Category: Nevin Manimala

Eur J Prev Cardiol. 2026 May 23:zwag267. doi: 10.1093/eurjpc/zwag267. Online ahead of print.

ABSTRACT

Randomized controlled trials (RCTs) remain the gold standard for causal inference in cardiovascular prevention but are often limited by cost, feasibility, and restricted generalizability. The rapid expansion of real-world data (RWD) offers new opportunities to address clinically relevant questions beyond the scope of RCTs, yet observational analyses remain highly susceptible to bias, particularly when study design is not aligned with the underlying causal question. Target trial emulation (TTE) is an increasingly adopted framework that improves the validity and interpretability of observational studies by explicitly specifying the protocol of the hypothetical randomized trial that would ideally answer the clinical question. This review provides a practical guide to TTE in cardiovascular prevention. We describe its conceptual foundations within the counterfactual framework, emphasizing the shift from a model-driven to a design-first approach, and outline the seven key components of the target trial protocol: eligibility criteria, treatment strategies, assignment procedures, time zero definition, outcomes, estimand, and statistical analysis plan. We clarify the role of analytical methods within TTE, including propensity score approaches, g-computation, and g-estimation, and provide guidance on selecting the appropriate method based on the estimand and treatment strategy. A step-by-step implementation framework is proposed, covering common pitfalls such as immortal time bias and prevalent user bias, the use of negative control analyses as diagnostic tools, and the handling of missing data. Illustrative examples from cardiovascular prevention demonstrate how TTE enhances causal interpretation across a range of clinical questions. TTE strengthens the credibility of real-world evidence by improving transparency, reducing avoidable design biases, and aligning analyses with clinically meaningful decisions. It does not eliminate residual confounding and should be viewed as complementary to, rather than a substitute for, randomized evidence.

PMID:42175748 | DOI:10.1093/eurjpc/zwag267

Chronobiol Int. 2026 May 23:1-9. doi: 10.1080/07420528.2026.2678271. Online ahead of print.

ABSTRACT

Excessive use of smartphones and tablets has become increasingly common among children, contributing to adverse physical and mental health outcomes. Evening chronotype and inadequate sleep habits have been identified as potential risk factors. However, despite growing concerns, there is limited evidence on the relationship between chronotype, sleep patterns, and digital device addiction in children. In this cross-sectional study, 213 Iranian schoolchildren aged 4-11 years were assessed using validated Persian versions of three standardized instruments: the Children’s Chronotype Questionnaire (CCTQ), the Children’s Sleep Habits Questionnaire (CSHQ), and the Smartphone and Tablet Addiction Questionnaire. This is the first study in Iran to employ the CCTQ to examine the association between chronotype and smartphone addiction in children. Data analysis included descriptive statistics, Spearman’s correlation, stepwise regression, and Kruskal-Wallis tests. Sleep problems and smartphone/tablet addiction were significantly more prevalent in children with an evening chronotype, followed by those with a neutral chronotype, and were lowest in those with a morning chronotype. In addition, the M/E and CSHQ scores were positively associated with smartphone/tablet addiction scores, whereas later sleep onset time on scheduled days showed a negative association. Specifically, each one-unit increase in the M/E score was linked to a 0.75-point increase in the average addiction score (β = 0.75, SE = 0.17, p < 0.01), and each one-unit increase in the CSHQ score corresponded to a 0.35-point increase (β = 0.35, SE = 0.13, p < 0.05). Conversely, each one-unit delay in sleep onset time on scheduled days was associated with a 0.15-point decrease in the average addiction score (β = -0.15, SE = 0.09, p < 0.05). Children with an evening chronotype appear more susceptible to both poor sleep habits and smartphone/tablet addiction. These findings, in line with previous research on adolescents and adults, support the notion that circadian misalignment plays a pivotal role in technology-related behavioral risks. Early identification of chronotype and the implementation of strategies to promote healthier sleep schedules may be beneficial for fostering healthier sleep patterns and more balanced device use among children.

PMID:42175734 | DOI:10.1080/07420528.2026.2678271

Am Surg. 2026 May 23:31348261455090. doi: 10.1177/00031348261455090. Online ahead of print.

ABSTRACT

BackgroundPostoperative respiratory depression (PRD) is potentially preventable yet remains difficult to preemptively detect. We evaluated whether three post anesthesia care unit (PACU) events-oversedation, caffeine administration for impaired arousal, and naloxone administration-can serve as early markers of delayed PRD requiring naloxone administration on wards.MethodsWe retrospectively identified patients who underwent general anesthesia between 2018 and 2023 at a quaternary care academic medical center. From electronic medical records, we retrieved PACU naloxone and caffeine treatments, scores of sedation assessments using the Richmond Agitation-Sedation Scale (RASS), and ward naloxone administrations within 24 hours after PACU discharge.ResultsAmong 95 870 patients, 186 (0.19%, 95% CI 0.17-0.22) required naloxone for respiratory depression after PACU discharge. Ward naloxone administration was independently associated with naloxone (OR 9.11, 95% CI 4.69-17.71, P < 0.001) and caffeine (OR 2.00, 95% CI 1.21-3.32, P = 0.007) administrations, and with PACU RASS scores ≤ -3 (OR 2.16, 95% CI 1.56-2.99, P < 0.001).ConclusionsNaloxone administration in PACU was the strongest predictor of delayed PRD, followed by oversedation and PACU caffeine administration, indicating that information routinely collected during PACU recovery may offer insight into delayed respiratory risk before transition to hospital wards. In light of the overall low incidence of ward naloxone use, these findings support selective, risk-based vigilance for patients exhibiting these PACU events rather than broad adjustments to existing monitoring practices.

PMID:42175723 | DOI:10.1177/00031348261455090

J Magn Reson Imaging. 2026 May 23. doi: 10.1002/jmri.70350. Online ahead of print.

ABSTRACT

BACKGROUND: Motion can degrade image quality during Ultrashort Time-to-Echo (UTE) pulmonary MRI and is particularly prevalent in patients with lung disease. Comprehensive assessment of the impact of motion compensation techniques on image quality and clinical interpretation is needed.

PURPOSE/HYPOTHESIS: To compare the impact of retrospective motion compensation schemes on image quality and clinical interpretation of pulmonary UTE MRI in idiopathic pulmonary fibrosis (IPF).

STUDY TYPE: Prospective.

POPULATION: 21 (male = 18; mean age, 69.9 ± 8.1 years) participants with suspected IPF.

FIELD STRENGTH/SEQUENCE: 1.5 T/3 T, 3D center-out radial (gradient-echo) UTE sequence with 2× radial oversampling, while free-breathing.

ASSESSMENT: Images were reconstructed to 1.25 mm isotropic resolution using five retrospective schemes: no gating, hard-gating, soft-gating, motion-resolved (XD-GRASP), and an iterative approach (iMoCo). Signal-to-noise ratios (SNR) were estimated within the lung parenchyma, airways, aorta, muscles, and liver. Contrast-to-noise ratios (CNR) were estimated using the mean airway signal as reference. Image sharpness was estimated using the maximum derivative of a line profile across the diaphragm and a wavelet-based autofocus measure. Three radiologists evaluated image quality, motion artifacts on a 5-point Likert scale, and diagnostic classification of usual interstitial pneumonia (UIP).

STATISTICAL TESTS: The Kruskal-Wallis non-parametric test was used for qualitative reader scores and one-way ANOVA for the quantitative metrics, with p < 0.05 as the threshold for significance.

RESULTS: CNR was highest using the iMoCo reconstructions (lung parenchyma: 1.64 ± 1.41 vs. 0.88 ± 0.81 via XD-GRASP). Image sharpness was significantly improved using compressed sensing (CS)-based techniques (XD-GRASP and iMoCo), compared to the other methods, using both diaphragm profile (CS: 6.28 ± 3.70 vs. non-CS: 3.73 ± 2.06) and wavelet metrics (CS: 2.33 ± 0.42 vs. non-CS: 2.05 ± 0.35). CS methods also demonstrated greatest image quality based on reader scores.

CONCLUSION: Motion compensation using compressed sensing methods can improve image quality and clinical utility of UTE-MRI in the identification and diagnostic classification of typical parenchymal fibrotic patterns.

EVIDENCE LEVEL: Level 2-Prospective study, with a reference standard determined during the course of the study (CT imaging).

TECHNICAL EFFICACY: Stage 1.

PMID:42175722 | DOI:10.1002/jmri.70350

Emerg Microbes Infect. 2026 May 23:2678657. doi: 10.1080/22221751.2026.2678657. Online ahead of print.

ABSTRACT

AbstractPulmonary infections caused by nontuberculous mycobacteria (NTM), particularly Mycobacterium avium complex (MAC), are increasingly recognized as an important clinical entity, yet distinguishing active pulmonary disease from asymptomatic colonization remains challenging because current diagnosis relies on composite criteria. In this study, we aimed to identify blood transcriptomic signatures that discriminate MAC pulmonary disease (MAC-PD) from pulmonary colonization (MAC-PC) and to evaluate their potential as candidate biomarkers. MAC-positive patients from two medical centers in Taiwan were enrolled as training and external validation cohorts, and peripheral blood transcriptomes were profiled. Candidate genes were identified using least absolute shrinkage and selection operator regression and recursive feature elimination across multiple random seeds, followed by filtering based on statistical robustness and biological relevance. Machine-learning models were then trained and externally validated. Among 120 patients (training cohort: 46 MAC-PD and 28 MAC-PC; validation cohort: 25 MAC-PD and 21 MAC-PC), seven enriched gene ontology terms were prioritized. Three models demonstrated robust performance in the validation cohort, with areas under the receiver operating characteristic curve of 0.78, 0.78, and 0.75, and accuracies of 0.76, 0.74, and 0.74, respectively. These models shared a five-gene core signature consisting of IGKV1D-39, IGKV6-21, OVCH1, PLAU, and DMD, highlighting convergent biological signals related to immune responses and tissue remodeling. Overall, blood transcriptomic profiling shows promise in differentiating MAC-PD from MAC-PC in our cohorts, and the identified five-gene core signature represents a biologically coherent, minimally invasive candidate biomarker panel warranting further prospective validation.

PMID:42175713 | DOI:10.1080/22221751.2026.2678657

Biomed Res Int. 2026;2026(1):e8893135. doi: 10.1155/bmri/8893135.

ABSTRACT

BACKGROUND: Medication safety is an important public health challenge, especially in pediatrics. Medication errors (MEs) are often underreported in pediatrics and can lead to adverse outcomes such as frequent readmissions, increased total healthcare costs, prolonged hospitalization, and related morbidity and mortality. Thus, this study is aimed at assessing the magnitude and determinants of MEs among pediatric hospitalized patients at comprehensive specialized hospitals in Northwest Ethiopia.

METHODS: A multicenter prospective observational study involving pediatric hospitalized patients was conducted over 4 months, utilizing systematic random sampling for participant selection. Three clinical pharmacists, after a day of training, collected data under the supervision of an MSc health professional, with support from pediatricians in each hospital for reviewing MEs and adjusting treatment plans. Pediatric patients were followed prospectively during their hospital stay from admission to discharge. Data collection occurred via the Kobo Toolbox platform and was analyzed with STATA Version 17.0. Both bivariate and multivariable logistic regression analyses identified factors related to MEs, with statistical significance set at a p value < 0.05.

RESULTS: Among 358 pediatric hospitalized patients, 53.63% experienced at least one ME, totaling 254 identified errors. The prescribing stage accounted for the highest percentage of errors (40.16%), followed by the administration stage (32.68%). The predominant types of MEs were dose errors (30.31%), frequency errors (14.96%), and omission errors (14.17%). Multivariable logistic regression analysis revealed that polypharmacy (≥ 5 medications) (AOR = 2.005, 95% CI: 1.269-3.168), male sex (AOR = 1.707, 95% CI: 1.097-2.656), and prolonged hospital stay (AOR = 1.673, 95% CI: 1.076-2.602) were significantly associated with the occurrence of MEs.

CONCLUSION: This study found that MEs were prevalent in pediatric hospitalized patients. Polypharmacy, male patients, and the length of hospital stay were independent predictors of MEs. To reduce MEs, computer-based prescribing practice and clinical pharmacy services should be routine practices in the study settings.

PMID:42175692 | DOI:10.1155/bmri/8893135

J Am Acad Orthop Surg Glob Res Rev. 2026 May 19;10(5). doi: 10.5435/JAAOSGlobal-D-25-00449. eCollection 2026 May 1.

ABSTRACT

OBJECTIVE: Fiberglass long leg casting is often used to treat specific lower extremity fracture patterns in children. However, cylindrical casting limits swelling, increasing risk of compartment syndrome. To account for edema, casts are frequently univalved, but it remains unclear whether univalve location affects skin surface pressures (SSPs) in long leg casts. We hypothesized that a lateral univalve would decrease anterior SSP, whereas univalve location would not affect posterior SSP in long leg casts.

METHODS: A 100-mL saline bag attached to a pressure transducer was placed along the anterior or posterior compartment of a volunteer underneath 20 and 26 long leg casts, respectively. The casts were randomly assigned to receive either lateral or medial univalve. The bag was insufflated with water to 100 mm Hg, and change in SSP was recorded with univalve (stage I), univalve with 3-mm spacer (stage II), univalve with 6-mm spacer (stage III), and bivalve (stage IV). Statistical analysis was done to detect an SSP difference of 10 mm Hg.

RESULTS: In the anterior and posterior compartments, no notable differences were found in SSP change within any stage between lateral and medial univalve. Comparing stage I and stage IV, a notable SSP change was found across all anterior and posterior compartment groups (P < 0.001, 95% confidence).

CONCLUSION: No notable difference was found in anterior or posterior SSP in long leg casts with either medial or lateral univalve. Our data support a “dealer’s choice” that the practitioner may select either medial or lateral univalve to reduce anterior and posterior SSP.

PMID:42175675 | DOI:10.5435/JAAOSGlobal-D-25-00449

J Inherit Metab Dis. 2026 May;49(3):e70202. doi: 10.1002/jimd.70202.

ABSTRACT

Neuronal ceroid lipofuscinosis type 2 (CLN2) disease, a lysosomal storage disorder, causes early childhood psychomotor regression, vision loss, seizures, and rapid progressive gray matter loss. However, the link between neurodegenerative processes induced by lysosomal pathophysiology and the clinical phenotype remains unclear. This study investigated the longitudinal association of gray matter atrophy on MRI with in-depth clinical phenotyping in 27 patients receiving intraventricular enzyme therapy (n_timepoints = 170; biannual clinical assessments and MRIs). Longitudinal changes in cortical thickness and subcortical volumes were modeled via linear mixed effects regression. We used linear regression to correlate 24-week (Δ24) changes in clinical assessments with global cortical thickness and applied multivariate data-driven statistics to model how specific brain regions are associated with clinical domains. Our analysis revealed a significant reduction in the mean cortical thickness over time (β = -0.002, p = 0.021), corresponding to an annual loss of 4.2%, compared to natural history controls with 12.5%, respectively. Regional analysis revealed a widespread pattern of cortical and subcortical gray matter atrophy. Global cortical thickness reductions over 24 weeks (Δ24) were significantly associated with changes in the Hamburg motor and language scale Δ24, Weill Cornell scale Δ24, and Movement Disorder Inventory Δ24. Multivariate statistics identified a significant latent dimension relating regional morphometric abnormalities to worse clinical outcomes, accounting for 82% of the shared variance. Leveraging connectome data, we demonstrated that atrophy was linked to brain network architecture. Given their strong associations with clinical outcomes, MRI-based brain morphometric measures are promising CLN2 disease biomarkers to aid diagnosis, monitor disease progression, and guide therapy.

PMID:42175674 | DOI:10.1002/jimd.70202

J Oral Rehabil. 2026 May 23. doi: 10.1111/joor.70219. Online ahead of print.

ABSTRACT

BACKGROUND: This cross-sectional observational study aimed to assess the relationships between headache (HA), orofacial pain (OFP), sleep bruxism (SB), trauma, emotional control, stress management, and illness acceptance, as measured by scales.

METHODS: Eligible patients underwent overnight videopolysomnography and completed validated questionnaires on pain, trauma, coping strategies, and illness acceptance; all data were analysed using TIBCO Statistica 13.

RESULTS: The results showed a positive correlation between experienced trauma and pain (p = 0.001 for HIT 6, p = 0.002 for MIDAS, p = 0.002 for SF-MPQ), as well as between pain and negative coping strategies such as denial (p = 0.020 for MIDAS, p = 0.038 for SF-MPQ), venting (p = 0.020 for HIT-6, p = 0.009 for MIDAS, p = 0.037 for SF-MPQ), taking psychoactive substances (p = 0.009 for SF-MPQ), behavioural disengagment (p = 0.007for HIT-6, p = 0.039 for SF-MPQ), and self-blame (p = 0.000 for HIT-6, p = 0.001 for MIDAS, p = 0.000 for SF-MPQ). The results also showed a correlation between lower illness acceptance and greater pain complaints (p = 0.000 for GCPS, p = 0.000 for HIT-6, p = 0.000 for MIDAS, p = 0.000 for SF-MPQ). We observed a significant negative relationship between self-blame and the bruxism episode index (BEI) (p = 0.006) and between venting and BEI (p = 0.039).

CONCLUSIONS: Factors such as trauma, the use of negative coping strategies, and low levels of illness acceptance among patients with chronic orofacial pain can be associated with increased pain, which in turn compromises the effectiveness of treatment therapy. Self-blame and emotional venting-showed significant negative correlations with BEI, indicating fewer SB episodes.

TRIAL REGISTRATION: www.

CLINICALTRIALS: gov, “Relationship Between Selected Parameters and Bruxism”, identifier NCT04214561.

PMID:42175672 | DOI:10.1111/joor.70219

Int J Lang Commun Disord. 2026 May-Jun;61(3):e70263. doi: 10.1111/1460-6984.70263.

ABSTRACT

BACKGROUND: Effective support for children’s speech, language, and communication development is essential to prevent long-term negative outcomes. Parental behaviours play a critical role in whether children are referred to and receive speech-language therapy.

AIMS: This study aimed to identify predictors of parents receiving Speech-language Therapy using longitudinal data from Growing Up in New Zealand.

METHOD: Data were drawn from the Growing Up in New Zealand study, which is representative of the national child population. The analysis focused on children with reported speech concerns by age 54 months (N = 771). The primary outcome was whether speech-language therapy had been received for speech concerns by that age.

RESULTS: Logistic regression showed children had significantly higher odds of receiving speech-language therapy if their mothers experienced low socioeconomic deprivation during pregnancy (OR = 2.31, p < 0.01) and if family doctors were perceived as highly helpful when the child was nine months old (OR = 3.77, p < 0.05). In contrast, children whose mothers identified Māori as their prioritised ethnicity were significantly less likely to receive speech-language therapy than those identifying as European/Pākehā (OR = 0.40, p < 0.001).

CONCLUSION: Findings highlight persistent ethnic and social inequities in access to speech-language therapy in New Zealand. Parental information-seeking may play a role but requires further research. These results support the need for targeted policies and early engagement strategies to ensure equitable receipt of speech-language therapy for children with speech, language, and communication needs.

WHAT THIS PAPER ADDS: What is already known on this subject Less than half of children with speech concerns receive speech-language therapy. Socio-economic and ethnic disparities are known to contribute to this gap. However, the specific factors influencing access to speech-language therapy, and the role of healthcare providers in supporting service uptake, are not well understood. What this study adds to the existing knowledge This study identifies key factors associated with non-receipt of speech-language therapy, including socio-economic deprivation, ethnicity, and perceived helpfulness of support. It underscores the important role of healthcare providers in early identification and in improving access to speech-language therapy services for children in at-risk groups. What are the actual clinical implications of this work? The findings highlight the need for targeted strategies to overcome barriers to speech-language therapy access. Strengthening collaboration between healthcare providers, such as general practitioners and early childhood professionals, may improve early intervention and service uptake among underserved populations.

PMID:42175668 | DOI:10.1111/1460-6984.70263