Category: Nevin Manimala

Disaster Med Public Health Prep. 2026 Apr 1;20:e75. doi: 10.1017/dmp.2026.10339.

ABSTRACT

OBJECTIVE: Attacks on health care are war crimes. This study aims to investigate the types, scales, and patterns.

METHODS: The secondary analysis explores public data from WHO’s “Surveillance System for Attacks on Health Care (SSA)” from January 2018 to December 2024.

RESULTS: The analysis shows that the attacks on health care and number of affected countries increased strongly. A total of 8,012 attacks on health care were recorded across 22 countries. Just over half of the attacks impacted health care personnel, and almost a quarter affected patients. Attacks can vary widely in type, complexity, and impact, which have regional specificities. The occupied Palestinian territory and Ukraine have suffered the most attacks on health care worldwide. Country-specific attack strategies are identified. Furthermore, the combination of violence with individual and heavy weapons in an attack accumulated the probability of injuries or deaths. Improvements were observed in a few countries. A 2-step cluster analysis reveals that the heterogeneous attacks can be well clustered into approximately 2 halves. It identifies patterns across countries. The most important predictor for clustering of the attacks on health care is violence with heavy weapons, which is frequently observed, for example, in Ukraine.

CONCLUSION: The global trend has worsened dramatically. Prevention and protection are needed.

PMID:41919438 | DOI:10.1017/dmp.2026.10339

Disaster Med Public Health Prep. 2026 Apr 1;20:e66. doi: 10.1017/dmp.2026.10344.

ABSTRACT

OBJECTIVES: Researchers have revealed that the incidence of aspiration pneumonia (AP) increases following a disaster, not only due to the disaster itself but also due to environmental factors, which will propose dysphagia rehabilitation targets. We aimed to delineate the current status of dysphagia rehabilitation in disasters.

METHODS: English literature was searched via scientific databases, representative journal homepages, trial registries, and gray literature.

RESULTS: A total of 242 articles were reviewed in full text, and 31 were included in this review. Most hazards were earthquakes (19/31), and most reports originated from Japan (19/31). The reported issues were summarized according to the International Classification of Functioning, Disability, and Health (ICF) codes. Twenty-seven codes related to areas such as Swallowing, Caring for teeth, and Food were the most frequently reported. In addition, three additional items not formally listed in the ICF were considered: nutrition, oral hygiene, and denture.

CONCLUSIONS: The mechanisms of emergency lifestyle-related aspiration pneumonia were identified, and approaches to prevent AP were proposed. We further discuss how to promote dysphagia rehabilitation in disasters. Nevertheless, multidisciplinary coordination is important, and more involvement of rehabilitation specialists is required.

PMID:41919436 | DOI:10.1017/dmp.2026.10344

Disaster Med Public Health Prep. 2026 Apr 1;20:e76. doi: 10.1017/dmp.2026.10337.

ABSTRACT

OBJECTIVE: This study qualitatively examines community experiences related to housing following natural disasters, focusing on damage to home infrastructure, barriers to completing repairs, and the resources needed for recovery and rebuilding.

METHODS: Participants included members from 3 historically underserved Houston communities (Kashmere Gardens, Fifth Ward, and Third Ward) with Social Vulnerability Index (SVI) rankings in the 80th percentile. Town hall-style conversations were held within each community; small focus groups were completed within the town halls. Reflexive thematic analysis was used to identify themes, supported by researcher triangulation, reflexivity, and member checking to establish trustworthiness.

RESULTS: Analysis identified 7 key themes :1) Successive Disasters Exacerbate Problems Driven by Gentrification, 2)Insufficient and Unequal Post-Disaster Resources Drive Dependence on Community Support Networks, 3) Systemic Delays in Relief Services to Underserved Communities Underscore The Need for Government Accountability, 4) Growing Distrust in Local Government to Address Evolving Post-Disaster Needs, 5) Navigating Complex Insurance Policies While Being Drained by a Disaster, 6) Trickle-Down Unpreparedness Starts at a City Level, and 7) Steps to Prepare for Future Disasters.

CONCLUSIONS: Systemic inequities in disaster preparedness and response affecting low-income Black and Hispanic communities are evident. Addressing these disparities requires prioritizing resource distribution, infrastructure investments, and community-driven planning and resilience building.

PMID:41919435 | DOI:10.1017/dmp.2026.10337

Disaster Med Public Health Prep. 2026 Apr 1;20:e68. doi: 10.1017/dmp.2026.10335.

ABSTRACT

On April 14 and October 1, 2024, and then for 10 days from June 13, 2025, Israel was under ballistic missile attacks, causing casualties and destruction. This report describes the response of an emergency department (ED) in Jerusalem to maintain quality care and safety during these attacks. It was vital to minimize the number of ED patients in unprotected zones. Patients in the unprotected area of the ED were relocated to protected zones, and a mechanism was implemented to close blast doors that had been blocked by a technical issue. Lessons learned included: adapting protected areas in the ED for continued patient care, properly closing blast doors, and maintaining flexible emergency protocols to address evolving hazards.

PMID:41919411 | DOI:10.1017/dmp.2026.10335

Disaster Med Public Health Prep. 2026 Apr 1;20:e77. doi: 10.1017/dmp.2026.10342.

ABSTRACT

The COVID-19 pandemic overwhelmed New York City’s healthcare infrastructure, prompting rapid adaptations to expand critical care capacity. Montefiore Medical Center’s Hutchinson Metro Center (the Hutch), a standalone ambulatory surgical center (ASC), was converted into an ICU within 5 days to address the surge in COVID-19 cases. This was done by repurposing 16 operating rooms and 60 post-anesthesia care unit beds into 14 ICU and 60 floor beds. A 5-step framework guided the conversion process, including: (1) feasibility of conversion, (2) critical structural logistics, (3) essential supplies and technology, (4) Clinical criteria, and (5) staffing. Key challenges were oxygen supply limitations, staffing shortages, and logistical hurdles such as medication and equipment procurement. This report highlights the potential of ASCs as adaptable overflow facilities during public health crises and provides a blueprint for future pandemic preparedness.

PMID:41919403 | DOI:10.1017/dmp.2026.10342

Int J STD AIDS. 2026 Apr 1:9564624261441374. doi: 10.1177/09564624261441374. Online ahead of print.

ABSTRACT

BackgroundTransgender women experience a disproportionate burden of HIV. National-level trend analyses in South Africa remain limited. This study asked whether modelled HIV prevalence among transgender women changed between 2022 and 2026, and whether disparities relative to the national population and adult females had narrowed over this period.MethodsA quantitative ecological analysis was conducted using modelled estimates from the Thembisa model (version 4.8) (2022-2026). Annual HIV prevalence and 95% confidence intervals were extracted. Estimates for 2022 and 2023 reflect retrospective modelled outputs, while estimates for 2024 to 2026 incorporate model projections. A Mann-Kendall trend test was conducted to assess the statistical significance of observed changes. Absolute differences and prevalence ratios were calculated.ResultsHIV prevalence among transgender women declined from 43% in 2022 to 40% in 2026. National prevalence remained stable (13%). The absolute gap decreased from 30 to 27 percentage points. In 2026, HIV prevalence among transgender women remained more than three times higher than national prevalence. The Mann-Kendall trend test confirmed a statistically significant downward trend (τ = -1.00, p = 0.017).ConclusionDespite modest declines, substantial disparities persist. Continued monitoring and targeted HIV strategies remain essential. These findings carry direct implications for South Africa’s National Strategic Plan on HIV and for the National Department of Health’s key population programming.

PMID:41919395 | DOI:10.1177/09564624261441374

Nucleosides Nucleotides Nucleic Acids. 2026 Apr 1:1-13. doi: 10.1080/15257770.2026.2649863. Online ahead of print.

ABSTRACT

Pancreatic ductal adenocarcinoma (PDAC) is among the most treatment-resistant malignancies, characterized by aggressive progression and limited drug penetration reducing chemotherapeutic efficacy. Gemcitabine, a pyrimidine nucleoside analog and standard-of-care therapy for PDAC, remains clinically important but is limited by the emergence of resistant tumor cell populations that underscore the need for strategies that enhance cytotoxic efficacy and overcome adaptive resistance mechanisms. Ultrasound-stimulated microbubble (USMB) therapy has emerged as a noninvasive, mechanically driven approach capable of transiently perturbing cellular membranes and enhancing therapeutic responses. We hypothesized that gemcitabine-induced metabolic and structural alterations may sensitize PDAC cells to subsequent disruption by USMB, resulting in enhanced cell death. To test this hypothesis, we assessed changes in proliferation, morphology, and cell death following gemcitabine and USMB treatments administered individually and in sequence to PANC-1 cells. Gemcitabine treatment alone (2 µM for 48h) significantly reduced cell proliferation by approximately 22% and induced pronounced morphological remodeling, including statistically increased average cell diameter from ∼19 µm to ∼22 µm, consistent with cytoplasmic expansion and structural reorganization. Notably, when gemcitabine-treated cells were subsequently exposed to USMB (1 MHz, 770 kPa negative pressure for 1 min), cell death increased dramatically to >80%, significantly exceeding the effects observed with either gemcitabine or USMB monotherapy indicating that gemcitabine pretreatment induces a mechanically vulnerable cellular state that can be exploited by USMB to achieve synergistic cytotoxicity. Therefore, the proposed combined biochemical-biophysical strategy offers a promising approach to suppress the rapid compensatory growth and therapeutic resistance commonly associated with monotherapy failure in PDAC cells.

PMID:41919380 | DOI:10.1080/15257770.2026.2649863

Health Serv Res. 2026 Apr;61(2):e70109. doi: 10.1111/1475-6773.70109.

ABSTRACT

OBJECTIVE: To examine the plausibly causal effect of Medicaid home- and community-based services (HCBS) use on Medicare community-initiated home health care (CIHHC) utilization among dual-eligible older adults and to provide evidence on whether access to home-based long-term care (LTC) reduces use of Medicare home health care, with potential implications for whether Medicare home health care is used as a substitute for LTC services when they are not or less accessible.

STUDY SETTING AND DESIGN: To address the endogeneity of Medicaid HCBS use, we employ an instrumental variable, the proportion of Medicaid HCBS enrollment in other counties within the same state in the previous quarter, in conjunction with a state-border design in estimating the effect of Medicaid HCBS use on Medicare CIHHC and its heterogeneity.

DATA SOURCES AND ANALYTIC SAMPLE: We use national Medicare and Medicaid claims data along with home health and nursing home assessment data from 2016 to 2019. Our sample consists of 36,955,226 beneficiary-quarter-level observations of older adults (65+) dually enrolled in Medicaid and Medicare and residing in contiguous state-border counties.

PRINCIPAL FINDINGS: Medicaid HCBS use reduces Medicare CIHHC utilization by approximately 1.02 percentage points (95% CI: -1.73 to -0.32), representing about 44% of the sample mean. This effect is concentrated among beneficiaries enrolled in Medicare-Medicaid integrated care plans and those living in urban counties. Moreover, the reduction is most pronounced among older adults who live alone and have around-the-clock assistance needs.

CONCLUSIONS: Our findings suggest a substitution between Medicaid HCBS and Medicare CIHHC among dual-eligible older adults at the margin of using Medicaid HCBS, a relationship that should be taken into account when evaluating either program. These findings also align with the hypothesis that Medicare CIHHC is being used as a substitute for LTC, and the availability of home-based LTC may help to alleviate this potentially inefficient use.

PMID:41919377 | DOI:10.1111/1475-6773.70109

Orthop Surg. 2026 Apr 1. doi: 10.1111/os.70302. Online ahead of print.

ABSTRACT

OBJECTIVE: Subtrochanteric shortening osteotomy (SSO) with autogenous cortical plate grafting is a critical but technically demanding procedure in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip. Conventional instruments often result in inaccurate osteotomies and unstable graft fixation. This study aimed to evaluate a novel surgical instrumentation system designed to address these challenges.

METHODS: A retrospective cohort study was conducted on 49 patients (60 hips) with Crowe type IV DDH who underwent primary THA with SSO. The control group included 25 patients (30 hips) treated with conventional instruments. The novel instrumentation group included 24 patients (30 hips) treated with the newly developed system. All surgeries were performed by a single senior surgeon. Demographic and clinical data were analyzed, and all patients completed the 24-month postoperative follow-up. Statistical analysis was performed using t-tests and chi-squared tests as appropriate.

RESULTS: The mean operative time was significantly shorter in the novel instrumentation group than in the control group (t = 2.123, p = 0.040). The novel instrumentation system was estimated to reduce the time required for the autogenous cortical plate technique by 43%. Patients in the novel instrumentation group also reported significantly less intraoperative blood loss (t = 3.078, p = 0.003). The satisfaction rate regarding autogenous graft and wire positions was significantly higher in the novel instrumentation group (χ² = 5.455, p = 0.020). No significant differences were observed in clinical scores between the two groups during the 24-month follow-up. No severe perioperative or postoperative complications occurred in either group.

CONCLUSION: The novel surgical instrumentation system demonstrated advantages over conventional devices in terms of operating time, blood loss, and satisfaction with autogenous graft and wire positioning. It represents an ideal set of surgical tools for Crowe type IV DDH patients undergoing THA with SSO.

LEVEL OF EVIDENCE: Level III, retrospective study.

PMID:41919348 | DOI:10.1111/os.70302

J Dermatolog Treat. 2026 Dec;37(1):2650070. doi: 10.1080/09546634.2026.2650070. Epub 2026 Apr 1.

ABSTRACT

BACKGROUND: The emergence of systemic targeted therapies for atopic dermatitis (AD) has significantly transformed the treatment landscape.

OBJECTIVE: This network meta-analysis aims to systematically evaluate the relative efficacy of approved systemic targeted therapies in adult patients with moderate-to-severe AD.

METHODS: Phase 3 or 4 randomized controlled trials (RCTs) assessing approved systemic targeted therapies for moderate-to-severe AD published up to July 29, 2025, were systematically identified. A Bayesian network meta-analysis was performed to analyze the proportion of patients achieving key efficacy indicators, including EASI-75, EASI-90, IGA 0/1, and NRS response.

RESULTS: A total of 27 reports encompassing 33 trials and 16,334 participants were included. The network meta-analysis demonstrated that Upadacitinib 30 mg consistently exhibited the highest probability of achieving each clinical endpoint. While pairwise comparisons revealed statistically significant differences among multiple targeted therapies, no significant differences were observed between dupilumab 300 mg and stapokibart 300 mg, or between ivarmacitinib 8 mg and upadacitinib 15 mg.

CONCLUSION: Among currently approved targeted systemic therapies, upadacitinib 30 mg once daily ranked highest across all evaluated efficacy outcomes. However, these findings are derived primarily from indirect comparisons, and head-to-head randomized trials are needed to confirm the relative effectiveness of these therapies.

PMID:41919337 | DOI:10.1080/09546634.2026.2650070