Category: Nevin Manimala

J Med Internet Res. 2026 Feb 3;28:e79671. doi: 10.2196/79671.

ABSTRACT

BACKGROUND: The HIV epidemic in the United States disproportionately impacts gay, bisexual, and other men who have sex with men (MSM). Despite the effectiveness of HIV preexposure prophylaxis (PrEP) in preventing HIV acquisition, uptake among MSM remains suboptimal. Motivational interviewing (MI) has demonstrated efficacy at increasing PrEP uptake among MSM but is resource-intensive, limiting scalability. The use of artificial intelligence, particularly large language models with conversational agents (ie, “chatbots”) such as ChatGPT, may offer a scalable approach to delivering MI-based counseling for PrEP and HIV prevention.

OBJECTIVE: This internal usability testing aimed to evaluate the development of an artificial intelligence-based chatbot, including its ability to provide MI-aligned education about PrEP and HIV prevention and potential to support PrEP uptake.

METHODS: The Chatbot for HIV Prevention and Action (CHIA) was built on a GPT-4o base model embedded with a validated knowledge database on HIV and PrEP in English and Spanish. The CHIA was fine-tuned through training on a large MI dataset and prompt engineering. The use of the AutoGen multiagent framework enabled the CHIA to integrate 2 agents, the PrEP Counselor Agent and the Assistant Agent, which specialized in providing MI-based counseling and handling function calls (eg, assessment of HIV risk), respectively. During internal testing from March 10-April 28, 2025, we systematically evaluated the CHIA’s performance in English and Spanish using a set of 5-point Likert scales to measure accuracy, conciseness, up-to-dateness, trustworthiness, and alignment with aspects of the MI spirit (eg, collaboration, autonomy support) and MI-consistent behaviors (eg, affirmation, open-ended questions). Descriptive statistics and mixed linear regression were used to analyze the data.

RESULTS: A total of 296 responses, including 145 English responses and 151 Spanish responses, were collected during the internal testing period. Overall, the CHIA demonstrated strong performance across both languages, receiving the highest combined scores in the general response quality metrics including up-to-dateness (mean 4.6, SD 0.8), trustworthiness (mean 4.5, SD 0.9), accuracy (mean 4.4, SD 0.9), and conciseness (mean 4.2, SD 1.1). The CHIA generally received higher combined scores for metrics that assessed alignment with the MI spirit (ie, empathy, evocation, autonomy support, and collaboration) and lower combined scores for MI-consistent behaviors (ie, affirmation, open-ended questions, and reflections). Spanish responses had significantly lower mean scores than English responses across nearly all MI-based metrics.

CONCLUSIONS: Our internal usability testing highlights the potential of the CHIA as a viable tool for delivering MI-aligned counseling in English and Spanish to promote HIV prevention and support PrEP uptake, though its Spanish language performance requires further improvement.

PMID:41632955 | DOI:10.2196/79671

JMIR Res Protoc. 2026 Feb 3;15:e79875. doi: 10.2196/79875.

ABSTRACT

BACKGROUND: Therapeutic emesis (TE), known as vamana karma, is a classical method of detoxification performed to eliminate vitiated kapha (bio-humor governing fluid regulation and structural cohesion of the body in normalcy) ailments from the body. The assessment of this complete process depends on physicians’ visual assessments of vomitus features and patient responses, introducing subjectivity and interobserver variability. Moreover, this method requires more than continuous monitoring; thus, it can sometimes lead to human error, resulting in missed expelled content or complications. We propose an artificial intelligence (AI) model to monitor TE to observe visual changes (ie, patient vomitus content and gestures) to provide better clinical outcomes. This approach is being explored for the first time in the traditional system of medicine.

OBJECTIVE: This study aims to develop and validate an AI-assisted digital framework for the objective evaluation of TE via (1) automatic vomitus detection, (2) content classification, (3) number of bouts expelled, (4) facial expressions and individual gestures, (5) determination of detoxification type, and (6) provision of a postpurificatory dietary regimen after completion.

METHODS: The study will be conducted in 3 phases. The first is the preparation of standard operating procedure for TE data collection. The second is data annotation of detected vomiting events. All analyses will be conducted using Python libraries, including scikit-learn (version 1.3.2; developed by the scikit-learn contributors, Python Software Foundation), TensorFlow (version 2.14.0; Google Brain Team, Google LLC), and tools supported under Google Summer of Code 2023 (Google LLC), along with SPSS Statistics (version 26.0; IBM Corp) for statistical analysis. In the third phase, model performance will be evaluated using standard machine learning metrics, and agreement with expert assessments will be measured using the Fleiss κ statistic. This study is exploratory in nature. Thus, 50 volunteers will be targeted.

RESULTS: This is the first study of its kind, so to create the dataset, we prepared a standard operating procedure for TE event data collection. Data collection was completed in December 2025. Data annotation and preliminary model preparation are ongoing, with final testing and validation expected to be completed by December 2025. External testing in the health care setting is expected to be completed by February 2026.

CONCLUSIONS: This work presents one of the first attempts to apply deep learning for objective analysis of the TE process in Ayurveda. By combining YOLOv9 for vomit detection and residual neural network for classification, the framework achieves promising accuracy in automated vomit identification. The results will demonstrate the potential of AI-assisted analysis in traditional medicine, although further clinical validation and expansion across multiple centers will be necessary before deployment in real-world settings.

PMID:41632954 | DOI:10.2196/79875

Perfusion. 2026 Feb 3:2676591261423026. doi: 10.1177/02676591261423026. Online ahead of print.

ABSTRACT

BackgroundEffective myocardial protection is essential for successful outcomes in open-heart surgery. Although both del Nido and St. Thomas cardioplegia solutions are widely used, comparative evidence in adult rheumatic mitral valve replacement remains limited. This study aimed to compare their myocardial protective efficacy and clinical outcomes.MethodsA prospective comparative study was conducted between May 2022 and October 2024. Total 50 adult patients undergoing mitral valve replacement-20 with severe mitral regurgitation (MR) and 30 with severe mitral stenosis (MS) were included. Patients were divided into two groups based on cardioplegia type (del Nido or St. Thomas). Intraoperative parameters, postoperative left ventricular ejection fraction (LVEF), troponin I levels, inotropic and ventilatory support, and ICU/hospital stay were analysed.ResultsBaseline characteristics were comparable across groups. The mean number of cardioplegia doses was significantly lower in the del Nido group (1.6 ± 0.5 vs 3.2 ± 0.8; p < 0.001). Postoperative LVEF was better preserved with del Nido cardioplegia (MS: 53.3 ± 7.2% vs 45.3 ± 10.6%; p = 0.023). Troponin I levels at 6, 24, and 48 h were lower in the del Nido group, though not statistically significant. Patients receiving del Nido required less inotropic and ventilatory support, with shorter ICU and hospital stays. One in-hospital death occurred in the del Nido group due to sepsis.ConclusionDel Nido cardioplegia offers comparable or superior myocardial protection to St. Thomas solution in adult mitral valve replacement, with fewer interruptions, reduced dosing, and faster postoperative recovery.

PMID:41632949 | DOI:10.1177/02676591261423026

Liver Transpl. 2026 Jan 20. doi: 10.1097/LVT.0000000000000811. Online ahead of print.

ABSTRACT

BACKGROUND: Early reoperation for bleeding after liver transplantation (ERBALT) is associated with increased morbidity and mortality. However, no reliable predictive tool is currently available. The primary aim was to evaluate the predictive ability of conventional coagulation tests (CCT) and viscoelastic assays (VEA), for identifying patients at risk of ERBALT within the first seven days following liver transplantation (LT).

METHODS: A total of 275 patients who underwent LT at a tertiary center were screened in this prospective observational study. CCT and VEA were obtained at four time points: (1) post-induction; (2) end of the an-hepatic phase; (3) 10 minutes after reperfusion (R10); and (4) 60 minutes after reperfusion (R60). Other recognized perioperative risk factors for ERBALT were recorded. A predictive score was developed based on the weighted coefficients from multivariable logistic regression.

RESULTS: The final analysis included 222 patients of whom 25 (11.26%) required ERBALT. These patients had more advanced liver disease (Child-Pugh score: 10 (8-11) vs. 8 (6-9), p=0.002) and required significantly higher volumes of fluids (4000 (3000-5750) mL vs. 3000 (2500-4000) mL, p=0.002) and blood products intraoperatively (80% vs. 51.3%, p=0.005). The score included R60-CTINTEM ≥230 seconds (4 points), R60-CTEXTEM ≥85 seconds (2 points); and intraoperative transfusion of ≥4 units of red blood cells (1 point) yielding a total score ranging from 0 to 7. Only 1% of patients with a score ≤3 required ERBALT, compared to 47.8% of those with a score of 7.

CONCLUSION: VEA demonstrated strong predictive value for early reoperation for bleeding after LT. The proposed risk score could facilitate the timely correction of coagulation and potentially improve clinical outcomes after LT.

PMID:41632943 | DOI:10.1097/LVT.0000000000000811

JCO Clin Cancer Inform. 2026 Feb;10:e2500234. doi: 10.1200/CCI-25-00234. Epub 2026 Feb 3.

ABSTRACT

PURPOSE: This trial aims to investigate the effectiveness of online digital intervention in patients with non-small cell lung cancer (NSCLC) in terms of adverse events (AEs) and quality of life (QoL).

METHODS: This randomized trial recruited 200 patients with advanced NSCLC (March 2022-October 2023). All patients received standard-of-care precise treatment, predominantly immunochemotherapy. The study was designed to assess AEs and QoL improvement. Through the CareAcross online platform, all patients received information about their disease and treatment and reported any of the 22 predefined AEs at any time. Patients were randomly assigned 1:1 in the intervention (A) and control (B) arm; patients in arm A automatically received, additionally, evidence-based guidance for the reported AEs. EuroQol 5-dimension 5-level responses were collected at baseline and at each treatment cycle. Resulting scores were compared between baseline and after the sixth cycle. In addition, patient case-level hospitalization data were collected and costs were estimated based on reimbursed costs as defined by the Ministry of Health, enabling a post hoc analysis.

RESULTS: Clinical characteristics were well-balanced. More AEs were reported by patients online versus to their clinicians (P < .01). Among the 22 AEs, 17 improved more in arm A, with the improvement in rash and stomatitis being statistically significant. In QoL, there was no improvement in any of the five EuroQol 5-Dimension dimensions. Digital intervention was cost-saving with lower mean costs for hospitalization (P < .001). Overall response rate, progression-free survival, and overall survival were not statistically different between the two arms, ensuring comparable clinical outcome.

CONCLUSION: Digital oncology tends to improve selected AEs and is cost saving. Patients report, digitally, more informative AEs. Digital oncology can be a complementary tool to the oncology team and warrants further exploration.

PMID:41632937 | DOI:10.1200/CCI-25-00234

J Am Acad Orthop Surg Glob Res Rev. 2026 Feb 2;10(2). doi: 10.5435/JAAOSGlobal-D-25-00422. eCollection 2026 Feb 1.

ABSTRACT

INTRODUCTION: Periprosthetic distal femur fractures (PDFFs) are increasing with rising arthroplasty volumes. An optimal fixation strategy remains debated. This study evaluated outcomes of single lateral locking plate constructs (sLLPs), retrograde intramedullary nails (IMNs), and dual constructs (nail-plate or dual plating).

METHODS: A retrospective cohort study was done at a level I trauma center (2012 to 2024). Adults with PDFF (AO/Orthopaedic Trauma Association 33) treated with sLLP, IMN, or dual constructs were included. All patients were assessed for postoperative weight-bearing status, while clinical outcomes required ≥6-month follow-up or earlier documented complications. Outcomes included revision surgery, infection, implant failure, hardware removal, wound dehiscence, and time to weight bearing as tolerated (WBAT).

RESULTS: Of 99 identified patients, 64 met criteria (IMN: n = 20; sLLP: n = 19; dual: n = 25). Mean age was 69.0 years; 75.0% female, 59.4% Black; mean follow-up 391.5 days. Immediate WBAT was ore common in dual (70.7%) and IMN (52.8%) groups than sLLP (9.1%; P < 0.001). Mean time to WBAT was shortest with dual constructs (13.8 days), followed by IMN (26.0) and sLLP (42.8; P = 0.020). On multivariable analysis, sLLP fixation was associated with increased odds of unplanned revision surgery (OR 6.27, 95% confidence interval, 1.29 to 30.50, P = 0.023), while neither IMN (P = 0.157) nor dual constructs (P = 0.071) demonstrated a significant association.

CONCLUSION: Single lateral locking plate fixation in PDFF was associated with higher odds of unplanned revision surgery. Dual construct patients had the shortest time to postoperative weight bearing and were more frequently permitted WBAT immediately after surgery.

PMID:41632935 | DOI:10.5435/JAAOSGlobal-D-25-00422

J Anim Physiol Anim Nutr (Berl). 2026 Feb 3. doi: 10.1111/jpn.70040. Online ahead of print.

ABSTRACT

Sorption isotherms evaluate water exchange between food and environments with different water activities (aw), providing valuable information on physical changes and susceptibility of deterioration due to lipid oxidation and microbial growth. In this context, the present study aimed to characterise the adsorption and desorption curves of extruded dry foods for dogs and cats using the Guggenheim-Anderson-De Boer (GAB) model, as well as to compare these results with those obtained from a simpler and faster method, the drying curve. Three foods for dogs and three for cats were evaluated. The equilibrium moisture content by isotherm method was determined at 30°C using the gravimetric method with six saturated saline solutions, covering aw from 0.11 to 0.83. The isotherm curves between aw and moisture content were plotted by GAB model. The drying curve for each food was plotted between aw and moisture using direct data obtained during the drying of samples after extrusion in an air oven at 60°C, to compare this result with the desorption curve. The parameters for each curve using the GAB model were determined using RStudio software. To compare the drying curves with the sorption isotherm, the Wilcoxon paired t-test was used. All pet foods exhibited a type II isotherm. The average R² was 0.99 for the adsorption curves, 0.87 for desorption and 0.99 for drying curves, showing a good fit of the models. The adsorption and desorption isotherms, as well as the drying curves, showed different predicted equilibrium moisture contents, with higher values predicted by the desorption method. In conclusion, the adsorption curves were the most suitable for the dry pet foods evaluated, and the drying curve could not be recommended due to the lower accuracy compared to the sorption isotherms.

PMID:41632916 | DOI:10.1111/jpn.70040

Clin Exp Dent Res. 2026 Feb;12(1):e70294. doi: 10.1002/cre2.70294.

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate the effect of sodium dicholoroisocyanurate (NaDCC) as intracanal medicament on the dentin microhardness and fracture resistance of teeth compared to calcium hydroxide (CH).

MATERIAL AND METHODS: Root canals of mandibular premolars (n = 153) were instrumented and randomized into two treatment groups and an untreated control group (n = 51). Treatment groups received either NaDCC or CH. After 1 week, 1 month, or 3 months, 17 teeth were randomly selected from each group, and two root cylinders were obtained: one for fracture resistance and the other for microhardness test. Two-way ANOVA, one-way ANOVA, and Tukey post hoc tests were used for statistical analysis.

RESULTS: The microhardness and fracture resistance in the control and CH groups were not affected by time (p > 0.05). However, NaDCC caused significant decreases in dentin microhardness after 1 month and 3 months (p < 0.001) as well as in fracture resistance (p < 0.05) after 1 month. The groups comparison at each time point showed no significant differences in microhardness and fracture resistance after 1 week (p > 0.05). However, after 1 month, a significant reduction in microhardness and fracture resistance was detected for NaDCC and in the fracture resistance for CH (p < 0.05). After 3 months, compared to the control group, lower microhardness in NaDCC and CH groups and lower fracture resistance in CH group were detected (p < 0.05).

CONCLUSION: Short-term application of NaDCC and CH did not adversely affect dentin microhardness. However, prolonged use reduced dentin microhardness, and both medicaments significantly decreased fracture resistance compared with the control group. Limiting the duration of intracanal medicament application is therefore recommended.

PMID:41632914 | DOI:10.1002/cre2.70294

Clin Exp Dent Res. 2026 Feb;12(1):e70299. doi: 10.1002/cre2.70299.

ABSTRACT

OBJECTIVES: To compare the 6-month clinical success of atraumatic restorative treatment (ART) and silver-modified atraumatic restorative treatment (SMART) in primary molars of children with early childhood caries (ECC), and to assess the impact of these treatments on oral health-related quality of life (OHRQoL).

MATERIALS AND METHODS: A randomized controlled split-mouth trial included 32 children (aged 3-7 years) with 68 primary molars exhibiting active dentin carious lesions (ICDAS II scores 4 or 5). Each child received one ART restoration using high-viscosity glass ionomer cement and one SMART restoration with silver diamine fluoride, followed by HVGIC in the same session. Clinical success was assessed after 6 months, using modified ART criteria. Parents completed the Arabic version of the Early Childhood Oral Health Impact Scale (A-ECOHIS) at baseline and after 6 months to assess changes in OHRQoL. Data analysis included chi-square, Fisher’s exact test, Student’s t-test with effect sizes reported, and a significance level set at 95%.

RESULTS: Of the 68 restorations (34 ART, 34 SMART), 6-month success rates were 67.6% for ART and 70.5% for SMART, with no statistically significant difference (p = 0.66). SMART showed slightly better caries arrest. Class I restorations had higher success rates than Class II for both techniques. Failures were mainly due to wear and marginal integrity loss. Mean ECOHIS scores improved from 16.9 at baseline to 10.13 at 6 months, though the change was not statistically significant (p = 0.125).

CONCLUSION: SMART and ART techniques showed similar short-term clinical outcomes, with SMART showing a minor, nonsignificant advantage in caries management. Failures in ART were more often linked to active caries and pulp involvement, suggesting that SMART may enhance caries arrest. Placement of both restorations did not significantly affect OHRQoL.

CLINICAL SIGNIFICANCE: Incorporating SDF may improve caries arrest and the effectiveness of GIC restorations in primary molars.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT07023939.

PMID:41632901 | DOI:10.1002/cre2.70299

Nat Prod Res. 2026 Feb 3:1-10. doi: 10.1080/14786419.2026.2625446. Online ahead of print.

ABSTRACT

A new tirucallane-type triterpenoid, didychaudianin A (1), along with two known tirucallane analogs (2 and 3), was isolated from the stem bark of D. gaudichaudianus (Meliaceae) growing in West Java, Indonesia. Their structures, including absolute configurations, were elucidated using HRESIMS, extensive 1D and 2D NMR spectroscopic analysis, ECD spectroscopy, and quantum chemical calculations based on density functional theory (DFT), supported by DP4+ statistical analysis. Cytotoxic evaluation against human cervical cancer HeLa cells revealed that 2 exhibited moderate activity, with an IC₅₀ value of 44.4 μM. Structure-activity relationship (SAR) analysis indicated that the stereochemistry at C-21 and the presence of a tetrahydrofuran ring in the side chain play a crucial role in modulating biological activity. The isolation of tirucallane-type triterpenoids (1-3) further enriches the chemical diversity of this compound class within the Didymocheton genus.

PMID:41632897 | DOI:10.1080/14786419.2026.2625446