Category: Nevin Manimala

Nutrition. 2026 Jun 30;151:113348. doi: 10.1016/j.nut.2026.113348. Online ahead of print.

ABSTRACT

OBJECTIVES: Nutritional care is essential for improving clinical outcomes in people with cancer, and communicating with healthcare professionals about clinical nutrition is fundamental for effective nutritional management. The aim of this study was to evaluate the perceptions of healthcare professionals and patients regarding nutritional care in oncology, including the role of nutritionists, professional practices, and patient experiences.

METHODS: This cross-sectional study included healthcare professionals and patients from public and private oncology institutions. Data were collected using semistructured questionnaires. Professionals were questioned regarding criteria related to identifying nutritional risk, conducting assessments, and recommending nutritional therapy. Patients reported their perceptions of nutritional care, prior nutritional counseling, adherence to recommendations, and willingness to pay for consultations. Quantitative variables were expressed as frequencies, percentages, means ± standard deviations, medians, and ranges. A P-value ≤ 0.05 was considered statistically significant.

RESULTS: The study included healthcare professionals (n = 130) and patients (n = 360). Most professionals acknowledged the need and relevance of nutritional care during cancer treatment, but reported assessing the nutritional status of patients based primarily on body weight. Although 81.4% of physicians could identify patients at nutritional risk, 31.4% relied primarily on weight loss and body mass index as the main criteria, suggesting potential limitations in the methods used. Patients in both systems recognized the importance of nutritional care, although 7.3% did not follow recommendations of dietitians, citing a lack of dietary novelty.

CONCLUSIONS: Professionals and patients recognize the importance of nutritional care and the role of dietitians in oncology; however, gaps remain in translating this recognition into practice.

PMID:42531663 | DOI:10.1016/j.nut.2026.113348

J Oral Biosci. 2026 Jul 30;68(5):100802. doi: 10.1016/j.job.2026.100802. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the diagnostic performance, feature-level agreement, and error patterns of a multimodal large language model (MLLM) across the oral dysplasia-malignancy continuum.

METHODS: In this retrospective diagnostic accuracy study, 300 histopathology images representing normal oral mucosa (n = 100), oral potentially malignant disorders (OPMD) (n = 100), and oral squamous cell carcinoma (OSCC) (n = 100) were evaluated using a standardized two-stage prompting framework consisting of morphological feature extraction followed by structured diagnostic classification. Reference diagnoses were established by three experienced oral pathologists. Interobserver agreement among pathologists was assessed using Fleiss’ κ statistics. Primary outcomes included overall accuracy, macro-F1 score, and balanced accuracy. Secondary outcomes included feature-level agreement, confidence-accuracy alignment, and clinically significant error patterns.

RESULTS: Interobserver agreement among the reference pathologists was substantial for the primary three-class diagnosis (Fleiss’ κ = 0.81). Overall accuracy was 0.667 (95% confidence interval [CI]: 0.620-0.727), with a macro-F1 score of 0.662 and balanced accuracy of 0.755. Performance varied substantially across diagnostic categories, with high sensitivity for normal mucosa (0.990; 95% CI: 0.968-1.000). Reduced sensitivities were observed for OPMD (0.430; 95% CI: 0.340-0.531) and OSCC (0.580; 95% CI: 0.495-0.688), indicating reduced discriminative ability relative to normal mucosa. Feature-level agreement was generally low, with the weakest agreement for architectural dysplasia features (κ = -0.116 to -0.068), slight agreement for invasion-related features (κ = 0.111-0.120), and the highest agreement was for nuclear hyperchromasia (κ = 0.281). Most misclassifications (84.8%) occurred at the dysplasia-malignancy interface. Proxy calibration analysis demonstrated systematic overconfidence in the histopathological predictions.

CONCLUSIONS: The MLLM demonstrated moderate performance in oral histopathology, with reliable recognition of normal tissue and reduced discriminative ability for OPMD and OSCC relative to normal mucosa, particularly at the dysplasia-malignancy interface. These findings support a potential assistive role under expert supervision while highlighting important limitations in clinically critical diagnostic settings.

PMID:42531661 | DOI:10.1016/j.job.2026.100802

J Inorg Biochem. 2026 Jul 24;284:113417. doi: 10.1016/j.jinorgbio.2026.113417. Online ahead of print.

ABSTRACT

Chiral coordination complexes continue to attract interest as potential therapeutic agents, yet their stereochemical properties are rarely examined with the rigor now standard in organic drug discovery. Here we investigate whether the Δ and Λ enantiomers of the highly potent Ru(II) oligothienyl photosensitizer ML19G01 exhibit intrinsic differences in photobiological activity. Five independently synthesized batches of rac-ML19G01 were separated by direct chiral chromatography on a functionalized cyclofructan-6 (CF6-RN) stationary phase using both LC and sub/supercritical fluid chromatography. Enantiomeric excess was established by analytical chiral HPLC, absolute configuration was assigned by vibrational circular dichroism (VCD)/DFT comparison, and removal of trifluoroacetic acid (TFA), triethylamine (TEA), and counterion impurities was verified by ¹H and ¹⁹F NMR. Enantiomeric integrity under illumination was confirmed to exclude photoracemization. Across 24 independent photobiological assays performed over several years in SK-MEL-28 melanoma cells, Δ- and Λ-ML19G01 displayed statistically indistinguishable dark and light EC₅₀ values and phototherapeutic indices. Although individual experiments occasionally suggested enhanced potency of one enantiomer, these differences were not reproducible and were not supported by ANOVA/Tukey analysis. Small deviations observed for the racemate arose from non-stereochemical factors, including polymorphism, differential purification histories, and statistical averaging. These results demonstrate that ML19G01 does not exhibit meaningful enantiospecific photobiological behavior and provide practical recommendations for the preparation, characterization, and biological evaluation of chiral coordination complexes.

PMID:42531660 | DOI:10.1016/j.jinorgbio.2026.113417

Rev Peru Med Exp Salud Publica. 2026 Jun 30;43(2):244-250. doi: 10.17843/rpmesp.2026.432.15834.

ABSTRACT

With the objective of describing the characteristics and comparing the need with the previous utilization of rehabilitation services in children with cerebral palsy at a referral hospital in Peru, a descriptive study was conducted through the review of medical records of 86 patients treated during 2024. It was found that 41.8% did not attend any educational institution and 44.2% did not have a disability certificate; among those who had one, the mean time to obtain it was 4.9 years. Less than half had a pelvic radiograph, despite hip dislocation being a frequent comorbidity. Although the majority required rehabilitation therapies, their coverage was limited, especially in occupational therapy and speech/swallowing therapy. Likewise, more than half of those who required botulinum toxin had not received it. These findings demonstrate significant discrepancies between the need and previous utilization of rehabilitation services in this population.

PMID:42531588 | DOI:10.17843/rpmesp.2026.432.15834

Rev Peru Med Exp Salud Publica. 2026 Jun 16;43(2):197-206. doi: 10.17843/rpmesp.2026.432.15609.

ABSTRACT

OBJECTIVES: To estimate the frequency of nasal carriers of Methicillin-Resistant Staphylococcus aureus(MRSA) among healthcare personnel of the Red de Salud Huamanga (Ayacucho, Peru) between October and November 2024.

MATERIALS AND METHODS: Descriptive cross-sectional study in 265 healthcare workers, recruited by convenience sampling. Nasal swabs were cultured on mannitol salt agar, MRSA was confirmed by cefoxitin disk diffusion (EUCAST v14.0 2024: diameter <22 mm). Antimicrobial susceptibility was evaluated by Kirby-Bauer. The use of personal protective equipment (PPE) was recorded by structured questionnaire. Absolute and relative frequencies were calculated.

RESULTS: Staphylococcus aureus was detected in 14.0% (37/265) of the participants. Of these isolates, 64.9% (24/37) were MRSA, representing a frequency of 9.1% (24/265). Of the total Staphylococcus aureus carriers, MRSA isolates were more frequent in interns/trainees (18.9%; 7/37) and nurses (16.2%; 6/37). Outpatient clinics (27.0%; 10/37) and emergency (13.5%; 5/37) concentrated the highest number of carriers. High resistance to erythromycin was observed in MRSA (70.8%) and in methicillin-susceptible Staphylococcus aureus (84.6%).

CONCLUSIONS: In the studied sample, approximately one in ten healthcare workers was a nasal carrier of MRSA. Given the convenience sampling, the findings should not be extrapolated as population prevalence. Strengthening the use of PPE, hand hy-giene, and microbiological surveillance are priority measures to reduce transmission.

PMID:42531582 | DOI:10.17843/rpmesp.2026.432.15609

Rev Peru Med Exp Salud Publica. 2026 Jun 30;43(2):189-196. doi: 10.17843/rpmesp.2026.432.16064.

ABSTRACT

OBJECTIVES: To determine the association between intimate partner violence and alexithymia in pregnant women treated at two hospitals in Cusco, 2025.

MATERIALS AND METHODS: A cross-sectional analytical study was conducted, which included 286 pregnant women treated in the outpatient clinics of Gynecology and Obstetrics at Hospital Antonio Lorena and Hospital Regional del Cusco between February and April 2025. Direct interviews were applied using the Toronto Alexithymia Scale (TAS-20) and the Woman Abuse Screening Tool (WAST). Statistical analysis was performed using the generalized linear model (GLM) with Poisson distribution, logarithmic link function, and robust variance, calculating adjusted prevalence ratios (aPR).

RESULTS: 286 pregnant women were included. 71.7% presented alexithymia and 55.6% reported intimate partner violence (IPV). The study reveals that the prevalence of alexithymia was 50% higher in pregnant women with IPV (aPR: 1.50; 95% CI: 1.26-1.79; p<0.001), adjusted for origin, educational level, employment status, economic situation, number of gestations, and pregnancy planning.

CONCLUSIONS: Intimate partner violence was significantly associated with a higher prevalence of alexithymia in pregnant women treated at two hospitals in Cusco. Pregnant women exposed to violence showed a 50% higher prevalence of alexithymia, even after adjusting for sociodemographic and obstetric variables.

PMID:42531581 | DOI:10.17843/rpmesp.2026.432.16064

Rev Peru Med Exp Salud Publica. 2026 Jun 25;43(2):171-178. doi: 10.17843/rpmesp.2026.432.15175.

ABSTRACT

OBJECTIVES: To explore gender disparity in the development of clinical practice guidelines (CPGs) in Peru.

MATERIALS AND METHODS: A descriptive and observational study was conducted. An electronic search for Peruvian CPGs published from 2015 until July 30, 2024, was performed. Microsoft Excel was used for data collection and RStudio for statistical analysis.

RESULTS: 177 CPGs published between 2015 and 2024 were analyzed that reported information related to the CPG development group (CDG). In general, the CDGs included 1527 men (58.8%) and 1070 women (41.2%) among clinical experts and methodologists. Men predominated as clinical experts, especially in specialties such as internal medicine and surgery; while women predominated as methodologists. The specialty with the highest male predominance was internal medicine (61.8%).

CONCLUSIONS: The study revealed lower female participation in the development of CPGs in Peru, as well as greater gender disparity in participation in the surgical field and in public institutions. The low participation of women in leadership positions influences this gap. Strategies are required to improve gender equity.

PMID:42531579 | DOI:10.17843/rpmesp.2026.432.15175

Rev Peru Med Exp Salud Publica. 2026 Jun 22;43(2):160-170. doi: 10.17843/rpmesp.2026.432.15170.

ABSTRACT

OBJECTIVES: To evaluate self-reported adherence to the essential components of tuberculosis preventive treatment (TPT), as an estimate of partial implementation fidelity, and to explore the moderating factors influencing its implementation in two referral services in the Central Department, Paraguay.

MATERIALS AND METHODS: A descriptive observational mixed-methods study with a convergent parallel design (January-May 2023) was conducted in two referral centers for people living with HIV. Partial implementation fidelity was estimated through self-reported adherence to the content and frequency dimensions of TPT implementation according to the National Tuberculosis Guide. Semi-structured interviews were conducted with key stakeholders to identify barriers and facilitators.

RESULTS: 11/13 physicians and 10 key stakeholders participated. Overall TPT fidelity was low (50.0%). Adherence to content was moderate (64.2%), while adherence to frequency was low (31.3%), evidencing a gap between perceived importance and clinical practice. The awareness/education component showed the lowest performance. The main barriers were identified in the internal environment, including organizational fragmentation between TB/HIV programs, limited resources, absence of operational protocols, and communication deficiencies. At the individual level, erroneous beliefs and low self-efficacy were identified. As facilitators, national normative alignment and the willingness of stakeholders to strengthen implementation were observed.

CONCLUSIONS: Low fidelity reflects mainly organizational and process failures, which highlights the need for facilitation strategies, interprogrammatic articulation, and capacity strengthening to achieve sustained implementation.

PMID:42531578 | DOI:10.17843/rpmesp.2026.432.15170

Obstet Gynecol. 2026 Jul 30. doi: 10.1097/AOG.0000000000006389. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate changes in pregnancy-associated drug overdose mortality in the United States from 2018 to 2023 and compare this with drug overdose mortality among reproductive-aged nonpregnant female decedents. Secondarily, to assess types and combinations of drugs that contribute to overdose mortality, regional patterns, and overdose timing.

METHODS: This was a cross-sectional study that used 2018-2023 National Center for Health Statistics death certificate data. Drug overdose deaths were identified using International Classification of Diseases, Tenth Revision codes, and specific drugs involved were identified using T codes. Among all female decedents of reproductive age (15-44 years), pregnancy-associated drug overdose deaths were identified from the pregnancy checkbox. We calculated absolute and relative changes in drug overdose mortality rates for pregnancy-associated deaths and non-pregnancy-associated deaths among reproductive-aged female individuals. The annual pregnancy-associated drug mortality rates were also calculated by drug type and U.S. region (Northeast, Midwest, South, and West).

RESULTS: There were 2,573 pregnancy-associated drug overdose deaths identified. Pregnancy-associated overdose mortality increased from 8.0 per 100,000 live births to 13.0 deaths per 100,000 live births (relative increase: 62.2%). The drug overdose mortality rate among female individuals of reproductive age increased from 16.8 per 100,000 live births to 22.3 per 100,000 live births across the same period (relative increase: 33.0%). The fentanyl-involved pregnancy-associated overdose mortality rate was higher than other drugs. The psychostimulant-involved rate increased across time (from 2.9 deaths/100,000 live births to 7.5 deaths/100,000 live births). Drug overdose mortality rates were highest in the South. Polysubstance-involved overdose deaths were also common, with fentanyl and psychostimulants accounting for 24.8% of deaths.

CONCLUSION: The relative increase in the drug overdose mortality rate among pregnant and postpartum individuals was nearly double that of nonpregnant female individuals of reproductive age, driven by fentanyl, increasing psychostimulant, and polysubstance overdose deaths.

PMID:42531570 | DOI:10.1097/AOG.0000000000006389

J Speech Lang Hear Res. 2026 Jul 30:1-33. doi: 10.1044/2026_JSLHR-25-00953. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to test the impact of modifying resistive load and time under tension (TUT) on respiratory excursion, submental excitation, and ratings of perceived exertion/effort (RPE) during expiratory muscle strength training (EMST). Task specificity between EMST, cough, and swallowing was also explored.

METHOD: Participants were outfitted with respiratory bands, submental surface electromyography, and a microphone. Tasks included maximal expiratory pressure (MEP) testing, voluntary and reflex cough testing, cup sips, and EMST. EMST included three sets of 10 repetitions in four conditions: short (0.2 s) at 50% MEP, long (1 s) at 50% MEP, short at 75% MEP, and long at 75% MEP (L75). Outcomes were respiratory kinematics, cough airflow, submental excitation, and RPE. Multilevel models and pairwise comparisons were used for statistical analysis.

RESULTS: Twenty healthy adults (M_age = 27 ± 5 years) participated. There were significant effects between EMST conditions where rib cage excursion ranged from 5% to 24% (of maximum), abdominal excursion ranged from 6% to 19%, submental excitation ranged from 40% to 57%, and RPE varied (p < .05). Several pairwise contrasts during cough and swallowing showed no significant differences with EMST conditions. Submental excitation during L75 was higher than the swallowing condition (p = .03).

CONCLUSIONS: Exercise parameters including resistive load and TUT that impacted the acute physiologic responses to EMST should be considered during exercise prescription to maximize physiologic adaptations and training specificity. Future research will examine the longitudinal impacts of modifying EMST exercise parameters on coughing and swallowing outcomes.

PMID:42531563 | DOI:10.1044/2026_JSLHR-25-00953