Nevin Manimala

IJID Reg. 2026 Jul 18;20:100960. doi: 10.1016/j.ijregi.2026.100960. eCollection 2026 Sep.

ABSTRACT

OBJECTIVES: The increasing incidence of primary multidrug-resistant tuberculosis (MDR-TB) creates a new burden in national tuberculosis (TB) control. Understanding the characteristics of primary MDR-TB aids in predicting its spread. This study aimed to determine the differences in characteristics of primary and acquired MDR-TB patients in a hospital setting in Indonesia.

METHODS: This is a retrospective cohort study of adult patients (aged >18 years) with pulmonary MDR-TB who received treatment at Hasan Sadikin General Hospital, West Java, Indonesia. Patients who finished MDR-TB treatment between 2020 and 2022 were included. Patients whose therapeutic outcomes could not be determined and those with incomplete data were excluded.

RESULTS: This study included 337 participants; 32% were primary MDR-TB and 68% were acquired MDR-TB. Findings showed a significant difference between primary and acquired MDR-TB by contact with a TB index case. Primary MDR-TB was 4.31 times higher in patients who had contact (prevalence odds ratio 4.31, 95% confidence interval 2.65-7.01). Other characteristics showed some differences but were not statistically significant.

CONCLUSION: Contact with the TB index case was found to differ significantly between primary and acquired MDR-TB. The transmission-driven nature of drug-resistant TB underscores the urgent need to reposition contact investigation and preventive therapy as central pillars of the MDR-TB control strategy.

PMID:42666390 | PMC:PMC13522372 | DOI:10.1016/j.ijregi.2026.100960

Front Comput Neurosci. 2026 Aug 14;20:1845838. doi: 10.3389/fncom.2026.1845838. eCollection 2026.

ABSTRACT

Reservoirs, typically implemented as recurrent neural networks (RNNs) with fixed random connection weights, can be combined with a simple trained readout layer to perform a wide range of computational tasks. However, increasing the magnitude of reservoir connection weights to exploit non-linear dynamics can cause the network to develop strong spontaneous activity that drives neurons into saturation, dramatically degrading performance. In this work, we investigate two distinct countermeasures against such runaway excitation. The first approach introduces a subtle non-homogeneous structure into the matrix of connection weights. w _ij , without altering the overall probability distribution p(w). We identify several favorable structuring principles, such as creating a small subset of neurons with weaker-than-average input connections. Even if the rest of the reservoir falls into runaway saturating behavior, this weakly coupled subset remains in a mildly non-linear regime whose dynamics can still be exploited by the readout layer. The second approach implements a form of automatic gain control (AGC), in which a dedicated control unit dynamically regulates the reservoir’s average global activation toward an optimal setpoint. Although the control unit modulates the excitability of the reservoir only via a global gain factor, this mechanism substantially enlarges the dynamical regime favorable for computation and renders performance largely independent of the underlying connection statistics.

PMID:42666383 | PMC:PMC13522119 | DOI:10.3389/fncom.2026.1845838

Front Public Health. 2026 Aug 14;14:1933281. doi: 10.3389/fpubh.2026.1933281. eCollection 2026.

ABSTRACT

BACKGROUND: Dental professionals are routinely exposed to occupational biological hazards, yet evidence from low-resource settings remains limited. This study assessed infection prevention and control (IPC) knowledge and practices, quantified occupational biological exposures, and identified factors associated with sharps injuries and occupational infections.

METHODS: A cross-sectional analytical study was conducted among 220 dental professionals in Bulawayo, Zimbabwe. Data were collected using a structured self-administered questionnaire and analysed using descriptive statistics and bivariate and multivariable logistic regression. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported.

RESULTS: Lifetime sharps injury was reported by 61.2% of participants, 14.7% reported a sharps injury during the preceding 12 months, and 18.3% reported an occupational infection. Despite high awareness of core IPC principles, occupational exposure remained common. Recent sharps injury was independently associated with early-career role (aOR = 4.01; 95% CI: 1.26-12.76), eye protection use (aOR = 2.88; 95% CI: 1.21-6.84), poor hand hygiene adherence (aOR for often/always = 0.34; 95% CI: 0.12-0.97), and lower perception scores (aOR = 0.49 per unit increase; 95% CI: 0.32-0.75). Public-sector employment was independently associated with self-reported occupational infection (aOR = 2.66; 95% CI: 1.25-5.64).

CONCLUSION: Dental professionals in Bulawayo experienced substantial occupational biological hazards despite generally high awareness of IPC principles. These findings demonstrate that IPC knowledge alone is insufficient to prevent occupational exposure. Strengthening competency-based IPC training, post-exposure management, institutional IPC systems, and targeted support for early-career dental professionals can reduce occupational injuries and occupational infections.

PMID:42666377 | PMC:PMC13522109 | DOI:10.3389/fpubh.2026.1933281

Asia Pac J Sports Med Arthrosc Rehabil Technol. 2026 Aug 19;46:7-23. doi: 10.1016/j.asmart.2026.07.001. eCollection 2026 Oct.

ABSTRACT

BACKGROUND: Proprioception dysfunction, including deficits in joint position sense (JPS) and kinesthesia, is a common sequela following anterior cruciate ligament (ACL) injury. While previous studies have compared proprioceptive outcomes in ACL-injured patients undergoing different types of surgical reconstruction or repair, their findings have been inconsistent, and a systematic review is lacking.

OBJECTIVE: To summarize and evaluate proprioceptive deficits (in JPS and kinesthesia) across different postoperative time points and joint angles in patients undergoing different types of ACL reconstruction or repair, compared to healthy controls.

LITERATURE SURVEY: A comprehensive literature search was conducted across PubMed, Embase, the Cochrane Library, CINAHL, Scopus, Web of Science, and SPORTDiscus databases using terms related to ACL injury, reconstruction or repair, and proprioception, covering all records through November 2025.

METHOD: ology: The following information was extracted from the included articles: demographic data, sample size, selection criteria, methodology, test indicators (e.g., time points and joint angles), proprioceptive test results, and other relevant variables. Network meta-analyses were conducted to synthesize proprioceptive outcomes.

RESULTS: Nineteen studies were included in the network meta-analysis. No statistically significant differences were found in intermediate-angle JPS or kinesthesia among various ACL reconstruction and repair techniques when assessed beyond six months postoperatively. Notably, our analysis revealed that hamstring tendon autografts (SMD = 1.9, 95% CI = 0.3, 3.5) and tibialis anterior allografts (SMD = 1.7, 95% CI = 0.1, 3.5) were associated with inferior small-angle position perception outcomes at the six-month follow-up compared to control.

CONCLUSION: The results indicate that, in small-angle position at six-month follow-up, ACL repair may yield similar or even better proprioceptive recovery compared to hamstring tendon autografts and tibialis anterior allografts. However, different types of reconstructive grafts or repairs do not show significant differences in proprioceptive recovery from most angles. These findings suggest that ACL repair demonstrates proprioceptive outcomes similar to those of ACL reconstruction, and different graft selections for ACL reconstruction may produce similar proprioceptive outcomes, allowing graft choice to be guided by specific clinical needs.

PMID:42666376 | PMC:PMC13522239 | DOI:10.1016/j.asmart.2026.07.001

J Stat Phys. 2026;193(9):118. doi: 10.1007/s10955-026-03680-5. Epub 2026 Aug 27.

ABSTRACT

From N + 1 random points on a line we wish to select M + 1 points so as to maximize the minimal spacing between them. We consider an initial configuration with independent and identically distributed spacings. Equivalently, the points are arrival times of a generic renewal process. For general spacing distributions, and for all M ≤ N , we derive exact distributional identities for the maximal minimal spacing and obtain its asymptotic behavior. The problem admits a reformulation in terms of a threshold-resetting random walk. The walk advances by successive random increments and is reset to the origin upon exceeding a fixed threshold. The probability that the optimal spacing exceeds a given value coincides with the probability that the walk completes at least M reset cycles within N steps. This yields an exact representation in terms of first-passage functionals of the walk. The same mapping suggests a numerical scheme for the max-min spacing problem in the regime of large N and M, whose accuracy is tested against the exact results obtained here.

PMID:42666375 | PMC:PMC13522019 | DOI:10.1007/s10955-026-03680-5

Front Microbiol. 2026 Aug 14;17:1906211. doi: 10.3389/fmicb.2026.1906211. eCollection 2026.

ABSTRACT

BACKGROUND: Human papillomavirus (HPV) vaccination provides high-level protection against cervical cancer through type-specific antibodies, although breakthrough and persistent high-risk HPV (hrHPV) infections may still occur in some vaccinated women. In addition to neutralizing antibodies, vaccination elicits other immune mechanisms that may influence viral persistence and disease progression. Because mucosal immunity is closely linked to the vaginal microbiota, microbial composition may also play an important role in HPV susceptibility, with Lactobacillus crispatus dominance associated with protection, and dysbiosis with impaired mucosal immunity. Whether HPV vaccination is associated with favorable microbiota signatures in women with confirmed cervical cancer-related conditions remains unknown.

METHOD: We analyzed vaginal samples via shotgun metagenomic sequencing from a cross-sectional study of 59 pre-menopausal women (<50 years) with confirmed cervical lesions (HPV-unvaccinated n = 26, vaccinated n = 33).

RESULTS: Alpha diversity (Shannon and Inverse Simpson indices) did not differ significantly by vaccination status, suggesting within-sample microbial diversity between the groups, but Bray-Curtis-based PERMANOVA indicated a statistically significant difference in overall community composition between groups (p = 0.042). Among women with CST I, 90.9% were vaccinated, whereas among women with CST IV, 60.0% were unvaccinated. At the species level, L. crispatus relative abundance was higher in vaccinated women in the unadjusted analysis; however, this association was attenuated and was not statistically significant after multivariable adjustment. HPV vaccination status was associated with a higher prevalence of L. crispatus-dominant, health-associated vaginal microbiota among women with cervical lesions.

CONCLUSION: These findings support the hypothesis that HPV vaccination status is associated with L. crispatus dominance in this population, but mechanistic pathways remain to be elucidated.

PMID:42666371 | PMC:PMC13522137 | DOI:10.3389/fmicb.2026.1906211

Front Psychiatry. 2026 Aug 14;17:1872413. doi: 10.3389/fpsyt.2026.1872413. eCollection 2026.

ABSTRACT

BACKGROUND: Depressive disorder is a leading cause of disability worldwide, and selective serotonin reuptake inhibitors (SSRIs) remain first-line pharmacotherapy. However, the efficacy and safety of adding Chinese patent medicines (CPMs) as adjunctive therapy to SSRIs have not been systematically evaluated in a network meta-analysis.

OBJECTIVE: To compare and rank seven CPMs combined with SSRIs for depressive disorder in terms of HAMD improvement, clinical response rate, and adverse drug reactions (ADRs) rate.

METHODS: We searched MEDLINE, EMBASE, PsycINFO, CENTRAL, CNKI, WanFang, and VIP from inception to April 1, 2026. Trials comparing any CPM + SSRI versus the same SSRI alone in adults with depressive disorder were included. Two authors independently extracted data and assessed risk of bias (RoB 2.0). Pairwise meta-analysis and network meta-analysis (using both netmeta and getmc packages) were performed; cumulative probability (SUCRA) rankings were derived from Bayesian analysis with getmc. Confidence in evidence was evaluated with CINeMA.

RESULTS: Sixty-five trials involving 5,975 patients were included. Compared with SSRIs alone, all CPM + SSRI combinations significantly improved HAMD score (MD range -2.60 to -6.20) and clinical response rate (OR range 1.8-5.0). For HAMD, JYW+SSRIs showed the highest SUCRA ranking, followed by BJTGT+SSRIs and SGJY+SSRIs, though these rankings are probabilistic. For response rate, BJTGT+SSRIs showed the highest SUCRA ranking, but statistically unconfirmed. For safety, TM+SSRIs showed the highest SUCRA ranking, though no ADR comparison reached significance; YXQN+SSRIs ranked second in SUCRA analysis, based on one small trial. Egger’s test indicated no publication bias for HAMD (p = 0.5753) but potential bias for clinical response rate (p = 0.0002). Sensitivity analysis excluding small studies confirmed the robustness of HAMD findings.

CONCLUSION: Adding CPMs to SSRIs may enhance efficacy and reduce ADRs. Although the rankings suggest promising efficacy, they are probabilistic in nature, and the effect estimates and their confidence intervals should be given greater weight in interpretation. No ADR comparisons reached statistical significance, and evidence supporting the safety and efficacy of some CPMs remains limited. Findings should be interpreted with caution, and future studies should further evaluate the safety and efficacy of combined therapy.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420261299414.

PMID:42666365 | PMC:PMC13522133 | DOI:10.3389/fpsyt.2026.1872413

Front Med (Lausanne). 2026 Aug 14;13:1917259. doi: 10.3389/fmed.2026.1917259. eCollection 2026.

ABSTRACT

BACKGROUND: In adults with out-of-hospital cardiac arrest (OHCA), the clinical benefit of expedited transfer compared with standard resuscitation pathways remains uncertain. This study aimed to evaluate randomized controlled trial evidence on the effects of expedited transfer on survival and neurological outcomes.

METHODS: PubMed, MEDLINE, Embase, and Scopus were searched from inception to 22 February 2026. Eligible studies were randomized controlled trials comparing expedited transfer with standard care in adults with prehospital OHCA. The primary outcome was all-cause mortality at the longest reported follow-up; secondary outcomes included neurological recovery, bleeding, mechanical circulatory support, time to return of spontaneous circulation, and length of hospital stay. Random-effects meta-analyses were performed; risk of bias was assessed using RoB 2, certainty of evidence using GRADE. Subgroup analyses were conducted according to clinical pathway type, comparing post-ROSC transfer to cardiac arrest centers with intra-arrest transport pathways for refractory OHCA.

RESULTS: Four randomized controlled trials involving 1,303 patients were included. Compared with standard care, expedited transfer did not significantly reduce all-cause mortality at the longest reported follow-up (RR = 0.97, 95% CI: 0.90-1.04) or improve favorable neurological outcome at hospital discharge (RR = 0.98, 95% CI: 0.81-1.18). No statistically significant between-group differences were observed for the remaining secondary outcomes. Sensitivity analyses were consistent with the primary analysis. Subgroup analysis showed no significant interaction according to expedited transfer pathway type (P for subgroup difference = 0.46).

CONCLUSION: Current randomized evidence does not support routine expedited transfer as a standard strategy for adults with OHCA.

PMID:42666358 | PMC:PMC13522188 | DOI:10.3389/fmed.2026.1917259

Front Public Health. 2026 Aug 14;14:1883113. doi: 10.3389/fpubh.2026.1883113. eCollection 2026.

ABSTRACT

BACKGROUND: Digital technologies have become major sources of health information; however, individuals’ ability to integrate such information varies according to their health literacy (HL) and eHealth literacy (e-HL). In concussion management, accurate knowledge and appropriate attitudes are important for symptom recognition and healthcare-seeking behaviors. Nevertheless, the relationships among HL, e-HL, and concussion-related knowledge and attitudes remain poorly understood.

OBJECTIVE: To evaluate the associations of HL and e-HL with concussion-related knowledge and attitudes among parents in South Korea and to examine the indirect associations between HL and these outcomes through e-HL.

METHODS: A cross-sectional online survey was conducted among parents in South Korea. HL and e-HL were assessed using the Korean version of the HLS-EU-Q16 and the eHealth Literacy Scale (eHEALS), respectively. Outcome variables were concussion-related knowledge and attitudes. Observed-variable mediation analyses were used to statistically decompose the associations of HL with these outcomes into direct and indirect components through e-HL. An exploratory sequential mediation model additionally evaluated whether concussion-related knowledge was involved in the indirect association between HL and concussion-related attitudes.

RESULTS: In total, 260 participants completed the survey. HL was positively correlated with e-HL (ρ = 0.45, p < 0.001) and concussion-related attitudes (ρ = 0.19, p = 0.003), but not with concussion-related knowledge (ρ = 0.03, p = 0.657). For concussion-related knowledge, neither HL nor e-HL was significantly associated with the outcome, and no significant indirect association was observed. For concussion-related attitudes, a significant indirect association between HL and attitudes through e-HL was observed (B = 0.117, 95% CI: 0.022-0.220; p = 0.021). The exploratory sequential mediation analysis showed no significant indirect association involving concussion-related knowledge.

CONCLUSION: Higher HL was associated with more favorable concussion-related attitudes, but not with concussion-related knowledge. An indirect association between HL and concussion-related attitudes was observed through e-HL, but not through concussion-related knowledge. This indirect association was consistent with the hypothesized model but did not establish temporal precedence or causal mediation. These findings suggest that future concussion education strategies may benefit from strengthening both HL and e-HL alongside the provision of factual concussion information.

PMID:42666352 | PMC:PMC13522205 | DOI:10.3389/fpubh.2026.1883113

Front Public Health. 2026 Aug 14;14:1808606. doi: 10.3389/fpubh.2026.1808606. eCollection 2026.

ABSTRACT

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis (CRS) imposes substantial clinical and economic burdens worldwide. In Saudi Arabia, prevalence estimates exceed 20% among adults, yet limited data are available regarding awareness, knowledge, attitudes, and practices (A-KAP) related to CRS among current and future healthcare providers. This study evaluated A-KAP regarding CRS among healthcare trainees and a smaller subgroup of healthcare professionals in the Hail region of Saudi Arabia and identified sociodemographic factors associated with CRS knowledge.

METHODS: A cross-sectional survey (Google Forms) was conducted among 363 participants using a structured questionnaire comprising 59 A-KAP items. Descriptive statistics, chi-square tests, and binary logistic regression were used to identify sociodemographic factors associated with CRS knowledge. Principal component analysis (PCA) was performed to explore latent knowledge domains (α = 0.05).

RESULTS: Overall, 73.0% of participants heard of CRS. Nasal congestion (90.9%) and nasal discharge (68.6%) were the most recognized symptoms, whereas orbital abscess (12.9%) and genetic predisposition (0.3%) were the least recognized. Arabic speakers demonstrated greater CRS awareness than English speakers (AOR = 0.21, 95% CI: 0.06-0.69), and participants with monthly incomes of 5,000-15,000 SAR were more likely to demonstrate good CRS knowledge than higher-income participants (AOR = 2.88, 95% CI: 1.21-6.86). PCA identified distinct symptoms, risk factors, and complication knowledge domains. Participants generally demonstrated positive attitudes toward healthcare-seeking behavior, specialist follow-up, and public awareness; however, uncertainty regarding treatment effectiveness (45.5%) and openness toward alternative or herbal therapies (28.4%) persisted.

CONCLUSION: Although participants demonstrated moderate awareness and generally positive attitudes toward CRS, important knowledge gaps remained, particularly regarding complications and genetic risk factors. Several sociodemographic factors were associated with CRS knowledge, highlighting the need for targeted educational interventions to strengthen CRS-related knowledge among healthcare trainees and professionals.

PMID:42666343 | PMC:PMC13522121 | DOI:10.3389/fpubh.2026.1808606