Category: Nevin Manimala

ACS ES T Water. 2026 Mar 12;6(4):2458-2467. doi: 10.1021/acsestwater.5c01470. eCollection 2026 Apr 10.

ABSTRACT

Evaluating drinking water treatment (DWT) performance requires understanding how dissolved organic matter (DOM) is transformed during treatment and how these transformations drive the formation of disinfection byproducts (DBPs), which remain major concerns in drinking water safety. While current regulations target a limited number of DBP classes, including trihalomethanes (THMs) and haloacetic acids (HAAs), chlorination of DOM produces a much broader pool of largely unregulated DBPs with poorly understood toxicological relevance. In this study, a full-scale conventional drinking water treatment plant was evaluated using an integrated analytical framework combining molecular-level DOM fingerprinting by high-resolution mass spectrometry, targeted DBP quantification by gas chromatography-mass spectrometry, and adsorbable organic halide measurements. This integrated approach enables the assessment of DOM transformation and DBP formation under realistic treatment conditions. Although approximately 60% of dissolved organic carbon (DOC) was removed, molecular fingerprinting revealed a highly selective DOM removal pattern. Aromatic and condensed aromatic compounds were preferentially eliminated, whereas aliphatic and unsaturated fractions persisted and showed a positive statistical association with DBP formation. These results indicate that bulk DOC removal alone is insufficient to mitigate DBP formation and highlight the need for treatment strategies targeting specific reactive DOM fractions to enhance drinking water safety.

PMID:41988169 | PMC:PMC13078287 | DOI:10.1021/acsestwater.5c01470

Ann Ital Chir. 2026 Apr 10;97(4):694-700. doi: 10.62713/aic.4469.

ABSTRACT

AIM: The optimal uterine suturing technique for repeat caesarean section in women with a scarred uterus remains controversial, and evidence comparing novel techniques, such as the breakwater suture, with conventional methods in terms of comprehensive recovery is limited. The objective of this study is to investigate the combined effects of single-layer suturing, double-layer suturing, and breakwater suture techniques on postoperative recovery in patients with scarred uteri undergoing repeat caesarean section.

METHODS: In this retrospective cohort study, 300 pregnant women with scarred uteri undergoing repeat caesarean section at The Maternal and Child Health Care Hospital of Tong Xiang between January 2022 and December 2024 were included. The sample was divided into three groups based on the type of suture used: single-layer suture group (n = 108), double-layer suture group (n = 103), and breakwater suture group (n = 89). Primary outcomes comprised postoperative recovery time, complications, uterine healing status, psychological state, and sleep quality.

RESULTS: There were no significant differences in baseline characteristics among the three groups (p > 0.05). Regarding postoperative recovery, the breakwater suture group demonstrated significantly shorter time to anal flatus, time to first ambulation, and postoperative hospital stay compared with both the single-layer and the double-layer suture groups (p < 0.05). Postoperative ultrasound revealed significantly greater uterine segment myometrial thickness in the breakwater suture group compared to the other two groups (p < 0.001). At six months postoperatively, the incidence of uterine diverticulum in the breakwater suture group (4.5%) was significantly lower than that in the single-layer suture group (15.7%); the overall difference among the three groups was statistically significant (p = 0.041). Furthermore, patients in the breakwater suture group demonstrated significantly better postoperative outcomes on the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Edinburgh Postnatal Depression Scale (EPDS), and Pittsburgh Sleep Quality Index (PSQI) compared with the other groups (p < 0.001).

CONCLUSIONS: In repeat caesarean sections in women with scarred uteri, the breakwater suture technique comprehensively promotes postoperative recovery and may be recommended as a suturing method.

PMID:41987623 | DOI:10.62713/aic.4469

Zhongguo Zhen Jiu. 2026 Apr 12;46(4):547-552. doi: 10.13703/j.0255-2930.20250221-k0003. Epub 2026 Feb 4.

ABSTRACT

OBJECTIVE: To observe the effect of electroacupuncture (EA) on intestinal function after laparoscopic colorectal cancer surgery.

METHODS: A total of 72 patients with malignant tumors of the sigmoid colon or rectum scheduled for laparoscopic surgery were randomly divided into an observation group (36 cases) and a control group (36 cases, 1 case discontinued). The observation group received EA starting from the first postoperative day. Acupoints used included Zhongwan (CV12), Qihai (CV6), and bilateral Quchi (LI11), Tianshu (ST25), Zusanli (ST36), Shangjuxu (ST37), and Xiajuxu (ST39). EA apparatus was connected between bilateral Tianshu (ST25), as well as ipsilateral Zusanli (ST36) and Shangjuxu (ST37), using continuous wave at a frequency of 2 Hz, current intensity of 2 to 3 mA, adjusted to patient tolerance. The control group received sham EA using the same acupoints. For sham EA, the needle tips were inserted into adhesive pads without touching the skin surface, and the EA apparatus was specially modified to be non-conductive, thus preventing any effective current circuit. Both groups were treated once daily for 30 min each time, for five consecutive days. The time to first anal exhaust, time to first defecation, number of postoperative administrations of the analgesic flurbiprofen axetil, and postoperative hospital stay were recorded in the two groups. Numerical rating scale (NRS) score was assessed from postoperative day 1 to 5, and the incidence of postoperative intestinal obstruction within 14 days was also recorded in the two groups.

RESULTS: The time to first defecation in the observation group was shorter than that in the control group (P<0.01). Among patients aged ≥65 years, the time to first anal exhaust and the time to first defecation in the observation group were earlier than those in the control group (P<0.05, P<0.01). A positive correlation was found between age and time to first exhaust and defecation (r=0.472, r=0.604, P<0.01). The NRS scores on postoperative day 4 and 5 in the observation group were lower than those in the control group (P<0.01, P<0.05). There were no statistically significant differences between the two groups in terms of the number of flurbiprofen axetil administrations or length of hospital stay (P>0.05). No cases of intestinal obstruction occurred in either group within 14 days postoperatively.

CONCLUSION: EA can accelerate the recovery of bowel function after laparoscopic colorectal cancer surgery, which might have greater clinical value for patients aged 65 years or older.

PMID:41987441 | DOI:10.13703/j.0255-2930.20250221-k0003

J Nurs Manag. 2026;2026(1):e9157658. doi: 10.1155/jonm/9157658.

ABSTRACT

BACKGROUND: Burnout among emergency healthcare providers, including physicians, nurses, and paramedics, is a growing global concern, particularly in developing countries where prevalence rates can reach 70%-80%. Burnout negatively impacts healthcare systems and patient outcomes. However, limited studies compare burnout rates across these professions or focus on the Middle Eastern context, including Jordan. This study aims to assess burnout prevalence among emergency physicians, nurses, and paramedics in Jordan and identify associated demographic and work-related factors.

METHODS: A cross-sectional descriptive study was conducted using a paper-based, self-administered questionnaire incorporating the Copenhagen Burnout Inventory (CBI). Participants were drawn from emergency departments in 15 hospitals and 13 ambulance stations. Data were analyzed using SPSS Version 25, employing descriptive statistics, ANOVA, and logistic regression to identify burnout predictors.

RESULTS: A total of 560 participants completed the survey (response rate: 70%). The prevalence rates for personal, work-related, and patient-related burnout were 83.7%, 79.2%, and 64.0%, respectively, with overall high burnout rates (75.6%). Sleep deprivation (p ≤ 0.002), poor supervisor relationships (p ≤ 0.01), and attempts to change workplaces (p ≤ 0.03) were associated with all burnout dimensions. Female participants and those with one to three children showed higher burnout odds (p = 0.004, p = 0.045, respectively). No significant differences in burnout rates were observed among professions.

CONCLUSIONS: This study highlights alarmingly high burnout prevalence rates among emergency healthcare providers in Jordan, stressing the need for tailored strategies to mitigate burnout and improve the resilience of the healthcare system. Future research should explore the long-term impacts of systemic factors and post-COVID-19 dynamics.

PMID:41986944 | DOI:10.1155/jonm/9157658

J Anat. 2026 Apr 15. doi: 10.1111/joa.70153. Online ahead of print.

ABSTRACT

The domestic dog (Canis lupus familiaris), a species characterized by remarkable phenotypic diversity resulting from selective breeding, is among the several mammals that may exhibit an anatomical perforation of the humeral condyle, designated as the supratrochlear foramen (STF). The prevalence of the STF varies considerably across mammalian species and has been proposed to reflect functional adaptations linked to evolutionary and biomechanical factors, particularly in the human humerus. To the best of our knowledge, comprehensive studies on STF variation within present-day canine populations remain scarce. This study aimed to determine the prevalence and morphology of the STF in extant dogs, and to compare these findings with those from Roman Imperial Period dogs, and Iberian wolves (Canis lupus signatus), a subspecies considered representative of the dog’s wild ancestor, in order to explore evolutionary changes within Canis lupus subspecies. We analyzed 269 humeri (123 extant dogs, 76 ancient dogs, 70 Iberian wolves) using osteometric measurements and statistical analysis. Our results demonstrate that the STF was observed in 73.17% of extant dogs, compared to 82.89% in ancient dogs and 98.57% in Iberian wolves, suggesting a reduction in its prevalence over time in domestic lineages that may be linked to human-driven selection processes. In all studied groups, the STF was consistently located closer to the lateral humeral epicondyle, and its predominantly transversely elongated shape reveals a common morphological pattern across Canis lupus subspecies. Despite differences in humeral size among groups, STF dimensions showed a positive correlation with overall humeral measurements, with larger humeri exhibiting proportionally larger and more frequent STFs. Extant dogs displayed the smallest STF dimensions, followed by ancient dogs, with Iberian wolves having the largest. Considering the potential impact of the STF on the biomechanical properties of the distal humerus, this study provides new insights into its anatomical variability in dogs, emphasizing its clinical relevance for orthopedic diagnostic accuracy and surgical treatments in veterinary medicine.

PMID:41986904 | DOI:10.1111/joa.70153

Neurocrit Care. 2026 Apr 15. doi: 10.1007/s12028-026-02519-x. Online ahead of print.

ABSTRACT

BACKGROUND: A subset of patients with anterior circulation large-vessel occlusion (LVO) stroke progressed to malignant middle cerebral artery infarction (mMCAi) despite successful recanalization following endovascular treatment. This study investigated whether full medical support (FMS) could improve functional outcomes beyond reducing mortality in this population.

METHODS: In this retrospective cohort study, consecutive patients from hospital-based stroke registry (May 2015 to August 2021) with anterior LVO stroke who developed mMCAi despite successful recanalization were included. Patients were stratified into two groups on the basis of the intensity of postprocedural care: the FMS group (aggressive neurocritical care) and the non-FMS group (limited medical support or comfort care). The primary outcome was survival without severe disability, defined as a modified Rankin Scale (mRS) score of 0-4 at 90 days. Secondary outcomes included ordinal shift analysis of the mRS, rates of functional independence (mRS 0-2 and 0-3), and 90-day mortality.

RESULTS: Among 114 eligible patients, 65 were assigned to the FMS group and 49 to the non-FMS group. The FMS group demonstrated a significantly higher rate of the primary outcome (46.2% vs. 6.1%; P < 0.001) along with a markedly lower 90-day mortality (23.1% vs. 81.6%; P < 0.001) compared with the non-FMS group. After adjustment for age, gender, and confounders, FMS remained independently associated with increased odds of achieving mRS 0-4 [adjusted odds ratio (aOR), 5.88; 95% confidence interval (CI) 1.31-26.40; P = 0.021) and with reduced mortality (aOR, 0.14; 95% CI 0.05-0.42; P < 0.001), while no statistically significant difference was observed in the proportion of patients achieving an mRS of 0-2 or in those achieving an mRS of 0-3.

CONCLUSIONS: In patients who developed mMCAi after successful recanalization, FMS is associated with a greater likelihood of survival without severe disability (mRS 0-4). These findings suggest that withdrawal of aggressive medical care in this population should be approached with caution.

PMID:41986794 | DOI:10.1007/s12028-026-02519-x

Sci Rep. 2026 Apr 15. doi: 10.1038/s41598-026-48407-4. Online ahead of print.

ABSTRACT

Systemic sclerosis (SSc) is an autoimmune disorder marked by fibrosis of the skin and internal organs, with B cells increasingly recognized as key players in its pathogenesis. However, the characteristics of the B cell receptor (BCR) repertoire in SSc remain insufficiently defined. In this study, we performed high-throughput sequencing of immunoglobulin heavy chain genes in 15 female anti-centromere antibody (ACA)-positive SSc patients and five age-matched healthy female controls to explore disease-specific repertoire biases. A total of 2,597,460 in-frame sequence reads and 384,111 unique reads were obtained. While diversity metrics, including the Shannon, Simpson, and Pielou indices, tended to be higher in the SSc group, the differences were not statistically significant. Notably, the average complementarity-determining region 3 (CDR3) length was significantly shorter in SSc patients compared to controls (16.91 ± 3.727 vs. 17.44 ± 3.836, p < 0.0001). Gene usage analysis revealed no significant differences in IGHJ or IGHC segments; however, several IGHV and IGHD segments displayed statistically significant differences. IGHD5-5 (1.636% vs. 0.547%, p = 0.0001) and IGHD5-18 (1.607% vs. 0.547%, p = 0.0001) were significantly overrepresented in the SSc group, whereas IGHV1/OR15-2 was significantly underrepresented (0.062% vs. 0.130%, p = 0.0080). Further analysis demonstrated that IGHD5-5 clones with a 15-nucleotide CDR3 length were more conserved and exhibited distinctive sequence patterns compared to other lengths or genes. Specific nucleotide lengths, including 15, 23, and 24 for IGHD5-5, and 18 for IGHV1/OR15-2, showed significant frequency differences between groups (p < 0.05). Sequence logo plots confirmed reduced variability in these conserved clones, suggesting antigen-driven clonal selection. These findings identify unique BCR repertoire features in ACA-positive SSc patients and suggest their potential utility as disease biomarkers or therapeutic targets.

PMID:41986546 | DOI:10.1038/s41598-026-48407-4

J Voice. 2026 Apr 14:S0892-1997(26)00131-1. doi: 10.1016/j.jvoice.2026.03.019. Online ahead of print.

ABSTRACT

OBJECTIVE: Dysphonia in patients with Parkinson’s Disease (PD) negatively impacts quality of life. Treatment options are evolving and include both invasive and non-invasive interventions. The present study aims to assess current therapies and their effectiveness through a scoping review of the literature.

DATA SOURCES: PubMed, Ovid, and Embase.

REVIEW METHODS: Three databases were searched for articles through 2023 pertaining to treatment of PD-related dysphonia in accordance with PRISMA guidelines. Included studies were reviewed to extract demographic information, treatment techniques, and outcomes. Of 277 studies reviewed, 49 publications met inclusion criteria with a total of 1388 patients.

RESULTS: Treatments were categorized into groups: voice therapy, pharmacologic intervention, deep brain stimulation (DBS), vocal fold augmentation, neurosurgical intervention, and dietary modification. Measures reported to assess outcomes were heterogenous across studies. Voice therapy had the highest number of studies with statistically significant results, totaling 18 studies. Other treatments, including DBS, demonstrated improvement in systemic symptoms with worsening of voice symptoms.

CONCLUSION: The literature of current therapeutic options for PD patients with dysphonia is heterogenous; however, voice therapy remains standard of care. Further studies should emphasize standardization of voice metrics to permit head-to-head comparisons across treatment modalities. There is also an opportunity to leverage combining therapies for PD patients, but optimization of such regimens requires further investigation.

PMID:41986189 | DOI:10.1016/j.jvoice.2026.03.019

BMJ Open. 2026 Apr 15;16(4):e110853. doi: 10.1136/bmjopen-2025-110853.

ABSTRACT

OBJECTIVE: Ethnic communities provide an appropriate setting for examining patterns of pregnancy and childbirth. Policy-making aimed at improving maternal health will be rendered ineffective in the absence of knowledge and comprehension of the traditions and beliefs associated with childbirth. The objective of this study was to cross-ethnically compare childbirth experiences.

DESIGN: This research used a cross-sectional methodology and was conducted in 2023. The sampling in the cities of Tabriz (Azeri), Sanandaj (Kurdish), Babol (Mazani), Khorramabad (Lur), Ahvaz (Arab) and Tehran (Fars) was conducted using the cluster random approach. The data collection instruments included questionnaires of sociodemographic and obstetric characteristics and childbirth experience (Childbirth Experience Questionnaire 2.0). In bivariate analysis, a one-way analysis of variance test was employed. In contrast, a general linear model (GLM) was used in multivariate analysis to adjust for the influence of sociodemographic and obstetric characteristics. The data were analysed using SPSS V.24 software. The p value less than 0.05 was considered significant.

SETTING: Health centres in cities with different ethnic groups all over Iran.

PARTICIPANTS: For this purpose, 1331 women from six ethnic groups who were referred to health centres were selected 4 to 6 weeks after giving vaginal birth.

RESULTS: The following are the mean (SD) scores (scoring range: 1-4) for the childbirth experiences of the participating women: Azeri 2.31 (0.32), Kurdish 2.14 (0.31), Fars 2.26 (0.42), Mazani 1.93 (0.38), Lur 2.14 (0.4) and Arab 2.06 (0.18). Results from GLM multivariate analysis showed that while Azeri (B: 0.25; 95% CI 0.16 to 0.35; p<0.001), Kurdish (B: 0.10; 95% CI 0.03 to 0.18; p=0.007) and Fars (B: 0.18; 95% CI 0.03 to 0.27; p=0.014) women had significantly higher mean scores for childbirth experience than Arabs (the reference group), women of Mazani ethnicity had significantly lower scores (B: -0.10; 95% CI -0.18 to -0.04; p=0.002).

CONCLUSIONS: Women of different Iranian ethnicities have varying childbirth experiences. Women of Azeri and Fars ethnic groups report higher satisfaction with childbirth than those of others. Mazeni women had the lowest mean scores for having a positive birth experience. To offer compassionate and effective treatment for their patients, healthcare providers must have a deep understanding of cultural diversity.

PMID:41985963 | DOI:10.1136/bmjopen-2025-110853

BMJ Open. 2026 Apr 15;16(4):e113798. doi: 10.1136/bmjopen-2025-113798.

ABSTRACT

OBJECTIVES: To assess access to child-appropriate medicines in Albanian community pharmacies by applying a child-adapted version of sustainable development goal (SDG) indicator 3.b.3.

DESIGN: Cross-sectional survey.

SETTING: Community pharmacies providing primary care medicines in six urban areas in Albania.

PARTICIPANTS: Thirty community pharmacies were surveyed. Two predefined baskets of child-appropriate essential medicines were assessed: 24 medicines for children aged 1-59 months and 25 medicines for children aged 5-12 years. Medicines were selected from these child-adapted SDG 3.b.3 medicine baskets proposed at an international level and then matched to paediatric formulations registered nationally for application to Albania.

OUTCOMES: Individual facility scores by age group and medicine type (originator brands (OBs) vs lowest-priced generics (LPGs)), as well as sensitivity analyses using alternative affordability thresholds.

RESULTS: The SDG 3.b.3 indicator score was 0%, as no surveyed facility reached the 80% access threshold. Mean facility scores were 42.6% for medicines intended for children aged 1-59 months and 29.6% for those aged 5-12 years, indicating poorer access for older children. Scores for OBs were particularly low (11.8% and 13.6%, respectively), reflecting reliance on LPGs. In younger children, ibuprofen and hydroxycobalamin showed 0% availability, while in school-aged children, paracetamol, propranolol and budesonide were absent across surveyed facilities; benzylpenicillin was absent in both age groups, whereas ceftriaxone was consistently available in both. Although all surveyed medicines were affordable, limited availability remained the primary barrier to access.

CONCLUSIONS: Application of the child-adapted SDG indicator 3.b.3 in Albania highlights substantial gaps in access to essential paediatric medicines in private community pharmacies, driven primarily by poor availability rather than affordability. The findings underscore the need for targeted supply-side policies. This study demonstrates the complementary value of composite SDG indicators and medicine-specific availability measures in monitoring progress toward universal health coverage for children.

PMID:41985961 | DOI:10.1136/bmjopen-2025-113798