Nevin Manimala

West Afr J Med. 2026 Apr 30;43(1):14-21.

ABSTRACT

BACKGROUND: Self-medication with antibiotics is a threat to global health and is becoming increasingly observed in both developed and developing countries with prevalence of 32.5 – 81.5% worldwide. This study assessed the socio-demographic, economic factors and use of antibiotic self-medication among dwellers in River State, South-south, Nigeria.

METHOD: This was a cross-sectional study among 250 patients who attended the Family Medicine Clinic at the Rivers State University Teaching Hospital, Port Harcourt. Interviewer-administered questionnaires were used for data collection. The data was analyzed using SPSS version 23. Chi-Square test was used to assess the association between socio-demographic and economic characteristics with antibiotic self-medication. A p-value of <0.05 was considered statistically significant.

RESULTS: Majority of the respondents were females (65.2%), were within the age group of 20-39 years (59.2%) and had tertiary level of education (64.0%), while about 2.8% had no formal education. The overall prevalence of antibiotic self-medication was 75.2%, males (81.6%) self-medicated more than the females (71.8%) and all the respondents with no formal education (100%) practiced self-medication. The association between self-medication and educational status was statistically significant with a p-value of 0.004. The antibiotic most frequently used for self-medication in this study was Ampiclox (Ampicillin plus Cloxacillin) -an antibiotic class of the Penicillin.

CONCLUSION: Self-medication with antibiotics is still prevalent and was associated with a person’s educational level. There is need for tailored educational programs to advocate for appropriate antibiotic utilization to mitigate this prevalent misuse.

PMID:42177752

Clin Pharmacol Ther. 2026 May 24. doi: 10.1002/cpt.70326. Online ahead of print.

ABSTRACT

BRAF inhibitors and MEK inhibitors (MEKi) have reshaped the treatment of BRAF^V600-mutant malignancies; however, cutaneous adverse drug reactions (ADRs) remain a frequent and clinically impactful toxicity. Although clinical trials provide insight into their safety profiles, real-world data on dermatologic ADRs are limited. We conducted a retrospective pharmacovigilance analysis of the WHO VigiAccess database, examining individual case safety reports (ICSRs) for seven BRAF and MEKi up to May 2025. Disproportionality analyses (reporting odds ratio (ROR), proportional reporting ratio (PRR), with 95% confidence intervals (CIs)) were performed for high-frequency dermatologic ADRs. Shannon entropy was used to assess the diversity of toxicity profiles across agents. Among 72,720 ICSRs, skin-related ADRs accounted for 39.78% of reports with vemurafenib, 16.49% with dabrafenib, and 14.62% with encorafenib. Among MEKi, the proportion of skin-related ADRs was highest for selumetinib (40.03%) and cobimetinib (34.31%). Rash was the predominant ADR across agents, but selumetinib demonstrated a significant disproportionality for dermatitis acneiform (ROR = 6.46, 95% CI [5.10, 8.18]). Photosensitivity reactions were most frequently reported with vemurafenib (11.31%) and cobimetinib (12.02%). Shannon entropy analysis identified two groups with differing ADR profile diversity: a higher-diversity group (cobimetinib, H = 3.66; dabrafenib, H = 3.60) and a lower-diversity group (trametinib, H = 3.51; binimetinib, H = 3.47); all cross-group comparisons were statistically significant after Holm-Bonferroni correction (p < 0.05). Chi-squared tests confirmed significant differences in skin ADR frequencies among agents (BRAF inhibitors: χ²(2) = 1393.21, p < 0.001, Cramér’s V = 0.255; MEKi: χ²(3) = 1129.77, p < 0.001, Cramér’s V = 0.175), with effect sizes indicating clinical relevance. Cutaneous ADRs are a defining toxicity of MAPK pathway inhibitors, with substantial interagent variability in frequency and phenotype. Real-world pharmacovigilance data underscore the necessity for agent-specific dermatologic monitoring strategies. Clinical pharmacists play a pivotal role in early ADR detection and management, enhancing adherence and optimizing therapeutic outcomes.

PMID:42177750 | DOI:10.1002/cpt.70326

Pharmacoecon Open. 2026 May 24. doi: 10.1007/s41669-026-00661-y. Online ahead of print.

ABSTRACT

BACKGROUND: Economic models support healthcare decision makers to efficiently assess value and allocate resources; formal validation is critical to ensure confidence in model outputs. The Obesity Lifecycle Model is a patient-level simulation model capturing natural history, clinical complications, quality-of-life and economic outcomes associated with obesity; however, it has yet to undergo formal external and cross-validation.

OBJECTIVE: The aim of this study was to validate the Obesity Lifecyle Model as per best practice guidelines from the Professional Society for Health Economics and Outcomes Research (ISPOR) and the Society for Medical Decision Making (SMDM) Task Force.

METHODS: Relevant data sources and outcomes were identified for all validations. Selected validation studies informed the model to simulate study outcomes. The model was populated with study characteristics to reproduce studies used in model development (dependent validation), studies not used in model development (independent validation), or other published models (cross-validation). Accuracy between predicted and observed outcomes was assessed using standard statistical methods and mean error calculations.

RESULTS: The model demonstrated overall concordance with observed outcomes, supported by coefficient of determination (R²) and ordinary least squares linear regression line (OLS LRL) estimates generally close to 1.0. Independent validation showed an underprediction for cardiovascular disease (CVD) and mortality with an OLS LRL of 0.9309 and an R² of 0.8984 across all populations (normoglycaemic/prediabetic populations: OLS LRL = 0.9485, R² = 0.8854; T2DM populations: OLS LRL = 0.9208, R² = 0.9068).

CONCLUSIONS: The Obesity Lifecycle Model demonstrates favourable concordance with observed clinical and quality-of-life outcomes, supporting its use for evaluating obesity-related complications and informing healthcare decision making.

PMID:42177716 | DOI:10.1007/s41669-026-00661-y

Metabolomics. 2026 May 24;22(3):78. doi: 10.1007/s11306-026-02435-3.

ABSTRACT

INTRODUCTION: Reflux esophagitis (RE) is a common upper gastrointestinal disorder, and its diagnosis currently relies primarily on invasive endoscopic examination. The lack of reliable non-invasive biomarkers substantially limits early detection and large-scale screening. Saliva represents a promising biofluid for metabolomics research, as it can reflect metabolic alterations associated with upper gastrointestinal pathology.

OBJECTIVES: This study aimed to identify potential salivary lipid biomarkers associated with RE, and to develop a non-invasive diagnostic model using metabolomics and lipidomics.

METHODS: Saliva samples from patients clinically diagnosed with RE and healthy controls were analyzed. The analysis included a discovery cohort (n = 144) and an independent validation cohort (n = 146). Differential metabolites were screened using the untargeted metabolomics approach of ultra-high performance liquid chromatography-mass spectrometry (UHPLC-MS), and then quantitative verification was conducted using targeted lipidomics. Multivariate statistical analysis, random forest algorithms, and receiver operating characteristic (ROC) analysis were applied.

RESULTS: Untargeted metabolomics revealed significant metabolic differences between RE patients and healthy controls, with marked enrichment of sphingolipid and glycerophospholipid metabolism. Targeted lipidomics identified six consistently dysregulated salivary lipids: DAG (18:1_18:2), S-1-P, PE (P-16:0_18:1), DAG (16:0_18:2), DAG (18:1_18:1), and DAG (16:0_18:1). A multimetabolite model based on these lipids effectively distinguished RE patients from healthy controls, achieving an AUC of 99.45% in the discovery cohort and 97.17% in the validation cohort.

CONCLUSION: This study identified a salivary lipid signature associated with RE and supports the potential of this lipidomic approach as a non-invasive method to distinguish RE from healthy controls.

PMID:42177704 | DOI:10.1007/s11306-026-02435-3

Environ Monit Assess. 2026 May 24;198(6):646. doi: 10.1007/s10661-026-15489-6.

ABSTRACT

This study examines the air quality trends associated with COVID-19 lockdowns and the subsequent recovery on air quality in Tehran, employing an established XGBoost framework for de-weathering with daily data from 22 monitoring stations from 2019 to 2025. A comprehensive analysis was conducted on six principal pollutants (PM₂.₅, PM₁₀, NO₂, O₃, SO₂, and CO) across four distinct temporal phases: Pre-pandemic, Pandemic, Post-COVID, and After Termination. While the model effectively reduced meteorological bias, exhibiting strong efficacy for particulate matter (R = 0.78-0.88; IOA = 0.68-0.88; FAC2 > 0.95), we explicitly acknowledge less consistent outcomes for reactive gases such as O₃ (R < 0.75; NMGE > 0.30). The imposition of lockdown measures coincided with significant reductions in pollutants associated with vehicular traffic: NO₂ exhibited a decline of – 30 to – 36%, PM₂.₅ decreased by – 18 to – 22%, and CO diminished by – 20%. In contrast, O₃ experienced an increase of + 20-30%, indicative of diminished NO titration. Principal Component Analysis (PCA) corroborated these trends, with PC1 (NO₂, PM₂.₅, CO) accounting for approximately 60% of the variance throughout the pandemic. In subsequent phases, partial recoveries were noted: PM₂.₅ escalated by + 15-20%, NO₂ stabilized at around -10%, SO₂ consistently decreased (-30% by 2025), whereas O₃ surged by + 20% by 2025, clustering with PM₁₀ in PC2, thereby highlighting the impacts of dust and secondary formation processes. Lockdowns yielded transient enhancements in air quality, with restricted long-term advantages. Sustainable progress necessitates the adoption of comprehensive policies targeting traffic, industrial emissions, VOCs, and dust management.

PMID:42177702 | DOI:10.1007/s10661-026-15489-6

Metabolomics. 2026 May 24;22(3):81. doi: 10.1007/s11306-026-02466-w.

ABSTRACT

INTRODUCTION: TMEM18 has been indicated by genome-wide association studies as a key gene linked to obesity, yet its exact function and connections with major metabolic networks are unknown.

OBJECTIVES: The current study is aimed to determine whether the TMEM18 rs7561317 polymorphism linked with anthropometric indicators of obesity is accompanied with alterations in serum metabolites.

METHODS: This was a case-control study in which a total of 542 participants (Pakistani nationals) were involved including overweight or obese cases and those having normal body mass index (BMI). All participants provided blood samples which were utilized to extract serum and genomic DNA. The genomic DNA of all participants was genotyped for the TMEM18 rs7561317 variant while their serum samples were subjected to untargeted gas chromatography-mass spectrometry based metabolomics.

RESULTS: A total of 42 putatively annotated metabolites were selected for further statistical analyses. Analyses revealed that the TMEM18 gene variant (rs7561317) exhibited statistically significant association with five metabolites namely urea, eicosane, geraniol, pentadecanoic acid and porphine as well as with BMI, percent body fat, waist circumference and weight. The G allele of this variant appears to increase the risk of developing overweight or obesity and may be associated with metabolite alterations.

CONCLUSION: The findings highlight the role of metabolite alterations in the manifestation of obese phenotype among individuals carrying the GG genotype of the TMEM18 rs7561317 variant.

PMID:42177698 | DOI:10.1007/s11306-026-02466-w

J Orthop Traumatol. 2026 May 24. doi: 10.1186/s10195-026-00923-9. Online ahead of print.

ABSTRACT

BACKGROUND: Reconstruction of critical-sized long bone defects is a complex orthopedic challenge. Free fibular grafts, vascularized (FVFG) and nonvascularized (NVFG), are established reconstructive options, but comparative clinical outcomes remain uncertain.

PURPOSE: To compare clinical and radiological outcomes of FVFG and NVFG in patients with post-traumatic critical bone defects more than 10 cm.

METHODS: A randomized controlled trial was conducted with 50 patients assigned equally to FVFG or NVFG groups. The primary outcome was time to union, while secondary outcomes included graft hypertrophy, functional scores (DASH and LEFS), complication rates, and donor site morbidity.

RESULTS: The mean time to union was 5.78 months in the FVFG group and 6.17 months in the NVFG group, showing no statistically significant difference (p = 0.447). Rates of graft hypertrophy, functional recovery, and complications were comparable between the groups.

CONCLUSIONS: Both FVFG and NVFG provide effective reconstruction for critical bone defects, with nearly similar healing times and functional outcomes. NVFG may represent a less complex alternative in selected cases.

PMID:42177697 | DOI:10.1186/s10195-026-00923-9

World J Urol. 2026 May 24;44(1):380. doi: 10.1007/s00345-026-06500-3.

ABSTRACT

BACKGROUND: The optimal management of medium-sized (1-3 cm) renal stones remains a clinical dilemma, with retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mPCNL) serving as competing minimally invasive options. To overcome the selection bias inherent in previous meta-analyses that included observational data, we aimed to compare the efficacy and safety of both techniques by exclusively analyzing randomized controlled trials (RCTs).

METHODS: A systematic literature search of five databases was conducted up to February 2026. Only RCTs comparing RIRS and mPCNL were included. The primary outcomes were the single session stone-free rate (SFR) and overall complication rate. Secondary outcomes included stone clearance-related outcomes, operative performance outcomes, and recovery-related outcomes. Data were pooled using a random-effects model, and trial sequential analysis (TSA) was applied.

RESULTS: Thirty RCTs encompassing 4173 patients were included. mPCNL demonstrated a significantly higher single-session SFR compared to RIRS (R.R: 0.92, 95% C.I: 0.88-0.96, p < 0.001). RIRS showed a trend toward a lower overall complication rate although the difference did not reach statistical significance (RR = 0.79, 95% CI: 0.63-1.01; p = 0.057), reduced blood transfusion requirements, smaller hemoglobin drops, and shorter hospitalization times. However, RIRS required significantly more postoperative auxiliary procedures. Operative times and high-grade Clavien-Dindo III-V complication rates were comparable between both techniques. TSA confirmed that the cumulative evidence for single-session SFR was sufficient and conclusive, whereas TSA findings for overall complication rate should be interpreted cautiously.

CONCLUSIONS: mPCNL achieves significantly higher SFR than RIRS in the management of 1-3 cm renal calculi. However, RIRS was associated with lower bleeding-related morbidity and shorter hospitalization, although no statistically significant difference was observed in the overall complication rate. Therefore, the choice between RIRS and mPCNL should be individualized, balancing maximal SFR against procedural invasiveness according to patient characteristics and stone complexity.

PMID:42177692 | DOI:10.1007/s00345-026-06500-3

Am J Orthod Dentofacial Orthop. 2026 May 23:S0889-5406(26)00190-3. doi: 10.1016/j.ajodo.2026.03.012. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to evaluate periodontal tissue changes after prophylactic gingival grafting in patients with skeletal Class III malocclusion undergoing presurgical orthodontic treatment involving mandibular incisor proclination.

METHODS: A total of 28 patients with skeletal Class III malocclusion scheduled for orthognathic surgery were included. Thirteen received subepithelial connective tissue grafts before orthodontic treatment (graft group), whereas 15 did not (nongraft group). Lateral cephalograms and cone-beam computed tomography images were taken before and after treatment to perform cephalometric and periodontal measurements. The primary outcomes were supracrestal gingival area (GA) and gingival thickness (GT) 1-5. Secondary outcomes included alveolar bone thickness (BT) 1-5, vertical bone height, and clinical crown length. Statistical analyses included intragroup changes, intergroup comparisons, and regression analyses.

RESULTS: In the graft group, GA and GT significantly increased. In contrast, BT2 and BT3 decreased, and vertical bone height increased, indicating vertical bone loss. No gingival recession was observed in either group. In exploratory analyses, increases in GA, GT1, and GT2 were negatively associated with a change in the incisor mandibular plane angle, whereas increases in GT3-5 were negatively associated with age.

CONCLUSIONS: Prophylactic gingival grafting before presurgical orthodontic treatment increased GT and GA in patients with skeletal Class III malocclusion, even in the presence of alveolar bone loss.

PMID:42177665 | DOI:10.1016/j.ajodo.2026.03.012

Med J Aust. 2026 May;224(5):e70202. doi: 10.5694/mja2.70202.

ABSTRACT

Australia’s rate of living donor kidney transplantation has stagnated. In 2024, there were 253 living donor kidney transplants, down from 354 in 2008, with the living donor rate falling to 9.5 donors per million population-well below peer nations. Despite growth in deceased donation, waiting list times continue to lengthen and can now reach 6-7 years for some groups, reflecting the rising numbers of Australians living with kidney failure. Access is unequal: First Nations people receive few living donor transplants; women are more likely to donate than men but are less likely to receive a living donor transplant; and people from lower socio-economic groups are disadvantaged. Barriers include information gaps, limited multilingual resources, time-intensive workups and financial disincentives. A coordinated reset, supported by national leadership, contemporary guidance, better data and streamlined, culturally safe pathways can restore growth.

PMID:42177664 | DOI:10.5694/mja2.70202