Nevin Manimala

Arthritis Care Res (Hoboken). 2026 Jul 6. doi: 10.1002/acr.80112. Online ahead of print.

ABSTRACT

OBJECTIVE: Orofacial manifestations are significantly impactful in patients with systemic sclerosis (SSc), yet remain understudied, with no dedicated clinical guidelines to inform their management.

METHODS: An international online survey comprising 38 questions addressing orofacial manifestations of SSc, including patients’ confidence in their treating teams, and perceived unmet needs. Descriptive statistics were used to summarize the data.

RESULTS: We included responses from 334 individuals with SSc, who were predominantly female (95%), older than 55 years (>90%), of white race (87%), and residing in North America (68%) or Europe (23.7%). Most participants were registered with a dentist (90%), and attended at least biannually (64%); however, while (71%) brushing at least twice daily, only 49% used interdental aids daily. Difficulties with oral hygeiene were mainly due to restricted mouth opening (76.7%) and reduced dexterity (65%). The most frequently reported orofacial manifestations were xerostomia (81%), facial appearance concerns (76%), restricted mouth opening (75%), dysphagia (71.3%), and denture-related problems (70% of denture users). Following SSc diagnosis, increased dental extractions (12.6%) and worsening periodontal health (16.3%) were reported. Patients expressed more confidence in their rheumatologists (69.7%) than their dentists (46.1%) in raising concerns regarding the management of SSc-related orofacial issues. Over half of the respondants (55.7%) felt their oral health needs were neglected, particularly regarding periodontal health (51%), enamel wear (35%) and dental caries (28%).

CONCLUSIONS: Orofacial issues are common and impactful yet frequently overlooked by clinicians involved in SSc patient care and management. We have identified important patient-focussed priorities to inform the future research agenda.

PMID:42405430 | DOI:10.1002/acr.80112

Headache. 2026 Jul 6. doi: 10.1111/head.70174. Online ahead of print.

ABSTRACT

OBJECTIVES/BACKGROUND: Cluster headache (CH) has historically been considered a male-dominated disorder, suggesting a role for androgens in its pathophysiology. We aimed to evaluate hormone profiles and symptoms of androgen deficiency in CH.

METHODS: In this prospective, matched case-control study with a nested repeated-measures component, fasted morning blood samples were collected in 30 males with chronic CH (CCH), 33 males with episodic CH (ECH; both during episode and remission), and in 30 age-matched male headache-free controls (HCs). Surveys assessing symptoms of androgen deficiency (Quantitative Androgen Deficiency of Aging Males [QADAM], Aging Males’ Symptoms [AMS]) were collected simultaneously. Steroid hormone profiles were compared among groups. The primary outcome was total testosterone (tT) including biochemical hypogonadism (tT ≤ 10.5). Secondary outcomes were hormonal pathways and individual hormones. Data were collected between October 2022 and April 2025.

RESULTS: Biochemical hypogonadism was observed in 20% of participants with CCH (n = 6), in 9% with ECH (n = 3), and in 7% of HCs (n = 2). None of the HCs had severe hypogonadism, in contrast to those with CH (CCH, n = 3/6; ECH, n = 1/3). AMS and QADAM scores indicated more symptoms of androgen deficiency in participants with hypogonadism, in ECH (AMS: B = 9.59 [95% CI = 5.69-13.50], p < 0.001; QADAM: B = -5.25 [95% CI = -7.39 to -3.11], p < 0.001) and CCH (AMS: B = 8.78 [95% CI = 4.45-13.12], p < 0.001; QADAM: B = -4.59 [95% CI = -6.97 to -2.22], p < 0.001) compared to HCs. In the unadjusted model, we observed a lower, albeit non-statistically significant, mean tT in participants with CCH versus HCs (CCH: B = -2.35 nmol/L [95% CI = -4.79 to 0.09], p = 0.059). In the adjusted model, the differences attenuated, suggesting a strong effect of body mass index and age on the mean tT (CCH: B = -0.93 nmol/L [95% CI = -3.81 to 1.95], p = 0.524; ECH: B = 0.55 nmol/L [95% CI = -2.05 to 3.15], p = 0.674). Measures of hormonal pathways and individual hormones did not differ among groups.

CONCLUSION: Biochemical hypogonadism was observed in one out of five males with CCH versus one out of 20 in the ECH and HCs. Apart from one case, gonadotrophin concentrations were not increased, suggesting a central origin. In the crude data we observed a lower, albeit non-statistically significant, mean tT in males with CCH, but this appeared to be mainly driven by body mass index and age, because it attenuated after correction. Clinical symptoms of androgen deficiency were more prevalent in CH compared to HCs, independent of hypogonadism. Physicians should be aware of potential increased risk and symptoms of (central) hypogonadism in CCH. Further investigation should explore shared underlying mechanisms and testosterone supplementation in CH.

PMID:42405415 | DOI:10.1111/head.70174

Endocr Metab Immune Disord Drug Targets. 2026 Jul 2. doi: 10.2174/0118715303434247251208072607. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to evaluate the effects of denosumab and alendronate on bone mineral density (BMD) and liver fibrosis markers in patients with both primary osteoporosis (OP) and metabolic dysfunction-associated steatotic liver disease (MASLD).

METHODS: This was a single-center, retrospective observational study. A total of 60 patients diagnosed with both OP and MASLD were identified from Zhejiang Hospital and categorized into two groups based on their actual treatment received: denosumab (n=30) or alendronate (n=30). Baseline data, including demographic information, clinical characteristics, BMD, and liver fibrosis markers, were obtained from medical records. These measures were again obtained from records after approximately one year of treatment to evaluate changes in BMD and liver fibrosis markers.

RESULTS: In the denosumab group, marked improvements in BMD were observed at the lumbar spine (L1-4), femoral neck, and total hip (all P < 0.01). Additionally, there were notable reductions in liver fibrosis markers, such as FIB-4 and NFS (P < 0.01 and P < 0.05, respectively). In the alendronate group, only an increase in lumbar spine (L1-4) BMD was noted (P < 0.05), with no statistically significant changes observed in femoral neck or total hip BMD (P > 0.05), nor in liver fibrosis markers.

CONCLUSION: Denosumab use was associated with improvements in BMD and reductions in liver fibrosis in patients with OP and MASLD, suggesting it may be a promising therapeutic option.

PMID:42405391 | DOI:10.2174/0118715303434247251208072607

Ther Adv Urol. 2026 Jul 3;18:17562872261463076. doi: 10.1177/17562872261463076. eCollection 2026 Jan-Dec.

ABSTRACT

BACKGROUND: Triplet therapy with androgen deprivation therapy (ADT), docetaxel, and androgen receptor pathway inhibitors (ARPIs), either darolutamide or abiraterone, is one of the standard treatments for metastatic hormone-sensitive prostate cancer (mHSPC); however, no randomized trial has directly compared both ARPIs within this regimen. Given practical and financial constraints, a head-to-head randomized trial directly comparing these ARPIs may be unlikely.

OBJECTIVE: To compare the real-world effectiveness of darolutamide- versus abiraterone-based triplet therapy in patients with mHSPC.

DESIGN: Retrospective cohort study using a multinational electronic health record network.

METHODS: We conducted a retrospective cohort study using the TriNetX research network. Patients with mHSPC treated with darolutamide- or abiraterone-based triplet therapy were identified and balanced using propensity-score matching. The primary outcome was overall survival (OS), and the secondary outcome was time to next treatment (TTNT), defined by treatment switch. Prespecified subgroup analyses focused on age, cardiometabolic comorbidities, and polypharmacy-related medication use.

RESULTS: Among 1607 eligible patients, 1252 were included after propensity score matching (626 per group). Darolutamide-based triplet therapy was associated with longer OS compared with abiraterone (hazard ratio (HR) 0.42). A favorable difference in TTNT was also observed (HR 0.66). These associations were consistent across clinically relevant subgroups, including patients aged ⩾65 years and those with ischemic heart disease or diabetes mellitus. In polypharmacy-enriched subgroups, darolutamide-based therapy was consistently associated with more favorable OS and TTNT.

CONCLUSION: In this large real-world analysis, darolutamide-based triplet therapy was associated with longer OS and TTNT compared with abiraterone-based triplet therapy in patients with mHSPC, particularly among older individuals and those with comorbidities. These findings are hypothesis-generating, suggesting that ARPI selection within triplet therapy may have clinically relevant implications, supporting the need for prospective studies.

PMID:42405379 | PMC:PMC13332278 | DOI:10.1177/17562872261463076

Stoch Partial Differ Equ. 2026;14(2):1015-1061. doi: 10.1007/s40072-026-00424-0. Epub 2026 Apr 4.

ABSTRACT

In this paper we extend the theory of energy solutions for singular SPDEs, focusing on equations driven by highly irregular noise with bilinear nonlinearities, including scaling critical examples. By introducing Gelfand triples and leveraging infinite-dimensional analysis in Hilbert spaces together with an integration by parts formula under the invariant measure, we largely eliminate the need for Fourier series and chaos expansions. This approach broadens the applicability of energy solutions to a wider class of SPDEs, offering a unified treatment of various domains and boundary conditions. Our examples are motivated by recent work on scaling limits of interacting particle systems.

PMID:42405359 | PMC:PMC13328241 | DOI:10.1007/s40072-026-00424-0

HSS J. 2026 Jul 2:15563316261456312. doi: 10.1177/15563316261456312. Online ahead of print.

ABSTRACT

BACKGROUND: Reported data remains mixed on the extent to which insurer status as a surrogate for socioeconomic status (SES) affects perioperative outcomes in patients undergoing total knee arthroplasty (TKA).

PURPOSE: This study evaluated postoperative outcomes utilizing insurance status as a surrogate for SES.

METHODS: This study retrospectively reviewed 8961 patients undergoing primary TKA at a single institution. Patients were grouped by insurance: Medicaid or non-Medicare commercial insurance. The primary outcome measure was revision surgery within 5 years of the index TKA. Time-to-event outcomes including reoperation, readmission, manipulation under anesthesia (MUA), and patient-reported outcome measures (PROMs) were analyzed.

RESULTS: Kaplan-Meier survival curves revealed greater time to revision survival probability in patients with Medicaid compared to patients with commercial insurance. No statistically significant differences were observed between groups for reoperation-free survival, readmission-free survival, or MUA-free survival. At both 1-year and 2-year postoperative follow-up, commercially insured patients had statistically significantly higher Knee Injury and Osteoarthritis Outcome Score Jr (KOOS Jr) scores compared with Medicaid patients. However, the absolute differences in KOOS JR scores at these time points did not exceed the previously established minimal clinically important difference.

CONCLUSION: Despite having increased comorbidities and higher body mass index, Medicaid patients treated at this high-volume institution had improved revision-free survival and no difference in rates of reoperation or readmission, while achieving similar PROMs during the first 2 years following TKA.

LEVEL OF EVIDENCE: Level III, Prognostic study.

PMID:42405356 | PMC:PMC13328111 | DOI:10.1177/15563316261456312

Infect Drug Resist. 2026 Jun 30;19:615697. doi: 10.2147/IDR.S615697. eCollection 2026.

ABSTRACT

BACKGROUND: Urinary tract infections (UTIs) are common bacterial infections worldwide, and increasing multidrug resistance (MDR) and extended-spectrum β-lactamase (ESBL) production among uropathogenic Enterobacterales have increasingly limited empirical and targeted treatment options, particularly in low- and middle-income countries.

METHODS: This laboratory-based cross-sectional study was conducted at Bangladesh Medical University, Dhaka, Bangladesh. Eligible MDR uropathogenic Enterobacterales isolates from routine diagnostic urine specimens were collected and tested after Institutional Review Board approval on 13 July 2025. Urine specimens were obtained as part of standard hospital diagnostic procedures from patients with suspected UTI. A total of 122 MDR isolates were included. Bacterial identification was performed using conventional biochemical methods. Antimicrobial susceptibility testing was performed by Kirby-Bauer disk diffusion following CLSI 2024 guidelines, and phenotypic ESBL production was detected by the double-disc synergy test. MDR classification was based on the complete routine antimicrobial susceptibility testing record, including amikacin and gentamicin. Descriptive statistics and exact binomial 95% confidence intervals (CIs) were calculated.

RESULTS: Among these 122 MDR isolates, Escherichia coli was predominant (81/122, 66.4%), followed by Klebsiella spp. (38/122, 31.1%) and Proteus spp. (3/122, 2.5%). Resistance was highest to nalidixic acid (122/122, 100.0%), ceftazidime (117/122, 95.9%), ceftriaxone (116/122, 95.1%), cefepime (113/122, 92.6%), ciprofloxacin (106/122, 86.9%), and meropenem (27/122, 22.1%). Phenotypic ESBL production was identified in 59/122 isolates (48.4%; 95% CI: 39.2-57.6%). DDST-positive isolates showed descriptively higher cephalosporin resistance than DDST-negative isolates, while ciprofloxacin resistance was similarly high in both groups. In this dataset, meropenem resistance was observed only among DDST-negative isolates.

CONCLUSION: Among MDR uropathogenic Enterobacterales from a single tertiary-care hospital in Bangladesh, ciprofloxacin and cephalosporin resistance and phenotypic ESBL production were high. Findings support routine ESBL screening, local susceptibility surveillance, and antimicrobial stewardship, but should be interpreted within the study’s MDR-only, single-center scope.

PMID:42405313 | PMC:PMC13332782 | DOI:10.2147/IDR.S615697

Build Environ. 2026 Jun 1;297:None. doi: 10.1016/j.buildenv.2026.114591.

ABSTRACT

Accurate, real-time estimation of core body temperature (CBT) during physical activity is essential for monitoring heat strain and mitigating the risk of heat-related illness under hot environmental conditions. Although numerous data-driven algorithms using wearable sensors have been proposed, their practical reliability remains unclear due to substantial methodological heterogeneity and the absence of standardized evaluation. This study combined a systematic review with a standardized quantitative benchmark. A total of 38 studies employing non-invasive inputs for CBT estimation were identified. Of these, 14 eligible models, including Kalman filter-based methods, statistical models, and machine-learning approaches, were re-implemented and evaluated under identical preprocessing and evaluation settings using two independent datasets: Dataset 1 (treadmill walking, $n=16$ ) and Dataset 2 (cycling, $n=13$ ). The benchmark revealed notable differences between originally reported performance and reproduced performance under standardized conditions. For the widely used heart-rate-based extended Kalman filter, the root mean square error (RMSE) increased from typically reported values of $\sim$ 0.21-0.41 ${}^{\circ }$ C to 0.41 ${}^{\circ }$ C on Dataset 1 and 0.66 ${}^{\circ }$ C on Dataset 2. Incorporating skin temperature improved tracking accuracy in some configurations, but performance gains were highly dependent on measurement site and dataset. Sensitivity for detecting elevated CBT ( $\ge$ 38.0 ${}^{\circ }$ C) varied markedly across methods, particularly for the cycling protocol. In conclusion, no single CBT estimation approach consistently outperformed others across all settings. Heart-rate-only models provided a stable baseline under limited sensing conditions, whereas multimodal approaches offered conditional benefits in more controlled scenarios. This work establishes a standardized benchmark framework to support fair comparison, method selection, and future development of (wearable) CBT estimation technologies.

PMID:42405303 | PMC:PMC13328076 | DOI:10.1016/j.buildenv.2026.114591

Orthop Rev (Pavia). 2026 Jul 1;18:163922. doi: 10.52965/001c.163922. eCollection 2026.

ABSTRACT

BACKGROUND: Venous thromboembolism remains an important complication after acute orthopedic trauma. Low molecular weight heparin has historically been the conventional pharmacologic standard for thromboprophylaxis, while aspirin has gained increasing clinical interest as a practical alternative. This systematic review and meta-analysis evaluated randomized controlled trial evidence comparing aspirin with low molecular weight heparin after acute orthopedic trauma.

METHODS: PubMed, Scopus, and Web of Science were systematically searched from database inception through March 21, 2026. Randomized controlled trials comparing aspirin with low molecular weight heparin in adults with acute orthopedic trauma requiring thromboprophylaxis were included. Primary outcomes were all cause mortality, bleeding complications, and infection related complications. Quantitative synthesis was performed where appropriate using pooled risk ratios with 95% confidence intervals under a random effects model. Venous thromboembolic outcomes were synthesized qualitatively because of heterogeneous endpoint definitions.

RESULTS: Four publications representing two independent randomized orthopedic trauma trial programs involving 12,540 participants were included. Meta analysis showed no statistically significant differences between aspirin and low molecular weight heparin for all cause mortality (risk ratio 1.02, 95% confidence interval 0.69 to 1.53), bleeding complications (risk ratio 0.96, 95% confidence interval 0.88 to 1.05), or infection related complications (risk ratio 1.05, 95% confidence interval 0.80 to 1.37). No statistical heterogeneity was observed across pooled outcomes.

CONCLUSION: Aspirin did not demonstrate statistically significant differences from low molecular weight heparin in mortality or major safety outcomes within the currently available randomized orthopedic trauma evidence. However, comparative venous thromboembolic efficacy remains uncertain because thromboembolic outcomes could not be validly pooled. Further trauma specific randomized studies with standardized outcome reporting are needed.

PMID:42405299 | PMC:PMC13331335 | DOI:10.52965/001c.163922

J Diabetes Metab Disord. 2026 Jul 2;25(2):182. doi: 10.1007/s40200-026-01992-7. eCollection 2026 Dec.

ABSTRACT

BACKGROUND: Insufficient physical activity (IPA) is a well-established cardiovascular risk factor. Iran has one of the highest cardiovascular disease (CVD) burdens in the Middle East and North Africa region. This study estimated prevalence-based, scenario-driven population-attributable fractions (PAFs) of prevalent CVD, coronary heart disease (CHD), and stroke statistically associated with insufficient non-occupational physical activity among Iranian adults aged ≥ 40 years under a counterfactual model of sufficient physical activity.

METHODS: We analyzed data from 16,552 adults aged ≥ 40 years from the nationally representative Iran STEPS 2021 survey. IPA was defined as < 600 MET-minutes/week of non-occupational physical activity. PAFs were estimated using Miettinen’s formula combining the prevalence of IPA among cases with sex-specific relative risks from a prospective meta-analysis after transformation to reflect IPA versus sufficient activity. Analyses incorporated sampling weights and complex survey design; 95% confidence intervals (CIs) were estimated via bootstrap.

RESULTS: Weighted prevalence was 11.48% (95% CI: 10.95, 12.04) for CVD, 10.43% (95% CI: 9.91, 10.96) for CHD, and 2.17% (95% CI: 1.94, 2.43) for stroke. Under a counterfactual scenario of sufficient activity, the estimated PAF was 19.2% (95% CI: 15.1, 23.2) for CVD, 15.9% (95% CI: 11.2, 20.5) for CHD, and 17.1% (95% CI: 11.5, 22.5) for stroke. Higher fractions were observed among women (25.2% for CVD) and adults aged ≥ 60 years (19.7% for CVD).

CONCLUSIONS: These scenario-driven estimates suggest that a substantial proportion of prevalent CVD would be statistically associated with IPA under a counterfactual model. Due to the cross-sectional design, reverse causation is likely and may upwardly bias estimates. Findings highlight women and older adults as priority subgroups for physical activity promotion. The PAF estimates should be interpreted as policy-oriented scenario measures rather than direct causal effects.

TRIAL REGISTRATION: Not applicable.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-026-01992-7.

PMID:42405266 | PMC:PMC13328525 | DOI:10.1007/s40200-026-01992-7