Category: Nevin Manimala

BMC Med Imaging. 2026 Feb 14. doi: 10.1186/s12880-026-02224-3. Online ahead of print.

ABSTRACT

BACKGROUND: HIV-associated neurocognitive disorders (HAND) are common complications in HIV-infected individuals, and working memory impairment is one of the core features. Although combination antiretroviral therapy (cART) has reduced the incidence of severe HAND, mild HAND remains prevalent. This study aims to explore the functional brain characteristics related to working memory in HIV-infected individuals with different cognitive states using resting-state and task-based functional magnetic resonance imaging (fMRI), and to identify candidate imaging markers for early diagnosis and inform future intervention targeting.

METHODS: Fifty-nine HIV-infected individuals (30 with cognitive integrity [CI], 29 with asymptomatic neurocognitive impairment [ANI]) and 37 healthy controls (HC) were enrolled. Resting-state and task-based fMRI were acquired. Task-fMRI was performed using a spatial working memory task to analyze brain activation, functional connectivity (FC), and reconfiguration efficiency of FC from rest to task. FC networks were constructed as ROI-ROI Pearson correlation matrices (Fisher z-transformed) and significant group differences were identified using network-based statistics. Pearson and Spearman correlation analyses were used to explore the relationships between reconfiguration efficiency and clinical/cognitive variables.

RESULTS: HC showed better task performance than both HIV groups, and ANI exhibited the poorest accuracy. Compared with CI, ANI had significantly lower neurocognitive domain T-scores in memory, attention/working memory, and abstraction/executive function. In task-fMRI analyses, ANI showed decreased activation in the bilateral orbital middle frontal gyri and the left middle temporal gyrus, alongside increased activation in the left cerebellum crus I relative to CI. Whole-brain analyses demonstrated widespread FC increases in both HIV groups at rest and during the task compared with HC. Reconfiguration efficiency differed across groups and showed stage-related associations with immune and cognitive measures.

CONCLUSIONS: Cognitive impairment in virally suppressed HIV is accompanied by altered working-memory network engagement, with greater cortico-cerebellar involvement in ANI. While static whole-brain FC showed widespread increases but limited CI-ANI separation under stringent correction, altered rest-to-task FC reconfiguration efficiency was associated with immune indices and neurocognitive/behavioral performance, suggesting that this cross-state metric may serve as a candidate marker for HAND phenotyping and risk stratification.

PMID:41691142 | DOI:10.1186/s12880-026-02224-3

Eur Radiol. 2026 Feb 14. doi: 10.1007/s00330-026-12372-3. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the performance of a body mass index (BMI)-based sub-milliSievert low-dose CT (LDCT) protocol with multiple reconstruction algorithms for image quality and lung nodule assessment.

MATERIALS AND METHODS: This prospective study included 214 participants who underwent standard-dose CT (SDCT, 3.68 ± 1.53 mSv) reconstructed with 50% adaptive statistical iterative reconstruction (ASIR-V-50%) and LDCT. LDCT was randomly divided into a higher-dose group (LD-A, 0.57-1.15 mSv, n = 108) and a lower-dose group (LD-B, 0.33-0.63 mSv, n = 106). Each group was stratified into four BMI-based subgroups with individualized protocols reconstructed with deep learning image reconstruction (DLIR-H and DLIR-M), ASIR-V-50%, and filtered back projection (FBP). Image quality, nodule detection across BMI subgroups, and the performance of four algorithms in detection, size measurement accuracy, and Lung-RADS v2022 consistency were analyzed.

RESULTS: In LDCT, DLIR-H provided superior image quality (p < 0.001) and the highest overall nodule detection rate (99.04%), surpassing ASIR-V-50% (98.55%) and FBP (97.87%) (both p < 0.05). The advantage was most evident for nodules < 6 mm, while all nodules ≥ 6 mm were consistently detected across algorithms. Detection rates showed no significant variation among BMI subgroups (all p > 0.05). For measurement accuracy, FBP and ASIR-V-50% performed better in LD-A (all p < 0.05), whereas DLIR-M was superior in LD-B (p < 0.001). All algorithms demonstrated excellent Lung-RADS agreement (κ > 0.9, p < 0.001).

CONCLUSION: A BMI-based sub-milliSievert LDCT protocol significantly reduced radiation exposure while maintaining nodule detection across BMI subgroups, with DLIR offering superior image quality and diagnostic performance.

KEY POINTS: Question Evidence remains scarce on BMI-based sub-milliSievert low-dose CT using different reconstruction algorithms, regarding image quality and nodules detection (particularly < 6 mm). Findings BMI-based sub-milliSievert low-dose CT ensured balanced detectability across populations, while deep learning reconstruction improved image quality and achieved excellent sensitivity for lung nodule detection. Clinical relevance Deep learning reconstruction enhanced BMI-based sub-milliSievert low-dose CT, supporting its application in personalized sub-milliSievert low-dose lung cancer screening.

PMID:41691132 | DOI:10.1007/s00330-026-12372-3

Odontology. 2026 Feb 14. doi: 10.1007/s10266-026-01335-1. Online ahead of print.

ABSTRACT

Artificial intelligence (AI) chatbots are increasingly used by dental students for self-directed learning, yet their performance in specialty-level subjects like oral medicine remains underexplored. As oral medicine encompasses diagnostic and clinical reasoning across interdisciplinary domains, assessing AI competence in this field is necessary. This study aimed to evaluate and compare the performance of four advanced AI chatbots-ChatGPT-4, Microsoft Copilot, Google Gemini, and DeepSeek-in answering case-based oral medicine multiple choice questions (MCQs) across Bloom’s cognitive levels and key subtopics. A total of 114 high-quality, case-based MCQs were developed and validated based on authoritative references. Each question was classified according to Bloom’s taxonomy and mapped to one of six oral medicine subdomains. The chatbots’ responses were evaluated for accuracy, response time, and word count. Statistical comparisons were performed using Cochrane Q test, Friedman test, McNemar’s test, and Cohen’s kappa for inter-model agreement. All four chatbots demonstrated high overall accuracy (≥ 97.4%), with Microsoft Copilot showing numerically the highest score (99.1%) although no statistically significant differences were observed among the models. ChatGPT-4 generated the fastest response (mean: 7.0 s), while Copilot provided the most detailed explanations. Performance was consistent across cognitive levels, with near-perfect accuracy in the “Applying” and “Analyzing” domains. Accuracy across subtopics was also high although minor discrepancies were noted in infectious diseases and oral potentially malignant disorders. Inter-chatbot agreement ranged from moderate to perfect (kappa = 0.315-1.00). Advanced AI chatbots, including ChatGPT-4, Copilot, Gemini, and DeepSeek, demonstrated similarly high performance in answering case-based multiple choice questions in oral medicine.

PMID:41691106 | DOI:10.1007/s10266-026-01335-1

Sci Rep. 2026 Feb 14. doi: 10.1038/s41598-026-39929-y. Online ahead of print.

ABSTRACT

To evaluate postoperative pain following emergency pulpectomy in permanent teeth diagnosed with symptomatic irreversible pulpitis and to compare outcomes with or without adjunctive low-level laser therapy (LLLT). This parallel, randomized, single-blind clinical trial included 70 patients with permanent teeth diagnosed with symptomatic irreversible pulpitis. Patients were randomly assigned to two groups (n = 35 each): the experimental group received gallium-aluminum-arsenide laser therapy (808 nm, 100 mW), while the control group received no laser intervention. Postoperative pain was assessed using the Numerical Rating Scale (NRS-10) and the Visual Analogue Scale (VAS). Bite sensitivity was evaluated before and after emergency treatment. Demographic characteristics and analgesic intake were recorded. The primary outcome was postoperative spontaneous pain assessed at multiple time points. Secondary outcomes included bite sensitivity and analgesic intake. Time-dependent reductions in postoperative pain were observed in both groups. Inter-group comparisons showed statistically significant differences at isolated time points (12 and 24 h), with higher pain scores in the experimental group; however, these differences did not translate into a significant overall treatment effect. Longitudinal analysis accounting for repeated measures demonstrated a significant effect of time (p = 0.001), while treatment group was not a significant determinant of postoperative pain. Effect estimates are presented with 95% confidence intervals. Within the limitations of this pragmatic emergency-care study, adjunctive low-level laser therapy was not associated with a reduction in postoperative pain in permanent teeth with symptomatic irreversible pulpitis.

PMID:41691099 | DOI:10.1038/s41598-026-39929-y

J Racial Ethn Health Disparities. 2026 Feb 14. doi: 10.1007/s40615-025-02833-8. Online ahead of print.

ABSTRACT

This study evaluates the impact of the Housing First (HF) intervention on healthcare utilization among homeless adults with mental illness, comparing ethno-racial (ER) and non-ER groups with moderate mental health support needs. We linked data from the At Home/Chez-Soi (AH/CS) randomized controlled trial with health administrative data from Ontario, including the Ontario Health Insurance Plan and several healthcare databases (e.g., Discharge Abstract Database, Ontario Mental Health Reporting System). We analyzed outcomes such as primary care visits, hospitalizations, emergency department (ED) visits, and Ambulance arrival Incidents. Applying the intention-to-treat principle, we used generalized estimating equation models using the Poisson distribution which included the intervention (HF vs. TAU), the time period (0-7 years post-randomization vs 1-year pre-randomization) and their interaction. Incidence rate ratios (IRRs) were estimated to assess the differences in outcome rate changes between HF vs TAU comparing the 0 to 7 year follow-up period with the pre-randomization year for each stratified ethno-racial group. The results revealed a mitigated HF effect among non-ER participants, with increased utilization rates for both primary care and acute care services. [Primary care visits [IRR 2.17 95% (1.03-4.57)], acute care visits (Mental health hospitalization [IRR 2.68 95% CI (1.17-6.20)], Ambulance arrivals to ED [IRR 1.94 95% (1.05-3.56)] and number of Ambulance arrivals to ED [IRR 3.67 95% (1.05-13.02)]). However, no statistically significant effect was found among the ER participants in any of the healthcare services examined. The differential impact of HF on healthcare utilization suggests persistent systemic barriers to care, such as stigma and discrimination among ER participants.Trial Registration: The study is registered with the ISRCTN (#42520374).

PMID:41691097 | DOI:10.1007/s40615-025-02833-8

Bone Marrow Transplant. 2026 Feb 14. doi: 10.1038/s41409-026-02803-6. Online ahead of print.

ABSTRACT

Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment landscape of relapsed/refractory (R/R) B-cell precursor acute lymphoblastic leukemia (B-ALL), with high remission rates across various CAR T-cell constructs. However, the durability of these responses remains a major challenge, with many patients experiencing relapse after an initial remission. This systematic review and meta-analysis aimed to compare the efficacy and safety of different CAR T-cell constructs across 40 clinical trials, including a total of 1540 R/R B-ALL patients. We assessed the impact of patient demographics, prior treatment exposure, and construct characteristics on treatment outcomes. The pooled complete remission rate (CRR) was 83.4% (I² = 49%), with a minimal residual disease-negative complete remission (MRDneg-CR/CRi) rate of 92.7% (I² = 48%). 4-1BB co-stimulatory domain constructs showed higher MRDneg-CR/CRi rates compared with CD28 (94.0% vs. 84.4%p = 0.048) and a lower incidence of immune effector cell-associated neurotoxicity syndrome. Additionally, CAR T-cell products targeting CD19 or CD19/CD22 patients presented higher MRDneg-CR/CRi rates than those targeting CD22 alone. In conclusion, our findings suggest that 4-1BB-based CAR T-cell therapy targeting CD19 offers the best efficacy and safety profile in R/R B-ALL.

PMID:41691095 | DOI:10.1038/s41409-026-02803-6

Arch Gynecol Obstet. 2026 Feb 14;313(1):95. doi: 10.1007/s00404-026-08322-5.

ABSTRACT

PURPOSE: This study assessed geographic variations in the supply, demand, and adequacy of the United States (US) obstetrics and gynecology physician (OGP) workforce.

METHODS: This was a cross-sectional analysis of OGPs using the Health Workforce Simulation Model. Supply and demand were defined as the numbers of full-time equivalent (FTE) OGPs working and needed, respectively. Adequacy was defined as the ratio of supply to demand. Comparisons were made using Chi-squared tests, and linear regression was used to analyze OGP workforce trends.

RESULTS: From 2025 to 2037, the demand for OGPs is projected to increase (52,620-54,020 FTEs, 2.7% increase, p < 0.001) while the supply of OGPs is projected to decrease (49,170-44,130 FTEs, 10.3% decrease, p < 0.001). As a result, OGP workforce adequacy is projected to decrease over the study period from 93.4% to 81.7% (P < 0.001). By 2037, the West had the lowest OGP workforce adequacy and the Northeast had the highest adequacy (74.4% vs 98.6%, P < 0.001). Non-metropolitan areas were projected to have lower OGP workforce adequacy than metropolitan areas (51.4% vs 85.1%, p < 0.001). The states with the lowest projected OGP workforce adequacy were Utah (49.3%), Idaho (51.5%), and Arizona (58.3%) in 2037.

CONCLUSION: OGP workforce supply is expected to fall short of anticipated demand, with uneven geographic distribution across the US. Addressing this imbalance will require strategic planning to expand the OGP workforce equitably, especially in non-metropolitan areas, the West, and certain identified states like Utah and Idaho.

PMID:41691088 | DOI:10.1007/s00404-026-08322-5

Cytotherapy. 2025 Dec 27;28(4):102039. doi: 10.1016/j.jcyt.2025.102039. Online ahead of print.

ABSTRACT

PURPOSE: We sought to determine the impact of fetal growth restriction (FGR) on the cellularity of the amniotic fluid, with a focus on its mesenchymal stem cell (MSC) population.

METHODS: Four time-dated pregnant Sprague-Dawley dams were exposed to alternating 12-h hypoxia (10.5% O2) cycles from gestational day 15 (E15) until term (E21; FGR group). Three time-dated pregnant Sprague-Dawley dams not exposed to hypoxia served as normal controls. At term, fresh amniotic fluid samples from all their fetuses (n = 88, equally divided between the two groups) underwent quantitative multicolor flow cytometry for the detection of live cells as well as of cells concomitantly expressing CD29, and CD44 (both are markers of MSCs), while being also negative for DAPI and CD45, utilizing standard gating strategies. Statistical analysis was by Wilcoxon rank-sum tests and median regression (P < 0.05).

RESULTS: Placental efficiency was significantly lower in the FGR group compared to controls (P < 0.001), confirming reproduction of the disease model. There was no significant difference in the median individual amniotic fluid volume between the groups (P = 0.792). Compared to controls, FGR fetuses had statistically significantly lower densities of both total live cells as well as of live MSCs in the amniotic fluid (both P < 0.001). There was a significant decrease in the total number of MSCs in the FGR group versus controls (P < 0.001).

CONCLUSIONS: Native amniotic fluid MSC may be consumed in the setting of FGR. This provides further biological basis for transamniotic stem cell therapy as a potential novel treatment for this disease.

PMID:41689918 | DOI:10.1016/j.jcyt.2025.102039

Mult Scler Relat Disord. 2026 Feb 2;108:107045. doi: 10.1016/j.msard.2026.107045. Online ahead of print.

ABSTRACT

BACKGROUND: Mazandaran province in Iran, identified as a high-prevalence area, has lacked comprehensive long-term studies on MS trends. This study aims to fill that gap by analyzing three decades of MS incidence and prevalence in Mazandaran using advanced statistical methods.

METHODS: This longitudinal study included clinically diagnosed MS cases from the two most populous cities in Mazandaran utilizing data from the national MS registry spanning 1994 to 2023. Prevalence and age-adjusted incidence rates were calculated, and annual percentage change (APC) was assessed using joint point regression. Bayesian statistical methods were applied for comprehensive trend analysis.

RESULTS: A total of 1333 MS patients were identified, the mean (±sd) age at diagnosis was 28.58±8.52 years. MS prevalence increased from 0.19 per 100,000 in 1994 to 127.24 per 100,000 in 2023. The age-adjusted incidence rate rose from 0.14 (95 %CI: 0-0.5) in 1994 to a peak of 10.44 (95 %CI: 7.8-13.0) in 2018, then declined to 4.39 (95 %CI: 2.7-6.1) in 2023. The APC in MS incidence was +14.1 % until 2018, followed by a -15.32 % decrease thereafter. Significant differences in mean age, Expanded Disability Status Scale (EDSS) score and MS type were observed before and after 2018. The Bayesian methods indicated that evaluated predictors were not statistically significant for MS prevalence.

CONCLUSION: This study demonstrates a marked increase in MS incidence in Mazandaran province until 2018, followed by a subsequent decline. The rising prevalence and decreasing mean age at diagnosis underscore the need for continued surveillance and further research to determine whether the recent decline in incidence will persist.

PMID:41689909 | DOI:10.1016/j.msard.2026.107045

J Pediatr Nurs. 2026 Feb 13;88:34-43. doi: 10.1016/j.pedn.2026.02.007. Online ahead of print.

ABSTRACT

OBJECTIVES: This study investigated the effect of the puppet-assisted House-Tree-Person Test (HTP-T) on fear and anxiety levels in children undergoing chemotherapy treatment and the factors influencing these outcomes.

METHODS: The study employed a one-group pretest-posttest quasi-experimental design combined with HTP-T analysis. The study was conducted with 29 children aged 5-12 years receiving chemotherapy at the pediatric hematology-oncology outpatient clinics of a university hospital in the Eastern Black Sea Region of Türkiye during the 2022-2024 years. Data were collected using “the Demographic Information Form for Children and Parents, the Children’s State Anxiety Scale (CSA), the Children’s Fear Scale (CFS), and HTP-T”. Data analysis was performed using descriptive statistics, repeated measures ANOVA, and HTP-T analysis.

RESULTS: Statistically significant differences were observed in children’s mean CSA (F = 3.898, p = 0.026, η2 = 0.122) and CFS (F = 5.313, p = 0.008, η² = 0.159) scores across the pre-treatment, during-treatment, and post-treatment measurements. The HTP-T analysis revealed that children had difficulty regulating anxiety and fear, expressed concerns about family and environmental events, reported feelings of loneliness, and exhibited strong emotional attachment to their families.

CONCLUSION: The study demonstrated that incorporating puppet-assisted HTP-T during chemotherapy contributed to reducing children’s fear and anxiety and offered a useful approach for identifying influencing factors.

IMPLICATIONS FOR NURSING PRACTICE: HTP-T, a therapeutic play technique incorporating puppetry and projective methods, may be effective in reducing fear and anxiety among children undergoing chemotherapy.

PMID:41689903 | DOI:10.1016/j.pedn.2026.02.007