Lancet Glob Health. 2027 Jul 6:104059. doi: 10.1016/j.langlo.2026.104059. Online ahead of print.
NO ABSTRACT
PMID:42624805 | DOI:10.1016/j.langlo.2026.104059
Category: Nevin Manimala
Am J Med Genet A. 2026 Aug 20. doi: 10.1002/ajmg.a.70287. Online ahead of print.
ABSTRACT
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common red blood cell enzymatic disorder worldwide. Although many heterozygotes are asymptomatic, affected neonates have an increased risk for hyperbilirubinemia and related complications. In the United States, detection of maternal G6PD heterozygous status often occurs incidentally during expanded carrier screening. We sought to characterize the diagnostic timing, clinical management, and neonatal outcomes among pregnancies complicated by maternal G6PD heterozygous status. We conducted a retrospective cohort study of pregnant individuals with a documented G6PD heterozygous diagnosis who received prenatal care at Baylor College of Medicine-affiliated hospitals between January 2013 and December 2025. Patients were identified through electronic health record queries and confirmed by manual chart review. Maternal demographics, diagnostic pathway, testing modality, medication exposures, and neonatal outcomes were abstracted. Descriptive statistics were used to summarize cohort characteristics. Thirty-six individuals with confirmed G6PD heterozygous status were included. Median maternal age was 31 years (IQR 27.5-38). Most patients identified as Black (66.7%) and non-Hispanic (88.9%), while four (11.1%) identified as Hispanic. Diagnosis occurred prior to the first pregnancy in 11.1% of patients, during pregnancy in 47.2%, and after pregnancy in 41.7%. Molecular testing alone was the most common diagnostic modality (55.6%), followed by enzymatic testing (27.7%) and combined testing (16.7%). Among molecularly characterized G6PD heterozygotes, the most frequent variant was c.202G>A (42.3%), followed by c.563C>T (19.2%). Genetic counseling related to G6PD status was documented for 75.0% of patients. Across 76 pregnancies, 82 neonates were delivered, including 71 singletons, four twin pregnancies, and one triplet pregnancy. Bilirubin measurements were available for 47 neonates, of which elevated bilirubin was documented in 16 (34.0%). Hyperbilirubinemia requiring phototherapy occurred in 12 neonates (25.5%). Infant G6PD enzyme testing was performed in 8 cases, of which 5 showed low enzyme levels. Neonatal hyperbilirubinemia occurred most frequently among pregnancies in which the mother carried the c.202G>A variant in G6PD. Maternal G6PD heterozygous status is often identified incidentally during pregnancy, yet subsequent newborn evaluation remains inconsistent. Although more than one-third of neonates born to heterozygote mothers developed hyperbilirubinemia, infant G6PD testing was infrequently performed. These findings highlight the variability in clinical management for individuals deficient in G6PD and demonstrate that identifying maternal heterozygotes provides an opportunity to improve targeted newborn screening as well as neonatal follow-up procedures.
PMID:42624797 | DOI:10.1002/ajmg.a.70287
ANZ J Surg. 2026 Aug 20. doi: 10.1111/ans.70896. Online ahead of print.
ABSTRACT
BACKGROUND: Pelvic exenteration is an extensive procedure for advanced or recurrent pelvic malignancies, associated with high morbidity and mortality. Malnutrition is common in this cohort and may affect postoperative outcomes, but the current evidence remains inconsistent.
MATERIALS AND METHODS: A systematic review was performed following PRISMA guidelines. Pooled analyses were used to assess the relationship between preoperative nutritional status (serum albumin, BMI, and Subjective Global Assessment (SGA)) and postoperative outcomes, with results shown as odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS: Nine retrospective cohorts comprising 1057 patients were included. The median age across studies was 56 years. Primary tumour types included colorectal, gynaecological, bladder, and soft tissue sarcoma. All studies reported complications, most of which were classified using the Clavien-Dindo system. Low BMI was linked to increased postoperative morbidity (OR 1.12, 95% CI 1.02-1.23, *p = 0.02). Hypoalbuminemia (< 35 g/L) (OR 1.38, 95% CI 0.62-3.08, p = 0.44) and SGA-defined malnutrition (OR 1.24, 95% CI 0.24-6.48, p = 0.09) showed non-significant but consistent trends towards higher complications in malnourished patients. Secondary outcomes were statistically significant, with malnourished patients experiencing longer hospital stays (SMD 0.44, 95% CI 0.26-0.62, *p < 0.00001) and more reoperations (OR 1.82, 95% CI 1.08-3.09, *p = 0.03).
CONCLUSION: Pre-operative malnutrition is linked to increased morbidity after pelvic exenteration. Low BMI was associated with increased postoperative morbidity following pelvic exenteration, while hypoalbuminaemia and SGA-defined malnutrition demonstrated consistent but non-significant associations. These findings support routine nutritional screening and preoperative optimisation in this high-risk patient group.
PMID:42624795 | DOI:10.1111/ans.70896
Neurorehabil Neural Repair. 2026 Aug 20:15459683261464105. doi: 10.1177/15459683261464105. Online ahead of print.
ABSTRACT
INTRODUCTION: Millions of stroke survivors in the US have sensory-motor impairments that significantly impact quality of life and place a long-term burden on families, communities, and the healthcare system. Neurorehabilitation aims to improve function, typically through repetitive practice of movements and task-related activities where doses are regularly titrated by skilled clinicians. Unfortunately, these highly intensive, skilled interventions are challenging to implement at the scale needed to serve the needs of stroke survivors. Rehabilitation technologies have long promised to be the workforce multiplier to normalize this large supply-demand mismatch in the U.S. healthcare system. Extensive investigations into rehabilitation devices have revealed myriad benefits. While rehab technologies have the potential to improve function, these inferences are largely derived from academic clinical studies which, while useful for exploring efficacy, do not represent marketplace (ie, commercial) conditions where interventions must operate to serve the larger population.
METHODS: Here, we present data from the first nationwide direct-to-consumer deployment of 2 home-based rehabilitation robotic systems.
RESULTS: Analysis of 3182 device deployments from August 2019 to June 2024 reveal surprising patterns in usage and compliance. We investigate the effects of socio-economic status, sex, rural-urban classification, and engagement on long-term utilization. Finally, we provide preliminary dose-response insights.
DISCUSSION AND CONCLUSIONS: We discuss the influence of market forces on commercial delivery of care to inform stakeholders of the challenges faced translating interventions to the consumer. Overall, we aim to derive lessons that can guide future implementations and improve the inclusivity and effectiveness of rehabilitation technologies deployed at scale.
PMID:42624792 | DOI:10.1177/15459683261464105
Thorax. 2026 Aug 20:thorax-2026-224765. doi: 10.1136/thorax-2026-224765. Online ahead of print.
ABSTRACT
BACKGROUND: Inequalities in chronic respiratory diseases persist, yet up-to-date evidence on outcomes remains limited. We described national mortality and exacerbation rates in people with asthma and chronic obstructive pulmonary disease (COPD) since the beginning of the COVID-19 pandemic and assessed variation by inequalities.
METHODS: England primary care records from the General Practice Extraction Service data for Pandemic Planning and Research were linked to Hospital Episode Statistics and Office for National Statistics mortality data. Cohorts of primary care diagnosed asthma and COPD were defined prior to 1 November 2019. Monthly age-sex-standardised exacerbation rates (Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) and Internationl Classification of Diseases (ICD) 10 codes) and mortality rates (ICD-10 codes) were calculated from 1 November 2019 to 31 March 2025, stratified by sex, Index of Multiple Deprivation (IMD), ethnicity and region.
RESULTS: The study included 7644 510 people with asthma and 1 211 975 with COPD. Mean monthly exacerbation rates were higher in females than males (33% and 30% higher for asthma and COPD, respectively), while mean monthly all-cause mortality rates were 13% and 15% higher in males than females. Mean monthly exacerbation and all-cause mortality rates were higher in IMD-1 compared with IMD-10 across all conditions (asthma: 123% and 100% higher, COPD: 68% and 41% higher, respectively). Mean monthly all-cause mortality and exacerbation rates were higher in the northeast than the southwest (asthma: 22% and 69% COPD: 15% and 42% higher, respectively). Outcome rates varied by ethnicity across conditions.
CONCLUSIONS: Inequalities in chronic respiratory disease outcomes persist across England despite sustained policy focus on reducing health inequalities.
PMID:42624774 | DOI:10.1136/thorax-2026-224765
Dent Mater. 2026 Aug 20:S0109-5641(26)00405-7. doi: 10.1016/j.dental.2026.08.008. Online ahead of print.
ABSTRACT
OBJECTIVES: To evaluate survival and success of ceramic crowns fabricated either of a lithium-disilicate-based glass ceramic or of a high translucent multilayer zirconia.
METHODS: Patients who received a computer-aided design/computer-aided manufacturing (CAD/CAM)-fabricated lithium-disilicate-based glass ceramic (CEREC Tessera, Dentsply Sirona) or high translucent multilayer zirconia (Katana Zirconia STML, Kuraray Noritace Inc.) crown were examined after a minimum observation time of 24 months. Two calibrated examiners assessed clinical performance of crowns using World Dental Federation (FDI) criteria. Survival and success rates were calculated using Kaplan-Meier method and statistically compared by log-rank test and Cox regression analysis. FDI criteria were compared by Mann-Whitney U tests (α=.05).
RESULTS: One-hundred restorations (n = 50 lithium-disilicate-based glass ceramic, n = 50 multilayer zirconia) placed in 63 participants were included. Multilayer zirconia crowns presented significantly (p < 0.01) higher survival (2-year-survival: 100%, mAFR: 0.0%) and success rates (2-year-success: 100%, mAFR: 0.0%) compared to restorations made from lithium-disilicate-based glass ceramic (2-year-survival: 82.0%, mAFR: 9.4%; 2-year-success: 82.0%, mAFR: 9.4%). Thirteen crowns made from lithium-disilicate-based glass ceramic (bulk fractures: n = 10, endodontic complication: n = 3) and 2 multilayer zirconia crowns failed (endodontic complication: n = 1, loose after loss of retention: n = 1). FDI criteria were not significantly different between both groups.
SIGNIFICANCE: Material selection is a critical determinant of the clinical performance of ceramic crowns. Short-time survival of lithium-disilicate-based glass ceramic was significantly lower compared with a high translucent multilayer zirconia.
PMID:42624766 | DOI:10.1016/j.dental.2026.08.008
Int J Oral Maxillofac Surg. 2026 Aug 20:S0901-5027(26)00343-7. doi: 10.1016/j.ijom.2026.08.003. Online ahead of print.
ABSTRACT
Advancements in medical image acquisition facilitate patient-specific virtual surgical planning and surgical navigation in maxillofacial interventions such as Le Fort I osteotomy. Augmented reality (AR) allows superimposition of patient data onto the surgical field for guidance. The aim of this study was to develop and assess an AR navigation system leveraging traditional navigation methods. The accuracy of a three-dimensionally (3D)-printed guide was compared with an AR system in a phantom study. Preplanned osteotomy lines were cut, and screw holes were drilled, simulating a Le Fort I osteotomy, and its accuracy was assessed by comparing pre- and postoperative computed tomography. Seven maxillofacial surgeons participated, each tasked with drilling 12 screws and performing two osteotomy cuts using either AR or the guide. There was no statistically significant difference in cutting accuracy between AR and the guide, with median errors of 0.71 and 0.72 mm, respectively. However, AR drilling accuracy (1.48 mm) was significantly worse than that of the guide (0.73 mm) and yielding a 75% success rate of AR-drilled holes suitable for patient-specific implant fixation. AR-based navigation using head-mounted displays does not yet achieve the clinical requirement for drilling, contrary to cutting, yet it appears to be a promising alternative to 3D-printed guides for Le Fort I osteotomy.
PMID:42624761 | DOI:10.1016/j.ijom.2026.08.003
J Sci Med Sport. 2026 Aug 10:S1440-2440(26)00521-9. doi: 10.1016/j.jsams.2026.08.200. Online ahead of print.
ABSTRACT
OBJECTIVES: Tackle technique is well researched in male rugby players, but not in female players. This study investigated the relationship between different tackle characteristics for the tackler and ball carrier and head acceleration event magnitude in adolescent female rugby players.
DESIGN: A prospective cohort study that followed forty-one, 12-17-year-old female rugby players over 2 seasons.
METHODS: Instrumented mouthguards and video analysis were used to quantify head acceleration events, by recording the peak linear and peak rotational acceleration that were associated with tackle events in both games and trainings.
RESULTS: We found twice as many head acceleration events ≥8 g for the tackler (n = 1233) than the ball carrier (n = 694). Tackling the ball carrier at the shoulder/chest resulted in the highest peak rotational acceleration (1973.6 ± 85.6 rads rad/s2, mean ± SE) for the tackler, which was higher than tackling the ball carrier at the torso/hip (1609.7 ± 69.8, p = 0.0002). A face up tackle recorded a higher peak rotational acceleration for the tackler than a face down tackle (1958.8 ± 83.3, 1601.6 ± 64.2 rads rad/s2, p < 0.0002, Cohen’s d = 0.24). For both the ball carrier and the tackler, an uncontrolled fall resulted in higher peak linear acceleration compared to a controlled fall (3.8 ± 2.7 g, p < 0.005, d = 0.29 and 4.2 ± 3.0 g, p < 0.006, d = 0.30 respectively).
CONCLUSIONS: Modifying tackle behaviours in female rugby may reduce head acceleration event magnitude associated with tackles and improve player safety.
PMID:42624747 | DOI:10.1016/j.jsams.2026.08.200
Acad Radiol. 2026 Aug 20:S1076-6332(26)00598-2. doi: 10.1016/j.acra.2026.08.010. Online ahead of print.
NO ABSTRACT
PMID:42624736 | DOI:10.1016/j.acra.2026.08.010
Nutr Metab Cardiovasc Dis. 2026 Aug 5:104955. doi: 10.1016/j.numecd.2026.104955. Online ahead of print.
ABSTRACT
BACKGROUND AND AIM: Cardiovascular-kidney-metabolic (CKM) syndrome confers elevated mortality risk, but whether dietary ketogenic ratio (KDR) is associated with mortality in this population remains unclear. We examined the association of KDR with mortality in adults with CKM syndrome and whether it persisted after accounting for broader diet-quality metrics.
METHODS AND RESULTS: We analysed adults with CKM stages 1-4 from NHANES 2003-2018 with mortality follow-up through 2019. Participants required a reliable Day 1 24-h dietary recall, non-missing KDR, and classifiable CKM stage. The primary cohort included 31,761 adults; 28,221 also contributed to a 2-day sensitivity analysis. Survey-weighted Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), with KDR analysed per 1-SD increase and by quartiles. During follow-up, 4481 all-cause deaths and 1199 heart disease deaths occurred. In the fully adjusted model, each 1-SD higher KDR was associated with lower all-cause mortality (HR 0.94, 95% CI 0.90-0.98), and the highest quartile had lower risk than the lowest quartile (HR 0.86, 95% CI 0.78-0.96). The association attenuated after adjustment for source-oriented low-carbohydrate diet (LCD) scores, changed little after Healthy Eating Index-2015 (HEI-2015) adjustment alone, and showed a similar pattern in the 2-day dietary cohort. Associations with heart disease mortality were not statistically robust.
CONCLUSION: Higher KDR was associated with lower all-cause mortality in CKM syndrome, but this association was partly attenuated by broader diet-quality metrics. KDR may be better interpreted as a complementary dietary metric rather than an independent dietary target.
PMID:42624724 | DOI:10.1016/j.numecd.2026.104955