Category: Nevin Manimala

Br J Nutr. 2026 May 6:1-29. doi: 10.1017/S0007114526107375. Online ahead of print.

ABSTRACT

Elevated LDL-cholesterol concentration is a major risk factor for CVD. Regular consumption of marine fish and seafood is associated with a reduced risk of CVD, although the n-3 PUFAs EPA and DHA have no cholesterol-lowering effect when given in physiologically relevant doses. Recent studies have demonstrated a lower LDL-cholesterol concentration in rodents after intake of cetoleic acid (CA, C22:1n-11), found in pelagic fish species such as herring. The primary aim was to investigate the effect of consuming capsules containing CA on LDL-cholesterol concentration in adults with overweight or obesity. The study was designed as a randomised clinical trial with two arms. Eighty participants were enrolled, and data from 75 participants were included in the statistical analyses. Participants consumed capsules containing either a CA concentrate (CECO group; 1480 mg CA and 232 mg EPA per day) or soyabean oil mixed with a n-3 PUFA concentrate without CA as comparator arm (SOYO3 group; 258 mg EPA/day) for eight weeks. The within-group changes in LDL-cholesterol were compared using ANCOVA with changes in body fat percentage as covariate. The LDL-cholesterol concentration was decreased from baseline to 8 weeks in the CECO group (n 37, median -0.1 (quartiles -0.1, 0.0) mmol/L) in comparison to the SOYO3 group (n 38, median 0.2 (quartiles 0.1, 0.2) mmol/L), with F=19.35, P=0.033 and η_p² = 0.212, corresponding to approximately 7% reduction in the CECO group relative to the SOYO3 group. To conclude, 8 weeks of dietary supplementation with CECO decreased the LDL-cholesterol concentration in adults with overweight or obesity.

PMID:42087284 | DOI:10.1017/S0007114526107375

Eur J Heart Fail. 2026 May 5:xuag150. doi: 10.1093/ejhf/xuag150. Online ahead of print.

ABSTRACT

AIMS: Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, has been shown to reduce cardiovascular (CV) and kidney events in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). We aimed to quantify the robustness of its CV benefits in phase 3 randomized controlled trials (RCTs) using fragility metrics coupled with conventional clinical effect measures.

METHODS AND RESULTS: We systematically searched MEDLINE and Scopus (from inception to June 2025) for phase 3 or 4 placebo-controlled RCTs of finerenone in T2DM and CKD reporting dichotomous CV outcomes. Three trials were included: FIDELIO-DKD, FIGARO-DKD, and the pooled FIDELITY analysis. We extracted hazard ratios (HRs), absolute risk reduction (ARR), relative risk reduction (RRR), number needed to treat (NNT), fragility index (FI), reverse fragility index (RFI), fragility quotient (FQ), and reverse fragility quotient (RFQ) for the primary composite CV outcome (CV death, non-fatal myocardial infarction [MI], non-fatal stroke, heart failure hospitalization [HFH]) and individual components. The primary composite outcome was significantly reduced in FIDELIO-DKD (HR 0.86, NNT 56; FI 4, FQ 0.0007) and FIDELITY (HR 0.86, NNT 59; FI 38, FQ 0.002), but not FIGARO-DKD (HR 0.87; RFI 7, RFQ 0.0009). Among individual outcomes, HFH showed the most consistent and robust benefit (FIDELITY HR 0.78, NNT 91; FI 23, FQ 0.001). Effects on CV death, MI, and stroke were numerically favorable but statistically non-significant, with low RFIs (mostly 1-3, and up to 9).

CONCLUSIONS: Finerenone significantly reduces HF hospitalization and modestly improves composite CV outcomes in T2DM with CKD, but effects on CV death, MI, and stroke are fragile. Combining fragility metrics with standard efficacy measures offers a clearer view of the reliability of trial results.

PMID:42087276 | DOI:10.1093/ejhf/xuag150

Fundam Clin Pharmacol. 2026 May;40(3):e70092. doi: 10.1111/fcp.70092.

ABSTRACT

Psychotropic medicines are known to impair cognitive function acutely, but the specific effects of individual substances remain underexplored. This study investigates the effects of dexamphetamine and zolpidem on cognitive performance to quantify the potential risk of intake and their pharmacokinetic and pharmacodynamic relationship. This randomized, double-blind, placebo-controlled trial (EudraCT 2021-005381 – 17) included 60 healthy men aged 26 ± 5 (mean ± SD) years. Participants received a single oral dose of 30-mg dexamphetamine, 5-mg zolpidem, or placebo (n = 20 per group). Cognitive performance was assessed at baseline and 3 and 8 h after dosing using the computerized Psytest system. Dexamphetamine and zolpidem improved sustained attention, with significant reduction of omissions at 8 h. Reaction time improved in both groups, but zolpidem impaired phasic alertness. Working memory remained unchanged. Plasma concentration of dexamphetamine and zolpidem was 70.8 ± 10.4 ng/mL and 39.0 ± 20.7 ng/mL at 3 h and 45.9 ± 7.9 ng/mL and 8.7 ± 6.6 ng/mL at 8 h, respectively. No correlation between drug plasma concentration and cognitive performance measures was demonstrable. Dexamphetamine caused the strongest subjective effects and highest liking ratings, whereas zolpidem elicited greater subjective dislike. Tolerability was best with placebo, followed by zolpidem and dexamphetamine. Single therapeutic doses of dexamphetamine and zolpidem modestly affected cognitive function 3 h after intake, with no relationship between cognitive performance and the study medicines’ plasma concentration. Both medicines improve cognition after 8 h but differed in subjective emotional effects. Nevertheless, generalizability is limited by the inclusion of healthy men only. Trial Registration: EudraCT: Nr: 2021-005381-17.

PMID:42087266 | DOI:10.1111/fcp.70092

Implement Sci Commun. 2026 May 5. doi: 10.1186/s43058-026-00955-6. Online ahead of print.

ABSTRACT

BACKGROUND: Syringe services programs (SSPs) are an evidence-based intervention for preventing infectious diseases and reducing the risk of overdose. Florida passed legislation that authorizes the implementation of SSPs (via the Infectious Disease Elimination Act; IDEA) in 2019. However, little is known about how organizational contexts and interorganizational networks shape adoption, implementation, and sustainment of this intervention.

METHODS: We conducted a cross-sectional, statewide survey of organizations engaged in implementing SSPs and related services between March and May 2025, using a community-based participatory research approach with the Florida Harm Reduction Collective. The survey assessed SSP implementation, barriers and facilitators, implementation climate, organizational sustainability, and interorganizational networks. Data were analyzed using descriptive statistics, t-tests for group comparisons, and social network analysis to examine relational structures and organizational centrality.

RESULTS: A total of 29 organizations representing 18 counties responded to the survey. Eight counties reported operating a sanctioned SSP, while none of the remaining counties had ordinances or champions supporting SSP adoption. Stigma and political resistance, lack of funding, and restrictive laws and policies were cited as major barriers to SSP implementation. There was an overall weak implementation climate for SSPs (mean = 1.4 on a 0-4 scale), though it was significantly stronger in counties with operational SSPs (1.8 vs. 1.1, p = 0.01). Organizations reported relatively strong organizational sustainability (mean = 5.6 on a 1-7 scale), with high ratings for program adaptation and lower scores for funding stability. Social network analysis revealed that the Florida Harm Reduction Collective served as the most central and influential node connecting diverse organizations statewide.

CONCLUSIONS: Our findings highlight both structural barriers (e.g., funding, stigma, restrictive policies) and organizational strengths (e.g., adaptability, network connectivity) in Florida’s harm reduction landscape. Addressing policy barriers, expanding and stabilizing funding availability, and leveraging statewide networks will be critical for strengthening implementation of SSPs in Florida and expanding equitable access to harm reduction services for people who use drugs.

PMID:42087235 | DOI:10.1186/s43058-026-00955-6

J Cardiothorac Surg. 2026 May 5. doi: 10.1186/s13019-026-04246-y. Online ahead of print.

ABSTRACT

OBJECTIVES: Current evidence does not support superiority of one cardioplegia type over another, but stems from low-risk populations. Therefore, we compared outcomes of multimorbid, high-risk infective endocarditis (IE) patients receiving Custodiol^®crystalloid or Calafiore blood cardioplegia during cardiac surgery.

METHODS: We retrospectively analyzed 553 patients (mean EuroScore II 22.7 ± 21.1) who underwent surgery for IE between 2009 and 2023 and received either cold crystalloid (Custodiol^®, n = 335) or warm blood (Calafiore, n = 218) cardioplegia. The primary endpoint was 1-year mortality. Secondary endpoints included 30-day mortality, postoperative stroke, and new-onset dialysis. Propensity score matching (1:1, 14 covariates) resulted in 175 matched pairs. Statistical analysis included nonparametric and exact tests.

RESULTS: In the overall cohort, patients receiving Custodiol^® were higher risk and had higher mortality and morbidity. After matching, there was no significant difference in 1-year mortality between patients receiving Custodiol^® and Calafiore (37.1% vs. 28.6%, p = 0.09). 30-day mortality trended to be lower in the Calafiore group without reaching statistical significance (22.9% vs. 14.9%, p = 0.057). However, stroke was less frequent (4.6% vs. 10.9%, p = 0.029), ICU stay was shorter (3[1-8] vs. 6[3-12.5] days, p < 0.001) and postoperative dialysis was numerically less common (13.7 vs. 20.6%, p = 0.091). These differences were most evident in procedures with shorter cross-clamp times, such as isolated mitral or aortic valve surgery, where mortality and recovery parameters consistently favored Calafiore.

CONCLUSIONS: In high-risk endocarditis patients warm blood cardioplegia may be superior to cold crystalloid, although differences did not reach statistical significance. However, propensity matching may not have accounted for all differences, which warrants further discussion and investigation.

PMID:42087214 | DOI:10.1186/s13019-026-04246-y

BMC Nutr. 2026 May 5. doi: 10.1186/s40795-026-01342-z. Online ahead of print.

ABSTRACT

BACKGROUND: Severe acute pancreatitis (SAP) is a life-threatening condition marked by systemic inflammation, organ failure, and high morbidity. Nutritional support plays a critical role in SAP management, with total enteral nutrition (TEN) and total parenteral nutrition (TPN) being the primary approaches. While TEN maintains gut integrity and may reduce complications, TPN bypasses the gastrointestinal tract and may worsen systemic inflammation. This study aimed to perform an updated systematic review and meta-analysis comparing the efficacy and safety of TEN versus TPN in SAP patients.

METHODS: Following PRISMA guidelines, we searched PubMed, Scopus, and Web of Science for randomized controlled trials and cohort studies comparing TEN and TPN in SAP. Outcomes included infection rate, organ failure, mortality, necrosis, surgical intervention, hospital stay, and serum markers (amylase, lipase, albumin, IL-6). Quality assessment was done using ROB2 and NOS tools. GRADE methodology was applied to assess evidence certainty.

RESULTS: A total of 23 studies involving 7,674 patients (2,750 TEN and 4,924 TPN) were analyzed. TEN was significantly associated with lower odds of infection (OR = 0.35; 95% CI: 0.18-0.70; p = 0.003), multiple organ failure (OR = 0.41; 95% CI: 0.21-0.78; p = 0.007), and mortality (OR = 0.50; 95% CI: 0.33-0.76; p = 0.001), compared to TPN. The requirement for surgical intervention was also reduced with TEN (OR = 0.26; 95% CI: 0.07-1.00; p = 0.05), although with high heterogeneity and low certainty. No significant differences were observed in pancreatic necrosis (OR = 0.88; p = 0.62) or hospital stay (MD = 1.9 days; p = 0.11). Biochemical markers including serum amylase, lipase, albumin, and IL-6 showed no statistically significant differences between the two groups. GRADE analysis rated the certainty of evidence as moderate for infection and hospital stay, low for organ failure and mortality, and very low for surgical intervention.

CONCLUSION: Our updated meta-analysis demonstrates that total enteral nutrition is associated with significantly better clinical outcomes than total parenteral nutrition in patients with severe acute pancreatitis, particularly in reducing infection, organ failure, and mortality. Although differences in secondary outcomes were not statistically significant, the overall evidence supports TEN as the preferred nutritional approach in SAP management.

PMID:42087204 | DOI:10.1186/s40795-026-01342-z

Crit Care. 2026 May 5. doi: 10.1186/s13054-026-06035-4. Online ahead of print.

ABSTRACT

BACKGROUND: In severe acute kidney injury (AKI), delayed renal replacement therapy (RRT) strategies allow many KDIGO stage-3 patients to avoid dialysis, but excessive postponement in those who ultimately require RRT may worsen outcomes. Early physiologically grounded markers to identify patients likely to need RRT are lacking. We evaluated whether combining early glomerular filtration kinetics and timed urinary urea excretion could improve discrimination of subsequent RRT initiation under a delayed strategy.

METHODS: TUBSAKI is a prospective bicentric ICU cohort including adults with KDIGO stage-3 AKI managed with a protocolized delayed RRT strategy. Blood and 24-hour urine samples were collected at diagnosis (D0) and day 1 (D1). Glomerular filtration dynamics were assessed using kinetic GFR (kGFR), and timed urinary urea excretion was assessed using UUEI. Discrimination for subsequent RRT was assessed using ROC curves and AUC. A combined logistic model (kGFR D0-D1 + UUEI D1) was internally validated by bootstrap, with sensitivity analyses adjusted for SOFA and KDIGO stage-3 oliguria.

RESULTS: Among 110 patients, 31 (28%) required RRT. kGFR D0-D1 showed good discrimination (AUC 0.81 [0.72-0.89]), and UUEI D1 moderate discrimination (AUC 0.74 [0.63-0.82]). The combined model showed an AUC of 0.85 ([0.76-0.91]), optimism-corrected AUC 0.83, and acceptable calibration. Discrimination remained stable after adjustment for SOFA and oliguria. Incremental gain over kGFR alone was modest and not statistically significant.

CONCLUSIONS: Early glomerular filtration kinetics and urinary urea excretion were associated with subsequent RRT initiation under a delayed strategy. The incremental clinical value of UUEI remained limited in this cohort, and external validation is required before clinical use.

PMID:42087193 | DOI:10.1186/s13054-026-06035-4

BMC Med Inform Decis Mak. 2026 May 6;26(1):160. doi: 10.1186/s12911-026-03350-2.

NO ABSTRACT

PMID:42087181 | DOI:10.1186/s12911-026-03350-2

BMC Sports Sci Med Rehabil. 2026 May 6. doi: 10.1186/s13102-026-01711-y. Online ahead of print.

ABSTRACT

BACKGROUND: Team-level defensive efficiency is a central determinant of success in professional football, yet defenders’ physical and motor profiles are rarely examined in relation to ecological defensive outcomes, particularly in under-researched professional leagues. This study investigated anthropometric and motor-fitness signatures of defensive efficiency among professional football defenders in the Nigeria Premier Football League (NPFL) using multivariate profiling methods.

METHODS: An observational ecological study was conducted among 36 professional defenders from Enugu Rangers International FC across three competitive seasons (2021/22-2023/24). Standardised anthropometric and motor-fitness assessments (agility, vertical-jump power, reaction time, balance, and coordination) were obtained during pre-season testing. Team-level defensive efficiency was derived from predefined ecological defensive indicators obtained from official league statistics, including goals conceded per match, defensive success index, points per goal conceded, and goal-prevention rate. Analyses included Spearman correlations, Kruskal-Wallis tests with eta-squared effect sizes (η²_H), principal component analysis (PCA), and k-means clustering; no individual-level regression was undertaken.

RESULTS: GA/PLD was relatively stable between full seasons (0.79 in 2021/22; 0.87 in 2023/24), whereas DSI and PPGC improved (0.68→0.74; 1.87→2.06), with GPR and GD/PLD also increasing (0.27→0.38; 0.29→0.53), indicating that comparable goals conceded yielded more favourable results. Defenders showed substantial muscularity (mean BMI 25.7 kg/m²; muscle mass 41.2 kg) and good motor fitness (agility 11.0 s). Anthropometric variables were strongly coupled, and BMI and jump classifications showed large effects on muscle mass, body fat, and jump power. PCA yielded three components explaining 72.5% of variance (body size/composition; agility-balance-coordination; power vs. adiposity), and k-means clustering identified three defender archetypes that differed most clearly in agility, separating heavier, slower stoppers from leaner, faster coverage profiles and balanced hybrids.

CONCLUSION: This ecological profiling study shows that, within a single NPFL club, professional defenders cluster into distinct anthropometric and motor-fitness archetypes-ranging from heavier high-mass stoppers to leaner, more agile mobile coverage defenders-while team-level indicators suggest increasingly efficient conversion of broadly stable goals conceded into better results and goal difference. These patterns do not establish individual causal effects but illustrate how multivariate profiling can support role allocation, interpretation of body-size and power metrics, and context-sensitive conditioning in data-limited professional environments. Inferences remain exploratory and are constrained by single-club sampling, lack of player-level event data, and unquantified cluster stability.

PMID:42087177 | DOI:10.1186/s13102-026-01711-y