Nevin Manimala

Diabet Med. 2026 Apr 12:e70330. doi: 10.1111/dme.70330. Online ahead of print.

ABSTRACT

AIMS: To evaluate whether faster insulin aspart (FIA) improves time in range (TIR) compared with standard insulin aspart (SIA) in children and adolescents with type 1 diabetes achieving glycaemia close to target treated with continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM).

METHODS: This prospective, open-label, randomized, 1:1 crossover trial included participants aged 6-17 years with T1D duration of ≥1 year, CSII use ≥3 months, CGM use ≥1 month, and HbA1c 64 mmol/mol (<8%). After a 2-week run-in period, they then crossed over to the alternate insulin for another 4 weeks. All participants used the same CGM system. Assessments were performed at the end of each treatment phase. The primary endpoint was the between-treatment difference in TIR (3.9-10.0 mmol/L, 70-180 mg/dL).

RESULTS: Seventy-seven children were enrolled (mean T1D duration approximately 7 years; 66% male; mean HbA1c 53 mmol/mol, 7%). Mean TIR was 68.5% (SD 12.3%) with SIA and 67.6% (SD 12.1%) with FIA, with no statistically significant difference (mean difference -0.9%; 95% CI -2.60 to 0.86; P = 0.322). Similar patterns were observed for additional glycaemic metrics. Time in tight range was also similar between treatments: 46.3% for SIA versus 45.4% for FIA (P = 0.674).

CONCLUSIONS: In this randomised crossover study of children and adolescents with T1D achieving glycaemia close to target on CSII, switching from SIA to FIA does not improve TIR. The absence of improvement across CGM-derived metrics suggests that FIA does not meaningfully enhance glycaemic outcomes in this clinical setting.

PMID:41968383 | DOI:10.1111/dme.70330

Hum Reprod. 2026 Apr 11:deag058. doi: 10.1093/humrep/deag058. Online ahead of print.

ABSTRACT

STUDY QUESTION: Can natural cycles (NC) be effectively utilized in advanced maternal age (AMA) undergoing oocyte donation, without compromising live birth rates (LBRs) and miscarriage outcomes, when compared to artificial cycles (ACs)?

SUMMARY ANSWER: In donor oocyte embryo transfer cycles, NC demonstrated superior outcomes in reproductive efficacy and obstetrical safety compared to AC, independent of the recipient’s age.

WHAT IS KNOWN ALREADY: Previous studies have posited that NC may result in better outcomes when compared to AC embryo transfer, including a lower risk of miscarriage and hypertensive disorders of pregnancy. Recent studies support that NC-frozen embryo transfer (FET) decreases obstetrical and neonatal complications compared to AC-FET, even if LBR differences remain controversial in some general populations. There is limited research on the use of NCs in women of AMA.

STUDY DESIGN, SIZE, DURATION: This retrospective, multicentre, cohort study included all single blastocyst embryo transfers following oocyte donation performed between January 2010 and December 2023, subdivided according to the type of endometrial preparation performed (NC or AC). The oocyte donation model was chosen to minimize the potential confounding effect related to poor oocyte competence in older women and the influence of ovarian stimulation performed during autologous IVF on endometrial receptivity prior to a fresh embryo transfer.

PARTICIPANTS/MATERIALS, SETTING, METHODS: The main objective of the study was to compare LBR. Secondary outcomes included hCG-positive pregnancy rate, clinical pregnancy rate, miscarriage rate, obstetric, and perinatal outcomes. Confounder-adjustment was performed using a multivariable generalized estimating equations model regression analysis, adjusting for multiple confounders. A sub-analysis compared results when the AC protocol was optimized with progesterone (P4) monitoring and rescue therapy. Additionally, an interaction variable was added to the final multivariable model to assess whether female recipient age may modify the effect of each type of endometrial preparation on LBRs.

MAIN RESULTS AND THE ROLE OF CHANCE: In total, 67 048 embryo transfers were analysed, including NC (n = 6922) and AC (n = 60 126). The NC group demonstrated consistent superiority over AC after adjustment for confounders across all transfers. NC was associated with a higher LBR (aOR 1.38, 95% CI 1.29-1.47; P < 0.01) and significantly lower miscarriage rate per hCG-positive pregnancy (aOR 0.68, 95% CI 0.61-0.76; P < 0.01). This superiority persisted even in optimized AC cycles with P4 monitoring and rescue therapy (LBR aOR 1.42, 95% CI 1.31-1.54; P < 0.01). Furthermore, NC was associated with significantly lower obstetrical risks in singleton pregnancies, including hypertensive disorders of pregnancy (aOR 0.72, 95% CI 0.56-0.94; P = 0.01), Caesarean delivery (aOR 0.86, 95% CI 0.77-0.96; P < 0.01), and large for gestational age (aOR 0.77, 95% CI 0.67-0.89; P < 0.01). The interaction between endometrial preparation method and female recipient age was not statistically significant (aOR 1.02, 95% CI 0.99-1.03).

LIMITATIONS, REASONS FOR CAUTION: The retrospective nature of the study and the inherent risk of bias related to unmeasured confounding factors may have impacted the results. Another limitation is the low percentage of NC included in the study (10.32% of all cycles), which could be related to the low uptake to this treatment modality in real-life practice.

WIDER IMPLICATIONS OF THE FINDINGS: NC may offer superior reproductive outcomes and is associated with lower obstetrical risks, with differences unlikely to be modified by female age. Therefore, it seems reasonable to suggest NC for older women, as they could benefit from the decreased risk of miscarriage and hypertension during pregnancy.

STUDY FUNDING/COMPETING INTEREST(S): No specific funding was obtained for this study. A.R.N. has received research grants (to institution) from Theramex; Consulting and Speakers’ fees and travel support from Organon and Merck KgaA; S.S.-R. has received consulting fees from Organon, IBSA, and Besins; Speakers’ fees and travel support from Organon, Ferring Pharmaceuticals, Theramex, IBSA, Gedeon Richter, Abbott, and Besins. He has also received travel support from Organon, Ferring, Theramex, IBSA, Gedeon-Richter, Abbott, and Besins. He holds stocks/shares with IVIRMA Lisboa. He is a member of the ESHRE Executive Committee and was the Senior Deputy of Safety and Quality for ESHRE.

TRIAL REGISTRATION NUMBER: N/A.

PMID:41968377 | DOI:10.1093/humrep/deag058

Eur J Dent Educ. 2026 Apr 12. doi: 10.1111/eje.70158. Online ahead of print.

ABSTRACT

INTRODUCTION: The healthcare sector contributes approximately 5% of global greenhouse gas emissions, and dentistry represents a notable environmental burden due to high energy consumption, material use, and medical waste generation. This study aimed to evaluate dental students’ awareness, attitudes, and perceptions regarding environmental sustainability and to assess the extent to which sustainability is integrated into the dental curriculum.

MATERIALS AND METHODS: This descriptive cross-sectional study was conducted between March and May 2025 at the Faculty of Dentistry of İnönü University, Türkiye. A total of 600 valid questionnaires were obtained from dental students across all academic years. Data were collected using a 28-item questionnaire developed based on current literature and expert evaluation (content validity index = 0.88; Cronbach’s α = 0.87). Descriptive statistics, χ² tests, Mann-Whitney U tests, Kruskal-Wallis tests, and binary logistic regression analyses were performed using SPSS 26.0.

RESULTS: Overall, 82% of students reported being familiar with the concept of sustainability; however, only 28% indicated that sustainability topics were included in their formal education. Students demonstrated generally positive attitudes towards environmentally sustainable dental practises, particularly regarding recycling, energy conservation, and resource management. Significant differences were observed according to gender and year of study in sustainability awareness and perceptions of curriculum integration (p < 0.05).

CONCLUSION: Although dental students display positive attitudes towards environmental sustainability, the findings suggest that sustainability is not systematically integrated into the dental curriculum. Integrating sustainability into dental education through clearly defined learning outcomes and structured curriculum development may contribute to the training of environmentally responsible oral healthcare professionals.

PMID:41968368 | DOI:10.1111/eje.70158

Implement Sci Commun. 2026 Apr 13. doi: 10.1186/s43058-026-00921-2. Online ahead of print.

ABSTRACT

BACKGROUND: Australia’s ≥ 28‑weeks stillbirth rate is 19.5% higher than that of high‑income countries with the lowest rates. The Safer Baby Bundle (SBB) is a national initiative to reduce stillbirth in Australia targeting five components of antenatal care and is the key prevention strategy within National Stillbirth Action and Implementation Plan. This paper reports the experience in one Australian state that delivered the Safer Baby Bundle Improvement Project (SBBIP) to support clinical staff implementing the SBB. In the setting of extreme maternity workforce challenges compounded by the COVID-19 pandemic, the implementation used a modified Breakthrough Series Collaborative (BTS).

METHODS: Over an 18-month period, antenatal services across Queensland used a modified BTS Collaborative approach, removing the need for teams to document Plan-Do-Study-Act cycles, use statistical process control (SPC) charts, document project progress scores and monthly reporting. Engagement during the improvement effort was assessed. A before-and-after multimethod study was used to evaluate the program. Routinely collected perinatal data, clinical audits, project administrative data and surveys of healthcare professionals and women receiving antenatal care were used to measure improvements before and after implementation, and logistic regression interrupted time series (ITS) analyses were used for comparisons of the outcomes.

RESULTS: Despite disruptions from the COVID-19 pandemic, the SBB was implemented across antenatal services, and the modified BTS implementation strategy achieved positive results. Eighty-nine percent of the 45 enrolled teams were actively engaged in the improvement effort across the SBBIP and all (100%) implemented one or more change ideas. Post implementation, improvements were observed in all key process measures and balance measures (planned singleton birth before 39 weeks, late preterm and early-term singleton births), whereas other measures remained unchanged. The stillbirth rate ≥ 28 weeks in singletons remained at 2.1 per 1000 births before and after implementation. ITS analyses of eligible measures supported these patterns.

CONCLUSIONS: In an environment challenged by workforce shortages, high workload demand, and competing priorities (global pandemic), a modified BTS Collaborative approach is a useful model to implement improvement at scale to reduce stillbirth risk factors.

PMID:41968363 | DOI:10.1186/s43058-026-00921-2

Cytometry A. 2026 Apr 12. doi: 10.1002/cyto.a.70024. Online ahead of print.

ABSTRACT

Rapid advancements in mass and flow cytometry technologies have allowed researchers to generate and analyze high-dimensional single cell datasets, often utilizing upwards of 40 protein markers. Such high-parameter cytometry is increasingly used in longitudinal immunological studies, but technical variations across experimental batch runs can confound biological signals. To mitigate the impact on downstream analyses, many studies include reference control samples in every run, and several approaches exist to adjust for batch effects. However, tools that objectively identify problematic batches and markers present within a dataset are limited. We introduce CytoBatchFlagR, a comprehensive and interpretable tool designed to flag batch-related problems at the marker and cell cluster level based on robust statistical evaluations. Batch and marker variations are assessed based on median signal intensities of negative and positive cell populations and positive cell frequencies, along with Earth Mover’s Distance (EMD) of signal intensity distributions. Additionally, CytoBatchFlagR identifies cell type specific batch problems via unsupervised clustering. The tool is suitable for mass and flow cytometry datasets where it objectively detects distinct types of batch issues. We developed and tested CytoBatchFlagR using three cytometry datasets to demonstrate its utility and performance. We also demonstrated CytoBatchFlagR’s effectiveness in assessing datasets that include or lack reference controls. CytoBatchFlagR improves quality control by enabling objective identification of technical variations that may impact downstream analysis in high-parameter cytometry data. The tool uses a series of complementary metrics to identify potential batch-related problems at the marker and cell population level and presents the results through interpretable visualizations. This allows users to make informed decisions about whether to apply batch correction or exclude specific batches or markers from downstream analyses. CytoBatchFlagR is freely available as R scripts, with documentation and a tutorial to help users get started.

PMID:41968341 | DOI:10.1002/cyto.a.70024

Am J Med Genet B Neuropsychiatr Genet. 2026 Apr 12. doi: 10.1002/ajmg.b.70017. Online ahead of print.

ABSTRACT

Major depression and suicide are critical public health concerns, particularly in underrepresented populations with unique genetic and sociocultural contexts. The Maya-mestizo population presents the highest suicide rates in the country but remains understudied in psychiatric genetics. This study evaluated the association between three genetic variants, rs7305115 (TPH2), rs6265 (BDNF), and rs2428707 (HTR2C), and the presence of major depression, melancholic subtype, and suicide risk in Maya-mestizo adults. A total of 598 participants were recruited from urban and rural areas. Psychiatric evaluations were performed using the MINI 5.0 (DSM-IV), and functional status was assessed with the Karnofsky scale. Genotyping was performed with TaqMan assays, and ancestry was confirmed with ancestry-informative markers. Analyses included Hardy-Weinberg equilibrium testing and logistic regression models adjusted for sex and included age, body mass index, Karnofsky performance scale score, and sociodemographic variables as covariates. The prevalence of major depression was 38.9%, while suicide risk reached 24.7%. The rs2428707 variant of HTR2C was significantly associated with major depression (OR 2.31, 95% CI 1.03-5.18, p = 0.041). Variants in TPH2 and BDNF were associated with the melancholic subtype. No statistically significant associations were found with suicide risk, though overlap with depressive phenotypes suggests shared vulnerability. This first report of psychiatric genetics in the Maya-mestizo population highlights the need for culturally and genetically tailored interventions.

PMID:41968289 | DOI:10.1002/ajmg.b.70017

Hum Brain Mapp. 2026 Apr 1;47(5):e70527. doi: 10.1002/hbm.70527.

ABSTRACT

Pregnancy induces neuroanatomical changes in the human brain. Previous studies detected both traces of motherhood decades after childbirth and adaptations in fathers. It is unclear which effects can be attributed to persisting traces of pregnancy and which are effects of parenthood. We investigated effects of past birth and of pregnancy loss in women, and effects of fatherhood in men, using univariate and machine learning analyses on 205 regional brain volumes. A group of mothers and an age-matched sample of nulliparous women (N = 4357 per group, mean age 63 years) from the UK Biobank, with no past pregnancy losses, showed significant volumetric group differences in 14 regions at Bonferroni-adjusted α = 0.05. Likewise, we identified 18 significant group differences between age-matched samples of fathers and non-fathers of the same size (mean age 63.4), with 9 regions overlapping between sexes. Brain-wide association statistics for past live birth in mothers and those for fatherhood correlated (r = 0.55). XGBoost machine learning models trained to classify parenthood status separately in both datasets showed performance that was low, but significantly above chance (10-fold cross validation: AUC = 0.56, p < 1e-5 Motherhood classifier, AUC = 0.54, p < 1e-5, Fatherhood classifier, 10 k permutations). We tested the motherhood classification model on an independent test sample comprising four age-matched groups: 1. women who have never been pregnant, 2. women with past pregnancy loss but no live births, 3. women with live births but no pregnancy loss, and 4. women who experienced both. Class probability was significantly associated with live births, but not past loss. These findings may suggest that neuroanatomical patterns of past childbirth partly also reflect traces of parenthood and not solely persisting traces of past pregnancy, although a more detailed characterization of pregnancy loss data would be needed for full confirmation of this interpretation. Therefore, further research is needed to quantify the extent and understand the nature of these changes, particularly considering the known vulnerability for mental disorders associated with reproductive events.

PMID:41968278 | DOI:10.1002/hbm.70527

J Hum Nutr Diet. 2026 Apr;39(2):e70238. doi: 10.1111/jhn.70238.

ABSTRACT

INTRODUCTION: Dietary risk factors significantly contribute to the global and national burden of non-communicable diseases (NCDs). Over recent decades, Iran has experienced a nutritional transition, shifting from traditional diets to increased consumption of processed foods, salt, and sugar-sweetened beverages. While some data suggest improvements in certain dietary risk factors, overall trends remain inconsistent. With rising NCD prevalence, continuous monitoring of their determinants, particularly dietary risk factors are crucial for informing effective public health interventions.

METHODS: We analysed data from eight nationally representative STEPS surveys conducted in Iran between 2005 and 2021. Using the WHO Stepwise approach to NCD surveillance, standardised, locally adapted questionnaires assessed dietary intake and sociodemographic variables among adults aged 18-65 years. Dietary risk factors included consumption of fish, fruits, vegetables, processed meats, salt, and sugar-sweetened beverages. Trends were modelled using a smoothing spline method with 1000 simulations, generating annual prevalence estimates with 95% uncertainty intervals.

RESULTS: From 2005 to 2025, significant dietary changes emerged: prevalence of adequate fish consumption halved (41.6% [95% UI: 36.8-46.4] to 20.0% [12.8-27.2]), while appropriate fruit intake increased modestly (22.8% [14.9-30.7] to 28.0% [11.2-44.5]). Adequate vegetable consumption followed a bell-shaped curve, peaking at 55.5% [45.8-65.2] in 2014 before declining to 50.9% [26.7-75.1]. Appropriate processed meat consumption improved substantially (48.8% to 95.8%), as well as appropriate salt intake (29.3% to 65.0%). Appropriate Sweetened beverage consumption demonstrated a U-shaped pattern, decreasing initially before rebounding to 85.9% (85.6-85.9) by 2025. These trends remained consistent across all age strata in stratified analyses.

CONCLUSION: Despite some improvements, overall adherence to dietary recommendations remains suboptimal. The reversal of early vegetable intake gains and low combined fruit and vegetable consumption highlight the urgent need for sustained, nationwide dietary interventions.

PMID:41968271 | DOI:10.1111/jhn.70238

Egypt Heart J. 2026 Apr 12;78(1):23. doi: 10.1186/s43044-026-00736-5.

ABSTRACT

BACKGROUND: Takotsubo cardiomyopathy (TC) is a cardiomyopathy characterized by temporary ventricular dysfunction, often resembling myocardial infarction. The association between ischemic stroke and TC remains unclear, with unknown true incidence. The objective of this study is to assess the incidence of ischemic stroke in TC patients and its risk factors.

METHODS: We carried out a comprehensive search of PUBMED, Google Scholar, PROQUEST, and ScienceDirect databases from their inception to February 2026. Studies reporting the incidence of ischemic stroke in TC patients were included. The quality of studies was evaluated utilizing the Joanna Briggs Institute Critical Appraisal Tools. Statistical analyses were performed using Review Manager and RStudio.

RESULTS: This study included six studies with 35,573 participants (841 had ischemic stroke and 34,732 did not). The pooled incidence of ischemic stroke was 4% (95% CI 0.01-0.06; I² = 91%). The incidence of all-cause mortality was 36% (95% I 0.02-0.71, I² = 81%) in TC patients with ischemic stroke, significantly higher than the 3.12% (95%CI:0.01-0.05, I² = 37%) observed in TC patients without stroke. The mortality risk was higher in TC patients with ischemic stroke (OR7.57; 95% CI 2.70-21.22). Age (MD: 3.04; 95% CI 0.74-5.34), sex (OR0.64; 95% CI 0.53-0.77), diabetes (OR1.73; 95% CI 1.00-3.00), and atrial fibrillation (OR1.87; 95% CI 1.28-2.72) were significantly related to the incidence of ischemic stroke. However, smoking and hypertension showed no significant association with ischemic stroke.

CONCLUSIONS: Ischemic stroke in TC patients correlates with an increased mortality rate and is associated with age, sex, and comorbidities, including diabetes and atrial fibrillation. Additional research is necessary to evaluate the possible advantages of anticoagulant therapy in TC patients.

PMID:41968267 | DOI:10.1186/s43044-026-00736-5

Int J Dent Hyg. 2026 Apr 12. doi: 10.1111/idh.70051. Online ahead of print.

ABSTRACT

OBJECTIVE: Investigate whether depressive symptoms are linked to a higher likelihood of reporting poorer oral health conditions in older adults.

THE BACKGROUND DATA DISCUSSING THE PRESENT STATUS OF THE FIELD: Understanding the potential negative effects of depressive symptoms on the perception of oral health in older adults is crucial for implementing tailored interventions and improving overall well-being in this demographic.

MATERIALS AND METHODS: This is a cross-sectional study using data from the 2019 Brazilian National Health Survey (PNS), conducted between 2019 and 2020. A total of 22,728 Brazilian older adults were analysed. A Poisson regression model was employed to examine the relationship between depressive symptoms and self-reported oral health. The selection of independent variables for statistical modelling was guided by a conceptual framework of social determinants. All analyses were performed using Stata 14.0.

RESULTS: The unadjusted findings suggest that individuals with 9 or more depressive symptoms had a 68% higher prevalence (PR: 1.68 [95% CI: 1.67-1.69]) of reporting poor self-perceived oral health compared to those with fewer depressive symptoms. After adjusting for confounding factors, it was observed that individuals with 9 or more depressive symptoms had an 11% higher prevalence (PR: 1.11 [95% CI: 1.08-1.13]) compared to individuals with fewer depressive symptoms.

CONCLUSION: Even after adjusting for factors, those with nine or more depressive symptoms were more likely to report poor oral health. This highlights the role of mental health in older adults’ oral health, emphasising integrated approaches for overall well-being and addressing emotional and physical aspects.

PMID:41968239 | DOI:10.1111/idh.70051