Category: Nevin Manimala

Front Pharmacol. 2026 Jun 15;17:1827330. doi: 10.3389/fphar.2026.1827330. eCollection 2026.

ABSTRACT

BACKGROUND: Fasting during Ramadan causes challenges for diabetes treatment, necessitating tailored counseling and adjustments for medication. Community pharmacists play a vital role in enhancing fasting safety, although their readiness has not been well investigated in southern Saudi Arabia. This study aimed to evaluate community pharmacists’ knowledge, attitudes, and practices (KAP) regarding diabetes management during Ramadan in the Aseer Region, and to identify perceived barriers and the need for additional training.

METHODS: A descriptive cross-sectional study was performed from February to May 2025 with 301 licensed community pharmacists in the Aseer Region. Participants were recruited through professional pharmacy social media platforms and pharmacy communication groups commonly used within the region. Data were collected utilizing a previously validated self-administered questionnaire. Descriptive and inferential statistics were conducted using SPSS v26, with a significance level set at p < 0.05. Inferential findings were interpreted cautiously as subgroup comparisons.

RESULTS: A total of 301 pharmacists participated. Knowledge of key safety measures during fasting was high, with 91.7% correctly identifying the blood glucose threshold (<60 mg/dL) requiring termination of fasting. Correct recognition of high-risk patients who should avoid fasting was reported for patients with recurrent hypoglycemia (88.7%) and elderly or unwell patients (87.4%). Knowledge related to medication regimen adjustment was lower, particularly in insulin dose modification, where 71.1% provided correct responses. In practice, more than 80% counseled patients on blood glucose monitoring and meal planning, while 63.8% addressed physical activity adjustments, and 68.1% counseled on medication regimen changes. The most frequently reported barriers were time constraints (85.7%), lack of updated training (84.7%), and inadequate counseling privacy (79.8%). Prior training was associated with higher knowledge and practice scores (p = 0.001). Pharmacists who attended training workshops demonstrated higher mean knowledge and practice scores than untrained pharmacists.

CONCLUSION: Community pharmacists in the Aseer Region demonstrated generally adequate knowledge and positive attitudes regarding diabetes management during Ramadan, particularly in fasting-safety counseling and patient education. However, important gaps remained in advanced medication regimen adjustment practices, especially insulin dose modification, as well as participation in structured public education activities. Continuing professional development programs focused on Ramadan-specific diabetes management and interprofessional collaboration may improve pharmacist-led diabetes care during Ramadan.

PMID:42371575 | PMC:PMC13310557 | DOI:10.3389/fphar.2026.1827330

Front Surg. 2026 Jun 15;13:1841574. doi: 10.3389/fsurg.2026.1841574. eCollection 2026.

ABSTRACT

OBJECTIVE: To discuss the clinical efficacy of the modified overlapping suture technique to treat horse-tail-like Achilles tendon tears.

METHODS: A retrospective analysis was conducted on data from 57 patients with horse-tail-like Achilles tendon tears treated with the overlapping suture technique from May 2020 to May 2024. Calculate the final Arner-Lindholm scores and compare the AOFAS scores, maximum plantar flexion angle, and dorsiflexion angle of the ankle joint before and after surgery, and record the muscle strength of the plantar flexor muscles of the ankle joint and compare it with that before the surgery.

RESULTS: On average, 57 patients completed follow-up within 2 years. One patient experienced delayed wound healing after surgery, two patients re-ruptured their Achilles tendons three weeks post-surgery due to accidental falls, and one patient had a contralateral Achilles tendon rupture 2-4 years post-surgery. In addition, there were no symptoms of peroneal nerve injury after the surgery. The excellent and good rate of the Arner-Lindholm score after surgery was 98.2%; the postoperative AOFAS scores were (92.56 ± 6.71) points, (95% CI, 90.81-94.30), which showed a significant difference compared to the preoperative score of (64.92 ± 9.08) points, (95% CI, 62.56-67.27) (p 0.00<0.01). The muscle strength of the plantar flexor group in the affected ankle joint post-surgery was (4.62 ± 1.7) grades (95% CI, 4.17-5.06), which showed no statistical significance compared to the healthy side (4.80 ± 1.3) grades (95% CI, 4.46-5.13) (p 0.527 > 0.05); however, there was a significant difference compared to the pre-surgery muscle strength of the plantar flexor group on the affected side (3.2 ± 0.7) grades (95% CI, 3.01-3.8) (p 0.00 < 0.01). In the final follow-up, the maximum plantar flexion angle of the affected ankle joint post-surgery was (37.1 ± 3.1)° (95% CI, 36.2-37.9)°, which showed no statistical significance compared to the maximum plantar flexion angle of the healthy side (38.3 ± 3.9)° (95% CI, 37.2-39.2)° (p 0.072 > 0.05); the dorsiflexion angle of the ankle joint post-surgery was (18.3 ± 2.2)° (95% CI, 17.7-18.8)°, which showed no statistical significance compared to the dorsiflexion angle of the healthy side (18.2 ± 1.4)° (95% CI, 17.8-18.5)° (p 0.773 > 0.05).

CONCLUSIONS: The modified overlapping suture technique can be used to treat patients with horse-tail-like Achilles tendon tears. After treatment, the motor function of their lower limbs can be restored. In addition, there are a few complications.

PMID:42371574 | PMC:PMC13310559 | DOI:10.3389/fsurg.2026.1841574

Nat Sci Sleep. 2026 Jun 24;18:597195. doi: 10.2147/NSS.S597195. eCollection 2026.

ABSTRACT

PURPOSE: The microbiota-gut-brain axis offers a novel framework for understanding insomnia; however, the hypothesis that specific immune pathways mediate the causal effects of gut microbial taxa on insomnia requires supporting genetic evidence. This study aimed to explore the genetic evidence supporting the causal interplay between the gut microbiota, immune phenotypes, and insomnia using large-scale genetic data.

PATIENTS AND METHODS: We employed two-sample bidirectional Mendelian Randomization (MR) using large-scale genome-wide association study (GWAS) summary statistics for gut microbiota, 731 immune cell phenotypes, and insomnia (FinnGen R12). Mediation analysis was conducted to quantify the specific indirect effects of immune cells.

RESULTS: We found suggestive genetic evidence linking 13 gut microbial taxa to insomnia risk. Notably, a directional divergence was observed within the Blautia genus at the species level, where Blautia A sp900066355 showed a robust protective association (surviving FDR correction), whereas other species within the genus increased risk at a nominal significance level (uncorrected P < 0.05). Furthermore, 17 immune phenotypes were found to be associated with insomnia. Exploratory mediation analysis suggested that monocytic myeloid-derived suppressor cells (M-MDSCs) may mediate the pathway linking the uncultured bacterium CAG-177 to insomnia, accounting for 10.7% of the total effect.

CONCLUSION: This study provides preliminary genetic evidence linking specific gut microbial taxa and immune phenotypes to insomnia risk, with Blautia A sp900066355 demonstrating robust protective effects. As a secondary hypothesis-generating observation, we propose a preliminary hypothesis that the depletion of protective M-MDSCs, rather than solely pro-inflammatory activation, may contribute to insomnia pathogenesis. Given the borderline statistical significance of this mediation finding, drawing direct therapeutic implications is currently premature.

PMID:42371562 | PMC:PMC13310490 | DOI:10.2147/NSS.S597195

Intest Fail. 2026 Feb 12;10:100361. doi: 10.1016/j.intf.2026.100361. eCollection 2026 Apr-Jun.

ABSTRACT

BACKGROUND: A new role within an intestinal failure unit was devised, which involved training a dietitian to undertake the role of an Advanced Practitioner working within the medical team. In the United Kingdom, dietitians can only undertake supplementary prescribing qualifications, and this study evaluates the safety and effectiveness of this type of prescribing practice in an intestinal failure Advanced Practitioner role.

MATERIALS AND METHODS: All adult inpatients with types 2 and 3 intestinal failure were included. An appropriate clinical management plan was agreed by the multidisciplinary team and a medical and surgical consultant reviewed the prescriptions made, including the clinical indication and rationale. Descriptive statistical analysis was used and data presented as means (+/- standard deviation) for continuous variables and percentages for categorical variables.

RESULTS: A total of 1030 prescription episodes were made by the supplementary prescriber in the 6-month study period. Of these episodes, 96.2 % (n = 991) related to parenteral or intravenous fluid prescriptions; 13.6 % (n = 135) of which related to a combination of parenteral support and intravenous fluid prescriptions and 0.2 % (n = 2) of these episodes were for resuscitation purposes. No prescription amendments were required following a weekly review by the medical or surgical consultant.

CONCLUSION: This study demonstrates that a dietetic-based Advanced Practitioner in a busy intestinal failure unit effectively and safely incorporated supplementary prescribing into their role. Supplementary prescribing was used to initiate a range of prescriptions, as part of a clinical management plan, and all were deemed to be the optimal prescription choice for the indication identified.

PMID:42371560 | PMC:PMC13310593 | DOI:10.1016/j.intf.2026.100361

Intest Fail. 2026 Feb 7;10:100355. doi: 10.1016/j.intf.2026.100355. eCollection 2026 Apr-Jun.

ABSTRACT

BACKGROUND: Parenteral nutrition (PN) is essential for patients with intestinal failure (IF) but is associated with complications such as dysbiosis, small intestinal bacterial overgrowth, catheter-related infections, and intestinal failure-associated liver disease (IFALD). Growing evidence indicates that gut microbiota alterations contribute to the pathogenesis of these complications, supporting microbiota-oriented interventions as potential adjunctive therapies.

METHODS: Data sources: A structured literature search was conducted in PubMed, Web of Science, and Scopus from inception to December 2025.Study eligibility criteria: Clinical trials, observational studies, mechanistic studies, and relevant reviews evaluating gut microbiota features or microbiome-targeted interventions in IF or PN-dependent populations were included.Participants: Pediatric and adult patients with intestinal failure or short bowel syndrome, as well as relevant animal models.Interventions: Microbiota-oriented strategies, including probiotics, prebiotics, synbiotics, antibiotics, and fecal microbiota transplantation (FMT).Statistical analysis: Due to substantial heterogeneity in study design, interventions, and outcomes, meta-analysis was not performed; findings were synthesized qualitatively.

RESULTS: PN dependence was consistently associated with reduced microbial diversity, enrichment of Proteobacteria and Lactobacillaceae, and depletion of obligate anaerobes and short-chain fatty acid-producing taxa. Microbiota-oriented interventions demonstrated biological plausibility and microbiome modulation in selected studies; however, clinical benefits were variable and generally modest. Safety concerns, limited microbial engraftment, small sample sizes, and patient heterogeneity limited generalizability.

CONCLUSION: Gut microbiota dysbiosis plays a contributory role in PN-related complications of IF. Microbiota-oriented interventions are promising but remain unproven, underscoring the need for well-designed, stratified clinical studies to define efficacy, safety, and responsive patient subgroups.

PMID:42371558 | PMC:PMC13310592 | DOI:10.1016/j.intf.2026.100355

PeerJ. 2026 Jun 25;14:e21430. doi: 10.7717/peerj.21430. eCollection 2026.

ABSTRACT

BACKGROUND: Khat use is an increasing public health concern in Somaliland, linked to various mental, physical, social, and psychological problems.

OBJECTIVE: This study examined the effect of khat consumption on work performance among small business employees in the City-Center Market, Hargeisa, Somaliland.

METHODOLOGY: A quantitative cross-sectional design was employed, with purposive sampling of 150 male respondents. Data were collected through a structured Likert-scale questionnaire measuring khat consumption patterns and work performance. Reliability was confirmed using Cronbach’s alpha, and multiple linear regression analysis was applied to assess the predictive effect of khat consumption on work performance. Demographic and occupational variables (education level, marital status, employment type, type of khat commonly chewed, and age categories) were included as controls.

RESULTS: Regression analysis showed khat consumption was significantly associated with work performance (B = 0.774, β = 0.879, t = 15.062, p < 0.001). Higher levels of khat use were associated with lower work performance, while other variables including education level (p = 0.281), marital status (p = 0.548), employment type (p = 0.902), type of khat (p = 0.700), and age (p = 0.429) showed no statistically significant effects.

CONCLUSION: The study suggests that khat consumption may negatively influence employee productivity, while demographic and occupational factors appear to have limited influence. These findings highlight the importance of workplace awareness and policy measures aimed at reducing the potential adverse impact of khat use on work performance.

PMID:42371551 | PMC:PMC13310483 | DOI:10.7717/peerj.21430

Hum Brain Mapp. 2026 Jul;47(10):e70593. doi: 10.1002/hbm.70593.

ABSTRACT

Establishing the reliability of spinal cord functional magnetic resonance imaging (fMRI) is critical before employing it to assess experimental or clinical interventions. Previous studies have mapped human motor activity primarily to the ipsilateral ventral horn, aligning with myotomal and dermatomal projections. Despite these insights, the test-retest reliability of spinal fMRI remains under-investigated. Here we assessed spinal cord activation during a sensorimotor paradigm involving right-hand grasping and grip force estimation in 30 healthy volunteers. Participants completed two identical scanning visits, each time performing the same task twice, enabling the investigation of test-retest reliability both within a single experimental visit and between visits performed on different days. Aggregating all task runs, motor-evoked activation was observed in ipsilateral ventro-dorsal regions of spinal segmental levels C5-T1, as well as in medial regions of levels C2-C3. Despite highly reliable task performance (grip force) and fMRI signal quality (temporal signal-to-noise ratio), the reliability of motor activation was predominantly poor-to-fair both within and between visits, with notable variability in spatial distribution observed across task runs. Increasing the number of task runs per individual improved the robustness of group-level activation, as indexed by higher activated voxel count, larger cluster spatial extent, and attenuated t-statistic distribution. Although we demonstrated that motor-evoked activation corresponds to the known neuroanatomical organisation of motor circuits, its low test-retest reliability presents a challenge for wider applications of spinal fMRI. Understanding the drivers of low reliability in functional imaging is warranted, but we suggest that looking beyond measurement error is required, including careful consideration of inherent within-individual variability underpinned by neurophysiological and psychological factors.

PMID:42367071 | DOI:10.1002/hbm.70593

J Adolesc. 2026 Jun 29. doi: 10.1002/jad.70211. Online ahead of print.

ABSTRACT

INTRODUCTION: Rooted in Buddhist thought, nonattachment refers to the ability to let go of rigid desires and fixed self-concepts, fostering a balanced and flexible engagement with one’s experiences. The present study examined whether interpersonal harmony moderated the association between nonattachment and general well-being among Chinese junior high school students. Interpersonal harmony was conceptualized as comprising two facets: harmony enhancement (a proactive motivation to cultivate warm and supportive relationships) and disintegration avoidance (a defensive motivation to suppress conflict to maintain surface harmony).

METHODS: A sample of 652 Chinese junior high school students completed the nonattachment scale (NAS), harmony scale, and general well-being scale (GWB). Hierarchical regression analyses were conducted with grade and family structure controlled.

RESULTS: The results indicated that nonattachment was positively related to general well-being. Both harmony enhancement and disintegration avoidance showed statistically significant but small moderating effects (ΔR² = 0.01). Specifically, the positive relationship between nonattachment and well-being was stronger at lower levels of harmony enhancement and disintegration avoidance and weaker at higher levels.

CONCLUSIONS: These findings suggest that nonattachment serves as a particularly important intrapersonal resource for adolescents experiencing limited relational harmony. Consistent with a person × context interaction framework, the psychological benefits of nonattachment appear to vary as a function of adolescents’ culturally rooted relational tendencies.

PMID:42367043 | DOI:10.1002/jad.70211

Prog Community Health Partnersh. 2026;20(2):183-194. doi: 10.1353/cpr.2026.a993186.

ABSTRACT

BACKGROUND: Workforce roles that address social determinants of health, such as regional health connectors (RHCs), can reduce health inequities that disproportionately affect people of lower socioeconomic status and marginalized communities.

OBJECTIVES: The aim of this evaluation was to describe, from the perspective of RHCs’ community partners, 1) strategies that RHCs employ, 2) social needs that RHCs address, and 3) outcomes associated with RHCs’ community efforts.

METHODS: This convergent mixed-methods evaluation included a cross-sectional statewide survey of Colorado RHC partners followed by interviews with a subset of participants. Descriptive statistics (frequency distributions, proportions, means, standard deviations) were used to summarize survey results. We used a thematic summary approach to qualitatively analyze interviews.

RESULTS: Survey participants (n = 182) were community partners working with RHCs, representing public health (36%), health care (30%) and social services sectors (25%). RHCs most commonly addressed access to care, food security, and housing support. Community partners reported that RHCs impact their organizations by connecting them to new resources, assisting in connecting the people they serve to resources to address social needs, and identifying and/or addressing resource gaps in the community. Survey comments and interviews (n = 11) illuminated RHCs’ involvement in connecting community members and organizations to tailored resources and services. Partners appreciated RHCs’ high-level perspective and broad knowledge base. Areas for improvement included organizational change affecting relationship development and processes to connect partners with resources.

CONCLUSIONS: The Colorado RHC model could help other regions build collaborations and leverage resources and support for health-related social needs to improve community health outcomes.

PMID:42366979 | DOI:10.1353/cpr.2026.a993186

Hypertension. 2026 Jun 29. doi: 10.1161/HYPERTENSIONAHA.125.26521. Online ahead of print.

ABSTRACT

BACKGROUND: Adaptive optics retinal imaging (rtx1e, Imagine Eyes, Orsay, France) enables high-resolution visualization of the retinal microvasculature, providing insights into systemic vascular health. Currently, no studies exist describing changes in wall-to-lumen ratio (WLR) during pregnancy, neither during the physiological course of pregnancy nor in pregnancy-associated complications.

METHODS: This single-center, prospective study at the Leipzig University Hospital, Germany, examines changes in retinal microvasculature by employing adaptive optics to calculate the WLR of an arteriole within a few seconds. The study examined a well-phenotyped cohort of 460 primarily White healthy singleton pregnancies, with 543 measurements taken from the first to the third trimester. The WLR was automatically determined using the nnUNet deep learning model.

RESULTS: Step-down selection mixed-effects modeling identified gestational week, maternal age, mean arterial pressure, and parity as significant contributors to WLR, whereas body mass index did not improve model fit. In the final model, advancing gestational week (P<0.001), higher maternal age (0.012), and higher mean arterial pressure (<0.001) were independently associated with increased WLR, whereas multiparous women showed significantly lower WLR values compared with nulliparous women, with negligible multicollinearity (variance inflation factor ≈1).

CONCLUSIONS: We identify WLR as a sensitive marker for imaging microvascular remodeling, serving as an indicator of adaptation to physiological pregnancy. Normal pregnancy is associated with an instant change of the retinal microvasculature indicated by an increase of WLR. Further studies are required to investigate the postpartum course of WLR and establish whether these changes are reversible.

REGISTRATION: URL: https://www.drks.de; Unique identifier: DRKS00032530.

PMID:42366971 | DOI:10.1161/HYPERTENSIONAHA.125.26521