Category: Nevin Manimala

Biomed Res Int. 2026;2026(1):e2741454. doi: 10.1155/bmri/2741454.

ABSTRACT

BACKGROUND AND AIMS: Sickle cell disease (SCD) is a genetic disorder characterized by intrinsic clinical manifestations, frequently exacerbated by vaso-occlusive episodes (VOEs), which significantly affect hematological parameters. This systematic review and meta-analysis is aimed at synthesizing evidence from studies published over the past 25 years on complete blood count profiles in SCD patients, both in the steady state and during VOEs. The objective was to clarify hypotheses and highlight the need for prospective studies to establish specific reference values for steady-state SCD patients, thereby improving patient management.

MATERIALS AND METHODS: In accordance with the PRISMA guidelines and the Cochrane Handbook, a systematic search of major databases (including PubMed, Web of Science, and Google Scholar) was conducted to identify analytical studies published between 2000 and 2025. Eligible studies compared complete blood count profiles in SCD patients during VOEs and in the steady state. Study selection and data extraction were performed independently by two reviewers, with disagreements resolved by consensus. Extracted data were entered into Microsoft Excel 2013 and analyzed using R statistical software (Version 4.3.2). Between-study heterogeneity was evaluated using Higgins’ inconsistency (Q) statistics, with results expressed as I² values and corresponding p values. The risk of bias in the included studies was assessed using the ROBINS-E tool.

RESULTS: Eight studies met the inclusion criteria. Pooled analyses demonstrated a significant impact of VOEs on hemogram parameters. This impact was characterized by anemia and erythrocytopenia (standardized mean difference [SMD], random-effects model: -0.97 [-1.45; -0.50]), accompanied by microcytosis (SMD, random-effects model: 0.18 [-0.21; 0.58]) and hypochromia (SMD, random-effects model: -0.90 [-2.96; 1.15]). These changes were also associated with reduced fetal hemoglobin levels, increased red cell distribution width (RDW), and reticulocytosis. Regarding the white blood cell lineage, VOEs were associated with leukocytosis (SMD, random-effects model: 0.73 [0.23; 1.24]) and a moderate increase across leukocyte subpopulations. Concerning the platelet lineage, VOEs exerted variable effects on platelet production, ranging from negative to positive influences, with an overall increase in platelet count (SMDs, random-effects model: -0.17 [-1.13; 0.78] and 0.78 [0.53; 1.03], respectively), accompanied by reductions in mean platelet volume and platelet distribution width (PDW).

CONCLUSION: This meta-analysis confirms the substantial influence of VOEs on red blood cell, white blood cell, and platelet parameters, as well as their associated indices. Importantly, although hematological parameters in the steady state are less severely altered than during VOEs, they often remain outside conventional reference ranges, reflecting a distinct physiological baseline in SCD patients. These findings underscore the urgent need for prospective studies to define specific hematological reference values for steady-state SCD patients, which is essential for optimizing their clinical management.

PMID:41995143 | DOI:10.1155/bmri/2741454

J Nurs Manag. 2026;2026(1):e4278999. doi: 10.1155/jonm/4278999.

ABSTRACT

AIM: To assess the psychological status and the prevalence of presenteeism among Spanish nurses working in emergency departments (EDs) and intensive care units (ICUs) and to explore the association between these variables.

BACKGROUND: Nurses working in ED and ICU settings experience higher levels of psychological stress, including burnout and lower job satisfaction. Anxiety and depression are common in this group and may contribute to nursing presenteeism. Presenteeism is defined as continuing to work despite feeling ill or unwell. There are gaps in research addressing the psychological status and presenteeism of ED and ICU nurses in Spain.

METHODS: A cross-sectional study using the Kessler Psychological Distress Scale (K-10) and the Stanford Presenteeism Scale (SPS-6) was conducted between April and December 2022. In total, 182 participants were included. The study followed the STROBE guidelines.

FINDINGS: Psychological distress was identified in 35.7% of participants, and a presenteeism prevalence of 43.8% was observed among nurses. A statistically significant association between psychological distress and presenteeism was found (p < 0.001). Age, educational background, and perceived work-related stress (p = 0.05) were identified as factors associated with psychological distress. Perceived work-related stress was also significantly associated with presenteeism (p < 0.05).

CONCLUSIONS: More than one-third of nurses working in ED and ICU settings experienced psychological distress, and a high prevalence of presenteeism was identified. Presenteeism was associated with higher levels of psychological distress.

IMPLICATIONS FOR NURSING: Early detection of psychological distress and the implementation of workplace interventions may help reduce presenteeism among nurses.

PMID:41995116 | DOI:10.1155/jonm/4278999

Sci Rep. 2026 Apr 16. doi: 10.1038/s41598-026-48150-w. Online ahead of print.

ABSTRACT

Groundwater is the principal buffer of France’s water security, yet its long-term response to intensifying climate variability and rising demand remains unresolved. We analyse 2000-2023/2024 in situ water-level records from 2536 piezometers across 717 aquifers, using Theil-Sen trend estimation with Mann-Kendall significance testing, and derive trend estimates at aquifer and city scales. A clear geographic divide emerges: aquifers in the south, southwest and Mediterranean fringe show widespread and locally steep declines, whereas northern and northwestern systems, including the Paris Basin, exhibit statistically significant but smaller-magnitude recoveries. Partitioning the record at 2015 reveals intensified deterioration in many southern and Mediterranean aquifers, while several large systems along the Atlantic margin and in northern France show incipient stabilisation. To our knowledge, this is the first high-resolution, in situ national assessment in metropolitan France to evaluate long-term groundwater trends and their evolution since 2015. These hotspot maps and multi-scale diagnostics can guide extraction limits, prioritise recharge efforts, and strengthen drought planning, setting a national benchmark for groundwater vulnerability under climate stress.

PMID:41991564 | DOI:10.1038/s41598-026-48150-w

BMJ Open. 2026 Apr 16;16(4):e101629. doi: 10.1136/bmjopen-2025-101629.

ABSTRACT

OBJECTIVES: The aim of this study is to determine if a geriatric co-management model, referred to as ‘The Geriatric Emergency Medicine (GEM)-team’ is associated with less admissions to hospital in older patients compared with the usual care without increasing the risk of mortality or 30-day emergency department (ED) readmissions.

DESIGN: This observational, controlled study used 18-month data prospectively collected from hospital records. Inverse probability weighting was used to account for baseline differences.

SETTING: An ED at a suburban Dutch general hospital, receiving approximately 10 000 patients aged 70 or older per year.

PARTICIPANTS: All patients aged 70 or older were screened according to predefined criteria. When positively screened patients were presented at the ED on weekdays between 09:00-17:00, they received geriatric co-management. Outside these hours and when the capacity of the GEM team was reached, patients received care as usual.

INTERVENTIONS: Geriatric co-management at the ED involves a geriatric multidisciplinary team in collaboration with the primary ED physician who share management and responsibility for the provided medical treatment and nursing care starting directly at the primary assessment.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was hospital admission and secondary outcomes were the composite outcome of 30-day ED readmissions and mortality.

RESULTS: Patients receiving geriatric co-management (n=972) had lower odds for hospitalisation (OR: 0.77, 95% CI 0.65 to 0.91) compared with the control group (n=1355) while 30-day ED readmissions and mortality did not differ between groups (OR: 1.11, 95% CI 0.91 to 1.36).

CONCLUSIONS: Geriatric co-management at the ED is associated with decreased hospital admissions while 30-day ED readmissions or mortality was not impacted. These preliminary results contribute to the evidence that geriatric co-management may be an effective intervention for older patients with frailty at the ED.

PMID:41991262 | DOI:10.1136/bmjopen-2025-101629

BMJ Open. 2026 Apr 16;16(4):e103702. doi: 10.1136/bmjopen-2025-103702.

ABSTRACT

OBJECTIVE: Heart failure (HF) is a major public health issue due to its high morbidity, mortality and healthcare burden. This study aimed to provide estimates of HF incidence, survival rates, outcome changes and their predictive factors in a central Italian population over the decade 2014-2023.

DESIGN: Population-based retrospective cohort study.

SETTING: Hospital discharge records from all hospitals in L’Aquila Province of Italy were analysed.

PARTICIPANTS: All residents who experienced a HF index hospitalisation between 2014 and 2023 were included. HF index hospitalisation was defined as the first hospitalisation for HF in patients with no prior hospitalisation from the same diagnosis for at least 4 years.

PRIMARY OUTCOME MEASURES: The primary outcomes were age-standardised and sex-standardised incidence rates of HF index hospitalisations and all-cause mortality following index hospitalisation. Incidence rate ratios (IRRs), survival and their associated factors were analysed with negative binomial regression models, Kaplan-Meier analysis and Cox proportional hazards models, respectively.

RESULTS: A total of 6965 incident cases from 17 588 HF hospitalisations in the decade under study were analysed. The overall standardised incidence rate was 1.73 per 1000 person-years, with significant differences by age and sex. Incidence rates decreased by 17% from 2014-2018 to 2019-2023 (IRR: 0.834; 95% CI 0.743 to 0.936). Cumulative 1-year and 5-year survival were 70.05% and 36.38%, respectively, with a progressively higher mortality risk in older people. Compared with the 2014-2018 cohort, the 2019-2022 cohort showed improved survival at 30 and 90 days and at 1 year overall and by age groups, with <50 exception.

CONCLUSIONS: HF incidence declined, particularly in older populations, and remained higher in men, while survival rates improved. Despite these trends, HF continues to represent a substantial clinical and public health burden.

PMID:41991261 | DOI:10.1136/bmjopen-2025-103702

Int Wound J. 2026 Apr;23(4):e70910. doi: 10.1111/iwj.70910.

ABSTRACT

Burn injuries pose a significant challenge in resource-limited settings, particularly during humanitarian crises. This study examines the epidemiology, management, and outcomes of burn patients at a tertiary hospital in Damascus, Syria, from 2021 to 2024. A single-centre retrospective cohort study was conducted on 500 admitted burn patients. Data on demographics, injury characteristics, management, complications and mortality were analysed using descriptive statistics, chi-square tests, Mann-Whitney U tests and binary logistic regression. The lethal area 50% (LA50) was estimated using the logistic regression equation: $\mathrm{LA}50=–\frac{\text{constant}+\sum \left(b_i{x}_i\right)}{b_{\text{TBSA}}}$ . The mean patient age was 20.5 ± 17.9 years, with a male predominance (55%). Flame burns (72.4%) at home (87.6%) were most common. The mean total body surface area burned was 30.99% ± 21.31%, with 68.6% being full-thickness injuries. The complication rate was 91%, with infection being most prevalent. The overall mortality rate was 39%, with sepsis (56.4%) as the leading cause. Logistic regression identified larger burn area (OR = 1.152, p < 0.001), full-thickness depth (ref. partial thickness, OR = 0.281, p < 0.001), older age and female gender as independent predictors of increased mortality. Deceased patients had significantly shorter hospital stays. LA50 was 42.63% for a 40-year-old male with a partial-thickness flame burn and a 10-day hospital stay; for a female with a full-thickness flame burn under the same conditions, it was 27.43%. This study reveals an alarmingly high burden of burn injuries in a crisis-affected setting, with extreme complication and mortality rates. The findings highlight the critical impact of extensive burns and sepsis, underscoring severe systemic constraints on care. Urgent context-specific interventions to strengthen acute burn management, infection control, and prevention strategies are imperative.

PMID:41991187 | DOI:10.1111/iwj.70910

Mol Cell Endocrinol. 2026 Apr 14:112807. doi: 10.1016/j.mce.2026.112807. Online ahead of print.

ABSTRACT

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. As a clinically heterogeneous condition, distinct subtypes of PCOS may exist with varying clinical and biochemical features which impact clinical handling of PCOS. Identifying sub-clusters of PCOS women is a critical and challenging issue toward individualized treatment. Using data on the DNA methylome of PCOS cases and healthy controls, we performed an epigenome-wide association study (EWAS) on DNA methylation variability to investigate epigenetic heterogeneity of PCOS to explore the molecular basis in its clinical heterogeneity. We identified 136 CpG sites that are significantly highly variable in DNA methylation in PCOS cases (p<1×10^-7). The EWAS results were significantly enriched for biological pathways including non-alcoholic fatty liver disease, polycomb repressive complex, and Hippo signaling pathway, all have been reportedly to involve in PCOS physiopathology. Based on the identified 136 significant sites, we were able to cluster PCOS cases into two major clusters. Correlation of the clusters with observed clinical variables found four reproductive hormones i.e. estradiol, progesterone, thyroid stimulating hormone and testosterone, that optimally characterize the clustering with high statistical significance (p=1.50×10^-3). Our results showed that variability analysis of the PCOS DNA methylome can be a valuable approach for exploring the biological basis in PCOS clinical heterogeneity to promote individualized treatment and management.

PMID:41990965 | DOI:10.1016/j.mce.2026.112807

J Hazard Mater. 2026 Apr 11;509:142041. doi: 10.1016/j.jhazmat.2026.142041. Online ahead of print.

ABSTRACT

This study provides the first global statistical assessment of how water quality parameters (WQPs) influence the formation and regulatory exceedances of major disinfection by‑products (DBPs) in drinking water (disinfected tap water), including trihalomethanes (THMs), haloacetic acids (HAAs), and haloacetonitriles (HANs). A dataset of over 800 drinking water samples from 30 countries was analysed using multivariate techniques (PCA, CCA, MRA, FAMD) to disentangle the contributions of seven WQPs to DBP formation. Bromide emerged as the dominant driver of DBP speciation, with the Br⁻:Cl⁻ ratio strongly favouring brominated DBPs, while temperature showed consistent positive associations with multiple DBPs. TOC, pH, and inorganic nitrogen species exhibited compound‑specific associations, reflecting the diverse precursor and formation pathways across DBP classes. Globally, HAAs were the most prevalent DBP group and exceeded safety thresholds more frequently than THMs and HANs. Elevated THMs and HANs levels occur in several European countries (France and Croatia, respectively) dependent on source waters chemistry, such as high Br⁻ levels. Iran from Middle East and India report the highest HAAs occurrence, driven by regional reliance on unregulated or saline sources. Overall, DBP occurrence was more strongly governed by water‑matrix chemistry than by geographic location or treatment type, underscoring the need for locally tailored water‑treatment strategies that account for parameters such as bromide levels, NOM characteristics, and temperature‑driven variability to effectively control DBP formation and ensure safe drinking water. This work offers practical guidance for water utilities and regulatory agencies by clarifying how fluctuations in WQPs shape DBP formation under typical operational conditions.

PMID:41990661 | DOI:10.1016/j.jhazmat.2026.142041

Arkh Patol. 2026;88(2):52-58. doi: 10.17116/patol20268802152.

ABSTRACT

OBJECTIVE: To establish the mechanisms of pathomorphism of grafted C6 glioma (glioblastoma, GB) under the influence of 1267 nm laser therapy using in vivo experiments.

MATERIAL AND METHODS: The experiment was performed on 40 Wistar rats with transplanted GB. In the experimental groups, 1 week after tumor transplantation, rats underwent daily laser therapy for 3 weeks. One therapy session lasted 51 minutes (3 laser irradiations for 17 minutes with 5-minute breaks between irradiations), at a dose of 12.6 kJ/cm² laser with a wavelength of 1267 nm. The comparison groups consisted of animals without a tumor and with a tumor, but without LT. Immunohistochemical markers of apoptosis (p53, Bax, Fas receptor), proliferation (Ki67), and autophagolysosome formation (LC3B, clathrin, and caveolin) were used. In statistical analysis, the Shapiro-Wilk test for the normality of the distribution was performed. The averages were compared using the Welch t-test.

RESULTS: The survival rate in the group with transplanted GB after laser therapy compared with the experimental group of animals without LT was 1.8 times higher after a course of LT with a dose of 12.6 kJ/cm² (64% and 34%, respectively). It was found that LT reduces the proliferation of GB cells (Ki67), activates the mitochondrial pathway of apoptosis (Bax and p53) in GB cells, and blocks the formation of autophagolysosomes (LC3B, clathrin, caveolin). Conclusion. Under the action of a laser (1267 nm), pronounced pathomorphosis of transplanted C6 glioma develops, its growth rate decreases, and animal survival increases from 34% to 64%. Thus, GB therapy with a laser with a wavelength of 1267 nm may become a promising therapeutic approach in the development of additional non-invasive GB treatment method.

PMID:41989546 | DOI:10.17116/patol20268802152

Inform Health Soc Care. 2026 Apr 16:1-11. doi: 10.1080/17538157.2026.2654150. Online ahead of print.

ABSTRACT

OBJECTIVES: This study conducted an informatics system evaluation of two LLMs (GPT-4o and DeepSeek-V3) for patient education, combining clinician-rated quality with patient-perceived usability across thematically stratified queries.

MATERIALS AND METHODS: In a blinded, within-subject design, 16 frequently asked questions about biologic therapies were categorized into three domains: treatment/drug selection, safety/adverse effects, and special conditions/daily life. Responses were standardized, generated without external retrieval, anonymized as A/B pairs. Thirty physicians assessed clinical appropriateness, scientific accuracy, comprehensiveness, while 60 patients rated readability, understandability, actionability, perceived adequacy, decision support, and trust on 5-point Likert scales. Analyses included paired t-tests, Holm/FDR corrections and two one-sided tests (TOST) to distinguish statistical non-difference from practical equivalence.

RESULTS: Physicians rated GPT higher across all domains (p < .002), with largest gaps in safety/side effects and treatment/drug selection. Patients favored GPT for understandability, actionability, and decision support (p < .001), while readability, adequacy, trust, and reading time were statistically and clinically equivalent.

CONCLUSION: Findings highlight the need for topic-aware governance: guideline-dense queries suited to retrieval-augmented generation and checklist compliance, and context-sensitive queries requiring uncertainty signaling and human oversight. This layered approach advances health informatics by defining where LLMs may substitute versus where they require verification, supporting safe and auditable integration into patient education.

PMID:41989204 | DOI:10.1080/17538157.2026.2654150