Category: Nevin Manimala

J Vet Intern Med. 2026 May 4;40(3):aalag097. doi: 10.1093/jvimsj/aalag097.

ABSTRACT

BACKGROUND: Acute infectious bronchopneumonia is widely reported in adult cattle, yet most descriptions focus on postmortem findings.

HYPOTHESIS/OBJECTIVES: To describe signalment, clinical, hematological, and ultrasonographic findings in affected cows, and to identify pathogens and clinical findings associated with outcome.

ANIMALS: Twenty-one cows from 11 farms.

METHODS: Prospective case series. All cows underwent clinical examination, thoracic ultrasonography, bronchoalveolar lavage for culture and PCR, and CBC. Thoracic ultrasonography was repeated to assess lesion dynamics after antibiotic treatment. Outcomes were classified as favorable (clinical recovery and maintained milk production) or unfavorable (death or reduced milk production leading to premature drying-off and early culling). Descriptive statistics were computed, and univariate analyses were performed to identify variables associated with outcome.

RESULTS: Mean age at inclusion was 47 months (range, 24-104). Cases occurred mainly in winter (10/21) and during the early postpartum period (10/21); 17/21 were dairy cows. Typical clinical signs associated with acute respiratory disease (coughing, wheezes, and crackles) were rarely observed. Thoracic ultrasonography revealed frequent consolidations (17/21) and pleural effusion (13/21), with lesion size decreasing over time. Mannheimia haemolytica and Pasteurella multocida were identified by PCR in bronchoalveolar lavage samples in 13/21 and 18/21 cases, respectively. Unfavorable outcomes (11/21) were associated with nasal discharge, left shift on CBC, reduced ruminal contractions, higher respiratory rate on day 0, and deeper consolidation lesions on days 0 and 5.

CONCLUSIONS AND CLINICAL IMPORTANCE: Ultrasonography is a valuable cow-side tool that supports diagnosis and provides key information on the clinical course of acute infectious bronchopneumonia in adult cows.

PMID:42207578 | DOI:10.1093/jvimsj/aalag097

JMIR Form Res. 2026 May 28;10:e89880. doi: 10.2196/89880.

ABSTRACT

BACKGROUND: Environmental factors account for 23% of global deaths and 25% of chronic diseases. In France, the Fourth National Environmental Health Plan prioritizes training health professionals in environmental health. Endocrine-disrupting chemicals (EDCs) are chemical substances that interfere with hormonal systems, contributing to a range of health effects. In 2024, the Primary Care and Environmental Health (PCEH) program at the University of Montpellier-Nîmes introduced an innovative e-learning module on EDCs for first-year family medicine residents.

OBJECTIVE: This study aimed to evaluate the impact of the PCEH e-learning module on participants’ satisfaction, knowledge, and self-reported behaviors regarding EDCs in household environments.

METHODS: This monocentric, matched before-and-after cohort study included all first-year family medicine residents at the University of Montpellier-Nîmes. The module, developed collaboratively by clinicians and educators, integrated interactive images, artificial intelligence-generated virtual rooms, short educational videos, games, and flash cards. Participants were assessed using pretraining and posttraining questionnaires administered immediately before and after the module. These questionnaires evaluated satisfaction (using a 5-point Likert scale), knowledge (using binary “yes” or “no” questions), and behaviors (using a 5-point Likert scale). Statistical analyses included the McNemar test for paired categorical variables and paired 2-tailed t tests for continuous variables, with a significance threshold set at a P value of less than .05.

RESULTS: This study aimed to evaluate the impact of an e-learning module on knowledge and behaviors related to endocrine disruptors. Our findings show significant improvements across all measured domains. Of 148 eligible residents, 78 (52.7%) completed both assessments over a 17-day period. Overall satisfaction was high (mean 4.0/5, SD 0.9), with positive ratings for the e-learning format (mean 4.1/5, SD 1.0) and module duration (mean 4.2/5, SD 1.0). Knowledge improved significantly, with a mean 55.56 (SD 13.54) increase in correct identification of EDCs across all substances (P<.001). Self-reported behaviors improved by an average of 2.13 points (95% CI 1.71-2.56) on the 5-point scale (P<.001), exceeding those reported in previous PCEH modules. Secondary outcomes showed high posttraining identification of at-risk populations and exposure locations, although recognition of some substances (eg, alkylphenols and phenoxyethanol) remained low.

CONCLUSIONS: This innovative e-learning module significantly improved residents’ knowledge and preventive behaviors related to EDCs. These findings support the integration of environmental health training into medical curricula and highlight the potential of scalable e-learning interventions to strengthen preventive competencies in primary care.

PMID:42207575 | DOI:10.2196/89880

Clin Exp Rheumatol. 2026 May 28. doi: 10.55563/clinexprheumatol/g80tlj. Online ahead of print.

ABSTRACT

OBJECTIVES: To estimate the epidemiology of Behçet’s syndrome (BS) in Sardinia using a combined administrative and clinical data latent class analysis (LCA).

METHODS: Cases with a diagnosis of BS were retrieved from 2006-2016 in the Hospital Discharge Records (HDRs), 2006-2016 Rare Diseases Regional Register (RDRR), and 2014-2016 in the Specialist Outpatient Database (SOD). Medical records from regional rheumatology clinics were reviewed and classified by the International Criteria for Behçet’s Disease (ICBD) and International Study Group (ISG) criteria. Statistical analysis involved cross-referencing databases and applying LCA to estimate the probability of a BS diagnosis. Prevalence and incidence of BS in Sardinia were calculated, as well as the sensitivity and specificity of each database source.

RESULTS: Administrative databases analysis retrieved 271 unique cases. A medical record review of 133 patients identified 116 BS cases, of which 107 matched administrative records and 9 were new. After excluding two deaths, 280 cases were considered for analysis (164 administrative-only, 107 mixed, 9 clinical-only). Using ICBD, the LCA confirmed 193 (68.9%) as BS cases (68.3% female, mean age 47). This yielded a 2016 Sardinian BS prevalence of 11.7 per 100,000 inhabitants (15.7) for women and 7.6 for men), with annual incidence rates ranging from 0.24 to 0.48 per 100,000 inhabitants (2014-2016). Prevalence and incidence were lower using the ISG criteria. Database sensitivity varies from 40.6% to 70.5%, while specificity ranges from 16.3% to 99.0%.

CONCLUSIONS: BS in Sardinia is a rare disease. Relying on a single data source to estimate.

PMID:42207566 | DOI:10.55563/clinexprheumatol/g80tlj

Clin Exp Rheumatol. 2026 May 21. doi: 10.55563/clinexprheumatol/mf8noj. Online ahead of print.

ABSTRACT

OBJECTIVES: Rheumatoid arthritis (RA) is a complex autoimmune disease with a strong genetic component. The STAT4 rs7574865 (G>T) variant has been associated with RA in various populations, but data from North Africa remain limited. This study aimed to investigate the association of rs7574865 with RA susceptibility in Moroccan patients.

METHODS: A case-control study was conducted including 87 Moroccan patients with severe RA and 69 healthy controls. Genotyping of rs7574865 was performed using TaqMan assays. Serum levels of anti-CCP2 and IgM-RF were measured by ELISA. Associations between genotypes, alleles, demographic, clinical, and serological features were analysed.

RESULTS: The GT genotype was more frequent in patients than in controls, and the T allele showed higher prevalence in the RA group. A significant genotypic association with RA risk was observed, while the TT genotype was absent in both groups. No associations were detected with demographic or general clinical characteristics. However, a significant clinical association was observed with anti-CCP2 status. The GT genotype also showed a noticeable trend in RF-positive and anti-CCP2-negative patients compared with controls, though differences between serological subgroups within patients were not statistically significant.

CONCLUSIONS: These findings provide the first evidence from Morocco that the STAT4 rs7574865 variant may contribute to RA susceptibility. While its effect appears moderate, the study highlights the importance of including North African populations in genetic studies of RA.

PMID:42207556 | DOI:10.55563/clinexprheumatol/mf8noj

JAMA Otolaryngol Head Neck Surg. 2026 May 28. doi: 10.1001/jamaoto.2026.1050. Online ahead of print.

ABSTRACT

IMPORTANCE: Age-related hearing loss is a major modifiable risk factor for dementia, yet the neural mechanisms linking auditory dysfunction to brain aging and cognitive decline remain unclear. In particular, it is unknown whether peripheral hearing loss, central auditory processing deficits, or hearing aid use best predict neurodegenerative change in older adults.

OBJECTIVE: To determine whether hearing thresholds, speech-in-noise ability, and hearing aid use are associated with longitudinal cortical atrophy and cognitive trajectories in cognitively normal older adults.

DESIGN, SETTING, AND PARTICIPANTS: This population-based, longitudinal cohort study with baseline and 3-year follow-up assessments was conducted among community-dwelling older adults in Australia. Participants were selected from the Aspirin in Reducing Events in the Elderly trial and categorized as having normal hearing, unaided hearing loss, or using hearing aids based on audiometry and self-reported hearing aid use. Structural magnetic resonance imaging, auditory, and cognitive data were collected between 2012 and 2017. Data were analyzed from August to October 2025.

EXPOSURES: Peripheral hearing loss assessed using better-ear 4-frequency average thresholds, central auditory processing assessed using binaural speech-in-noise performance, and hearing aid use and duration of use.

MAIN OUTCOMES AND MEASURES: Longitudinal change in cortical thickness and regional brain volumes derived from T1-weighted magnetic resonance imaging, focusing on auditory and Alzheimer disease-vulnerable regions. Global cognition was assessed using the Modified Mini-Mental State Examination.

RESULTS: A total of 312 adults (mean [SD] age, 73.5 [3.3] years; 167 [54%] female) without dementia at baseline were included. At baseline, hearing loss groups showed poorer audiometric and speech-in-noise performance but did not differ in global cognition. Over 3 years, widespread age-related cortical atrophy was observed, and poorer baseline speech-in-noise performance was associated with faster cortical thinning in inferior parietal (β = -0.002; 95% CI, -0.003 to 0.001), precuneus (β = -0.001; 95% CI, -0.002 to 0.000), middle temporal cortex (β = -0.001; 95% CI, -0.002 to -0.001), and superior temporal sulcus regions (β = -0.001; 95% CI, -0.002 to 0.000), independent of hearing thresholds and hearing aid use. There was not a statistically significant association between hearing loss/hearing aid use and longitudinal neurostructural change or cognitive decline.

CONCLUSIONS AND RELEVANCE: In this cohort study of cognitively normal older adults, central auditory processing impairment, not peripheral hearing loss or hearing aid use, was associated with accelerated cortical thinning in speech-processing networks. Speech-in-noise performance may represent an early behavioral marker of neural vulnerability preceding measurable cognitive decline.

PMID:42207546 | DOI:10.1001/jamaoto.2026.1050

JAMA Netw Open. 2026 May 1;9(5):e2615020. doi: 10.1001/jamanetworkopen.2026.15020.

ABSTRACT

IMPORTANCE: The after visit summary (AVS) is believed to be a critical mechanism for postvisit communication, and health systems are widely adopting digital AVS systems to comply with federal regulations. However, little is known regarding the physician time cost of writing the AVS and whether patients routinely engage with the digital AVS.

OBJECTIVE: To assess patterns of patient digital AVS engagement following ambulatory care visits and the associated physician time cost.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed ambulatory care visits that occurred between June 1, 2018, and May 31, 2023, at a large, urban, academic health care system with multiple hospitals and outpatient clinics. All ambulatory visits by adults between the study period that were captured in the institutional electronic health record system were included. Data were analyzed in May 2025.

MAIN OUTCOMES AND MEASURES: The primary outcome was engagement with the digital AVS through the patient portal following an ambulatory visit. Secondary measures included patient demographic factors, visit variables (including clinic specialty [primary care, urgent care, medical specialties, surgical specialties] and visit type [video, nonvideo]), and physician-specific behaviors (including time spent writing patient instructions, using composition tools, and physically printing the AVS).

RESULTS: A total of 6 262 623 ambulatory care visits were analyzed. Most visits were made by female patients (3 890 100 [62.1%]), and 51.0% of all patients were aged 55 years or older. Digital AVS engagement increased from 20.8% in 2018 to 37.6% in 2023. Physicians spent a median (IQR) duration of 1.38 (0.52-3.28) minutes per visit writing patient instructions, despite the AVS not being viewed in 62.4% of encounters. AVS composition varied by physician specialty, with surgeons using a greater percentage of templated text (63.6% of AVS text) and medical specialists entering more text manually (50.7% of AVS text). Patient engagement varied by demographic factors, with higher engagement among married vs single patients (AME, 6.6 [95% CI, 6.1-7.1] percentage points) and retired vs employed patients (AME, 5.1 [95% CI, 4.5-5.6] percentage points). Lower engagement with the digital AVS was found among males vs females (AME, -3.1 [95% CI, -3.7 to -2.5] percentage points), non-English speakers vs English speakers (AME, -15.0 [95% CI, -15.9 to -14.2] percentage points), and those with Medicare (AME, -3.3 [95% CI, -4.2 to -2.5] percentage points) or public insurance (AME, -3.6 [95% CI, -4.4 to -2.9] percentage points) compared with private insurance. Physician behavior was also associated with digital AVS engagement, with presence vs nonpresence of physician-written patient instructions associated with higher engagement (40.5% vs 34.3%) and printed vs nonprinted AVS associated with lower engagement (31.6% vs 38.8%). Compared with primary care, medical and surgical specialties were associated with lower digital AVS engagement (medical: AME, -4.3 [95% CI, -5.3 to -3.2] percentage points; surgical: AME, -2.9 [95% CI, -4.1 to -1.7] percentage points), while urgent care showed no significant difference (AME, -0.6 [95% CI, -2.2 to +1.0] percentage points).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of ambulatory visits, digital AVS engagement increased but remained low and was associated with a high time investment for physicians. This inefficiency in postvisit communication emphasizes the need to reconsider such communication, particularly with unmarried males, non-English-speaking populations, and publicly insured populations, and in specialty care settings.

PMID:42207516 | DOI:10.1001/jamanetworkopen.2026.15020

JAMA Netw Open. 2026 May 1;9(5):e2615350. doi: 10.1001/jamanetworkopen.2026.15350.

ABSTRACT

IMPORTANCE: Individuals with acute, chronic, and life-limiting illness often rely on family caregivers to navigate health care, but caregivers’ ability to spend time providing support may be limited by socioeconomic constraints, such as inflexible work hours.

OBJECTIVE: To develop and validate the Family Caregiver Constraint Index (FCCI), a summary measure of area-based factors that can affect synchronous caregiver engagement with health care systems.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used 2017 to 2021 American Community Survey 5-year estimate data for 32 789 populated US 5-digit zip code tabulation areas (neighborhoods) and selected candidate indicators relevant to caregiving-related domains. Initial variable selection was guided by engagement with community members with chronic disease and/or family caregiver experience. Analyses were conducted between June 2023 and July 2025.

MAIN OUTCOMES AND MEASURES: Principal components analysis identified and quantified distinct subindices and correlations among indicators, which were used to construct scores for subindices and create a standardized summary FCCI score. The association between the FCCI and hospital-based health care outcomes from the Dartmouth Atlas of Health Care was examined using crude and adjusted linear regression models that accounted for year and state in which the HSA is located.

RESULTS: The American Community Survey sample from which the FCCI is developed draws from the US population of 329 725 481 persons, of whom 166 518 866 (50.5%) are female and 52 888 621 (16.0%) are aged 65 years or older. The 13-item FCCI mapped to 4 subindices: competing demands (work and childcare responsibilities, 2 items), long-distance work commute (2 items), income constraint (5 items), and recent immigration (4 items). Higher FCCI scores were associated with greater inpatient days (increase of 0.80 day; 95% CI, 0.71-0.89 day; P < .001) and intensive care unit and/or coronary care unit days (increase of 0.48 day; 95% CI, 0.40-0.56 day; P < .001) during the last 6 months of life, higher percentage of in-hospital deaths (increase of 1.06%; 95% CI, 0.79%-1.34%; P < .001) and percentage of deaths that included an intensive care unit and/or coronary care unit admission (increase of 1.27%; 95% CI, 0.99%-1.54%; P < .001).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of barriers to family caregiver engagement, the FCCI ranked neighborhoods based on area-level factors that adversely impact the time available for family caregivers to be synchronously present for their care recipient’s health care visits. Future research should examine the relationships among FCCI scores, caregiver engagement, hospital care, caregiver well-being, and patient health outcomes.

PMID:42207514 | DOI:10.1001/jamanetworkopen.2026.15350

JAMA Netw Open. 2026 May 1;9(5):e2615550. doi: 10.1001/jamanetworkopen.2026.15550.

ABSTRACT

IMPORTANCE: Buprenorphine can prevent opioid overdose deaths among patients with opioid use disorder (OUD). Among privately insured patients using buprenorphine, it is unclear whether switching from a non-high-deductible health plan (HDHP) to an HDHP is associated with changes in buprenorphine dispensing or OUD-related health care visits.

OBJECTIVE: To evaluate the association between switching to an HDHP, buprenorphine dispensing, and OUD-related health care visits.

DESIGN, SETTING, AND PARTICIPANTS: Repeated cross-sectional difference-in-differences analysis of the 2010 to 2023 Optum Labs Data Warehouse, a longitudinal clinical database with deidentified claims. Analyses included privately insured adults who were continuously enrolled throughout a baseline and follow-up year and had buprenorphine dispensing in the baseline year. The treatment group included patients who switched from a non-HDHP to an HDHP. The control group included patients who remained in a non-HDHP. Data were analyzed from January 1, 2025, through February 1, 2026.

EXPOSURE: Switching to an HDHP.

MAIN OUTCOMES AND MEASURES: Annual number of days with active buprenorphine prescriptions; annual number of OUD-related outpatient visits; annual number of OUD-related emergency department visits or hospitalizations. Linear models with patient fixed effects compared changes in outcomes among the treatment and control groups. In a subgroup analysis, the treatment group was limited to patients experiencing a deductible increase exceeding the median of $1250.

RESULTS: Among 14 801 included patients (9419 [63.6%] male), switching to an HDHP was associated with a differential decrease in the number of days with active buprenorphine prescriptions (-29.0; 95% CI, -35.0 to -22.9) but not with changes in OUD-related outpatient visits (-0.5; 95% CI, -1.0 to 0.05) or OUD-related emergency department visits and hospitalizations (4.0 events per 100 patients; 95% CI, -0.5 to 8.4 events per 100 patients). In the subgroup analysis, switching to an HDHP was associated with a differential decrease in the number of OUD-related outpatient visits (-1.0; 95% CI, -1.8 to -0.3). Results for other outcomes were similar to the overall analysis.

CONCLUSIONS AND RELEVANCE: In this repeated cross-sectional study using difference-in-differences analysis of privately insured patients using buprenorphine, those who switched to an HDHP were more likely to decrease buprenorphine use. When deductible increases were large, patients who switched to an HDHP were also more likely to decrease the number of OUD-related outpatient visits. Findings suggest that switching to an HDHP may be associated with heightened barriers to OUD treatment.

PMID:42207512 | DOI:10.1001/jamanetworkopen.2026.15550

JAMA. 2026 May 28. doi: 10.1001/jama.2026.6214. Online ahead of print.

ABSTRACT

IMPORTANCE: Adverse drug effects from blood pressure (BP)-lowering drugs contribute to significant undertreatment and poor overall BP control rates.

OBJECTIVE: To review adverse effects and discontinuation of BP-lowering drugs and their combinations from the 5 major classes in short-term clinical trials.

DATA SOURCES AND STUDY SELECTION: Cochrane Central Register of Controlled Trials for randomized clinical trials, MEDLINE, and Epistemonikos were searched from the date of inception until December 31, 2024, for double-blind randomized clinical trials of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers (ARBs), β-blockers, calcium channel blockers (CCBs), thiazide and thiazide-like diuretics, or their combinations, with follow-up durations between 4 and 26 weeks.

DATA EXTRACTION AND SYNTHESIS: Data extraction was performed by 2 independent reviewers. Synthesis was performed using fixed-effect network meta-analyses according to drug class, summarized using odds ratios (ORs) and 95% credible intervals (CrIs) and surface under the cumulative ranking curves. Final statistical analysis was conducted in April 2026.

MAIN OUTCOMES AND MEASURES: Treatment discontinuation due to adverse events (AEs), defined as discontinuation of randomized treatment due to an AE. Secondary outcomes included headache, dizziness, edema, and cough.

RESULTS: A total of 716 trials were included, with mean (SD) follow-up of 8.6 (5) weeks, including 159 362 participants (mean [SD] age, 54.6 [7] years; 44% female; mean baseline BP, 158/100 mm Hg). Compared with placebo, treatment discontinuation due to AEs was significantly increased by CCBs (OR, 1.43 [95% CrI, 1.23-1.67]; risk difference [RD], 1.2% [95% CrI, 0.6%-2.0%]), angiotensin-converting enzyme inhibitors plus CCBs (OR, 1.46 [95% CrI, 1.13-1.87]; RD, 1.1% [95% CrI, 0.2%-2.4%]), and β-blockers plus thiazide diuretics (OR, 1.58 [95% CrI, 1.04-2.47]; RD, 1.7% [95% CrI, 0.1%-4.3%]). All ARB-containing regimens had fewer treatment discontinuations due to AEs than placebo, and these differences were statistically significant for ARB monotherapy (OR, 0.73 [95% CrI, 0.61-0.86]; RD, -0.8% [95% CrI, -1.3% to -0.4%]) and ARBs plus CCBs (OR, 0.61 [95% CrI, 0.47-0.79]; RD, -1.2% [95% CrI, -1.8% to -0.6%]). In network meta-analyses, 5 combination and 2 monotherapy regimens had higher surface under the cumulative ranking curve values than placebo for treatment discontinuation due to AEs, suggesting overall symptomatic improvement compared with placebo. All regimens significantly increased dizziness, and all but CCBs significantly decreased headache compared with placebo.

CONCLUSIONS AND RELEVANCE: This meta-analysis of short-term randomized clinical trials found that adverse drug effects that led to discontinuation of BP-lowering therapy varied by drug class and regimen, with several combination therapies being better tolerated than monotherapies. Some regimens were associated with fewer drug withdrawals than placebo, suggesting a net symptomatic improvement. These findings are based on trial-level results and rely on assumptions underlying the network meta-analysis; they may not apply to individual patients.

PMID:42207501 | DOI:10.1001/jama.2026.6214

Am J Phys Med Rehabil. 2026 May 28. doi: 10.1097/PHM.0000000000003046. Online ahead of print.

ABSTRACT

BACKGROUND: People with mobility disabilities experience significant barriers to regular physical activity, increasing risks of chronic disease and reducing quality of life. Mobile health (mHealth) programs may help by offering accessible, home-based exercise options. This study compared a 24-week mHealth intervention-with and without social networking-to an attention control condition.

METHODS: In this type 1 hybrid randomized controlled trial, 459 adults with mobility disabilities were randomized to one of three groups: M2M (exercise videos), M2Mplus (exercise videos plus social networking and optional coaching), or attention control (health articles). The 24-week intervention was delivered via a tablet-based app with follow-up through 48 weeks. The primary outcome was the Godin Leisure-Time Exercise Questionnaire (GLTEQ) health contribution score, measured at baseline, 12, 24, and 48 weeks.

RESULTS: At the 24-week primary endpoint, the M2Mplus group showed significantly greater increases in GLTEQ health contribution scores compared with attention control (LSM=4.8; 95% CI 1.7-7.8; P=.002). By 48 weeks, the difference was no longer statistically significant.

DISCUSSION: This large hybrid trial shows that scalable mHealth exercise programs can increase short-term physical activity among adults with mobility disabilities, though sustaining activity after the intervention ends remains challenging.

PMID:42207491 | DOI:10.1097/PHM.0000000000003046