Nevin Manimala

Front Oncol. 2026 Jul 16;16:1779553. doi: 10.3389/fonc.2026.1779553. eCollection 2026.

ABSTRACT

AIM: This study investigates the link between proliferation markers (PCNA, p16, Ki-67) and histopathological factors, exploring their prognostic value in breast cancer patients.

MATERIALS AND METHODS: We analyzed female breast cancer patients who underwent surgery. Data collected included demographics, clinical parameters (hemogram, Ca 15.3, menopause status, etc.), family cancer history, pathology, treatments (neoadjuvant, surgical, oncological), tumor staging, lymph node status, receptor status (ER, PR, cerb-b2), and survival. Paraffin blocks were retrospectively analyzed for PCNA, p16, and Ki-67 expression via immunohistochemical staining.

RESULTS: PCNA scores showed no association with demographic or clinical features, though a statistically significant inter-marker correlation with p16 was found (both markers increased together). P16 scores were not linked to other parameters aside from Ki-67 (also demonstrating positive correlation). Higher Ki-67 index was associated with decreased ER and PR expression and, importantly, decreased survival. Although a significant correlation was observed between PCNA and p16 expression levels, neither marker demonstrated independent prognostic significance with respect to overall survival.

CONCLUSIONS: Although PCNA and p16 expression levels were inter-correlated, neither marker showed an independent association with clinicopathological variables or overall survival in our cohort. In contrast, the Ki-67 index was significantly associated with hormone receptor status, pathological stage, and shorter overall survival, and remains the most informative proliferation marker for prognostic stratification in breast cancer. Further prospective studies with standardized scoring and multivariate analysis are warranted to clarify the prognostic value of PCNA and p16.

PMID:42534781 | PMC:PMC13422137 | DOI:10.3389/fonc.2026.1779553

Front Psychol. 2026 Jul 16;17:1901610. doi: 10.3389/fpsyg.2026.1901610. eCollection 2026.

ABSTRACT

Teacher caring is a crucial relational resource for student development in higher education, yet the process by which it connects to students’ perceived course-related learning gains remains underexplored. Drawing on caring theory, social cognitive theory, learning engagement theory, and a supportive relationship perspective, this study tested a sequential mediation model. This model posits that teacher caring is associated with perceived course-related learning gains through academic self-efficacy and learning engagement. A cross-sectional, anonymous online questionnaire survey was administered to Chinese undergraduate students. Out of 632 returned questionnaires, 562 valid responses remained after data cleaning, resulting in a valid response rate of 88.9%. The results showed that teacher caring was positively associated with academic self-efficacy, learning engagement, and perceived course-related learning gains. The CFA measurement model demonstrated a good fit, and composite score path analyses using standardized scores supported the proposed model. Bootstrap mediation tests indicated that both academic self-efficacy and learning engagement partially mediated the association between teacher caring and perceived course-related learning gains, and they also formed a significant sequential indirect path. These results remained stable even after controlling for gender, year of study, major category, region, and university identifier. The findings suggest that teacher caring should be understood not merely as emotional warmth or general support, but as a relational resource linked to students’ confidence in learning and active engagement in coursework. Because the study relied on cross-sectional self-report data, the results should be interpreted as statistical associations consistent with the proposed relational-motivational pathway rather than as evidence of causal ordering.

PMID:42534778 | PMC:PMC13422389 | DOI:10.3389/fpsyg.2026.1901610

Air Qual Atmos Health. 2026;19(8):168. doi: 10.1007/s11869-026-02060-y. Epub 2026 Jul 29.

ABSTRACT

Particulate Matter (PM_2.5) exposure contributes to the global disease burden, yet its monitoring remains sparse and uneven, with limited ground sensor infrastructure. Road-traffic proxy indicators can provide indirect estimates of PM_2.5 where measurements are limited but require context-specific validation. We evaluated three PM_2.5 road-traffic-related proxies: (i) population-Weighted Road Network Density (wRND), (ii) Euclidean (straight line) distance from highways (EH), and (iii) Euclidean distance from main roads (EM). We validated these proxies using high-resolution outdoor filtered PM_2.5 personal exposure measurements collected over 1 year from 343 postpartum participants in The Gambia, Kenya, and Mozambique. Proxy-PM_2.5 associations were assessed using Spearman correlation, and predictive utility was tested using country-specific and global Random Forest (RF) models (3-fold cross-validation), reporting R², RMSE, and feature importance. Spatial mapping showed heterogeneous proxy-PM_2.5 relationships across and within sites, with elevated PM_2.5 occurring in both low- and high-proxy contexts. wRND-PM_2.5 correlations were weak overall and statistically significant only in Mozambique (r = 0.351; p = 0.005), with non-significant associations in Kenya (r = – 0.041; p = 0.673) and The Gambia (r = – 0.020; p = 0.909). EH-PM_2.5 correlations were positive in The Gambia (r = 0.335; p = 0.053) and Mozambique (r = 0.292; p = 0.020) but negative and significant in Kenya (r = – 0.224; p = 0.018). Single-variable RF models performed poorly across all countries (R² < 0.45) and the Global model (R² = 0.42). Combining proxies improved performance in Kenya (R² = 0.52; RMSE = 31.7 µg/m³) and Mozambique (R² = 0.60; RMSE = 8.9 µg/m³), Global R² = 0.46; RMSE = 29.1 µg/m³), although in The Gambia, the combined model (R² = 0.53; RMSE = 37.6 µg/m³) did not exceed the best single-proxy model. Road-network proxies provided limited but context-dependent signals of personal PM₂.₅ exposure. Their performance varied substantially across countries, indicating that road-based indicators should not be used as stand-alone exposure measures in heterogeneous sub-Saharan African settings. Instead, they are most defensible as locally validated components of hybrid exposure models that also incorporate meteorology, land use, biomass burning, household energy, and other non-traffic sources.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11869-026-02060-y.

PMID:42534776 | PMC:PMC13421249 | DOI:10.1007/s11869-026-02060-y

Front Allergy. 2026 Jul 16;7:1911930. doi: 10.3389/falgy.2026.1911930. eCollection 2026.

ABSTRACT

INTRODUCTION: Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease of the upper airways, frequently characterized by recurrence and impaired quality of life. Persistent inflammation and bacterial biofilms contribute to disease chronicity. Topical plant-derived therapies may offer a preventive strategy in long-term CRS management. This study evaluated the effectiveness of a Pistacia lentiscus-based nasal medical device in reducing the impact of CRS recurrence on patients’ daily life.

METHODS: In this retrospective, observational, single- center case-control study, 100 adult patients with chronic rhinosinusitis (CRS) and recurrent disease were identified and included from clinical records. Patients were stratified according to prior exposure to nasal drops containing ultra-fractionated Pistacia lentiscus oil in addition to isotonic saline nasal irrigation, or to isotonic saline nasal irrigation alone, according to routine clinical practice. All patients had undergone a 12-month follow-up regimen with assessments available at baseline, 30 days, and 12 months. The primary outcome was symptom severity measured using the Sino-Nasal Outcome Test (SNOT-22). Secondary outcomes included nasal cytology parameters, biofilm presence, nasal discharge, bacterial elements, supranuclear stria, and ciliary motility.

RESULTS: Of the 100 identified subjects, 92 were included in the final analysis due to loss to follow-up. In the exposed group, SNOT-22 scores showed a 40.6% reduction after the first month, compared with a 7.8% reduction observed in the control group (p < 0.001). Only patients exposed to Pistacia lentiscus oil demonstrated statistically significant reductions over time in nasal discharge (p < 0.005), biofilm presence (p < 0.005), and bacterial elements (p < 0.05), while no significant changes were observed in the control group for these parameters. Ciliary motility remained unchanged in both groups across the study period.

DISCUSSION: Overall, within the limits of this retrospective case-control design, patients exposed to Pistacia lentiscus oil in addition to standard saline irrigation showed greater improvement in patient-reported symptoms and selected cytological markers compared with patients treated with saline irrigation alone.

PMID:42534765 | PMC:PMC13422398 | DOI:10.3389/falgy.2026.1911930

Health Equity. 2026 Jun 8;10:24731242261455433. doi: 10.1177/24731242261455433. eCollection 2026 Jan-Dec.

ABSTRACT

INTRODUCTION: Disparities in medical education are documented across the training continuum, yet little is known about how racial and socioeconomic factors shape disciplinary actions during residency.

METHODS: We conducted a cross-sectional anonymous survey of resident physicians affiliated with the Committee of Interns and Residents. The survey captured demographic characteristics and experiences with negative feedback, remediation, and discipline. We used descriptive statistics and logistic regression.

RESULTS: We analyzed 1,755 validated responses (9.2% completion). Compared with White participants, Black participants had higher odds of being asked to meet with program leadership (unadjusted odds ratio [OR] = 1.93, 95% confidence interval [CI]: 1.32-2.82), and this association strengthened after adjustment for gender, specialty type, and early-life socioeconomic indicators (adjusted OR [AOR] = 2.24, 95% CI: 1.48-3.38). Black participants were nearly three times as likely to report ever being on remediation (OR = 2.93, 95% CI: 1.51-5.72), although adjusted models were limited by small event counts. When disciplinary outcomes were combined, Black participants were 55% more likely than White participants to experience any disciplinary action in unadjusted analyses (OR = 1.55, 95% CI: 1.10-2.19), and this association strengthened after adjustment (AOR = 1.76, 95% CI: 1.21-2.57). Hispanic and Asian participants did not demonstrate higher odds of disciplinary action compared with White participants.

CONCLUSION: Racial and socioeconomic inequities in residency discipline challenge assumptions that discipline reflects merit alone. Programs should implement transparent, uniform disciplinary processes and create supportive training environments for all trainees.

PMID:42534758 | PMC:PMC13421930 | DOI:10.1177/24731242261455433

Cureus. 2026 Jun 30;18(6):e111807. doi: 10.7759/cureus.111807. eCollection 2026 Jun.

ABSTRACT

Objective The gingival sulcus and biological width are key anatomical structures involved in maintaining periodontal health and guiding prosthodontic treatment planning. Although their clinical importance has been well established, data describing these parameters in Moroccan populations remain limited. This study aimed to evaluate the mean gingival sulcus depth and biological width among young Moroccan adults and to provide baseline descriptive data for future periodontal assessment and treatment planning. Methods A descriptive cross-sectional study was conducted involving 133 dental students (72 males and 61 females), aged 21 to 23 years, at the Dental Consultation and Treatment Center (CCTD) of Ibn Rochd University Hospital, affiliated with the Faculty of Dental Medicine of Casablanca (FMDC), Casablanca, Morocco. Each participant underwent standardized clinical and radiographic examinations of one anterior and one posterior tooth. Sulcus depth was measured using a calibrated periodontal probe, while biological width was assessed using periapical radiographs. A single calibrated examiner performed all measurements following a standardized protocol. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA), and mean values were compared using Student’s t-test. Results The mean sulcus depth was 1.11 mm for anterior teeth and 2.17 mm for posterior teeth, with a statistically significant difference (p < 0.0001). The mean biological width was 2.05 mm, consistent with classical reference values reported in the literature. No statistically significant sex-related differences were observed for either parameter. Sulcus depth was significantly greater in posterior teeth than in anterior teeth (p < 0.0001), and biological width differed significantly between anterior and posterior sites (p = 0.003). Conclusions The findings are consistent with previously reported values in the literature and confirm the relative stability of biological width in healthy periodontal tissues. These findings provide descriptive anatomical data that may contribute to biologically informed prosthodontic treatment planning. Further studies incorporating additional periodontal parameters and more diverse populations are recommended to improve external validity.

PMID:42534746 | PMC:PMC13422043 | DOI:10.7759/cureus.111807

Front Psychiatry. 2026 Jul 16;17:1851981. doi: 10.3389/fpsyt.2026.1851981. eCollection 2026.

ABSTRACT

OBJECTIVE: To explore the chain mediating effects of resilience and self-efficacy on the association between social support and quality of life (QoL) among patients with severe stroke.

METHODS: This cross-sectional study enrolled 272 inpatients between June 2023 and June 2025. Validated instruments were used to assess social support (SSRS), resilience (CD-RISC), self-efficacy (GSES), and quality of life (QoL) (SS-QOL). PROCESS Model 6 with 5,000 bias-corrected bootstrap samples was used to test sequential mediation while adjusting for key covariates.

RESULTS: Mean scores indicated moderate levels of social support, resilience, self-efficacy, and QoL. Quality of life scores were significantly higher among patients aged <60 years compared to those aged ≥60 years (54.62 ± 14.07 vs. 49.34 ± 13.12), among patients with higher education levels (college or above: 54.73 ± 14.27 vs. primary school or below: 47.26 ± 11.38), among patients covered by Employee Health Insurance compared to self-funded patients (53.26 ± 13.42 vs. 42.36 ± 11.25), and among patients with lower NIHSS scores (10-14 points: 56.38 ± 13.45 vs. 15-24 points: 46.44 ± 12.41). All comparisons were statistically significant at P < 0.05. All main variables were positively correlated. The direct association between social support and QoL was significant (adjusted unstandardized β = 0.88, 95% CI [0.790, 0.975]), accounting for 53.5% of the total association. The three indirect associations were: (1) SSRS – CD-RISC – SS-QOL: β = 0.255, 95% CI [0.192, 0.329]; (2) SSRS – GSES – SS-QOL: β = 0.126, 95% CI [0.020, 0.208]; and (3) SSRS – CD-RISC – GSES – SS-QOL: β = 0.385, 95% CI [0.289, 0.510],supporting the hypothesized chain mediation model.

CONCLUSION: Social support was strongly associated with QoL, both directly and indirectly through resilience and self-efficacy and their sequential pathways. These findings highlight potential intervention targets, although causal inferences are limited by the study’s cross-sectional design. Strengthening social support and related psychological resources may improve rehabilitation outcomes in patients with severe strokes.

PMID:42534726 | PMC:PMC13421905 | DOI:10.3389/fpsyt.2026.1851981

Cureus. 2026 Jun 30;18(6):e111811. doi: 10.7759/cureus.111811. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Mind mapping is a visual, non-linear learning technique in which information is organized around a central concept with related topics and subtopics arranged as branches. It promotes active learning by helping students organize, understand, and recall information. In medical education, where students are required to learn large volumes of conceptual content, mind mapping may serve as a useful self-directed learning tool.

AIM: This study aimed to evaluate the effectiveness of mind mapping as a self-directed learning method among first-year Bachelor of Medicine, Bachelor of Surgery (MBBS) students and to assess students’ perceptions regarding its use in the context of physiology.

MATERIALS AND METHODS: This quasi-experimental, non-randomized controlled crossover study was conducted among 100 first-year MBBS students at All India Institute of Medical Sciences (AIIMS) Jammu in Jammu, India. Students were divided into two routine practical batches of 50 each. In Phase 1, Batch A served as the mind mapping group and Batch B as the traditional learning group for the topic “Acid-Base Disorders”. All students were first trained in mind map preparation using a topic unrelated to the study intervention. Students in the mind mapping group studied the assigned topic by preparing mind maps, while students in the traditional learning group used their usual study methods. Immediate and delayed post-tests were conducted, with the delayed test performed one month after the intervention. In Phase 2, crossover was performed using the topic “Physiology of EEG and Clinical Relevance”, and the same process was repeated. At the end of the study, students’ perceptions were assessed using a structured five-point Likert scale questionnaire. Data were analyzed using IBM SPSS Statistics for Windows, Version 15.0 (SPSS Inc., Chicago, Illinois, United States), and a p-value of ≤0.05 was considered statistically significant.

RESULTS: Immediate assessment scores did not differ significantly between the mind mapping and traditional learning groups in either phase or in the combined analysis. In the delayed assessment for Phase 2, the mind mapping group scored significantly higher than the traditional learning group. The combined delayed assessment analysis also showed significantly higher scores in the mind mapping group compared with the traditional learning group, with 100 observations in each group (6.97±1.97 vs. 6.30±2.28; p=0.029; Cohen’s d=0.313). Student perception was favorable, with most students reporting that mind mapping improved understanding, organization of concepts, engagement, confidence, active participation, and independent learning. These findings suggest that mind mapping was well accepted by students as a self-directed learning strategy and may contribute positively to independent learning, engagement, and the overall learning experience in undergraduate medical education.

CONCLUSION: Mind mapping did not significantly improve immediate assessment performance compared with traditional learning; however, it was associated with better delayed assessment scores, suggesting a potential benefit in long-term retention. Students perceived mind mapping as an engaging and useful self-directed learning tool. Mind mapping may be incorporated as an adjunct to traditional teaching-learning methods in undergraduate medical education.

PMID:42534708 | PMC:PMC13422079 | DOI:10.7759/cureus.111811

Front Endocrinol (Lausanne). 2026 Jul 16;17:1873295. doi: 10.3389/fendo.2026.1873295. eCollection 2026.

ABSTRACT

BACKGROUND: Diabetes mellitus type 2 is a chronic metabolic disorder which characterized by increased blood glucose that affects different body systems. Increasing blood glucose to high levels cause sorbitol induced blood vessel damage, brain malfunction and degeneration of the nerves that can lead to cognitive dysfunction or dementia. For the best of our knowledge, this is the first study in Yemen, which demonstrate the association between neurocognitive dysfunction and diabetes. This study aimed to determine the prevalence of neurocognitive dysfunction among Yemeni diabetic type2 patients and investigate the relations between these dysfunction, diabetic risk factors, and sociodemographic characteristics.

METHODS: The present cross-sectional study was carried out in Diabetes center of Al-Thawra public hospital from November 2024 to January 2025 and the sample size was 400 T2DM patients (aged 35 to 65 years) which calculated by Steven Thompson Equation. Statistical analysis was performed by SPSS program and Mini-Mental State Examination (MMSE) was used for screening neurocognitive dysfunctions (NCDs) as a score varying from zero to 30, and impairment is indicated by a score of 23 or lower.

RESULTS: the result showed that, higher prevalence of (NCDs) 43% among T2DM patients (219 (54.75%) male and 181(45.25%) female). Neurocognitive dysfunction was significantly increased in elderly, low-educated, non-employed and long duration diabetes patients with P– value (0.001, 0.001, 0.001, 0.001) respectively. While it was significantly decreased in patients with low BMI and those make regular exercise with (P– value = 0.002 and 0.002) respectively.

CONCLUSION: the study showed a relatively high prevalence of neurocognitive dysfunction among patients with T2DM. In addition to that, neurocognitive dysfunction was more common among older patients, higher BMI, lower education, unemployment, diabetes duration and complications.

PMID:42534703 | PMC:PMC13421405 | DOI:10.3389/fendo.2026.1873295

Health Sci Rep. 2026 Jul 30;9(8):e72854. doi: 10.1002/hsr2.72854. eCollection 2026 Aug.

ABSTRACT

BACKGROUND AND AIMS: Human monkeypox (mpox) is a re-emerging zoonotic viral disease in Africa. Despite recent reports in Ethiopia, no studies have assessed healthcare workers’ (HCWs) knowledge and attitudes in the Central Ethiopia Region. This study aimed to determine HCWs knowledge and attitudes toward the re-emergence of mpox in public health facilities.

METHODS: From June 16 to 28, 2025, 419 HCWs were chosen at random for an online cross-sectional study. The data were gathered using a self-administered questionnaire distributed through Google Forms. We used SPSS version 26 for the statistical analysis. Multivariable logistic regression was used to identify factors associated with knowledge and attitudes. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to determine statistical significance.

RESULTS: Of the 419 participants, 46.8% (95% CI: 42.0-51.7) had good knowledge, while 43.4% (95% CI: 39.1-48.0) showed positive attitudes. Good knowledge were significantly positively associated with a master’s degree or higher (AOR = 3.46; 95% CI: 1.60-7.47), health officer (AOR = 7.00; 95% CI: 3.20-15.32) and pharmacist (AOR = 2.68; 95% CI: 1.17-6.13), low (AOR = 5.15; 95% CI: 2.02-13.10) and medium monthly income (AOR = 2.35; 95% CI: 1.32-4.20), and positive attitude (AOR = 2.11; 95% CI: 1.25-3.59), in contrast significantly negatively associated with work experience (5-10 years) (AOR = 0.13; 95% CI: 0.07-0.24). Positive attitudes were significantly positively associated with medical doctor (AOR = 4.78; 95% CI: 2.39-9.55), and information about mpox during medical education (AOR = 3.29; 95% CI: 1.91-5.67), in contrast significantly negatively associated with female sex (AOR = 0.18; 95% CI: 0.08-0.41), age ≥ 32 years (AOR = 0.45; 95% CI: 0.28-0.73), and lack of current information access (AOR = 0.47; 95% CI: 0.26-0.88).

CONCLUSION: HCWs had low levels of knowledge and positive attitudes toward mpox. To get better at being ready for and responding to mpox in Ethiopia, it is important to strengthen continuing professional education, target training, and raise awareness.

PMID:42534696 | PMC:PMC13421795 | DOI:10.1002/hsr2.72854