Category: Nevin Manimala

Curr Med Chem. 2026 Mar 19. doi: 10.2174/0109298673408383251203080930. Online ahead of print.

ABSTRACT

BACKGROUND: The sarcopenia index (SI) was recommended as a surrogate marker of sarcopenia based on the serum creatinine-to-cystatin C ratio, given its accessibility and effectiveness. However, the impact of SI on chronic heart failure (HF) has not been addressed.

METHODS: A total of 1209 chronic HF patients from a retrospective cohort study were included. Cox regression and inverse probability of treatment weighting (IPTW) were used to analyze the impact of the SI on all-cause death and hospitalization. The C-index, net reclassification improvement (NRI), and discrimination improvement (IDI) were used to assess the predictive ability for all-cause death after the addition of SI.

RESULTS: By IPTW analysis, chronic HF patients with a high SI (SI> 62.5) demonstrated a decreasing trend of 28-day hospital death (HR=0.44, 95% CI = 0.06, 3.27, p=0.422), 3-month death (HR=0.45, 95% CI = 0.06, 3.42, p=0.441) and 6-month death (HR=0.44, 95% CI = 0.06, 3.27, p=0.422) compared with a low SI group (SI≤62.5). The subsequent meta-analysis revealed that a low SI was significantly associated with all-cause mortality (OR 0.42, 95% CI = 0.28, 0.62, I2 = 0, p < 0.0001) in patients with chronic HF. Finally, the SI significantly improved the predictive performance of 6-month allcause mortality in chronic HF patients via the integrated IDI (0.002, 95% CI= 0.00-0.120, p=0.033) but not the C-index (Z statistic=0.116) or NRI (0.114, 95% CI= -0.301–0.263).

DISCUSSION: Heart failure and sarcopenia share common pathogenetic pathways, including hormonal changes, malnutrition, inflammation and oxidative stress.

CONCLUSION: A low SI may indicate a poorer prognosis in patients with chronic heart failure. These findings should be validated in larger, prospective studies.

PMID:41863167 | DOI:10.2174/0109298673408383251203080930

Perspect Sex Reprod Health. 2026 Mar 21. doi: 10.1111/psrh.70060. Online ahead of print.

ABSTRACT

PURPOSE: We sought to understand the relationship between Kentucky medical students’ personal beliefs and values about the state’s restrictive abortion climate and their considerations for residency training and/or post-residency practice in Kentucky.

METHODS: We surveyed medical school students enrolled in two medical schools in Kentucky about their personal beliefs and values regarding the state’s abortion climate and whether they were considering residency training and/or staying post-residency in Kentucky. We used descriptive statistics to examine differences in responses, stratified by consideration for residency training and staying. We further examined these relationships among the subset of students who were considering a residency in obstetrics and gynecology (OBGYN).

RESULTS: The survey response rate was 17.9%. Overall, 77.8% (n = 210) of respondents indicated that the current anti-abortion climate in Kentucky did not align with their personal beliefs and values. Among all medical students, 51.1% (n = 138) indicated they were considering staying in Kentucky post-residency, including 29% of those considering an OBGYN residency. Among those considering an OBGYN residency (n = 74), 51.4% (n = 38) reported that they were considering staying in Kentucky for residency, compared with 48.6% (n = 69) of those who were not considering an OBGYN residency.

CONCLUSIONS: While most responding medical students reported their personal beliefs and values do not align with the state’s anti-abortion climate, the majority are considering staying in Kentucky for residency and post-residency practice, regardless of their interest in an OBGYN residency. This suggests that opinions about the anti-abortion climate may not factor prominently in students’ decisions about residency training and practice location.

PMID:41863155 | DOI:10.1111/psrh.70060

J Vet Diagn Invest. 2026 Mar 21:10406387261432653. doi: 10.1177/10406387261432653. Online ahead of print.

ABSTRACT

Digital microscopy is increasingly used in veterinary diagnostic pathology. However, limited independent research has been published on its use, especially for the purpose of evaluating blood films. Hence, determining the potential limits of blood film assessments obtained via digital microscopy is needed. We compared the agreement of digital and optical cytology for the detection of common cellular morphology changes and abnormalities in veterinary blood films. Twenty-two veterinary clinical pathologists and residents evaluated canine, feline, and equine blood films on glass slides via optical microscopy and digitized blood film slides, with a ≥8-wk washout period between evaluations. One of the equine cases was a patient experimentally infected with Theileria haneyi. Using a standardized rubric, 16 erythrocyte features, 2 platelet features, and 2 leukocyte features were scored from absent to 4+. Additional comments at pathologist discretion were recorded. Changes in erythrocyte shape, platelets, and leukocytes were readily identified on both digital and glass slides. T. haneyi organisms were identified on significantly fewer digitized blood film slides than glass slides. Additionally, intra-observer consistency was low between digitized blood film slide and glass slide evaluation. Relative to glass slides, digitized blood film slides appear generally adequate for identifying erythrocyte, leukocyte, and platelet morphology changes, but may be inadequate for identifying intracellular T. haneyi organisms; however, more studies are needed. Clinicians should exercise caution when interpreting results from digitized blood film slides in which blood-borne infectious disease may be present.

PMID:41863154 | DOI:10.1177/10406387261432653

Acta Anaesthesiol Scand. 2026 Apr;70(4):e70225. doi: 10.1111/aas.70225.

ABSTRACT

PURPOSE: Pre-admission functional status affects patients’ ability to overcome the deteriorating effects of acute critical illness. We aimed to develop a clinical prediction model for 90-day and 1-year mortality based on pre-admission data, including functional status, in adult delirious ICU patients.

METHODS: We included participants randomized to the three highest-enrolling hospitals in the Agents Intervening against Delirium in the Intensive Care Unit (AID-ICU) trial, with pre-admission data on the Clinical Frailty Scale, Comorbidity-Polypharmacy Score, and Barthel-20 score. Ten candidate models were evaluated using multiple modeling approaches. Final models were chosen based on the hyperparameter setting maximizing the Cox-Snell pseudo R². All baseline variables and trial allocation were included. Final models were retrained on the full dataset, with internal validation performed using bootstrapping validation adjusting for optimism.

RESULTS: Of 1000 participants in AID-ICU, 632 were included: 630 provided data on 90-day mortality, and 610 on 1-year mortality. The elastic net regression models demonstrated stable, robust performance. The optimism-adjusted areas under the receiver operating characteristic curves were 0.74 (95% confidence interval [CI]: 0.70-0.78) and 0.74 (95% CI: 0.70-0.77) for the 90-day and 1-year mortality models, respectively. Calibration was good across the risk spectrum. Frailty, age, the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU), advanced cancer, and surgical admission contributed most to the prediction models.

CONCLUSIONS: We developed models to predict 90-day and 1-year mortality at ICU admission in patients enrolled in the AID-ICU trial, using baseline variables, including functional status measures. The models showed fair discrimination and good calibration, with frailty, age, SMS-ICU, advanced cancer, and surgical admission as key predictors. Future studies are needed to test whether the model is valid in other ICU settings and whether its performance is sufficient to have clinical value.

EDITORIAL COMMENT: This article presents mortality prediction models for ICU patients with delirium that incorporate pre-admission functional status and apply several modern statistical learning approaches, providing an instructive and transparent example of contemporary prediction modeling. The resulting elastic net regression models showed fair discrimination and good calibration for predicting 90-day and 1-year mortality, with frailty, age, and illness severity emerging as the strongest predictors. However, such models should be interpreted cautiously at the individual patient level and may be most useful for identifying patients at increased risk who may benefit from careful clinical assessment, individualized treatment, and close follow-up.

PMID:41863137 | DOI:10.1111/aas.70225

Psychogeriatrics. 2026 May;26(3):e70158. doi: 10.1111/psyg.70158.

ABSTRACT

BACKGROUND: With the advent of disease-modifying therapies for Alzheimer’s disease, there is a growing demand for more cost-effective methods that predict amyloid PET positivity. In Japan, the combination of structural brain MRI and regional cerebral blood flow (rCBF) single-photon emission computed tomography (rCBF SPECT) is routinely used in clinical practice for neuroimaging. The present study investigated the utility of this imaging approach for amyloid PET positivity in real-world clinical settings.

METHODS: A retrospective analysis of 101 patients who visited the Memory Clinic at Juntendo University Hospital between April 2019 and September 2023 was performed. All patients had undergone amyloid PET imaging at their own expense, in addition to a neuropsychological assessment, structural brain MRI and rCBF SPECT. Among 58 cases that underwent a voxel-based specific regional analysis system for Alzheimer’s disease (VSRAD), volumetric differences between the amyloid-positive and -negative groups were assessed using Statistical Parametric Mapping (SPM) version 12.

RESULTS: Among the 101 patients analysed, 68 were positive and 33 were negative for amyloid. Twenty-nine patients had a change in clinical diagnosis after amyloid PET imaging, which affected subsequent management. Using VSRAD, VOI severity (continuous value) was set to 0.95 based on Youden’s index and AUC (95% CI) was 0.72 (0.572-0.867), with a sensitivity of 90%, specificity of 52% and accuracy of 78%. In the visual assessment, MRI and rCBF SPECT were combined, and AUC (95% CI) was 0.767 (0.629-0.905), with a sensitivity decrease to 21% and specificity increase to 95%. The SPM12 analysis revealed clusters in the right medial temporal lobe at an uncorrected threshold (p < 0.001). However, no voxels survived family-wise error (FWE) correction (p < 0.05).

CONCLUSION: A VSRAD analysis of brain MRI has moderate discriminatory ability as a screening tool for predicting amyloid PET positivity. The addition of SPECT to MRI was not associated with a statistically significant improvement compared with MRI alone. SPECT may contribute to the differential diagnosis of non-Alzheimer’s disease. MRI alone could be considered an option to increase the pre-test probability of amyloid PET positivity.

PMID:41863136 | DOI:10.1111/psyg.70158

Curr Med Imaging. 2026 Mar 16. doi: 10.2174/0115734056429704251125042910. Online ahead of print.

ABSTRACT

BACKGROUND: Although fetal MRI has been increasingly widely used in clinical and research settings, quantitative studies specifically targeting the ossification centers of the atlas and axis remain scarce. This study aims to quantitatively assess the ossification centers of the atlas and axis in fetuses using Magnetic Resonance Imaging (MRI) and establish standardized reference data for prenatal evaluation.

MATERIALS AND METHODS: This study included 41 human fetuses (24 males and 17 females) at 17 to 42 weeks of gestation, collected after spontaneous abortion or preterm birth that met ethical standards. High-resolution imaging was obtained by an MRI scanner. Three-dimensional volumetric data of the ossification centers were obtained and analyzed using the 3D Slicer software. Morphometric parameters, which included the 3D maximum diameter, projection surface area, and volume, were measured. Statistical analysis was conducted with SPSS 23, and growth dynamics were evaluated by regression models.

RESULTS: Analysis shows that the ossification centers of the atlas and axis increase proportionally with gestational age, and there is a significant correlation between age and measurement parameters. The average 3D maximum diameter, projected surface area, and volume show consistent growth patterns, with no significant differences between genders. The linear regression model is the best at describing developmental dynamics, with high coefficients of determination for all parameters (R 2>0.70).

DISCUSSION: This study indicates that the ossification centers of the fetal atlas and axis increase proportionally with gestational age, and a high correlation is observed in all morphological measurement parameters. Compared with ultrasound or CT, MRI has been proven to be a superior non-invasive imaging method that can provide high-resolution three-dimensional data for detailed evaluation of the fetal cervical spine without radiation exposure. The lack of gender-based differences supports the use of a unified growth model. These normative data provide valuable benchmarks for detecting cervical dysplasia. Although the sample size and cross-sectional design are relatively limited, this study provides clinically applicable growth references that may aid in the early diagnosis of congenital spinal abnormalities.

CONCLUSION: This study provides standardized morphometric data for the main ossification centers of the atlas and axis in human fetuses. These findings contribute to a better understanding of fetal cervical spine development and establish a reference framework for early detection of congenital abnormalities. In addition, the research findings emphasize that MRI is a reliable and non-invasive tool for the detailed assessment of fetal skeletal maturity.

PMID:41863132 | DOI:10.2174/0115734056429704251125042910

Curr Hypertens Rev. 2026 Mar 18. doi: 10.2174/0115734021421550260109060131. Online ahead of print.

ABSTRACT

INTRODUCTION: While medication non-compliance for hypertension (HTN) and type II diabetes mellitus (T2DM) patients drives poor outcomes globally, its specific clinical and financial impact in Jordan is poorly quantified. This study aimed to determine the prevalence of medication noncompliance, quantify its effect on hospitalization rates and costs, and assess the role of sociodemographic factors in a Jordanian patient cohort.

METHODS: A prospective cohort study was conducted at a major Jordanian hospital from 2022 to 2023. A final sample of 159 patients with HTN and/or T2DM was followed for one year. Participants were classified as compliant (n = 86) or non-compliant (n = 73) based on patient self-reports and pharmacy refill data. Hospitalization rates, intensive care unit admissions, and sociodemographic data were compared between groups.

RESULTS: The prevalence of poor compliance was 45.9% (n = 73). Poor compliance was strongly associated with hospitalization (p < 0.001). Non-compliant patients had significantly higher rates of floor admissions (82.6% vs. 16.4%) and intensive care unit admissions (37.2% vs. 0%) compared to the compliant group (n = 86). This resulted in substantially higher healthcare costs. After statistical adjustment, poor compliance was the most powerful independent predictor of hospital admission (Adjusted Odds Ratio 45.78), while baseline sociodemographic factors were not significantly associated with admission.

DISCUSSION: Our findings highlight that medication non-compliance is a major cause of hospitalizations and escalating healthcare costs in Jordan. The prevalence of non-adherence observed in our cohort (45.9%) aligns with trends reported in neighboring regional studies. Consequently, further research into the specific socio-behavioral barriers to adherence is essential.

CONCLUSION: Medication non-compliance is a prevalent and critical driver of preventable hospital admissions and high healthcare costs among Jordanian patients with HTN and T2DM. These findings underscore an urgent need for targeted interventions to improve compliance and reduce the associated healthcare burden.

PMID:41863125 | DOI:10.2174/0115734021421550260109060131

Clin Psychol Psychother. 2026 Mar-Apr;33(2):e70258. doi: 10.1002/cpp.70258.

ABSTRACT

This study examined the association between therapist-level flourishing and burnout with early client dropout. Participants included 141 therapists (M_age = 46.1; 82.8% White; 80.7% female) and 12,988 adult clients (M_age = 37.8; 41.9% White; 62.5% female) using a US-based digital mental health network. Early dropout was operationalised as attending fewer than three sessions. Therapists completed self-report measures of burnout and flourishing. Multilevel logistic regression examined therapist-level predictors of early dropout, accounting for nested client data. Approximately 27.8% of clients dropped out early. Therapists accounted for 9.4% of the variance in client dropout. Therapist flourishing was significantly associated with lower dropout rates (OR = 0.90, 95% CI [0.814, 0.998]), while therapist burnout was not (OR = 1.01, 95% CI [0.758, 1.353]). More years in practice (OR = 1.02, 95% CI [1.013, 1.031]) and larger weekly caseloads (OR = 1.02, 95% CI [1.003, 1.033]) were both significantly linked to higher early dropout rates. Dropout was significantly lower for White clients (OR = 0.827, 95% CI [0.736, 0.929]) and White therapists (OR = 0.711, 95% CI [0.539, 0.938]). Therapist flourishing may support early client retention, while higher caseload, more experience and racial/ethnic disparities are associated with increased dropout. Findings highlight the need for wellness promotion, structural support and culturally responsive practices in psychotherapy.

PMID:41863114 | DOI:10.1002/cpp.70258

Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2026 Mar 21;47(1):85-91. doi: 10.2478/prilozi-2026-0009. Print 2026 Mar 1.

ABSTRACT

Objective: Neonatal sepsis is a leading cause of morbidity and mortality in newborns. Timely and accurate diagnosis remains a challenge due to the nonspecific clinical signs and the limited sensitivity and specificity of conventional biomarkers such as C-reactive protein (CRP), procalcitonin (PCT), and white blood cell (WBC) count. Presepsin, a soluble CD14 subtype, has been proposed as a promising early marker of bacterial infection. This study aimed to assess the diagnostic value of serum presepsin in comparison with traditional inflammatory markers in neonates with suspected sepsis. Methods: In a prospective observational study conducted at a single tertiary care center, 18 neonates with clinical signs of sepsis were evaluated. The patients were divided into culture-proven (n=7) and culture-unproven (n=11) sepsis groups. Presepsin levels were measured using a chemiluminescent assay and compared to CRP, PCT, and WBC counts. Results: The median presepsin levels were higher in culture-proven cases (740 ng/L vs. 393 ng/L), but without statistical significance. Similar trends were observed for CRP and PCT, while WBC counts showed no diagnostic value. Conclusion: Although presepsin demonstrated potential as an early biomarker, its diagnostic performance in this small cohort was inconclusive. Combined use of presepsin with conventional markers and clinical evaluation may improve early sepsis diagnosis in neonates.

PMID:41863111 | DOI:10.2478/prilozi-2026-0009

Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2026 Mar 21;47(1):25-45. doi: 10.2478/prilozi-2026-0003. Print 2026 Mar 1.

ABSTRACT

Background: Post-traumatic stress disorder (PTSD) is traditionally conceptualized as a disorder of fear learning and emotional dysregulation; however, accumulating evidence indicates that objective cognitive dysfunction, particularly memory impairment, represents a core and enduring feature of the disorder. Prior quantitative syntheses have been limited by heterogeneous control groups, pooling of disparate cognitive outcomes, and inadequate handling of statistical dependence across outcomes. Objective: This systematic review and meta-analysis is aimed at determining whether trauma-exposed adults diagnosed with PTSD exhibit objective impairments in memory performance compared with trauma-exposed adults without PTSD. Methods: A comprehensive search of PubMed/MEDLINE, Embase, PsycINFO, and Web of Science was conducted up to December 17, 2025. Eligible studies included trauma-exposed adults (≥18 years) with PTSD diagnosed using DSM or ICD criteria and a trauma-exposed non-PTSD comparator group. Objective neuropsychological measures of verbal episodic memory and working memory were extracted. Risk of bias was assessed using the Newcastle-Ottawa Scale. Standardized mean differences (Hedges’ g) were pooled using multilevel random-effects meta-analytic models to account for within-study dependence. Results: Ninety studies met the criteria for the systematic review, of which 88 contributed quantitative data to the meta-analysis. Across studies, individuals with PTSD demonstrated significantly poorer memory performance compared with trauma-exposed controls without PTSD. Impairments were most consistent for verbal episodic memory and working memory, with effects observed across diverse trauma types and assessment instruments. Considerable heterogeneity was present but did not negate the overall pattern of PTSD-specific cognitive impairment. Sensitivity analyses confirmed the robustness of findings. Although funnel plot asymmetry suggested possible publication bias, trim-and-fill-adjusted estimates remained statistically significant. Conclusions: Trauma-exposed adults with PTSD exhibit reliable and clinically meaningful impairments in objective memory performance beyond the effects of trauma exposure alone. These findings support conceptualizations of PTSD as a disorder involving maladaptive memory processing and underscore the importance of incorporating cognitive assessment and intervention into PTSD research and clinical care.

PMID:41863109 | DOI:10.2478/prilozi-2026-0003