Category: Nevin Manimala

Pak J Med Sci. 2026 Aug;42(8):2123-2128. doi: 10.12669/pjms.42.8.12258.

ABSTRACT

OBJECTIVE: To compare the effectiveness of oral lactase enzyme versus lactose-free formula in the management of secondary lactose intolerance in persistent and severe persistent diarrhea.

METHODS: This randomized controlled trial was conducted at the pediatric unit of Ziauddin University Hospital, Kemari, Karachi, Pakistan, from June, 2023 to July,2024. A total of 50 children were included in this study following the inclusion criteria of both genders aged 6-24 months and presented with persistent or severe persistent diarrhea due to secondary lactose intolerance. In Group-A, five drops of lactase enzyme (200 units lactase/drop)/ounce of milk were added 5-30 minutes before feeding, while in Group-B, lactose-free formula milk/diet was advised. They were monitored from day one through day five and assessed for outcome measures, comprising clinical (on day five) and laboratory assessments (stool pH and reducing substances on day six), success or failure, and duration of hospital stay (less or more than five days).

RESULTS: In a total of 50 children, the median age was 11 (9-15.3) months. There were 30 (60.0%) children who presented with vomiting, while 14 (28.0%) had severe dehydration. At day five, lactase enzyme children showed significantly less episodes of diarrhea versus lactose free formula (20.0% vs. 48.0%, p=0.037), while all other complaints were statistically similar (p>0.05). The duration of hospital stay was significantly less among children in lactase enzyme group versus lactose free formula group (p=0.001).

CONCLUSION: The effectiveness of lactase enzyme supplementation was better than lactose-free formula in children with persistent diarrhea due to secondary lactose intolerance.Clinical Trial Registration: NCT06827405 (https://clinicaltrials.gov).

PMID:42668931 | PMC:PMC13525527 | DOI:10.12669/pjms.42.8.12258

Pak J Med Sci. 2026 Aug;42(8):2045-2051. doi: 10.12669/pjms.42.8.15956.

ABSTRACT

OBJECTIVES: To assess the frequency of bullying and its association with depression, anxiety, stress, and coping strategies among undergraduate dental students.

METHODOLOGY: A cross-sectional study was conducted among 124 dental undergraduates at Bibi Aseefa Dental College, Larkana, Pakistan (August 2025-January 2026). Bullying exposure was assessed using an adapted 15-item Negative Acts Questionnaire-Revised (NAQ-R), while psychological distress was measured using the 21 items Depression, Anxiety, and Stress Scale (DASS-21), Coping strategies were evaluated using the 24 items Brief-COPE inventory and were categorized as adaptive and maladaptive. Data were analyzed using descriptive statistics, Chi-square tests, and Spearman’s correlation, with a p-value < 0.05 considered statistically significant.

RESULTS: Most students reported high bullying exposure (74.2%). Moderate to extremely severe depression was observed in 50.8%, severe to extremely severe anxiety in 54.0%, and moderate to severe stress in 29.9% of participants. Bullying exposure was significantly associated with depression (χ² = 18.2, p = 0.020), stress (χ² = 16.6, p = 0.035), and anxiety (χ² = 29.2, p < 0.001). Spearman’s correlation revealed that bullying was positively correlated with anxiety (ρ = 0.427, p < 0.001) and maladaptive coping (ρ = 0.403, p < 0.001), while maladaptive coping strongly correlated with anxiety (ρ = 0.648, p < 0.001). Adaptive coping showed weaker positive correlations with anxiety, suggesting increased coping efforts in response to distress. Multivariable analysis identified high bullying exposure (OR ≈6.0, p<0.001) and maladaptive coping (OR ≈ 1.18, p<0.001) as significant independent predictors of moderate to severe anxiety.

CONCLUSION: Bullying is highly prevalent among dental students and strongly associated with anxiety, depression, and maladaptive coping. Targeted interventions, including bullying prevention, mental health support, and resilience training, are essential to safeguard student well-being.

PMID:42668930 | PMC:PMC13525524 | DOI:10.12669/pjms.42.8.15956

Cureus. 2026 Jul 30;18(7):e113650. doi: 10.7759/cureus.113650. eCollection 2026 Jul.

ABSTRACT

INTRODUCTION: Acute leukemias are the most common hematologic malignancies in children, but detailed epidemiological and immunophenotypic data are limited in Morocco. A better characterization of these diseases is needed to optimize diagnostic strategies.

OBJECTIVE: To describe the epidemiological, clinical, and biological features of pediatric acute leukemias and to evaluate the diagnostic contribution of flow cytometry in a Moroccan university hospital center, based on available diagnostic tools.

METHODS: We conducted a retrospective, single-center study at the hematology laboratory of Ibn Sina University Hospital, Rabat, including all children under 15 years diagnosed with acute leukemia between January 1, 2022, and January 1, 2024. Diagnosis was based on bone marrow cytology, cytochemistry, and flow cytometry. Cases were classified according to the World Health Organization (WHO) 2008 classification based on the available diagnostic tools, as cytogenetic and molecular studies were not available in our setting. Cytochemical staining for myeloperoxidase (MPO) was systematically performed. Positivity thresholds for flow cytometry followed European Group for the Immunological Characterization of Leukemias (EGIL) recommendations. Statistical analyses used Fisher’s exact and Kruskal-Wallis tests, with p < 0.05 considered significant.

RESULTS: A total of 106 children with a mean age of 6.9 years were included. Acute lymphoblastic leukemia (ALL) accounted for 81.1% (n = 86), acute myeloid leukemia (AML) for 16.0% (n = 17), and biphenotypic acute leukemia (BAL) for 2.8% (n = 3). Three cases of Burkitt lymphoma were identified and excluded from the ALL group. The overall male-to-female ratio was 1.86 (69 boys, 37 girls), with no significant difference between subtypes (p = 0.46). Subtype distribution varied significantly with age (p = 0.02). The main clinical features were tumor syndrome (84.0%), fever (67.0%), and hemorrhagic syndrome (50.9%). Fever was significantly more frequent in B-ALL than in other subtypes (p < 0.001), as was hemorrhagic syndrome (p = 0.03). Significant differences between subtypes were also observed for leukopenia (p = 0.04), leukocytosis (p = 0.003), pancytopenia (p = 0.03), and major hyperleukocytosis (>100 × 10⁹/L, p < 0.001). Hypercellular marrow was found in 84.4% of cases, with a median blast count of 88% (interquartile range, IQR: 78-92), significantly higher in ALL than in AML (p = 0.008). Immunophenotyping allowed reclassification of six of the 95 MPO-negative suspected ALL cases: four were reclassified as acute myeloid leukemia with minimal differentiation and two as BAL. In addition, one BAL was identified among the 14 MPO-positive cases, raising the total number of BAL to three.

CONCLUSIONS: Flow cytometry is a valuable tool for the diagnosis of pediatric acute leukemias in resource-limited settings, contributing to the classification of ALL, identification of acute myeloid leukemia with minimal differentiation, and diagnosis of BAL based on cytology, cytochemistry, and immunophenotyping. The high frequency of aberrant antigen expression supports the need for a standardized diagnostic algorithm combining cytology, cytochemistry, and immunophenotyping. Larger prospective studies with cytogenetics and follow-up are needed to refine prognostic value.

PMID:42668927 | PMC:PMC13525706 | DOI:10.7759/cureus.113650

Clin Trials. 2026 Aug 29:17407745261467982. doi: 10.1177/17407745261467982. Online ahead of print.

ABSTRACT

INTRODUCTION: Randomized controlled trials are the gold standard for evaluating interventions but are resource-intensive and impose considerable burden on participants. Historical control designs, which incorporate data from previous trials into new analyses, could reduce sample size requirements, but their practical application is limited. This study explored the feasibility of constructing a historical control using the Bayesian meta-analytic predictive approach based on data from a systematic review of metformin in type 2 diabetes mellitus.

METHODS: We extracted baseline and end point glycated hemoglobin values and participant characteristics from 25 randomized trials (36 comparisons). Using the RBesT package in the R software, meta-analytic predictive priors were constructed, and their contribution to new data was quantified using the effective sample size metric. Between-trial heterogeneity (τ) was initially set to the default conservative value (0.5) and subsequently estimated and replaced in the analysis using the output from the metafor package based on the reported study-level variances. Additional stratified analyses based on follow-up duration and publication year were conducted.

RESULTS: Initial models yielded low effective sample size values (1-4), indicating minimal information borrowing from historical data. The presence of a high level of heterogeneity (τ = 0.55-0.85) appeared to limit the priors’ influence. Further investigation into a stricter data set showed that four outlier studies reduced the estimated τ from the data to 0.0935, which increased effective sample size from 18 (conservative model) to 52 (data-derived model), while estimated treatment effects remained stable (-1.34% to -1.36% glycated hemoglobin).

DISCUSSION: Between-trial heterogeneity (τ) estimation critically influences the informativeness of meta-analytic predictive-based historical control analysis. Despite having 25 trials with the same condition, the effective sample size was very low. Data-driven τ estimation substantially increased effective sample size without altering the treatment effect estimates and could represent a valid alternative to historical controls in clinical trial design compared with default conservative choices.

PMID:42668260 | DOI:10.1177/17407745261467982

Eur Urol Focus. 2026 Aug 29:S2405-4569(26)00151-3. doi: 10.1016/j.euf.2026.07.005. Online ahead of print.

ABSTRACT

BACKGROUND: Prostate-specific membrane antigen (PSMA)-radioguided surgery (RGS) is an emerging technique providing real-time intraoperative guidance. The prospective TRACE-I trial demonstrated that robot-assisted ^99mtechnetium-PSMA-Investigation & Surgery-RGS ([^99mTc]Tc-PSMA-I&S-RGS) using a DROP-IN gamma probe is feasible and safe in recurrent prostate cancer (PCa).

OBJECTIVE: To report the oncological outcmes of a post hoc analysis of the prospective TRACE-I trial cohort.

DESIGN, SETTING, AND PARTICIPANTS: TRACE-I prospectively enrolled 30 patients with biochemical recurrence (prostate-specific antigen (PSA) ≥0.2 ng/ml after radical prostatectomy (RP) or ≥2 ng/ml above nadir after radiotherapy (RT) and ≤3 pelvic recurrences (nodal and/or local) on PSMA-positron emission tomography/computed tomography (PET/CT; 2020-2023).

INTERVENTION: Patients underwent single-photon emission CT/CT and then robot-assisted PSMA-RGS.

OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS: Oncological outcomes were biochemical progression (PSA ≥0.2 ng/ml after RP or ≥2 ng/ml above nadir after RT), radiological recurrence on PSMA-PET/CT, and time to salvage therapy. Biochemical progression-free survival (bPFS), distant metastasis-free survival (dMFS), and therapy-free survival (TFS) were analysed using Kaplan-Meier and univariable Cox regression.

RESULTS AND LIMITATIONS: Among 30 patients (19 RP, 9 RT, and 2 RP + RT), the median age was 68 yr, and the median PSA at RGS was 1.02 ng/ml (interquartile range, 0.46-2.86), 28 (93%) showed PSA decline after RGS, and 20 (66%) reached PSA <0.2 ng/ml or PSA nadir. The 1- and 2-yr bPFS were 40% and 30%; 2-yr dMFS and TFS were 62% and 58%, respectively. Recurrences were pelvic in 37% and distant in 40%. Limitations include single-centre design and small sample size.

CONCLUSIONS: PSMA-RGS in the robotic setting for recurrent PCa shows an early PSA decline in almost all patients. Although biochemical progression after PSMA-RGS is common, PSMA-RGS presents an opportunity to prolong bPFS and TFS in a selection of patients.

PATIENT SUMMARY: We updated outcomes from TRACE-I patients with recurrent prostate cancer. We found that PSMA-guided surgery led to PSA declines in most patients and delayed disease progression in some, but careful patient selection is essential.

PMID:42668258 | DOI:10.1016/j.euf.2026.07.005

Encephale. 2026 Aug 29:S0013-7006(26)00157-0. doi: 10.1016/j.encep.2026.06.001. Online ahead of print.

ABSTRACT

OBJECTIVES: Mental health disorders and suicidal behaviors are a major public health issue worsened by the COVID-19 pandemic. Social prescribing initiatives such as Art on Prescription aim to integrate artistic activities into healthcare to promote well-being and reduce depressive symptoms. This pilot study aimed to assess the impact of an Art on Prescription program on individuals at risk of suicide.

METHODS: An AoP program was implemented in Montpellier coordinated by the Department of Emergency Psychiatry and Acute Care at Montpellier University Hospital, in partnership with MO.CO. (Montpellier Contemporain). Fifty-one adults, referred after an emergency visit for suicidal ideation or a suicide attempt, were enrolled between 2022 and 2024. The program was delivered through five successive cycles. Each participant was enrolled in one cycle only, led by an artist, and included one museum visit followed by five weekly creative sessions. Depressive symptoms (PHQ-9, Patient Health Questionnaire-9) and well-being (WEMWBS, Warwick-Edinburgh Mental Wellbeing Scale) were assessed at the end of each of the five creative sessions. Wilcoxon tests and Generalized Estimating Equations (GEE) were used for analysis.

RESULTS: Among the 29 participants with complete data from the first to the fifth creative sessions, a significant improvement in well-being was observed (mean WEMWBS increase: +2.24; P=0.02), whereas the decrease in depressive symptoms was not statistically significant (PHQ-9: -0.79; P=0.12). In the full sample (n=51), the comparison between the first and third creative sessions showed a significant decrease in depressive symptoms (-0.65; P=0.05), but a non-significant increase in well-being (+1.22; P=0.11). GEE models confirmed a significant negative association between PHQ-9 and WEMWBS scores (β=-1.1; P<0.001), with no significant effect of time or interaction.

CONCLUSIONS: The Art on Prescription program appears to have a positive impact on well-being and depressive symptoms in individuals at risk of suicide. These findings support the potential value of innovative, non-pharmacological interventions as a complement to traditional psychiatric care, aligned with recovery-oriented approaches.

PMID:42668255 | DOI:10.1016/j.encep.2026.06.001

Encephale. 2026 Aug 29:S0013-7006(26)00158-2. doi: 10.1016/j.encep.2026.04.013. Online ahead of print.

ABSTRACT

BACKGROUND: Post-traumatic stress disorder (PTSD) is a common consequence of traumatic experiences in children, highlighting the need for culturally adapted screening instruments. The objective of this study was to translate and validate the self-report questionnaire, the Children’s Revised Impact of Event Scale-13 (CRIES-13), into Tunisian Arabic.

METHODS: We conducted a cross-sectional study among children aged eight to 18 years, recruited from the Child and Adolescent Psychiatry Department of Mongi Slim Hospital between February 2024 and February 2025, who had experienced a stressful life event. Non-inclusion criteria included insufficient cognitive or linguistic abilities to complete the questionnaire. Exclusion criteria were refusal to participate and incomplete questionnaires. The CRIES-13 questionnaire was translated using the forward-backward translation method. Its psychometric properties were evaluated in terms of content validity, reliability, and construct validity. The internal structure was assessed using confirmatory factor analysis. For preliminary external validation, the Tunisian version of the Clinician-Administered PTSD Scale for Children and Adolescents, Fifth Edition (CAPS-CA-5), was used.

RESULTS: A total of 300 children were included in the study. The translated version was deemed satisfactory. Internal consistency was good, with a Cronbach’s alpha of 0.841. Item – subscale correlations were statistically significant and conceptually coherent. Confirmatory factor analysis supported the three-factor model and demonstrated acceptable model fit indices, as follows: χ²/df=2.78; root mean square error of approximation (RMSEA)=0.077; Standardized Root Mean Square Residual=0.092; Comparative Fit Index=0.897; Tucker-Lewis Index=0.871; Goodness-of-Fit Index=0.918; Adjusted Goodness-of-Fit Index=0.880; and Akaike Information Criterion=230. Statistically significant correlations were found between the CRIES-13 and its external validator, the Clinician-Administered PTSD Scale for Children and Adolescents, Fifth Edition (CAPS-CA-5) (r=0.897; P<0.01).

CONCLUSION: The Tunisian Arabic version of the CRIES-13 demonstrated satisfactory psychometric properties. It can be considered a reliable and valid screening tool for PTSD among Tunisian children.

PMID:42668253 | DOI:10.1016/j.encep.2026.04.013

Biosystems. 2026 Aug 29:105935. doi: 10.1016/j.biosystems.2026.105935. Online ahead of print.

NO ABSTRACT

PMID:42668219 | DOI:10.1016/j.biosystems.2026.105935

Food Microbiol. 2027 Jan;141:105266. doi: 10.1016/j.fm.2026.105266. Epub 2026 Aug 12.

ABSTRACT

To achieve precise control of kiwifruit wine fermentation, this study integrated non-targeted metabolomics and multivariate statistical analysis to systematically analyze dynamic metabolic trajectories and microbial functional contributions across two fermentation stages: alcoholic fermentation and malolactic fermentation. The results indicated that both processes had critical contributions to the quality of kiwifruit wine, acting synergistically through interconnected metabolic pathways. The metabolic pathway and correlation analysis showed that alcoholic fermentation mainly involved the decomposition and utilization of nutrients, with non-Saccharomyces yeasts proliferating extensively and producing most esters and alcohols, while malolactic fermentation mainly concerned energy supply and organic synthesis, in which Lactiplantibacillus plantarum adapted to nutrient-limited and stressful conditions while producing aroma-active volatiles. Correlation and pathway enrichment analyses further demonstrated tight associations between non-volatile metabolite turnover and the generation of volatile compounds, highlighting the integrated role of microbial metabolism in shaping flavor and quality attributes of kiwifruit wine.

PMID:42668203 | DOI:10.1016/j.fm.2026.105266

Food Microbiol. 2027 Jan;141:105242. doi: 10.1016/j.fm.2026.105242. Epub 2026 Jul 10.

ABSTRACT

Fruits and vegetables are vital to a healthy diet; however, consuming unwashed or improperly prepared produce can lead to parasitic infections. This study aims to provide evidence-based information on the extent of parasitic contamination and its associated factors on fruits and vegetables from the Gedeo Zone, Ethiopia. A community-based cross-sectional study was conducted from March 26 to July 25, 2025, in Dilla, Gedeo Zone, Ethiopia, to assess parasitic contamination of fruits and vegetables. A multistage sampling technique was employed. Socio-demographic data and potential contamination risk factors were gathered using structured questionnaires. About 200 g of each sample was examined for intestinal parasites using direct wet mount and Modified Ziehl-Neelsen staining techniques. Data were analyzed using SPSS version 25. Among the 442 fruit and vegetable samples examined, 148 (33.5%) were found to be contaminated with intestinal parasites. Among the 148 samples found to be positive by iodine wet mount examination, Entamoeba histolytica/dispar was the predominant parasite (13.8%). Moreover, produces displayed on the floor had significantly higher contamination than those on shelves/tables (AOR = 6.85; p < 0.001). Contamination was also significantly associated with samples from open markets, collected from the farms, and vendors with untrimmed fingernails. Parasitic contamination in fruits and vegetables was found to be high. Therefore, food and drug authorities and public health institutions should raise awareness among vendors and consumers about safe handling and consumption, while city administrations and the agricultural sector promote hygienic markets and proper farming and transportation practices.

PMID:42668179 | DOI:10.1016/j.fm.2026.105242