Nevin Manimala

Womens Health (Lond). 2026 Jan-Dec;22:17455057261481009. doi: 10.1177/17455057261481009. Epub 2026 Aug 28.

ABSTRACT

BackgroundThe prevalence of obesity has increased alarmingly over the last decades in the United Arab Emirates (UAE). Bariatric surgery (BS) is a more effective approach to losing weight than dieting in morbidly obese women. Perinatal depression is a well-known risk to maternal and neonatal health across the globe.ObjectivesTo determine whether bariatric surgery predicts depression among pregnant women in this descriptive cross-sectional study.DesignA descriptive cross-sectional survey study conducted in a major pediatric and maternity hospital in Abu Dhabi, UAE.MethodsForty-one pregnant women with a history of BS who attended a major pediatric and maternity hospital in Abu Dhabi, UAE, between July 2021 and November 2022 were recruited for the study. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen the participants for depression symptoms. An analysis of sociodemographic variables and depression scores was performed. Categorical variables were compared using chi-square tests. Continuous variables were compared using independent t-tests, and skewed data using the Mann-Whitney test. The ethical approval of the study was obtained from the Research and Ethics Committee of the hospital (No. RP DAE/2021/102) on 15 June 2021. Written informed consent was obtained from all participants prior to their enrollment in the study.ResultsDepression was present in 46.3% of the participants, among whom 2.7% were experiencing severe depression. The analysis of the EPDS scores between the Roux-en-Y bypass (RYGB) and sleeve gastrectomy (SG) groups indicates a higher EPDS score in the SG group compared to the RYGB group (U = 220.000; p = 0.015). There were no significant differences in the proportions of participants across the different sociodemographic characteristics based on depression score classification.ConclusionsThe prevalence of depression was high among pregnant women with a history of bariatric surgery. Although the results were based on a small sample, the results of this study indicate the risk of depression is higher in pregnant women who had had sleeve gastrectomy bariatric surgery.

PMID:42664494 | DOI:10.1177/17455057261481009

Neurology. 2026 Sep 22;107(6):e218475. doi: 10.1212/WNL.0000000000218475. Epub 2026 Aug 28.

ABSTRACT

BACKGROUND AND OBJECTIVES: Former American football players exposed to repetitive head impacts (RHI) are at a risk of chronic traumatic encephalopathy (CTE), but chronic pain, polypharmacy, and extensive orthopedic surgeries may also contribute to cognitive and behavioral symptoms. This study evaluated associations between chronic pain, centrally acting medications (CAMs), and orthopedic surgeries with cognitive and behavioral symptoms among former American football players.

METHODS: The sample included former professional (PRO) and collegiate (COL) football players and unexposed, asymptomatic men (UE) from DIAGNOSE CTE. Number of CAMs, orthopedic surgeries, and average pain scores were compared between the groups. Among former football players, logistic regression tested associations between CAMs, average pain score, and orthopedic surgeries with diagnoses of cognitive impairment and neurobehavioral dysregulation (NBD) using traumatic encephalopathy syndrome (TES) research criteria. Linear regression tested associations between CAMs, average pain score, and orthopedic surgeries with the Montreal Cognitive Assessment (MoCA) and behavioral and mood symptom scales. Covariates included age, education, race, and total years of football.

RESULTS: The study included 236 men (120 PRO, 60 COL, 56 UE). The mean ages were 59.1 (PRO), 53.5 (COL) and 59.6 (UE) years. PRO and COL used more CAMs (mean PRO = 0.76, COL = 1.14, UE = 0.14), had higher average pain scores (PRO = 4.22, COL = 3.21, UE = 1.05), and more orthopedic surgeries than the UE (mean PRO = 2.76, COL = 1.22, UE = 0.34). CAMs and average pain scores were associated with increased odds of consensus diagnosed NBD (CAMs OR = 2.15, 95% CI 1.53 to 3.26; average pain score OR = 1.55, 95% CI 1.32 to 1.85). CAMs and average pain scores were associated with increased measures of impulsivity, depression, anxiety, behavioral regulation, and aggression. CAMs and average pain scores were not associated with consensus diagnosed cognitive impairment, but CAMs were negatively associated with MoCA score (estimate = -0.47, 95% CI -0.81 to -0.13). There was no association between number of orthopedic surgeries and cognition or NBD.

DISCUSSION: CAMs and chronic pain are associated with NBD and CAMs are associated with reduced MoCA scores in former American football players.

PMID:42664488 | DOI:10.1212/WNL.0000000000218475

JCO Clin Cancer Inform. 2026 Jul-Sep;10(3):e2600105. doi: 10.1200/CCI-26-00105. Epub 2026 Aug 28.

ABSTRACT

PURPOSE: Machine learning models that predict survival time for patients are increasingly used for clinical decision support. Validating model performance in deployment is important but challenging because the only timely source of follow-up/death data is the electronic medical record (EMR), which is known to undercapture deaths, resulting in informative censoring. We examined whether model performance evaluation using EMR data alone can distinguish between low- and high-quality models using high-quality cancer registry data combined with EMR data as a comparison to calculate model performance.

MATERIALS AND METHODS: This was a retrospective study of 3,330 patients with metastatic cancer diagnosed from 2008 to 2018. We used regularized Cox proportional hazards regression trained on features from the EMR to predict length of survival after diagnosis. We trained models by varying the number of features to span a range of baseline discrimination performance and validated performance first using higher-quality EMR and cancer registry outcome data as a reference standard, followed by EMR data alone to simulate the scenario when real-time validation is performed and only EMR data are available.

RESULTS: The model with all features had a C-index of 0.66 (95% CI, 0.65 to 0.68) and an integrated Brier score (IBS) of 0.17 (95% CI, 0.16 to 0.18) when validating with reference standard data, compared with a C-index of 0.67 (95% CI, 0.65 to 0.69) and an IBS of 0.16 (95% CI, 0.15 to 0.17) with EMR data only. When using fewer features, performance estimates dropped similarly in both scenarios. When using reference standard data, the model was found to be reasonably calibrated, but with EMR data, the model was incorrectly found to systematically underpredict survival.

CONCLUSION: EMR data were useful for validation of model discrimination, but not calibration.

PMID:42664478 | DOI:10.1200/CCI-26-00105

Med Probl Perform Art. 2026 Aug 28;41(3):89-97. doi: 10.21091/mppa.2026.03009.

ABSTRACT

BACKGROUND: Temporomandibular disorders (TMDs) comprise a heterogeneous group of conditions affecting the temporomandibular joints, masticatory muscles, and related structures, and may influence both quality of life and professional performance. Professional musicians represent an occupational group exposed to combined physical and psychosocial demands that may increase vulnerability to temporomandibular symptoms.

OBJECTIVE: To determine the prevalence of temporomandibular symptom reporting and its association with socio-demographic and occupational factors, as well as health-related quality of life, among Portuguese professional orchestral musicians.

METHODS: A cross-sectional study was conducted involving 271 professional musicians from Portuguese orchestras. Data were collected using a self-administered questionnaire incorporating the Fonseca Anamnestic Index (FAI) and the SF-12v2 Health Survey, alongside sociodemographic and occupational variables. Descriptive statistics, chi-square tests, Student’s t-tests, Mann-Whitney U tests, and multiple logistic regression analyses were performed with a significance level of p < 0.05.

RESULTS: Temporomandibular symptoms were identified in 61.6% of participants. Female musicians showed a significantly higher prevalence than males (77.4% vs 48.3%, p < 0.001). Younger musicians (18-29 years) presented the highest prevalence, whereas those aged over 50 years showed the lowest frequency. Part-time employment was associated with increased odds of symptom reporting (OR = 2.15, 95% CI: 1.07-4.31). No significant associations were observed with education level, instrument category, or weekly practice time. Musicians reporting temporomandibular symptoms demonstrated significantly lower physical and mental health scores on the SF-12v2 (p < 0.01).

CONCLUSION: Temporomandibular symptoms are highly prevalent among professional orchestral musicians and are associated with demographic and occupational factors, as well as reduced health-related quality of life. These findings highlight the importance of preventive and multidisciplinary approaches addressing the occupational demands of orchestral performance.

PMID:42664464 | DOI:10.21091/mppa.2026.03009

Eur J Gastroenterol Hepatol. 2026 Oct 1;38(10):1213-1223. doi: 10.1097/MEG.0000000000003263. Epub 2026 Jul 27.

ABSTRACT

OBJECTIVE: To compare lenvatinib (LEN) and atezolizumab plus bevacizumab (Atezo + Bev) as first-line therapy in super-older adults (≥80 years) with hepatocellular carcinoma (HCC) and evaluate whether early relative dose intensity (RDI) is associated with outcomes.

METHODS: This retrospective cohort study included super-older adults initiating LEN or Atezo + Bev between May 2018 and August 2025. The primary endpoint was overall survival (OS); secondary endpoints included progression-free survival (PFS) and adverse events. Inverse probability of treatment weighting and multivariable Cox regression were performed. Within the LEN cohort, a day 56 landmark analysis evaluated the prognostic significance of 8-week RDI (RDI8 ≥ 75% vs. <75%).

RESULTS: Median OS was 15.6 and 10.7 months with LEN and Atezo + Bev [hazard ratio: 0.77, 95% confidence interval (CI): 0.42-1.41], whereas median PFS was 6.73 and 9.73 months, respectively (hazard ratio: 1.18, 95% CI: 0.65-2.17). IPTW and multivariable analyses yielded similar results. Within the LEN cohort, RDI8 greater than or equal to 75% was independently associated with improved OS (30.8 vs. 14.7 months; adjusted hazard ratio: 0.23, 95% CI: 0.07-0.73, P = 0.013). Grade greater than or equal to 3 adverse events occurred in 37 and 50% of the LEN and Atezo + Bev cohorts, respectively.

CONCLUSION: Although LEN and Atezo + Bev showed no statistically significant difference in real-world survival in this exploratory cohort, these findings require validation in larger studies. Higher early LEN dose intensity was consistently associated with improved survival and may represent an important therapeutic consideration in super-older adults with HCC.

PMID:42664455 | DOI:10.1097/MEG.0000000000003263

Eur J Gastroenterol Hepatol. 2026 Oct 1;38(10):1205-1212. doi: 10.1097/MEG.0000000000003255. Epub 2026 Jul 24.

ABSTRACT

BACKGROUND: Cirrhosis produces a rebalanced hemostatic state that predisposes patients to bleeding and thrombosis. We evaluated hepatic outcomes associated with deep vein thrombosis (DVT), pulmonary embolism, and portal vein thrombosis (PVT) in patients with cirrhosis.

METHODS: We conducted a retrospective cohort study using the Nationwide Readmissions Database from 2016 to 2022. Adults with cirrhosis identified during January index hospitalizations were followed through the end of the same calendar year and classified as having no thromboembolism, DVT, pulmonary embolism, or PVT. The primary outcome was liver transplantation. Secondary outcomes included in-hospital mortality, ascites, esophageal or gastric varices, variceal hemorrhage, acute liver failure, and hepatic decompensation. Survey-weighted logistic regression estimated adjusted odds ratios (aORs).

RESULTS: The weighted cohort included 365 467 patients: 363 007 without thromboembolism, 730 with DVT, 1036 with pulmonary embolism, and 694 with PVT. DVT was associated with lower odds of liver transplantation [aOR, 0.19; 95% confidence interval (CI), 0.05-0.83] and mortality (aOR, 0.54; 95% CI, 0.37-0.77). Pulmonary embolism was associated with lower odds of varices, ascites, acute liver failure, and hepatic decompensation. PVT was associated with higher odds of varices (aOR, 2.47; 95% CI, 1.95-3.13) and variceal hemorrhage (aOR, 2.83; 95% CI, 1.59-5.02).

CONCLUSION: Thrombotic phenotypes in cirrhosis have distinct prognostic associations. PVT was associated with portal hypertensive complications, whereas apparently favorable associations with DVT and pulmonary embolism should be interpreted cautiously.

PMID:42664454 | DOI:10.1097/MEG.0000000000003255

J Occup Environ Med. 2026 Aug 28. doi: 10.1097/JOM.0000000000003873. Online ahead of print.

ABSTRACT

OBJECTIVE: This study examined Thai wildland firefighters’ cardiopulmonary fitness, comparing previous and updated NFPA criteria.

METHODS: Chiang Mai wildland firefighters’ health was cross-sectionally examined. Chester Step cardiopulmonary fitness was assessed using the fixed 12-MET threshold and age- and sex-adjusted 50th percentile criterion. McNemar test indicated standard concordance, and multivariable linear regression found MET values. Statistical significance was assigned by p-values < 0.05.

RESULTS: Significant differences in fitness classifications between two methods (p < 0.05). Two previously passed participants failed, while 13 previously failed participants passed. Age (B=-0.07; 95% CI: -0.13, -0.01; p=0.016) and resting heart rate (B=-0.11; 95% CI: -0.16, -0.07; p<0.001) strongly correlated with METs.

CONCLUSION: The age- and sex-adjusted 50th percentile criteria requirements allow for better cardiovascular fitness and practical work duties. Updates in standards are beneficial for firefighters’ safety and health monitoring.

PMID:42664435 | DOI:10.1097/JOM.0000000000003873

Turk J Anaesthesiol Reanim. 2026 Aug 28;54(4):282-290. doi: 10.4274/TJAR.2026.262473.

ABSTRACT

OBJECTIVE: This study evaluated gender representation among speakers, session chairs, and society leadership roles at the Turkish Society of Anaesthesiology and Reanimation (TARK) Congresses between 2015 and 2024, focusing on temporal patterns and subspecialty-based variation.

METHODS: This retrospective observational analysis of conference sessions included all scientific sessions listed in official TARK congress programmes from 2015 to 2024. Names, roles, and session topics were extracted from publicly available documents. In the absence of self-identified gender data, participants were categorised as women or men using names, academic titles, congress documents, and publicly accessible institutional or professional information, when clarification was required. Gender proportions were compared using chi-square tests. Temporal patterns were evaluated using logistic regression analyses, and subspecialty-specific analyses were performed using intensive care as the reference category. The leadership composition of the society was evaluated descriptively.

RESULTS: A total of 2,627 congress roles were analysed, including 966 session chairs and 1,661 speakers. Women accounted for 50.3% of session chairs and 50.8% of speakers, with no statistically significant temporal change during the study period. Marked variation was observed across subspecialties. Women were least represented in intensive care sessions (30.9%) and most represented in obstetric and paediatric anaesthesia sessions (82.1%), reflecting a higher relative representation of women speakers in the latter than in intensive care. Leadership composition varied across terms, with no persistent predominance of either gender according to the descriptive assessment.

CONCLUSION: Gender representation at TARK congresses remained numerically balanced over the ten-year study period; however, the absence of a significant temporal increase and the presence of persistent subspecialty clustering suggest a stable but uneven distribution across academic areas.

PMID:42664424 | DOI:10.4274/TJAR.2026.262473

J Sex Med. 2026 Aug 5;23(9):qdag268. doi: 10.1093/jsxmed/qdag268.

ABSTRACT

INTRODUCTION: Vaginoplasty is a high benefit but technically complex procedure that is associated with reduced gender dysphoria, improved quality of life, and high patient satisfaction. Despite increasing utilization of gender-affirming vaginoplasty, national data identifying predictors of perioperative morbidity remain limited. This study evaluates patient risk factors and morbidity following gender-affirming vaginoplasty to inform patient counseling and optimize perioperative care.

METHODS: This retrospective cohort study utilizes the American College of Surgeons National Surgical Quality Improvement Program database (2011-2023) to characterize patient profiles, operative factors, and outcomes for vaginoplasty. Patients were identified using ICD-9/10 codes for gender dysphoria and relevant CPT codes. Multivariable analyses were performed to identify factors independently associated with surgical complications, readmissions, and reoperations.

RESULTS: A total of 978 vaginoplasty procedures were identified. Procedure volumes increased rapidly from under 15 operations a year through 2015, to a peak of 156 procedures in 2017. Most procedures were performed by plastic surgeons (82.6%), followed by urologists (16.2%).Overall, 16.0% of patients experienced an adverse event within 30 days, including 13.0% with recorded complications, 3.6% with an unplanned readmission, and 4.9% with an unplanned reoperation.On multivariable analysis, Black race (relative risk [RR] 1.59, 95% confidence interval [CI] 1.12-2.27 relative to White patients), obese BMI (RR 1.56, 95% CI 1.04-2.34), and procedures attributed to urology (RR 1.52, 95% CI 1.09-2.11 relative to plastic surgery) were associated with higher recorded risk of adverse events, while hypertension was associated with increased risk of readmission or reoperation (RR 2.04, 95% CI 11.05-3.96).

CONCLUSIONS: Vaginoplasty is a complex but rapidly growing surgical procedure with low rates of serious adverse outcomes in the 30-day postoperative period. This study characterizes short-term outcomes and risk factors in one of the largest national cohorts of gender-affirming vaginoplasty to date. Although procedures attributed to urology as the primary specialty were associated with higher recorded adverse event rates, this finding may reflect differences in case complexity or multidisciplinary practice patterns rather than surgeon specialty itself. Observed differences across patient characteristics and operative contexts highlight the importance of preoperative optimization, multidisciplinary collaboration, and standardized perioperative care.

PMID:42664394 | DOI:10.1093/jsxmed/qdag268

J Prim Care Community Health. 2026 Jan-Dec;17:21501319261485526. doi: 10.1177/21501319261485526. Epub 2026 Aug 28.

ABSTRACT

ObjectivesPulse-oximeter oxygen saturation (SpO₂) is widely used in outpatient respiratory care because it is fast and noninvasive, but arterial blood gas (ABG) testing provides a more direct measure of arterial oxygen saturation (SaO₂). Prior studies show that pulse oximeters may overestimate oxygen saturation in individuals with darker skin tones, potentially leading to missed recognition of clinically meaningful hypoxemia. However, limited research has examined measurement agreement in outpatient occupational lung disease settings.MethodsA retrospective agreement analysis was conducted using paired ABG-derived SaO₂ and pulse-oximeter SpO₂ measurements from the same outpatient visit at a rural West Virginia Black Lung Clinic. Paired measurements were defined as SaO₂ and SpO₂ readings recorded during the same clinical encounter. Agreement was evaluated using the Bland-Altman approach, which quantifies the average difference between two methods (mean bias) and the range within which most individual differences are expected to fall (limits of agreement). Hidden hypoxemia was defined as SaO₂ ≤ 88% with concurrent SpO₂ ≥ 90% or ≥ 92%.ResultsThirty-five participants were included; all male and self-identified as African American. Mean age was 70.7 years (SD 8.9). At rest, pulse oximetry overestimated SaO₂ by an average of 1.29 percentage points (SD 3.74), with 95% limits of agreement from -6.04 to +8.62 percentage points. Following exercise, mean bias was +0.75 percentage points (SD 3.68), with limits of agreement from -6.46 to +7.96. Although average differences were modest, individual discrepancies were sometimes several percentage points higher or lower than ABG values. ABG-defined hypoxemia occurred in 1/35 participants at rest and 1/34 post-exercise; in both cases, SpO₂ remained ≥ 90% and ≥ 92%, consistent with hidden hypoxemia. Regression analysis did not demonstrate statistically significant proportional bias at either timepoint.ConclusionsIn this outpatient Black Lung Clinic sample, pulse oximetry averaged only modest overestimation of SaO₂, but individual readings varied widely. This matters because oxygen and disability-related decisions are made one patient at a time, and differences of several percentage points can change classification near common thresholds. These findings support cautious interpretation and use of pulse-ox values in outpatient occupational lung disease care and justify larger, multi-site studies.

PMID:42664382 | DOI:10.1177/21501319261485526