Nevin Manimala

Cardiol Young. 2026 Mar 25:1-7. doi: 10.1017/S1047951126111913. Online ahead of print.

ABSTRACT

BACKGROUND: Non-code dose boluses of epinephrine are utilised in critically ill paediatric patients during periods of hemodynamic deterioration, often with the hopes of preventing a cardiac arrest. Data regarding the physiologic effects of these administrations are limited. The primary aim of this study was to use high-fidelity physiologic data to characterise the effects of intravenous non-code dose bolus epinephrine.

METHODS: Paediatric patients in the cardiac ICU who received non-code dose bolus epinephrine were identified. Those who received fluid boluses or chest compressions within 2 minutes of bolus epinephrine were excluded. Autoregressive integrated moving average analyses with exogenous variables were conducted to characterise the time-dependent changes in hemodynamic indices. Cluster analyses were then conducted to determine patterns in hemodynamic changes associated with bolus epinephrine.

RESULTS: A total of 71 non-code dose bolus epinephrine administrations were included in the final analyses. Heart rate, blood pressure, and renal near infrared spectroscopy all demonstrated statistically significant changes after bolus epinephrine administration. Peak change in each was 40%, 52%, and 9%, respectively, with peaks occurring between 60 seconds and 120 seconds after administration. Three response-based clusters were identified.

CONCLUSION: Non-code dose bolus epinephrine is associated with a significant increase in heart rate, blood pressure, and systemic oxygen delivery. Cluster analysis using the peak change identified distinct clinical clusters.

PMID:41878889 | DOI:10.1017/S1047951126111913

Cancer Control. 2026 Jan-Dec;33:10732748261433284. doi: 10.1177/10732748261433284. Epub 2026 Mar 25.

ABSTRACT

IntroductionThis study investigates the cumulative association between adverse childhood experiences and lung cancer risk and analyzes whether a healthy lifestyle could modify this association.MethodsUsing the UK Biobank, we analyzed 156,798 participants who completed a baseline Mental Health Questionnaire. Lung cancer risk from age 30 was recorded, classifying childhood adversity severity using cumulative categories (none, mild [1-2 types], and severe [≥3 types]). We used multi-variable Cox regression and competing risk models to estimate hazard ratios (HR) between childhood adversity and lung cancer risk. Mediation analyses assessed the role of smoking.ResultsDuring a median follow-up of 41 years from age 30, 677 participants were diagnosed with lung cancer, and 401 died. Lung cancer risk increased progressively with increasing childhood adversity severity. Compared with individuals without childhood adversity, those who experienced any adversity had a 37% higher risk of lung cancer (HR 1.37, 95% CI 1.15-1.63), while those with severe adversity had an 82% higher risk (HR 1.82, 95% CI 1.27-2.62), demonstrating a clear summative effect. Participants who experienced any form of adversity had a 18% increased risk of dying from lung cancer (HR 1.18 [1.05-1.32]). Smoking severity was higher among participants with childhood adversity and accounted for approximately 40% of the observed association. Timely smoking cessation was associated with a substantially lower risk of lung cancer (approximately 75%). However, in the severe adversity group, smoking cessation did not provide a protective effect (HR 0.47 [0.20-1.09]). Smoking cessation significantly reduced lung cancer mortality regardless of adversity level.ConclusionChildhood adversity was associated with a higher risk of lung cancer in a cumulative manner, even after accounting for non-cancer death. Smoking accounted for a substantial proportion of the association between childhood adversity and lung cancer risk, and smoking cessation was associated with lower lung cancer risk across adversity levels. The association between childhood adversity and lung cancer remained robust, warranting further research to explore additional mediating pathways.

PMID:41878887 | DOI:10.1177/10732748261433284

J Am Heart Assoc. 2026 Mar 25:e045411. doi: 10.1161/JAHA.125.045411. Online ahead of print.

ABSTRACT

BACKGROUND: Mortality in adults with congenital heart disease (CHD) is strongly driven by disease complexity. Social determinants of health (SDOH) influence adult CHD (ACHD) health outcomes but their impact on mortality is unclear. This study examined the influence of clinical factors and SDOH on all-cause mortality in patients with ACHD.

METHODS: Single-center retrospective cohort study of patients with ACHD in the Mayo ACHD Registry who had a verifiable residential address between January 1, 2004 and December 31, 2023. Clinical and SDOH indicators were extracted, including insurance type, language, rural-urban commuting area code, and a housing-based socioeconomic index, an individual-level measure of socioeconomic status derived from 4 objective housing characteristics and categorized into quartiles (Q1-Q4). Cox proportional-hazards models were fitted to evaluate associations with mortality, incorporating CHD severity, arrhythmias, SDOH indicators, and other comorbidities. County of residence was included as a random effect, and model discrimination was assessed using the concordance statistic.

RESULTS: Among 6134 patients with ACHD, the mean age was 38±16 years; 51% were male; 78.7% were White and 44.9% had rural residence. Independent predictors of mortality included cyanotic CHD (adjusted hazard ratio [aHR], 5.70 [95% CI, 2.90-11.23]), Fontan palliation (aHR, 4.98 [95% CI, 2.56-9.70]), ventricular tachycardia (aHR, 1.71 [95% CI, 1.16-2.52]), older age at first visit (aHR, 1.05 per year [95% CI, 1.04-1.05]), male sex (aHR, 1.19 [95% CI, 1.03-1.39]), public insurance (aHR, 1.60 [95% CI, 1.35-1.90]), rural residence (aHR, 1.25 [95%, CI 1.06-1.47]), and non-English language (aHR 1.75 [95% CI 1.38-2.23]). The housing-based socioeconomic index quartile was not associated with mortality. The final model achieved a concordance statistic of 0.77.

CONCLUSIONS: Mortality in patients with ACHD is strongly influenced by both clinical factors and SDOH, independent of socioeconomic status. Addressing barriers to care such as language, insurance, and geography is essential for improving ACHD survival particularly in those at increased mortality risk.

PMID:41878868 | DOI:10.1161/JAHA.125.045411

J Am Heart Assoc. 2026 Mar 25:e045222. doi: 10.1161/JAHA.125.045222. Online ahead of print.

ABSTRACT

BACKGROUND: Hospital length of stay (LOS) among patients with heart failure (HF) is relevant for patients, payers, and hospitals. Risk adjustment of LOS supports fair and equitable reimbursement for facilities that may experience more complex cases, oftentimes serving marginalized populations. We aimed to assess factors contributing to HF LOS, building on commonly available information across a wide range of facilities.

METHODS: A Fine and Gray Cox proportional hazards model was fitted to assess hospital LOS using a large US cohort of 89 621 patients with HF hospitalized during the fourth quarter of 2023, controlling for censoring among patients leaving against medical advice and for competing risks of in-hospital all-cause mortality. In our primary aim, we risk-adjusted HF LOS for patient-level sociodemographic and clinical episode characteristics as well as facility-level factors. Model performance was assessed via concordance statistics across derivation and validation cohorts, and risk adjustments were reported as subdistribution hazard ratios. As a secondary aim, we explored facility-level risk-adjusted idiosyncratic differences in LOS.

RESULTS: Sociodemographic, clinical episode, and facility-level characteristics can explain differences in hospital LOS among patients with HF, with most variables being statistically significant. The model exhibited moderate performance with similar results across the derivation (C=0.686 [95% CI, 0.682-0.691]) and validation (C=0.691 [95% CI, 0.686-0.695]) cohorts.

CONCLUSIONS: Excess LOS can be attributed to multiple characteristics at the sociodemographic, clinical episode, and facility levels. We demonstrate a HF LOS risk-adjustment method that does not rely on, though can be expanded with, extensive patient clinical information, supporting more equitable assessments of facility performance and reimbursement.

PMID:41878833 | DOI:10.1161/JAHA.125.045222

Appl Neuropsychol Adult. 2026 Mar 25:1-12. doi: 10.1080/23279095.2026.2645975. Online ahead of print.

ABSTRACT

OBJECTIVE: This study was designed to examine the potential of process variables within the Hopkins Verbal Learning Test – Revised (HVLT-R) to serve as embedded performance validity tests (PVTs).

METHOD: Archival data were collected from 52 adults referred for neuropsychological testing. Performance validity was psychometrically operationalized using a combination of free-standing and embedded PVTs.

RESULTS: Seven HVLT-R process variables individually correctly classified on average 77-79% of the sample. The process variables were combined into a single validity composite (PRO-7), which produced statistically and clinically superior signal detection performance, correctly classifying 83-85% of the sample. The PRO-7 was unrelated to performance on tests of cognitive ability but had extremely strong linear relationship with composite PVTs. Male sex and lower levels of education was associated with failing the PRO-7.

CONCLUSIONS: HVLT-R process variables were statistically and clinically significant predictors of psychometrically operationalized invalid performance and were associated with implausibly low (non-credible) scores on a range of neuropsychological tests. The PRO-7 is a promising alternative approach to traditional PVTs based on the method of threshold. Generalizability of the findings is constrained by the small sample size. Replications are needed to further examine the utility of HVLT-R process variables as PVTs.

PMID:41878828 | DOI:10.1080/23279095.2026.2645975

J Leukoc Biol. 2026 Mar 25:qiag042. doi: 10.1093/jleuko/qiag042. Online ahead of print.

ABSTRACT

Gut microbiota have been increasingly implicated in osteoarthritis (OA), but causal pathways remain unclear. Using the Gut-Immune-Joint Axis framework, we analyzed publicly available genome-wide association study (GWAS) summary statistics from one primary and two secondary datasets to evaluate genetically predicted associations between gut microbiota and OA and to test immune cells as potential mediators. Bidirectional Mendelian randomization (MR) identified five bacterial genera genetically associated with OA in the primary dataset, with no evidence of reverse causality. Two-step MR highlighted Bilophila and the immune cell subtype CD45 on CD33dim HLA DR+ CD11b- as being associated with OA (P < 0.05), and multivariable MR suggested partial mediation by this immune cell (20.0%, P = 0.003). In secondary analyses, two genera were associated with knee OA (KOA) and five with hip OA (HOA), again without reverse genetic effects. Terrisporobacter, the HLA DR+ CD4+ to T cell ratio, and the HLA DR+ CD4+ to lymphocyte ratio were associated with KOA (all P < 0.05), with mediation by the HLA DR+ CD4+ to T cell ratio (-12.0%, P = 0.001). Roseburia and Myeloid DC AC were associated with HOA (all P < 0.05). Collectively, these findings support causal links between specific gut microbial genera and OA and implicate immune-cell traits as mediators, strengthening the Gut-Immune-Joint Axis concept and highlighting potential therapeutic targets.

PMID:41878816 | DOI:10.1093/jleuko/qiag042

Folia Morphol (Warsz). 2026;85:e01726031. doi: 10.5603/fm.110558.

ABSTRACT

BACKGROUND: To evaluate the morphological characteristics of the pterygoid process – including pneumatization and sclerosis – alongside vidian canal (VC) type and length in patients with nasopharyngeal carcinoma (NPC) compared to healthy controls using computed tomography (CT).

MATERIALS AND METHODS: This retrospective study included 200 subjects, comprising 38 patients with histopathologically confirmed NPC and 162 age- and sex-matched healthy controls. All CT scans were acquired using a standardized protocol with thin-slice axial images and multiplanar reconstructions. Evaluated features included pterygoid process pneumatization and sclerosis, VC type (classified as Type 1-3), and VC length bilaterally.

RESULTS: Pterygoid process pneumatization showed no statistically significant difference between the NPC and control groups (right: 21.1% vs 24.7%, p = 0.794; left: 21.1% vs 18.5%, p = 0.898). In contrast, right-sided pterygoid plate sclerosis was significantly more frequent in NPC patients (68.4%) than in controls (4.9%) (p < 0.005). Significant differences in VC types were found between groups. Type 3 canals were more common in NPC patients (right: 39.5%, left: 39.5%) than in controls (right: 21.0%, left: 23.5%), while Type 2 was reduced in the NPC group (right and left: 15.8%) vs controls (right: 33.3%, left: 34.6%); significant for both sides (right: p = 0.024; left: p = 0.038). VC length was also significantly greater in the NPC group (right: 14.18 mm; left: 13.08 mm) compared to controls (right: 12.25 mm; left: 12.35 mm). The VC length positively correlated with age (right: r = 0.267; left: r = 0.339).

CONCLUSIONS: Sclerosis of the right pterygoid plate and an increased prevalence of Type 3 VCs were significantly associated with NPC. Anatomical variations in VC type and length may have diagnostic implications in radiological interpretation and radiotherapy planning in NPC patients.

PMID:41878812 | DOI:10.5603/fm.110558

Hypertension. 2026 Mar 25. doi: 10.1161/HYPERTENSIONAHA.125.26213. Online ahead of print.

ABSTRACT

BACKGROUND: Sex differences influence cardiovascular risk assessment and management; however, their role in aldosterone-mediated cardiac remodeling in primary aldosteronism remains incompletely understood.

METHODS: We conducted a retrospective study of 547 patients with primary aldosteronism, including 249 men and 298 women. Clinical and echocardiographic data were collected at baseline and 1 year following aldosterone-targeted therapies.

RESULTS: The mean age was 53.8 years in men and 54.6 years in women. At baseline, men had a higher left ventricular mass index (LVMI), whereas women had a higher prevalence of left ventricular (LV) hypertrophy and worse diastolic function, as indicated by a higher ratio of early diastolic transmitral to mitral annular velocity (E/e’) and left atrial volume index. In multivariable analyses, plasma aldosterone concentration was associated with baseline LVMI in both sexes. Associations between plasma aldosterone concentration and baseline diastolic indices, including E/e’ and left atrial volume index, were observed in men but not in women in sex-stratified models. However, formal interaction testing did not demonstrate significant sex-by- plasma aldosterone concentration interactions for left atrial volume index, E/e’, or LAVI. After 1 year of treatment, LVMI reduction was comparable between sexes. Improvement in E/e’ was significantly less pronounced in women. LAVI decreased significantly in men but not in women, although between-sex differences in change were not statistically significant.

CONCLUSIONS: Sex-specific differences in cardiac remodeling and diastolic function were observed in patients with primary aldosteronism. Despite lower baseline LVMI, women exhibited a more adverse cardiac phenotype, with a higher prevalence of left ventricular hypertrophy and worse diastolic function. Following aldosterone-targeted therapies, structural regression was similar between sexes, whereas diastolic function improved to a lesser extent in women.

PMID:41878808 | DOI:10.1161/HYPERTENSIONAHA.125.26213

Public Health Nutr. 2026 Mar 25:1-36. doi: 10.1017/S1368980026102195. Online ahead of print.

ABSTRACT

OBJECTIVE: Child hunger is a significant global health concern prioritised by multiple global public health organisations. In 2006, the United States Committee on National Statistics (CNSTAT) highlighted the need for clarity and consistency in the operationalisation and measurement of child hunger. This review examines whether these recommendations have been implemented in child nutrition programming over the past two decades. In addition, we explore how child hunger is currently conceptualised and measured across different contexts.

DESIGN: We conducted a pre-registered rapid review of studies that define or measure ‘child hunger’. Six electronic databases (Web of Science, MEDLINE, Embase, PsycINFO, Social Science Database, and ERIC) and websites of 20 public health organisations were searched for reports that mentioned the term “child hunger” or “child” near “hunger” published after 2006.

SETTING: There were no restrictions on study settings.

PARTICIPANTS: Studies focusing on children under the age of 18 years were included.

RESULTS: Sixty-seven articles measured child hunger and were therefore eligible for inclusion. Of these, only 23 provided a definition of child hunger. Definitions commonly described child hunger as a consequence of, or as a subcategory of household ‘food insecurity’. Most scales used in the included studies examined the quantity or amount of food intake by children, while few measures also assessed the quality of food consumed. The physiological dimension of hunger was not measured by any of the questionnaires.

CONCLUSIONS: The findings underscore the need for more comprehensive and standardised approaches that account for the multidimensional nature of child hunger.

PMID:41878797 | DOI:10.1017/S1368980026102195

Int Health. 2026 Mar 25:ihaf161. doi: 10.1093/inthealth/ihaf161. Online ahead of print.

ABSTRACT

This study estimated the pooled prevalence of visual acuity (VA) outcomes and potentially blinding cataract surgery complications in Nigeria. Ethical clearance was waived by the Ethical Review Board of the Kano State Ministry of Health. We searched PubMed, African journals online, Embase, MEDLINE and Google Scholar to identify relevant studies from January 1990 to February 2025. Data on presenting and best-corrected visual acuities at ≥6 weeks after cataract surgery, intraoperative posterior capsular rupture with vitreous loss and postoperative endophthalmitis were extracted from included studies. I2 statistics were used to assess heterogeneity across studies. Articles were systematically reviewed and a random effects meta-analysis model was applied to estimate the pooled effect size across studies. All statistical analyses were performed using Stata version 17.0 software. Sixteen studies, with a total of 3631 cataract-operated eyes, were included in the review. A total of 80.0% of all operated eyes had a preoperative VA of <3/60. At ≥4 weeks the percentage with good presenting VA ranged from 8% to 86%, with evidence of improved outcomes over time (95% confidence interval [CI] 45.0 to 67.0, I2=96.7%). With the best correction, 75% (95% CI 66.0 to 83.0, I2=98%) had a good outcome at ≥6 weeks postoperatively. The pooled prevalence of posterior capsular ruptures with vitreous loss was 4.0%, while 1.0% had postoperative endophthalmitis. In this review, the VA outcome after cataract surgery in Nigeria is well below the World Health Organization-recommended benchmark of >90% for a good result, with a higher rate of potentially blinding complications. The findings of this review suggest the need for improvement in modern surgical techniques, quality biometry and stocking of intraocular lenses of different powers and types to improve visual outcome and reduce complication rates.

PMID:41878785 | DOI:10.1093/inthealth/ihaf161