Category: Nevin Manimala

JAMA Netw Open. 2026 Jul 1;9(7):e2622211. doi: 10.1001/jamanetworkopen.2026.22211.

ABSTRACT

IMPORTANCE: Pertussis, or whooping cough, can be life threatening in infants, yet the concept of severe pertussis remains poorly defined in the literature. Lack of standardization may impair research and public health interventions.

OBJECTIVE: To assess the variability in terminology and criteria used to define severe pertussis in the published literature.

EVIDENCE REVIEW: A systematic review of the literature drawn from PubMed and Web of Science databases was performed. Studies involving infants with pertussis that provided a definition for severe pertussis and published from database inception to April 2025 were included without language restrictions. Study characteristics and detailed definitions of severe pertussis were extracted. Variations in terminology and criteria used across definitions were described.

FINDINGS: Of the 914 unique studies identified, 133 underwent full-text review, and 78 were included in the study, encompassing 49 observational studies, 22 case reports, 3 case-control studies, and 4 reviews; no randomized clinical trials were included. Five different terms used to define severe pertussis were identified: severe (44 of 78 studies [56%]), malignant (12 of 78 studies [15%]), critical (9 of 78 studies [12%]), fatal (9 of 78 studies [12%]), and fulminant (4 of 78 studies [5%]). Across studies, 22 different criteria were used to define clinical severity, which were classified into 3 categories (ie, clinical, biological, and outcome). The most commonly reported criteria included respiratory failure (40 of 78 studies [51%]), pulmonary hypertension (30 of 78 studies [38%]), leukocytosis (28 of 78 studies [36%]), death (29 of 78 studies [37%]), and intensive care unit admission (29 of 78 studies [37%]).

CONCLUSIONS AND RELEVANCE: This systematic review revealed substantial heterogeneity in the definition of severe pertussis in the literature. A consensus-based definition of severe pertussis is urgently needed to improve the understanding of its pathophysiology and to enhance clinical management, clinical research, and public health decision-making.

PMID:42496978 | DOI:10.1001/jamanetworkopen.2026.22211

JAMA Netw Open. 2026 Jul 1;9(7):e2624984. doi: 10.1001/jamanetworkopen.2026.24984.

ABSTRACT

IMPORTANCE: Exclusive breastfeeding (EBF) during the postpartum hospital stay is associated with longer breastfeeding duration. Electronic health record (EHR) data can be used to uncover patterns in missed and inequitable breastfeeding care that may be associated with persistent breastfeeding disparities.

OBJECTIVES: To assess the association of documented postpartum in-hospital breastfeeding care with EBF and test differences in documented care by feeding intention and demographic and clinical characteristics.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of EHR data from a single academic hospital network in Minnesota included 22 857 patients who intended to provide breastmilk and delivered singleton infants born at 37 weeks’ or more gestation between January 1, 2018, and December 31, 2022. Data preparation was completed between September 2023 and May 2024; analyses were completed between June and December 2025.

EXPOSURES: Ratio of the number of documented lactation support events per 8-hour nursing shift to the number recommended during the postpartum stay (breastfeeding support ratio [BSR]). Current guidelines recommend a BSR of 1.00 or more.

MAIN OUTCOMES AND MEASURES: Multivariable logistic regression with restricted cubic splines was used to estimate the probability of EBF during the hospital stay and to estimate the relative risk (RR) of a BSR less than 1.00.

RESULTS: The sample included 22 857 dyads (mean [SD] maternal age, 31.0 [5.1] years; mean [SD] gestational age, 39.4 [1.1] weeks), with feeding intentions of 91.1% EBF (n = 20 826) and 8.9% breastmilk and formula (n = 2031). There was a nonlinear positive association between BSR and the probability of EBF, with a probability of 0.49 (95% CI, 0.44-0.54) for a BSR of 0.00, a probability of 0.78 (95% CI, 0.76-0.80) for a BSR of 1.00, and a probability of 0.91 (95% CI, 0.90-0.92), with a plateau in the association above a BSR of 2.00. The positive association of BSR with EBF was weaker, with a higher RR of a BSR less than 1.00, among American Indian or Alaska Native patients (adjusted RR, 1.94; 95% CI, 1.26-2.62); Asian, Native Hawaiian, and Other Pacific Islander patients (adjusted RR, 2.35; 95% CI, 2.08-2.62); and Black or African American patients (adjusted RR, 1.83; 95% CI, 1.60-2.07) than among White patients. There were further disparities in documented breastfeeding support identified, with higher risk of a BSR less than 1.00, by breastfeeding intention (both breastmilk and formula: adjusted RR, 4.65; 95% CI, 4.25-5.05), need for an interpreter (adjusted RR, 1.52; 95% CI, 1.32-1.72), age younger than 25 years (adjusted RR, 1.33; 95% CI, 1.14-1.51), marital status (single: adjusted RR, 1.34; 95% CI, 1.21-1.48), health insurance type (public health insurance: adjusted RR, 1.25; 95% CI, 1.06-1.45), body mass index of 30 or more (adjusted RR, 1.40; 95% CI, 1.25-1.56), current tobacco smoking (adjusted RR, 2.09; 1.72-2.47), cesarean delivery (adjusted RR, 1.16; 95% CI, 1.04-1.28), gestational age of 37 to 38 weeks (adjusted RR, 1.26; 95% CI, 1.14-1.38), and low-birth-weight status (<2500 g; adjusted RR, 1.87; 95% CI, 1.42-2.32).

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that, in a large EHR-based postpartum patient sample, the frequency of documented breastfeeding support was positively associated with EBF during the hospital stay, an early predictor of breastfeeding duration. However, there were numerous disparities in the level of support documented. More frequent in-hospital breastfeeding support, above currently recommended levels, could help reduce gaps in breastfeeding outcomes.

PMID:42496977 | DOI:10.1001/jamanetworkopen.2026.24984

JAMA Netw Open. 2026 Jul 1;9(7):e2625015. doi: 10.1001/jamanetworkopen.2026.25015.

ABSTRACT

IMPORTANCE: There is limited research examining the association between wildfire smoke, an increasingly frequent exposure, and headache-related emergency department (ED) visits, despite headaches being a leading cause of years lived with disability globally.

OBJECTIVE: To examine the association between wildfire-sourced fine particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) and ED visit for migraine and other primary headache syndromes (MOPHS) compared with nonwildfire-sourced PM2.5, and to assess the variation across sociodemographic factors.

DESIGN, SETTING, AND PARTICIPANTS: This case-crossover study used conditional logistic regression to examine ED visits during wildfire seasons (May 1 to October 31) from 2010 to 2023 in Alberta and Ontario provinces in Canada. Case days were matched to referent days by day of week, month, year, and forward sortation area (first 3 postal code characters). Seven-day cumulative lags were evaluated. All ED visits recorded in the National Ambulatory Care Reporting System with a primary diagnosis of MOPHS were included. Statistical analyses were conducted from April to December 2025.

EXPOSURE: Total PM2.5 concentrations and wildfire day (WFD). Daily mean wildfire-sourced PM2.5 was estimated using the Canadian Optimized Statistical Smoke Exposure Model. WFDs were defined by smoke plume presence and total PM2.5 concentration exceeding a predefined threshold based on the mean plus 1.5 SD of PM2.5 on days without a smoke plume. Wildfire-sourced PM2.5 was defined as the difference between total PM2.5 concentration on a WFD and expected background PM2.5 concentration on non-WFDs.

MAIN OUTCOMES AND MEASURES: ED visits for migraine (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada code G43) and other primary headache syndromes (code G44).

RESULTS: Among the 997 701 ED visits for 622 753 patients (mean [SD] age, 24.6 [16.8] years; 760 795 females [76.3%]) for MOPHS identified during the study period, 86.2% of visits were for migraines and 13.8% were for other primary headache syndromes. Wildfire-sourced PM2.5 was associated with a 6.07% (95% CI, 5.75%-6.39%) increase in ED visits. Associations appeared attenuated in the least materially and socially deprived quantile (for both provinces combined, the percentage increase in MOPHS was smallest for the Material and Social Deprivation Index quintile 1: 3.61% [95% CI, 1.93%-5.63%] and largest for quintile 5: 10.42% [95% CI, 7.41%-13.49%]). In contrast, total PM2.5 concentration on non-WFDs was not significantly associated with ED visits (0.21%; 95% CI, -0.20% to 0.62%).

CONCLUSIONS AND RELEVANCE: In this case-crossover study of ED visits in Alberta and Ontario, acute exposure to wildfire-sourced PM2.5 was associated with increased ED visit for MOPHS; associations were greater in magnitude for wildfire-sourced PM2.5 than nonwildfire-sourced PM2.5. These findings support the need for further research into wildfire smoke and severe headache-related outcomes.

PMID:42496976 | DOI:10.1001/jamanetworkopen.2026.25015

JAMA Netw Open. 2026 Jul 1;9(7):e2625069. doi: 10.1001/jamanetworkopen.2026.25069.

ABSTRACT

IMPORTANCE: The current rate of automated external defibrillator (AED) pad application before emergency medical service (EMS) arrival in pediatric out-of-hospital cardiac arrest (OHCA) in Japan has not been sufficiently investigated.

OBJECTIVE: To describe the current rate of AED pad application and evaluate factors associated with AED pad application as well as factors associated with survival in pediatric patients with OHCA.

DESIGN, SETTING, AND PARTICIPANTS: This was a nationwide, prospective, population-based cohort study using data from the All-Japan Utstein Registry between 2021 and 2023. Pediatric patients with OHCA aged 0 to 17 years in whom resuscitation was attempted before EMS arrival were included. Data analyses were conducted from January to May 2026.

EXPOSURE: OHCA stratified by age (infants [<1 year], younger children [1-4 years], older children [5-12 years], and adolescents [13-17 years]).

MAIN OUTCOMES AND MEASURES: The outcome measures were the application of AED pads before EMS arrival as well as 1-month survival with a favorable neurological outcome, defined as a cerebral performance category scale of 1 or 2. Multivariable logistic regression analyses were performed to estimate adjusted odds ratios (aORs) and 95% CIs for factors associated with each outcome.

RESULTS: A total of 3352 pediatric patients with OHCA were analyzed. The median (IQR) age was 3 (1-4) years, 1983 patients (59.2%) were male, and 185 patients (5.5%) received AED pad application before EMS arrival. Arrests among infants (aOR, 0.28; 95% CI, 0.13-0.47) and younger children (aOR, 0.22; 95% CI, 0.10-0.49) vs adolescents, arrests occurring at home vs another public area (aOR, 0.06; 95% CI, 0.03-0.11), and arrests occurring at nighttime vs daytime (aOR, 0.52; 95% CI, 0.33-0.82) were significantly associated with a reduced probability of AED pad application before EMS arrival. In contrast, arrests occurring at school vs another public area (aOR, 6.74; 95% CI, 3.73-12.21) and receipt of bystander CPR (aOR, 28.69; 95% CI, 12.91-63.75) were associated with an increased probability of AED pad application before EMS arrival. Favorable neurological outcome was significantly higher in the AED pad application group than in the non-AED pad application group (aOR, 3.11; 95% CI, 1.30-7.44). Ventricular fibrillation as first documented rhythm had a large magnitude of association with increased favorable neurological outcome (aOR, 27.49; 95% CI, 13.95-54.19).

CONCLUSIONS AND RELEVANCE: In this cohort study from Japan, approximately 5% of pediatric patients with OHCA received AED pad application before EMS arrival, and AED pad application was associated with higher odds of 1-month survival with a favorable neurological outcome. Further efforts are needed to increase AED access and use in public places where children gather, including schools.

PMID:42496975 | DOI:10.1001/jamanetworkopen.2026.25069

JAMA Netw Open. 2026 Jul 1;9(7):e2625117. doi: 10.1001/jamanetworkopen.2026.25117.

ABSTRACT

IMPORTANCE: Respiratory syncytial virus (RSV) infection is the leading cause of infant hospitalizations in the US. Two immunization options are available to protect infants against hospitalization-maternal vaccination during pregnancy or RSV antibody shot administration for infants after birth. Gaps in immunization coverage suggest missed opportunities to protect infants against RSV-associated hospitalization.

OBJECTIVE: To describe RSV immunization intentions, behaviors, and preferences among pregnant women and parents of young children (ages 0-5 years).

DESIGN, SETTING, AND PARTICIPANTS: For this survey study, 2 concurrent national cross-sectional surveys were implemented in April 2024. Participants were recruited from a representative online survey panel of US adults. Participants were 18 years or older and either pregnant or the parent of a young child. Data were analyzed from May to November 2025.

MAIN OUTCOMES AND MEASURES: The outcomes of interest were prevalence of positive intention to receive RSV antibody shot for child among pregnant women and parents and prevalence of positive intention to receive RSV maternal vaccine among pregnant women.

RESULTS: Of 1765 parents and 174 pregnant women, most were aged 30 years or older (parent: 78.1% [95% CI, 76.2%-80.0%]; pregnant women: 64.0% [95% CI, 56.8%-71.1%]). Among pregnant women eligible for vaccination, 55.5% (95% CI, 47.7%-63.3%) reported a positive intention toward maternal RSV vaccination. Among pregnant women with negative or unsure intention, 35.8% (95% CI, 24.3%-47.3%) would probably or definitely accept RSV vaccination following a strong health care practitioner recommendation. Among parents, 59.8% (95% CI, 57.5%-62.1%) reported a positive intention toward RSV antibody shot administration for their child. Among parents with negative or unsure intention, 27.0% (95% CI, 23.7%-30.2%) would probably or definitely accept the RSV antibody shot for their child following a strong health care practitioner recommendation. More participants preferred maternal vaccination (parents: 48.3% [95% CI, 46.0%-50.6%]; pregnant women: 58.2% (95% CI, 50.9%-65.6%]) over infant RSV antibody shot administration (parents: 9.4% (95% CI, 8.1%-10.8%]; pregnant women: 6.2% (95% CI, 2.6%-9.8%). Top reasons for negative or unsure intentions in both groups included lack of information and safety concerns.

CONCLUSIONS AND RELEVANCE: In this survey study, pregnant women and parents of young children preferred maternal RSV vaccination for protecting infants against RSV infection. For some participants with negative or unsure intentions about RSV immunization, a strong health care practitioner recommendation shifted intention toward accepting immunization. Future research efforts should design and evaluate novel communication strategies for providing information about RSV immunization options to eligible families, in addition to strengthening health care practitioner recommendation in favor of immunization.

PMID:42496974 | DOI:10.1001/jamanetworkopen.2026.25117

J Cancer Educ. 2026 Jul 24. doi: 10.1007/s13187-026-02951-9. Online ahead of print.

ABSTRACT

Children and adolescents with a history of childhood cancer may experience psychosocial, cognitive, and school-related difficulties, yet survivorship education and follow-up need to reflect heterogeneous needs rather than assume uniform impairment. This cross-sectional case-comparison study compared shared psychosocial and metacognitive outcomes in 61 participants with a history of childhood cancer and 57 age-aligned typically developing peers aged 8-17 years, and examined trauma-related symptoms and school-related burden within the cancer-history group. Shared Strengths and Difficulties Questionnaire outcomes and harmonized Metacognitions Questionnaire-derived outcomes were analyzed using Welch tests, Hedges’ g, and false-discovery-rate correction. Within the cancer-history group, correlations and theory-driven regression models examined metacognitive correlates of psychosocial, trauma-related, and school-impact outcomes. The analyses provided no evidence of statistically reliable between-group differences after correction, although the modest sample means that small group differences cannot be excluded. Within the cancer-history group, low cognitive confidence in memory was strongly associated with hyperactivity/inattention and total difficulties, and negative beliefs about worry were the clearest unique statistical correlate of trauma-related symptoms. School-related burden was common, with 60.7% endorsing at least one school-impact item, but this prevalence should be interpreted cautiously because comparable school-impact data were not collected from peers. The findings inform cancer education by identifying targets for survivorship psychoeducation, family-school-health-care communication, and school reintegration support: perceived cognitive competence, worry-related beliefs, and school participation.

PMID:42496966 | DOI:10.1007/s13187-026-02951-9

Biochem Genet. 2026 Jul 24. doi: 10.1007/s10528-026-11428-9. Online ahead of print.

ABSTRACT

Shilajit, a natural product with a documented history of use in traditional medicine for millennia, poses considerable challenges in elucidating its biological origin and pharmacological properties. In this study, a multidisciplinary approach integrating DNA metabarcoding and biochemical profiling was employed to investigate processed shilajit samples from the Pamir-Alai Mountains. Environmental DNA analysis identified 50 plant taxa across taxonomic levels ranging from order to species, indicating substantial botanical contributions to shilajit’s composition. Among the identified taxa, Apiaceae and Asteraceae were the most represented families, while Vincetoxicum rossicum, Populus alba, and Quercus suber were the dominant species detected through metabarcoding analysis. Complementary biochemical analyses demonstrated notable antioxidant capacity and the presence of diverse bioactive compounds. Furthermore, oxidative stress-related biomarkers (NO, MDA, and GSH) were evaluated in the brain tissue of healthy rats following shilajit administration. No statistically significant differences were observed between the control and shilajit treated groups, suggesting that shilajit maintains physiological oxidative balance in healthy brain tissue. These findings provide important baseline biochemical data and support future investigations of shilajit’s biological effects in validated oxidative stress and neurological disease models.

PMID:42496934 | DOI:10.1007/s10528-026-11428-9

Biochem Genet. 2026 Jul 24. doi: 10.1007/s10528-026-11434-x. Online ahead of print.

ABSTRACT

Integrating high-throughput sequencing with phylogenetic analysis now spans everything from single genes to long-read pangenomes and metagenomes, yet practitioners still face fragmented, tool-centric guidance. This review revisits algorithms, tools, and workflows for sequence and phylogenetic analysis in the NGS-based omics era, with a focus on comparative performance and scenario-driven decision-making. We first organise classical approaches to tree reconstruction – distance methods, maximum parsimony, maximum likelihood, and Bayesian inference – around core criteria of consistency, efficiency, robustness, and computational cost. We then examine multiple sequence alignment strategies, contrasting progressive, consistency-based, and structure-aware algorithms (such as MAFFT variants and T-Coffee family tools) with segment-based and incremental approaches (for example DIALIGN, anchored domains, and local updates) and alignment-free representations based on k-mers, absent words, and related statistics. For inference, we compare heuristic engines optimised for ultra-large alignments (FastTree, VeryFastTree, online tree optimisation) with full ML frameworks (IQ-TREE, RAxML-NG) and Bayesian platforms for time-scaled phylogenies and phylodynamics (MrBayes, BEAST family). We explicitly discuss trade-offs in accuracy, memory, scalability, and uncertainty support, and show how GPU-enabled implementations change the feasible design space. Beyond these core components, we address current trends that strongly influence method choice: long-read assemblies and pangenomes; data quality issues, contamination, recombination, and horizontal gene transfer; phylogenetic placement and alignment-free screening in metagenomics; and real-time pathogen surveillance using Nextstrain-style workflows. A dedicated section covers workflow management and containerisation (Snakemake, Nextflow, Docker/Singularity) together with benchmarking datasets and FAIR reporting, positioning reproducible pipelines as a first-class requirement rather than an afterthought. To make the review directly actionable, we provide a methodological checklist, a decision framework figure mapping input data to recommended strategies, and a large comparative table summarising algorithmic principles, best use cases, strengths, limitations, scalability, uncertainty support, and reproducibility notes for widely used tools. Applications in infectious disease genomics, oncology, and microbiome research illustrate how these choices translate into biological and clinical insight in practice.

PMID:42496932 | DOI:10.1007/s10528-026-11434-x

J Neurooncol. 2026 Jul 24;179(1):14. doi: 10.1007/s11060-026-05711-3.

ABSTRACT

BACKGROUND: Brain metastases (BrM) are a major cause of morbidity among patients with breast cancer (BC), particularly those with HER2+ or triple-negative disease. The relationship between neoadjuvant chemotherapy (NAC) and subsequent risk of BrM in patients with early-stage BC remains poorly defined.

METHODS: We conducted a single-centre retrospective cohort study of 457 consecutive patients who were treated with NAC for early-stage BC at Sunnybrook Odette Cancer Centre between 2008 to 2019, among whom 25 developed BrM (cohort 1). To evaluate factors associated with shorter time to BrM development, an additional 129 patients with BC who received NAC and were subsequently diagnosed with BrM were identified (cohort 2). Descriptive statistics were used to summarize patient and treatment characteristics. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and identify factors associated with the development of BrM. Univariable analyses (UVA) were performed for all covariates. Bayesian Information Criteria determined best models from subsets of covariates when performing multivariable analyses (MVA).

RESULTS: Among 586 patients, the median age at BC diagnosis was 49.0 (IQR: 42-58) years. The most common BC subtype was HER2+ (n = 225, 38.4%), followed by hormone receptor (HR)+/HER2- (n = 213, 36.3%) and triple negative BC (n = 132, 22.5%). Following NAC, 134 patients (22.9%) had a pathologic complete response (pCR) and 409 (69.8%) had residual disease. In the overall cohort, the median time from BC diagnosis to BrM development was 38.0 (IQR 19.1-70.9) months. In cohort 1, 25 patients (5.5%) developed BrM with a median follow-up of 43.1 months. Median time to BrM was shortest for patients with triple-negative BC (18.0 months), followed by those with HER2+ (32.0 months), and HR+/HER2- disease (49.1 months). In the pooled cohort (n=586), multivariable analysis identified residual nodal involvement (HR 4.46 [95% CI 2.67-7.45], p<0.0001), inflammatory BC (HR 3.11 [95% CI 1.95-4.96], p<0.0001), and HER2+ or triple-negative subtype (HR 2.87 [95% CI 1.80-4.58], p<0.0001) as independently associated with shorter time to BrM development.

CONCLUSIONS: Among patients treated with NAC for early-stage BC, residual nodal disease, inflammatory BC, and HER2+ or triple-negative subtype are associated with a higher risk of BrM development. Whether BrM screening is warranted among patients with these high-risk features warrants evaluation.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42496928 | DOI:10.1007/s11060-026-05711-3

J Egypt Public Health Assoc. 2026 Jul 24;101(1):26. doi: 10.1186/s42506-026-00224-3.

ABSTRACT

BACKGROUND: International medical students face elevated risks of depression, anxiety, post-traumatic stress disorder (PTSD; characterized by re-experiencing, avoidance, and a sense of threat per ICD-11), and complex PTSD (C-PTSD; encompassing core PTSD symptoms alongside disturbances in self-organization, including emotion dysregulation, negative self-concept, and relationship difficulties). This study aims to determine the prevalence of these conditions among students at Ain Shams University (n = 310) and to compare those from conflict-affected regions with those from non-conflict regions.

METHODS: This analytical cross-sectional survey (October 2024-January 2025) employed the Depression, Anxiety, and Stress 21 Scale (DASS-21) and the International Trauma Questionnaire (ITQ). Statistical significance was set at p < 0.05.

RESULTS: Students experienced a high symptom burden: 36.5% had extremely severe depression, 42.3% had extremely severe anxiety, and 18.4% had extremely severe stress. PTSD was identified in 18.4% of students, while C-PTSD was identified in 21.5%. Students from conflict-affected regions exhibited significantly higher rates across all outcomes compared with non-conflict peers (depression, anxiety, stress, PTSD, and C-PTSD: all p < 0.05).

CONCLUSION: International medical students, particularly from conflict-affected areas, exhibit substantial mental health problems. The prevalence of C-PTSD (21.5%) exceeded that of PTSD (18.4%), underscoring chronic trauma impact. Targeted interventions-trauma-informed counseling, peer support, and resilience training-are urgently needed. Findings provide baseline data for the development of culturally sensitive mental health programs at Ain Shams University and similar institutions.

PMID:42496924 | DOI:10.1186/s42506-026-00224-3