30;79(3-4):103-109. doi: 10.18071/isz.79.0103.

ABSTRACT

BACKGROUND AND PURPOSE: In the last two decades, the quality of life and life expectancy of multiple sclerosis (MS) patients have improved, related to the growing number and efficacy of disease-modifying drugs (DMD). Due to multifactorial causes, the prevalence of MS has also increased. Our aim was to assess and quantify the changes of patient management in clinical practice in the last 17 years.

METHODS: Of all out- and inpatients seen at the Department of Neurology, Semmelweis University, we have screened those who have at least once received the diagnostic code of MS (G35 in ICD-10) in calendar years of 2006, 2012, 2016, and 2022. After reviewing their medical documents, we have validated the MS diagnosis and examined the duration of inpatient stays, the number of outpatient consultations and type of DMD.

RESULTS: The yearly number of MS patients seen at the Department has grown from 139 in 2006 to 514 in 2022. The proportion of patients who have received at least one type of DMD in the given year has changed from 21.6% to 76.8% respectively. While in 2006, 54.7% of patients had to be hospitalized at least once in relation with MS, in 2022 only a minority (6%) needed inpatient care, but with a difference between treated and untreated patients (3.8% vs 13.4%). Regarding outpatient consultations, not only its absolute yearly number, but also the yearly number per patient has grown (from 1.7 in 2006 to 5.1 in 2022), especially among treated subjects.

CONCLUSION: In accordance with international and Hungarian guidelines, the ratio of MS-patients receiving DMD has greatly increased, and – probably not independently of this trend – the need for hospitalization has diminished. Paralelly, the outpatient management load multiplied. These changes should be considered when allocating resources.

PMID:41902458 | DOI:10.18071/isz.79.0103

J Vasc Access. 2026 Mar 28:11297298261435727. doi: 10.1177/11297298261435727. Online ahead of print.

ABSTRACT

INTRODUCTION: The use totally implantable venous access devices (TIVAD) has significantly improved the quality of care and comfort of life of oncology patients.

AIM: The aim of this study was to retrospectively analyze the incidence and etiology of infections in patients with TIVAD, with a distinction between oncology and hematology patients. In addition, the influence of age, tumour type, presence of neutropenia and palliative status on the prevalence of specific pathogens was assessed.

MATERIALS AND METHODS: The medical records of patients hospitalized in the oncology and haematology departments of the municipal hospital in Warsaw between 2022 and 2023 were retrospectively analysed. IBM SPSS Statistics 29 software was used for data analysis. Infection characteristics, age of patients, type of bacteria by type of cancer, type of bacteria versus age of patients, type of bacteria versus patient status are presented in tables.

RESULTS: On the Oncology ward there were 24 infections in 21 patients, while on the haematology ward there were 43 infections in 28 patients. On the Oncology ward, TIVAD infections occurred in 57.14% of patients with gastrointestinal cancer, while on the Haematology ward they occurred in 78.57% of patients with lymphoma. The results as infection density per inpatient TIVAD in oncology department it was 1.24 per 1000 person-days of TIVAD stay. In contrast, in the hematology department results as infection density per inpatient TIVAD it was 3.40. Gram-negative infections accounted for 80.60% (n = 54) and Gram-positive infections for 19.40% (n = 13). The distribution was similar in both wards (75.00% Gram-negative in oncology, 83.72% in haematology).

CONCLUSIONS: Hematology patients were more likely to have TIVAD infections than oncology patients. In most studies, patients with solid tumours and hematological malignancies were analysed together, despite significant clinical differences. Therefore, we decided to analyze these two groups of patients separately.

PMID:41902444 | DOI:10.1177/11297298261435727

Acta Obstet Gynecol Scand. 2026 Mar 28. doi: 10.1111/aogs.70187. Online ahead of print.

ABSTRACT

INTRODUCTION: Labor epidural analgesia (LEA) is widely used for intrapartum pain management, but its effects on uterine activity (UA) remain unclear. Electrohysterography (EHG) is a promising non-invasive method for intrapartum UA monitoring. The aim of this study was to explore the effect of LEA on UA by means of EHG, to develop better understanding of labor physiology, and inform clinical decision-making.

MATERIAL AND METHODS: Patients in active labor with singleton, term pregnancies who received electrophysiological monitoring from 60 min before until 120 min after LEA initiation were included. Contraction parameters such as frequency, duration, area under the curve (AUC), baseline, and maximum amplitude were obtained from an EHG-derived tocogram using a computer-based algorithm. The primary outcome was the difference in mean uterine contraction frequency before and after initiation of LEA. Secondary outcomes included the comparison of various contraction parameters, derived from EHG, before and after LEA initiation, as well as their temporal changes over time. The effect of possible confounders on UA was examined. Mixed effects models were used for statistical analyses.

RESULTS: In total, 86 patients were included. No significant difference in mean uterine contraction frequency and contraction duration was found before and after LEA initiation. Nevertheless, start of LEA was associated with a significant reduction in AUC, baseline activity, and signal amplitude.

CONCLUSIONS: LEA initiation does not affect uterine contraction frequency or duration, but it is associated with a significant reduction in relative EHG-derived amplitude parameters (AUC, baseline tone, and maximum amplitude), which could potentially affect progression of labor. Further studies are required to explore these parameters and their clinical implications.

PMID:41902441 | DOI:10.1111/aogs.70187