Category: Nevin Manimala

Comp Immunol Microbiol Infect Dis. 2026 May 12;128:102479. doi: 10.1016/j.cimid.2026.102479. Online ahead of print.

ABSTRACT

Domestic dogs are frequently exposed to tick-borne pathogens such as Babesia vogeli, Hepatozoon canis, Anaplasma platys and Ehrlichia canis, which can cause a wide range of clinical manifestations, although little is known about the epidemiological and clinicopathological profiles of mono- and co-infections. This study aimed to characterize infection patterns and identify clinical and epidemiological factors associated with mono-infections, and co-infections with two or more pathogens in naturally infected dogs. We analyzed 181 dogs from a hospital population with suspected hemoparasitic infections, assessed hematocrit and platelet counts, and used statistical models (Chi-square, Fisher’s exact test, odds ratios, and multinomial logistic regression) to evaluate associations between infection types and clinical or epidemiological variables. This is the first comprehensive Brazilian study correlating infection type with clinical and epidemiological factors. Dogs with a history of tick infestation were 3.41 times more likely to be co-infected with two pathogens, and infections involving two (84.6%) or three or more pathogens (90.9%) were more frequent in dogs without the use of tick control medications. Male dogs and those presenting epistaxis, hyporexia or anorexia, dehydration, onychogryphosis, and ectoparasites were more likely to be co-infected with three or more pathogens. Thrombocytopenia was common in all groups, with dogs co-infected with three or more pathogens showing 16.3 times higher odds and dogs co-infected with two pathogens had increased odds of anemia (OR = 2.11). These results underscore the importance of tick control and comprehensive pathogen screening in endemic regions, especially in Brazil’s semi-arid northeast, to enhance diagnosis, management, and prevention strategies.

PMID:42127483 | DOI:10.1016/j.cimid.2026.102479

Semergen. 2026 May 13;52(5):102770. doi: 10.1016/j.semerg.2026.102770. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the association between healthcare resources and premature mortality from ischemic heart disease in the Spanish autonomous communities between 2018 and 2023.

METHODS: An observational ecological study was conducted using aggregated data by autonomous community and year. The dependent variable was premature mortality from ischemic heart disease (< 75 years, adjusted for age). Independent variables included primary care physician density and per capita healthcare expenditure. Descriptive statistics, Pearson correlations, and multiple lineal regression were applied.

RESULTS: The average premature mortality rate was 20.53/100,000 inhabitants (SD=4.59), being higher in men (34.21 vs. 7.66 in women) and in the Canary Islands, Asturias, and Andalusia. The rate remained stable over time (19.91-21.04/100,000). No significant associations were found between mortality and healthcare resources. However, healthcare expenditure correlated positively with the density of primary care physicians (r=0.307; P=.001).

CONCLUSIONS: Although the availability of healthcare resources did not explain the differences in premature mortality, this study highlights the persistent territorial and sex-based heterogeneity in Spain and the need for comprehensive strategies that combine investment, prevention, and the reduction of inequalities. The findings provide useful evidence for planning cardiovascular health policies at the regional level.

PMID:42127482 | DOI:10.1016/j.semerg.2026.102770

Breast. 2026 May 12;88:104797. doi: 10.1016/j.breast.2026.104797. Online ahead of print.

ABSTRACT

BACKGROUND: Women living with HIV (WLHIV) may present with distinct clinical and laboratory characteristics at the time of breast cancer diagnosis. While previous studies, including multi-country cohorts such as the ABC-DO study, have described baseline patient and tumor features, data on pre-treatment laboratory parameters in routine clinical settings remain limited. This study aimed to characterize baseline clinical and laboratory factors at diagnosis and assess differences by HIV status.

METHODS: We analyzed data from women newly diagnosed with breast cancer at three tertiary hospitals in Tanzania. HIV status was obtained from medical records or provider-initiated testing. Baseline clinical and laboratory variables measured before systemic cancer therapy were evaluated. Multivariable logistic regression was used to identify factors independently associated with HIV status.

RESULTS: Among 425 women with newly diagnosed breast cancer, 47 (11%) were living with HIV. Advanced disease at presentation was common across the cohort. Neutropenia (absolute neutrophil count <1.5 × 10⁹/L) was more frequent among WLHIV than among women without HIV (15% vs 3%) and remained independently associated with HIV status (adjusted odds ratio [aOR] 3.52, 95% confidence interval [CI] 1.26-9.79).

CONCLUSIONS: WLHIV more frequently presented with neutropenia and advanced disease at diagnosis. By identifying clinically relevant differences in hematologic status are detectable at presentation using routinely collected data, this study addresses a key gap in real-world evidence from sub-Saharan Africa. These findings provide clinically actionable insight into baseline patient status at entry into cancer care and may inform early clinical assessment and supportive care planning in resource-constrained settings.

PMID:42127480 | DOI:10.1016/j.breast.2026.104797

Clin Neurol Neurosurg. 2026 May 8;268:109465. doi: 10.1016/j.clineuro.2026.109465. Online ahead of print.

ABSTRACT

OBJECTIVE: Efgartigimod, a neonatal Fc receptor (FcRn) antagonist, has been shown to reduce pathogenic immunoglobulin G (IgG) autoantibodies, notably anti-acetylcholine receptor (AChR) antibodies, in myasthenia gravis (MG). While clinical trials have established its safety and efficacy, real-world evidence regarding its therapeutic effectiveness and steroid-sparing potential remains limited. This study aimed to evaluate the real-world efficacy and steroid-sparing benefits of efgartigimod in the clinical management of MG.

METHODS: Forty-one patients with generalized myasthenia gravis (gMG) were enrolled in this prospective study. Participants received efgartigimod treatment and were followed for 26 weeks. Clinical outcomes, primarily Myasthenia Gravis Activities of Daily Living (MG-ADL) scores and corticosteroid dosages, were systematically evaluated. Statistical analyses were performed using R version 4.5.0.

RESULTS: Patients were stratified into two cohorts based on treatment cycles: 22 received two cycles of efgartigimod, while 19 received a single cycle. Bulbar and respiratory symptoms improved within two weeks, whereas ocular and limb weakness required a more prolonged treatment duration to achieve clinical benefit. Myasthenia Gravis Activities of Daily Living (MG-ADL) scores demonstrated a significant decline, with a more rapid response observed in severe cases. By Week 26, the proportion of patients requiring more than 16 mg/d of methylprednisolone decreased from 63.4% at baseline to 14.6%. The two-cycle cohort exhibited a lower mean cumulative methylprednisolone dose (4861.50 mg vs. 5469.24 mg). No treatment-related adverse effects were observed.

CONCLUSION: Efgartigimod demonstrated variable clinical responses across different muscle groups, with early improvements in bulbar and respiratory function alongside significant steroid-sparing advantages. Given that baseline MG-ADL scores serve as a reliable predictor of the time to achieve minimal symptom expression (MSE), and considering that repeated treatment cycles further augment therapeutic efficacy, efgartigimod represents a promising steroid-sparing immunomodulatory strategy for the management of MG.

PMID:42127467 | DOI:10.1016/j.clineuro.2026.109465

J Plast Reconstr Aesthet Surg. 2026 Apr 18;117:226-234. doi: 10.1016/j.bjps.2026.04.011. Online ahead of print.

ABSTRACT

BACKGROUND: The deep inferior epigastric perforator (DIEP) flap is a reliable salvage option following complications of implant-based breast reconstruction (IBR). However, comparative data on indications and outcomes between radiated and non-radiated breasts remain limited.

METHODS: A ten-year retrospective cohort study was performed by including patients who underwent DIEP flap reconstruction following complicated IBR. Data were compared between radiated and non-radiated breasts using the Mann-Whitney U, Chi-square, and Fisher’s exact tests.

RESULTS: Among the 1684 patients who underwent IBR, 620 (36.8%) required implant removal or exchange, and 63 (3.7%) ultimately underwent DIEP flap reconstruction. In total, 89 breasts underwent DIEP reconstruction after complications of implant, among which 33 (37%) had received post-mastectomy radiation to the ipsilateral implant or tissue expander. Radiated breasts had higher rates of infection (25% vs. 7%, p = 0.02) and implant removal (34.4% vs. 7%, p = 0.002) rates prior to DIEP conversion. The median interval between mastectomy and DIEP reconstruction tended to be shorter in radiated breasts (28 vs. 39 months, p = 0.09). Capsular contracture was the most common indication for conversion (46.9% radiated vs. 29.8% non-radiated, p = 0.1). Flap survival was 100% in radiated breasts and 96.5% in non-radiated breasts (p = 0.53).

CONCLUSIONS: Permanent implant-to-DIEP conversion occurred in 3.7% of patients. Radiated breasts were more likely to experience infection and implant removal before conversion. Although the time to DIEP tended to be shorter in radiated patients, this was not statistically significant. DIEP flap reconstruction provides high survival in both groups, confirming its reliability as a salvage option.

PMID:42127452 | DOI:10.1016/j.bjps.2026.04.011

Clin Nutr. 2026 Apr 9;62:106661. doi: 10.1016/j.clnu.2026.106661. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Although whole-body phase angle (PhA) is a recognized prognostic marker in cardiovascular surgery, the clinical significance of segmental PhA and the impact of fluid overload on its interpretation remain insufficiently elucidated. This study investigated the associations between segmental PhA, physical function, and long-term prognosis in patients undergoing cardiovascular surgery.

METHODS: This retrospective cohort study included consecutive patients who underwent elective cardiovascular surgery between October 2016 and March 2021 at Nagoya Heart Center, Japan. Preoperative whole-body, upper extremity, and lower extremity PhA were measured using bioelectrical impedance analysis. We analyzed correlations between PhA and physical functions. Additionally, the impact of fluid overload was assessed by stratifying patients based on an extracellular-to-total body water ratio (ECW/TBW) cut-off of 0.400. Long-term all-cause mortality was evaluated using multivariate Cox regression analyses adjusting for confounders including age, sex, cardiac and renal function.

RESULTS: A total of 859 patients were included in the present analysis (mean age = 68.4 ± 11.9 years, 67.6% male). Segmental PhA significantly correlated with muscle mass, grip strength, and knee extension strength. However, in patients with fluid overload (ECW/TBW ≥0.400), the associations between PhA and physical function were attenuated, and the correlation with age lost statistical significance. Regarding prognosis, low PhA values across all segments were independent predictors of long-term all-cause mortality, even after adjusting for confounders.

CONCLUSIONS: Segmental PhA is a robust predictor of long-term mortality in cardiovascular surgery patients. However, because fluid overload confounds the relationship between PhA and physical function, clinicians must account for fluid status when interpreting PhA as a marker of muscle quality..

PMID:42127431 | DOI:10.1016/j.clnu.2026.106661

Sleep. 2026 May 13:zsag130. doi: 10.1093/sleep/zsag130. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Sleep duration is a key component of overall sleep health, but prior population-level studies characterizing this have relied on brief self-report questions (often one item) or used different objective devices within the same study. We examined the normal variation of sleep duration in an adult population using a single consumer-grade wearable device with a unified algorithm.

METHODS: Retrospective cohort study conducted in the United States. Data were analyzed from 274,128 U.S.-based adults aged 20 to 69 who used a Samsung Galaxy Watch between February 2023 and April 2023; participants were included if they had ≥20 valid weekdays and ≥8 valid weekend days of data. Sleep duration was the primary outcome, defined as the longest continuous nighttime sleep period between 6:00 p.m. and 6:00 a.m. averaged over a three-month period. Sleep duration and weekday-weekend variability were examined across age groups and by sex using descriptive statistics and independent t-tests.

RESULTS: Overall, average sleep duration was 7.57 hours, with a 10th-90th percentile range of 6.5 to 8.9 hours. Sleep duration was shortest in the 40-49 year old group (7.54 hours) and longest in the 60-69 year old group (7.75 hours; p < .001). Overall, 23.0% of adults slept less than 7 hours, more commonly among those aged 40-49 (25.1%) and 50-59 (24.7%). Across all age groups, weekend sleep was longer than weekday sleep by an average of 28 minutes, with the largest gap in the 40-49 year old group (34 minutes), and the smallest in the 60-69 year old group (20 minutes). Women consistently slept longer than men (+18 minutes on average), and exhibited greater between-subject variability in total sleep duration (SD = 1.61 hours for women vs. 1.54 hours for men).

CONCLUSIONS: This study demonstrates considerable variability in objectively measured sleep duration across adulthood, spanning a broad range and differing by age groups and sex. These findings provide reference distributions that may inform clinical expectations and public health messaging regarding sleep duration.

PMID:42127423 | DOI:10.1093/sleep/zsag130

JMIR Form Res. 2026 May 13;10:e89681. doi: 10.2196/89681.

ABSTRACT

BACKGROUND: Due to demographic changes, the number of older people is increasing, often accompanied by limitations in mobility, nutrition, and independence. Preventive monitoring is rare, as care systems struggle with staff shortages and limited resources. Technical assistance systems can support older people in self-assessing their health and maintaining independence. We developed the AS-Tra system, which combines an application with a measurement and training station (MuTS), to enable early detection of nutrition and mobility-related deficits and risks.

OBJECTIVE: This paper presents the pilot study of the AS-Tra system with the aim of evaluating its usability and testing the feasibility of collecting health-related data from older adults (≥70 y) with early/mild deficiencies in nutritional state and mobility in preparation for a future randomized controlled trial.

METHODS: The system used in this 4-week pilot study was developed as a complex intervention in accordance with the Medical Research Council framework. Participants (target n=10) were recruited through a participant registry. They completed standardized mobility assessments (grip strength, Timed “Up and Go,” and 5-Time Chair Rise) at baseline and after 1, 2, and 4 weeks (T0, T1, and T2, respectively). Mini Nutritional Assessment-Short Form and short physical performance battery were recorded at baseline and at T2. Participants received a tablet app for regularly documenting nutrition and an activity sensor for 7 days of physical activity monitoring and performed weekly training starting at T0. At T2, the System Usability Scale (SUS) and feedback questionnaires (Evaluation Overall System [EOS] questionnaire-the evaluation of all subcomponents on a scale of 1-5, weekly Experience Report) were additionally collected. Data were analyzed descriptively using IBM SPSS Statistics, in which data were shown as total numbers, percentages, and means with SDs, and data from the activity sensor were displayed and analyzed using Python.

RESULTS: A total of 9 older adults, with 1 dropout (mean 80, SD 5 y, 50% female), participated in this study. The SUS score was good (mean 79, SD 13.4 points). The MuTS devices had minor technical problems (in <17% of MuTS sessions), while 57% (17/30) of the users experienced instability issues with the food diary in the tablet app. The average overall system ratings were positive, with an EOS score of 2.01 (SD 0.99).

CONCLUSIONS: The usability of the technical assistance system used in this study was rated as good. The data collection using questionnaires, sensors, and automated assessments proved feasible. The biggest challenge was the tablet-based food diary, which still needs improvement before the effectiveness of the AS-Tra system regarding mobility and nutritional status can be evaluated in a randomized controlled trial.

PMID:42127422 | DOI:10.2196/89681

Int Clin Psychopharmacol. 2026 May 13. doi: 10.1097/YIC.0000000000000630. Online ahead of print.

ABSTRACT

Attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) frequently co-occur. However, evidence on the clinical effects of stimulant treatment in ADHD-BPD comorbidity remains limited. This prospective study aimed to investigate the longitudinal effects of methylphenidate (MPH) on borderline personality features in adults with ADHD-BPD. Thirty-six adults diagnosed with ADHD who also met the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria for BPD were treated with MPH and followed for at least 16 weeks. Clinical ratings of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition BPD criteria and psychometric measures assessing symptom severity and personality functioning were obtained at baseline and follow-up. Twenty-four participants (66.7%) completed the follow-up. Follow-up duration ranged from 3.9 to 12.3 months, with a mean duration of 7.8 ± 2.48 months. The number of BPD criteria significantly decreased after treatment (r = 0.82, P < 0.001). Nineteen participants no longer met the diagnostic threshold for BPD, and 10 achieved remission (≤2 BPD criteria). Baseline anger dysregulation (P = 0.009) and mood stabilizer use (P = 0.029) were associated with continued MPH treatment. Our findings preliminarily suggest that MPH, especially combined with mood stabilizers, may be associated with clinical benefits and acceptable tolerability in patients with comorbid ADHD-BPD. While causal conclusions cannot be drawn, replication in randomized controlled trials is warranted.

PMID:42127382 | DOI:10.1097/YIC.0000000000000630

J Strength Cond Res. 2026 May 13. doi: 10.1519/JSC.0000000000005531. Online ahead of print.

ABSTRACT

Carminatti, LJ, de Souza, PV, Cetolin, T, Mohr, PA, Netto, AS, Ortiz, JG, da Silva, JF, and Teixeira, AS. A cross-sectional analysis of Carminatti’s test versions: Age- and position-specific variations and normative reference values in male soccer players. J Strength Cond Res XX(X): 000-000, 2026-The primary aims were: (a) to compare the peak speed (PST-CAR) and peak heart rate (HRpeak) between the 2 Carminatti’s test (T-CAR) protocols, and (b) to compare T-CAR performance across age groups and playing positions. Part I used a randomized crossover design where 26 elite U-20 players completed the original T-CAR (starting at 9 km·h-1) and a modified, shorter version (starting at 12 km·h-1) to assess their interchangeability. Part II involved a cross-sectional analysis of a large data set (n = 3,161) to establish normative values and assess T-CAR performance from Under-11 to professional levels. Statistical significance was set at 5%. Part I revealed no significant differences in PST-CAR or HRpeak between the 2 T-CAR versions, with a nearly perfect correlation for PST-CAR (r = 0.93) and a very large correlation for HRpeak (r = 0.89). The intraclass correlation coefficient results indicated excellent consistency, with values of 0.96 (95% CI = 0.92 to 0.98) and 0.94 (95% CI = 0.87 to 0.97) for PST-CAR and HRpeak, respectively. Part II demonstrated that T-CAR performance improved with age, with the most substantial gains occurring between the U-13 and U-15 age groups. Furthermore, position-specific differences emerged from the U-15 level onward, with wide defenders and midfielders generally outperforming central defenders. In conclusion, the modified T-CAR is a valid and time-efficient alternative to the original protocol for assessing intermittent endurance performance in highly trained soccer players. The normative data established in this study provide valuable benchmarks for practitioners to monitor long-term athletic development according to age and playing position.

PMID:42127380 | DOI:10.1519/JSC.0000000000005531