Category: Nevin Manimala

Neurol India. 2026 Jul 1;74(4):621-626. doi: 10.4103/neurol-india.Neurol-India-D-25-00926. Epub 2026 Jul 21.

ABSTRACT

BACKGROUND: Embolic Strokes of Undetermined Source (ESUS) accounts for about 9-25% of all ischemic strokes. Atrial cardiopathy (AC) is a recently described pathology of the left atrium and is found to be associated with embolic strokes. This study aimed to study the prevalence and outcomes of AC among patients with ESUS.

METHODS: This is a single-centre, prospective, observational study conducted over a period of 1 year. AC was diagnosed by the presence of any one of the following biomarker using electrocardiogram (P-wave duration ≥110 ms, prolonged PR interval ≥200 ms, P-wave terminal force V1 ≥5000 μV*ms), echocardiogram (left atrial diameter ≥39 mm in men and ≥37 mm in women, left atrial volume index ≥34 ml/m2) or serum (N-terminal-probrain natriuretic peptide [NT-proBNP] ≥250 pg/mL) at baseline among patients with ESUS. All the patients were followed up after 90 days. The study cohort was divided into two groups: ESUS with AC and ESUS without AC. Both groups were compared using the Mann-Whitney U test. Fisher’s exact test was used to identify the parameter associated with recurrent stroke. P <0.05 was considered statistically significant.

RESULTS: A total of 63 patients were included in the study with a mean age of 59.2 (5.6) years. A total of 48 patients (76%) were included in the ESUS with AC group, and 15 patients (24%) were included in the ESUS without AC group. NT-proBNP was the most common AC biomarker found in 24 (39%) patients, followed by elevated left atrial diameter found in 23 (37%) patients. Recurrent stroke was seen in 11 (18%) patients during 90-days follow-up. Abnormal P-wave terminal force V1 and P-wave duration ≥110 ms were significantly associated with stroke recurrence (P = 0.054).

CONCLUSION: There is a high prevalence of AC among patients with ESUS, and NT-proBNP >250 pg/mL is the most common biomarker. Abnormal P-wave terminal force in V1 and P-wave duration may be associated with stroke recurrence.

PMID:42478394 | DOI:10.4103/neurol-india.Neurol-India-D-25-00926

Neurol India. 2026 Jul 1;74(4):606-610. doi: 10.4103/neurol-india.Neurol-India-D-25-00971. Epub 2026 Jul 21.

ABSTRACT

BACKGROUND: Migraine is a prevalent primary headache disorder associated with substantial disability. Restless legs syndrome (RLS), a sensorimotor disorder linked to dopaminergic dysfunction, has been increasingly reported as a comorbidity in migraine, particularly in chronic forms and those with aura. Data on this association in the Indian population remain limited.

OBJECTIVE: To determine the prevalence of RLS in patients with migraine and assess clinical correlations including age, gender, aura status, disease duration, and disability.

METHODS: A cross-sectional observational study was conducted over 12 months at a tertiary care hospital in North India. Adults aged 18-65 years diagnosed with migraine (ICHD-3 criteria) were consecutively enrolled. RLS was diagnosed using IRLSSG criteria. Patients were stratified into two groups based on RLS presence. Disability was assessed using the Migraine Disability Assessment (MIDAS) questionnaire. Statistical analysis included independent t-tests and Chi-square tests; P < 0.05 was considered significant.

RESULTS: Of 150 migraine patients, 54 (36%) met diagnostic criteria for RLS. The RLS group had a higher mean age than the non-RLS group (45.2 ± 11.9 vs. 38.2 ± 12.2 years; P = 0.001). RLS prevalence was significantly higher in patients with aura (64.8%) than in those without (21.9%; P < 0.001). The mean migraine duration was longer in the RLS group (13.7 ± 7.3 vs. 9.6 ± 7.4 years; P = 0.001). MIDAS scores were also significantly higher in the RLS group (15.3 ± 6.7 vs. 9.8 ± 4.2; P < 0.001). Gender distribution did not differ significantly.

CONCLUSION: RLS is a frequent comorbidity in migraine, particularly among older patients and those with aura. Its presence is associated with longer migraine duration and greater disability. Routine screening for RLS in migraine patients may aid in comprehensive management and potentially reduce disease burden.

PMID:42478391 | DOI:10.4103/neurol-india.Neurol-India-D-25-00971

Neurol India. 2026 Jul 1;74(4):574-585. doi: 10.4103/neurol-india.Neurol-India-D-25-00766. Epub 2026 Jul 21.

ABSTRACT

Mild cognitive impairment (MCI) represents a transitional state between normal cognitive aging and dementia, with significant implications for public health. The objective of our study was to estimate the pooled prevalence of MCI among Indian elderly individuals (≥60 years). We conducted a systematic review and meta-analysis in accordance with PRISMA-2020 guidelines. Four databases (PubMed, Scopus, Embase, Web of Science) were searched up to January 2025. Twenty-six studies met the eligibility criteria. Random-effects models were used to calculate pooled prevalence with 95% confidence intervals (CIs), stratified by community- and hospital-based settings. Heterogeneity was assessed using I² and τ² statistics. Subgroup and meta-regression analyses examined potential sources of heterogeneity. Publication bias was evaluated using funnel plots, Egger’s regression test. The methodological quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. The pooled prevalence of MCI was 21% (95% CI: 13%-29%) in community settings and 44% (95% CI: 31%-57%) in hospital-based populations. Higher prevalence was observed among individuals with type 2 diabetes (53%), hypertension (57%), and those undergoing hemodialysis (38%). Diagnostic tool choice significantly influenced prevalence, with MoCA-based assessments yielding higher estimates than MMSE or Petersen criteria. Substantial heterogeneity was present across studies (I² >96%). Publication bias was minimal. MCI is prevalent among India’s elderly population, particularly in individuals with chronic conditions. These findings underscore the need to integrate cognitive screening into national noncommunicable disease programs and to adopt standardized, context-appropriate diagnostic protocols for early identification and intervention.

PMID:42478385 | DOI:10.4103/neurol-india.Neurol-India-D-25-00766

Nucleic Acids Res. 2026 Jul 17;54(14):gkag514. doi: 10.1093/nar/gkag514.

ABSTRACT

Transcription factor (TF) binding is typically described in terms of short sequence motifs and their immediate flanking regions. However, increasing evidence suggests that broader genomic context may influence TF-DNA interactions. By a thorough analysis of the DNA sequence in the broad context ($pm$ 5000 bp) of in vivo binding sites (as identified in a ChIP-seq or a Cut&Tag experiment), we show that the average GC content is in most cases statistically significantly increased around the binding site in a patch spanning 1000-1500 bp. This increase was observed consistently in experiment targeting the same TF in different cell lines. The surrounding of binding sites of certain TFs like MYC display a directional alteration of dinucleotide frequencies. Using sequence-derived structural descriptors, we hypothesize that DNA shape reflects (and may partly explain) patterns in sequence composition. In addition, we observe differences in sequence affinity to various potential cooperating TFs between cell lines. Altogether, we interpret these observations as indicating that the observed feature distortion reflects a coarse scanning mechanism that facilitates TF target-site recognition in absence of clear sequence sequence consensus.

PMID:42478380 | DOI:10.1093/nar/gkag514

J Prim Care Community Health. 2026 Jan-Dec;17:21501319261471881. doi: 10.1177/21501319261471881. Epub 2026 Jul 21.

ABSTRACT

ObjectivesCancer screening uptake in the United States remains below national targets despite established screening recommendations. Patient portals may support preventive care delivery, but their association with cancer screening uptake and population-level contribution remains unclear. We evaluated the association between patient portal use and breast, cervical, and colorectal cancer screening among screening-eligible U.S. adults.MethodsWe conducted a cross-sectional study using pooled data from the nationally representative Health Information National Trends Survey. Screening-eligible adults were defined according to U.S. Preventive Services Task Force criteria for breast, cervical, and colorectal cancer screening. The primary exposure was self-reported patient portal use within the prior 12 months. Outcomes included receipt of breast, cervical, and colorectal cancer screening. Survey-weighted modified Poisson regression was used to estimate adjusted prevalence ratios (aPRs), adjusting for sociodemographic and clinical characteristics. Adjusted absolute differences were estimated using marginal standardization, and population attributable risk percent (PARP) was calculated to estimate the population-level contribution of portal use.ResultsAmong 23,920 respondents, 13,210 (55.2%) reported patient portal use. Portal users had higher screening uptake than non-users for breast cancer screening (85.7% vs 75.1%; p<0.001), cervical cancer screening (83.8% vs 73.7%; p<0.001), and colorectal cancer screening (84.0% vs 72.5%; p=0.002). After adjustment, portal use was associated with higher prevalence of breast cancer screening (aPR 1.15, 95% CI 1.05-1.27; p=0.004) and cervical cancer screening (aPR 1.12, 95% CI 1.04-1.20; p=0.002), with a more modest association for colorectal cancer screening (aPR 1.08, 95% CI 0.99-1.17; p=0.07). Adjusted absolute differences associated with portal use were +14.3%, +12.9%, and +9.0% for breast, cervical, and colorectal cancer screening, respectively. PARP estimates were 7.7%, 6.9%, and 3.6%, respectively.ConclusionPatient portal use was associated with higher uptake of breast and cervical cancer screening, with a more modest and not statistically significant association for colorectal cancer screening after adjustment. Although portal engagement may support preventive care delivery, its population-level contribution to screening uptake was modest, suggesting that portal-based strategies should be paired with broader interventions addressing access, digital literacy, and structural barriers to cancer screening.

PMID:42478347 | DOI:10.1177/21501319261471881

J Chem Inf Model. 2026 Jul 21. doi: 10.1021/acs.jcim.6c01901. Online ahead of print.

ABSTRACT

Clinical attrition in drug development is frequently driven by suboptimal pharmacokinetic and toxicological (ADMET) properties rather than inadequate target efficacy. Accordingly, early-stage ADMET assessment has become an increasingly important component of Structure-Based Drug Design (SBDD). Here, we present empirically derived chemical navigability guidelines based on an analysis of ADMET-related properties predicted by admetSAR 3.0 across approved drugs curated from DrugBank. These parameters were integrated into an intuitive color-coded visualization framework for rapid compound assessment. The proposed guidelines are intended as context-dependent heuristics derived from statistical trends within the predicted chemical space of approved drugs rather than as universal decision rules. The utility of the ADMET-first strategy was further evaluated using an external and independent library of 1,756 KEAP1/NRF2 modulator compounds from ChEMBL, employing experimentally determined biological activity (pChEMBL) instead of docking-derived metrics. Enrichment analysis demonstrated that ranking compounds according to the ADMET-score identified true active compounds substantially earlier than random selection, achieving an enrichment factor (EF) of 1.29 in the top 5% of the library and recovering approximately 80% of active compounds within a limited fraction of the evaluated chemical space. We provide a freely accessible (https//admetSAR.umh.es), curated database of more than two million ADMET-annotated commercially available compounds from the MolPort library, prefiltered according to the proposed chemical navigability guidelines.

PMID:42478342 | DOI:10.1021/acs.jcim.6c01901

Mediators Inflamm. 2026;2026(1):e7778073. doi: 10.1155/mi/7778073.

ABSTRACT

BACKGROUND: Patients receiving massive transfusion after acute hemorrhage are at risk for transfusion-related acute lung injury (TRALI), a severe complication. Neutrophil extracellular traps (NETs) play a key role in acute lung injury. This study aimed to explore the link between NETs and TRALI and to develop a risk-prediction model using machine learning for early detection and intervention.

METHODS: In this multicenter prospective study, 513 patients with acute massive hemorrhage who underwent transfusion therapy (March 2020-February 2025) were consecutively recruited. All biomarker assays, sampling time points, and the statistical analysis plan were prespecified and ethically approved before study initiation. Based on TRALI occurrence after transfusion, they were divided into an injured group (n = 42) and a uninjured group (n = 471). Clinical features and NET-related markers were compared. LASSO regression was used for variable selection, followed by random forest for importance ranking. Multivariate logistic regression identified independent predictors, and a nomogram model was built and evaluated using ROC analysis, calibration, and decision curve analysis.

RESULTS: The injured group had significantly higher rates of smoking history, total infusion volume, perioperative transfusion volume, and transfusion frequency (all p < 0.05). Levels of citrullinated histone H3 (citH3), myeloperoxidase (MPO), neutrophil elastase (NE), interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and interleukin-8 (IL-8) were also elevated (all p < 0.05). LASSO identified seven key variables, with citH3 and MPO showing high importance. Multivariate analysis confirmed citH3 (OR = 1.142), MPO (OR = 5.017), and NE (OR = 1.014) as independent predictors of TRALI (all p < 0.05). The combined model achieved an AUC of 0.85 (95% CI: 0.78-0.92), indicating strong predictive performance.

CONCLUSION: TRALI risk in acute massive hemorrhage patients is associated with NET-related markers, particularly citH3, MPO, and NE. A model integrating these indicators provides valuable early identification of TRALI, aiding clinical decision-making.

PMID:42478331 | DOI:10.1155/mi/7778073

Pain Res Manag. 2026;2026(1):e6121920. doi: 10.1155/prm/6121920.

ABSTRACT

INTRODUCTION: Transcranial alternating current stimulation (tACS), which can noninvasively entrain oscillatory brain activity, has attracted scientific attention as a possible technique to control pain. However, there is a scarcity of studies investigating the preventive effect of tACS on postoperative pain.

METHODS: This double-blind, randomized, sham-controlled trial enrolled 72 patients undergoing elective video-assisted thoracoscopic surgery (VATS). Patients were randomly allocated (1:1) to receive a single 20-min session of α-tACS on the primary somatosensory cortex (S1) or sham stimulation postoperatively. The primary outcomes were postoperative numerical rating scale pain scores and opioid consumption at 24 h postoperatively. Secondary outcomes included cumulative opioid consumption within 48 h and Quality of Recovery-15 (QoR-15) score. Adverse events were also assessed.

RESULTS: The tACS group exhibited significantly lower resting pain scores versus the sham group (β = -0.49, 95% confidence interval [CI], -0.78 to -0.20, p = 0.001) and lower movement pain scores versus the sham group (β = -0.45, 95% CI, -0.84 to -0.06, p = 0.025), though cumulative opioid consumption showed no difference at 24 h (median difference [MD] = 1.0 mg; 95% CI, -2.3 to 2.5; p = 0.76) and 48 h (MD = 3.3 mg; 95% CI, -0.6 to 9.1; p = 0.10) postoperatively. Additionally, the area under the curve for resting pain over 2-24 h (AUC_{2-24 h}) and 2-48 h (AUC_{2-48 h}), as well as the AUC_{2-48 h} of movement pain scores, were significantly lower in the tACS group. Moreover, QoR-15 scores and adverse events were also comparable.

CONCLUSION: For patients undergoing VATS, a single α-tACS treatment targeting the bilateral S1 regions yielded a statistically significant yet modest reduction in postoperative pain. However, no significant decrease in postoperative opioid consumption was observed, and further research is warranted.

TRIAL REGISTRATION: Chinese Registry of Clinical Trials: ChiCTR2300078723.

PMID:42478315 | DOI:10.1155/prm/6121920

Riv Psichiatr. 2026 Jul-Aug;61(4):181-192. doi: 10.1708/4747.47645.

ABSTRACT

The history of the transition from Kraepelin’s concept of manic-depressive psychosis and endogenous depression to the current model of major depression is traced. In particular, the changes that have characterized the transition from the narrative psychopathology of the positivist era to the operational psychiatry of the DSM-III and its successors over the last century are critically reviewed. The birth of psychopharmacology, with the consequent entry of market interests into psychiatry and de-institutionalization, have shifted psychiatric patients from mental hospitals to outpatient clinics, resulting in enormous changes in both quantity and quality of samples. The changing composition of psychiatric population, with an ever-increasing prevalence of non-psychotic cases, and the progressive abandonment of the phenomenological cultural substratum in favor of more empirical paradigms, has rendered old classifications based on narrative criteria inadequate. Hence the need for more ‘scientific’ models, driven mainly by the need for reproducibility, was necessary for the application of scientific empirical methods. This article focuses on the changes that the concept of depressive illness has undergone in the transition from descriptive psychopathology to the current operational diagnoses. The various forms of depression described prior to DSM-III (endogenous depression, neurotic depression, reactive depression, atypical depression, seasonal depression, masked depression, involutional depression, depressive pseudodementia), examined in the frame do DSM-5, are either excluded because of the lack of evident depression (masked depression, depressive pseudodementia) or all absorbed into the single broad category of major depressive disorder, which thus becomes a broad container which is likely to lack homogeneity, as has been repeatedly pointed out over the years. On the other hand, what the authors of DSM (the latest edition in particular) have proposed as a remedy, the sub-categorization of the disorder through the description of specific typer (the specifiers), is in fact ignored both in research and in clinical practice.

PMID:42478310 | DOI:10.1708/4747.47645

Riv Psichiatr. 2026 Jul-Aug;61(4):166-171. doi: 10.1708/4747.47643.

ABSTRACT

BACKGROUND: Violent behaviours continue to be a significant problem worldwide. The introduction of Motion Rooms, particularly within acute psychiatric settings, can provide a safe and therapeutic intervention that, by promoting emotional self-regulation, reduces emotional distress and aggressive behaviors.

AIM: To assess the effects of a therapeutic intervention through the use of the Motion Room on the risk of violent behavior and the use of physical restraint.

MATERIALS AND METHODS: A longitudinal design was used to evaluate the effectiveness of the Motion Room in an acute psychiatric unit. The Italian version of the Broset Violence Checklist (BVC-ita) was used for the assessment of the risk of aggression before (T0) and 2 hours after intervention (T1).

RESULTS: 102 patients were enrolled, 96 (94.12%) completed the intervention. The number of subjects at moderate/high risk decreased significantly at T1 (p=0.01). In the two hours following the intervention, one patient was subjected to physical restraint.

CONCLUSIONS: Our results suggest that sensory rooms can be a strong support for nursing staff in preventing aggressive behavior in an acute psychiatric ward. Further research with broader sampling and randomized studies is needed.

PMID:42478308 | DOI:10.1708/4747.47643