Category: Nevin Manimala

J Foot Ankle Res. 2026 Mar;19(1):e70123. doi: 10.1002/jfa2.70123.

ABSTRACT

BACKGROUND: Foot ulceration is a debilitating and often disabling complication of diabetes mellitus, with negative prognostic associations in terms of morbidity and mortality. Percutaneous needle tenotomy (PNT) is increasingly recognized as a safe, minimally invasive procedure for treating tendon-related deformities, including mechanical forefoot ulceration. This study evaluated clinical outcomes of needle flexor tenotomies performed by a podiatrist versus an orthopaedic surgeon.

METHODS: This service evaluation reviewed consecutive adult patients with foot ulceration who received needle tenotomy by a senior podiatrist, excluding those who underwent alternative procedures/amputation. Orthopaedic surgeon conducted tenotomy was the comparison group.

RESULTS: Podiatrist: 30 patients underwent needle tenotomy (total-31 feet) (23 patients had diabetes). Orthopaedic surgeon: 10 patients underwent needle tenotomy (total-12 feet). Median age was 71.5 years (range: 39.0-92.0), with 8 males/2 females. (8 patients had diabetes). The podiatrist-led group was older and had higher HbA1c, greater proportion of smokers, larger ulcer size and longer ulcer duration pre-intervention (median 54 vs. 20 weeks and p = 0.002) than the orthopaedic surgeon-led group. Despite these differences in disease severity, time to ulcer resolution (median 4.7 vs. 2 weeks, p = 0.119) and the rate of complete healing (86.7% vs. 100% and p = 0.556) did not differ significantly between groups.

CONCLUSION: The lowest cost of the minor surgical foot procedure as a day case = £554 (€662) with this cost at least halved by conducting the procedure in a podiatry clinic. In conclusion, podiatrist-led percutaneous needle tenotomy is a safe and effective intervention for foot ulcers, achieving healing outcomes comparable to an orthopaedic surgeon. We hope that the procedure can be adopted more widely.

PMID:41655273 | DOI:10.1002/jfa2.70123

J Int Med Res. 2026 Feb;54(2):3000605261416668. doi: 10.1177/03000605261416668. Epub 2026 Feb 8.

ABSTRACT

BackgroundPostoperative pain following liver resection remains a clinical challenge, and the optimal analgesic strategy is still debated.ObjectiveTo determine whether a single intrathecal morphine injection provides superior analgesia and opioid-sparing effects compared with conventional systemic or regional techniques in adult patients undergoing liver surgery.MethodsPubMed, Embase, Web of Science citation index, and the Cochrane Library were searched from inception to August 2025 for randomized controlled trials comparing intrathecal morphine with alternative analgesic regimens in liver resection. The primary outcome was pain intensity at rest 24 h after surgery (standardized mean difference). Secondary outcomes included pain intensity at 48 and 72 h and cumulative opioid consumption within 24 h postoperatively. Random-effects meta-analyses and I² statistics were used to assess pooled effects and heterogeneity.ResultsEleven randomized controlled trials (n = 535) met the inclusion criteria. Intrathecal morphine reduced 24-h postoperative pain scores with a moderate effect (standardized mean difference = -0.64; 95% confidence interval: -0.84 to -0.44; p < 0.001; I² = 55%) and decreased 24-h opioid consumption by 11.6 mg morphine equivalents (95% confidence interval: -19.3 to -3.9 mg; p = 0.003; I² = 96%). Differences in pain intensity at 48 and 72 h were not statistically significant. Adverse-event profiles were comparable between groups.ConclusionA single dose of intrathecal morphine provides clinically meaningful early analgesia and opioid-sparing benefits after liver resection without increasing adverse events. Incorporating intrathecal morphine into multimodal analgesic protocols may accelerate recovery; however, further high-quality trials are warranted to refine dosing and identify optimal patient selection.

PMID:41655272 | DOI:10.1177/03000605261416668

J Int Med Res. 2026 Feb;54(2):3000605261417447. doi: 10.1177/03000605261417447. Epub 2026 Feb 8.

ABSTRACT

ObjectiveThis study aimed to evaluate the safety profile of progesterone by analyzing adverse event data from the Food and Drug Administration Adverse Event Reporting System (FAERS) between 2004 and 2024.Materials and methodsThis retrospective, observational pharmacovigilance study was based on data from the FAERS database. A total of 1827 adverse event reports associated with progesterone were retrieved. Disproportionality analysis methods, including the reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker, were used to evaluate the frequency, signal strength, and time-to-onset of adverse events.ResultsAmong 24,589,239 adverse event reports in the reporting system, 1827 were associated with progesterone, covering 22 system organ classes and 152 preferred terms. The most frequently reported preferred terms were maternal exposure during pregnancy (151 cases), spontaneous abortion (144 cases), and abnormal product odor (114 cases). The top three preferred terms showing the strongest signals were decidual cast (reporting odds ratio: 2825.23), chondrodermatitis nodularis chronica helicis (reporting odds ratio: 3897.61), and autoimmune dermatitis (reporting odds ratio: 1519.29). Most adverse events occurred within 30 to 180 days after exposure. Newly identified preferred terms associated with progesterone included acute eosinophilic pneumonia, meningioma, and autoimmune dermatitis.ConclusionsThis study identified notable safety concerns associated with progesterone use and detected several rare adverse events. These findings underscore the need for continued monitoring, updated prescribing guidelines, and further investigation into progesterone formulations and adverse event mechanisms.

PMID:41655271 | DOI:10.1177/03000605261417447

Diabetes Metab Res Rev. 2026 Feb;42(2):e70135. doi: 10.1002/dmrr.70135.

ABSTRACT

BACKGROUND AND AIM: Diabetic neuropathy (DN) is a recognised risk factor for fragility fractures. However, the mechanisms linking DN, bone health, and falling risk remain unclear. We aimed to assess bone health and risk of falls, with their contributing factors, in young elderly patients with type 2 diabetes (T2D) and mild-to-moderate DN.

METHODS: We enrolled 144 subjects with T2D, excluding those with severe DN (neuropathy disability score -NDS- ≥ 9) or fracture history. Clinical and biochemical data were collected, including surrogate markers of insulin resistance, such as the triglycerides/HDL (TG/HDL) ratio and triglycerides/glucose (TyG) index. Bone mineral density (BMD) and trabecular bone score (TBS) were evaluated using DXA scans. Falls were self-recorded prospectively over 4 years using diaries.

RESULTS: Subjects with DN (27%) had higher BMI (p = 0.036), fasting blood glucose (p = 0.04), serum triglycerides (p = 0.016), TG/HDL ratio (p = 0.012) and TyG index (p = 0.003) compared with those without DN. After adjustment for gender, age, BMI, HbA1c, TyG index and TG/HDL ratio, subjects with DN showed significantly lower BMD at the femoral neck (0.702 [0.638-0.850] g/cm² vs. 0.789 [0.717-0.860] g/cm², p = 0.015) and total femur (0.890 [0.820-1.055] g/cm² vs. 0.983 [0.889-1.076] g/cm², p = 0.027). No differences were observed in spine BMD or TBS. However, TBS was negatively correlated with the TG/HDL ratio (r = -0.215, p = 0.013) and visceral adipose tissue (r = -0.310, p < 0.001). After 4 years of follow-up, subjects with painful neuropathy at baseline had a higher rate of falls (p = 0.011).

CONCLUSION: DN is associated with decreased BMD and increased risk of falls. Among factors associated with DN, insulin resistance was also associated with decreased bone quality.

PMID:41655239 | DOI:10.1002/dmrr.70135

Cutan Ocul Toxicol. 2026 Feb 8:1-6. doi: 10.1080/15569527.2026.2626680. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to investigate the potential role of systemic inflammatory biomarkers associated with high-density lipoprotein cholesterol (HDL) in the pathogenesis of Xanthelasma Palpebrarum (XP).

METHODS: HDL, low-density lipoprotein cholesterol (LDL), total cholesterol (TC), triglyceride (TG), lymphocyte, neutrophil, monocyte, platelet and red cell distribution width-standard deviation (RDW-SD) values were obtained from peripheral blood samples of patients who underwent XP excision. Monocyte-to-high-density lipoprotein cholesterol ratio (MHR), lymphocyte-to-HDL cholesterol ratio (LHR), platelet-to-HDL cholesterol ratio (PHR), neutrophil-to-HDL cholesterol ratio (NHR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) were calculated and statistically compared. Multivariate logistic regression and ROC analyses were performed to determine predictive values.

RESULTS: The study compared the XP group (63 patients) and the control group (54 healthy individuals), finding no significant differences in age and gender (p = 0.059 and p = 0.406, respectively). Neutrophil, lymphocyte, monocyte, and platelet counts, as well as MHR, LHR, PHR, NHR, and SII values, were significantly higher in the XP group (p < 0.001, p = 0.015, p = 0.042, p = 0.018, p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p = 0.016, respectively). HDL levels were significantly lower in the XP group (p < 0.001). Among all parameters, NHR had the highest predictive value with an area under the curve (AUC) of 0.81. NHR (Odds ratio: 1.07) was identified as a potential risk factor for XP.

CONCLUSION: This study highlights the potential role of systemic inflammation associated with HDL in the pathogenesis of XP by triggering oxidative stress mechanisms, lipid peroxidation, and tissue-level inflammatory damage, and emphasizes the need to investigate treatments that regulate inflammation in XP therapy.

PMID:41655202 | DOI:10.1080/15569527.2026.2626680

Phys Sportsmed. 2026 Feb 8. doi: 10.1080/00913847.2026.2627863. Online ahead of print.

ABSTRACT

BACKGROUND: Branched-chain amino acids (BCAAs) – leucine, isoleucine, and valine – are widely used in sports nutrition, yet their effects on endurance performance remain uncertain. Most studies emphasize biochemical markers without linking them to functional outcomes. This is the first systematic review to evaluate whether biochemical alterations induced by BCAA or leucine supplementation are associated with actual performance or recovery benefits in endurance athletes.

METHODS: A systematic review was conducted in accordance with PRISMA 2020, the Cochrane Handbook for Systematic Reviews of Interventions, and the GRADE approach. Searches were performed in PubMed, Embase, and Web of Science up to 11 July 2024. Eligible studies included endurance runners or athletes, used BCAA or leucine supplementation, and reported outcomes related to performance, recovery, or adverse effects. Risk of bias was assessed using the ROBINS-I tool.

RESULTS: From 152 records, 15 studies met inclusion criteria. No consistent improvement was observed in performance, fatigue, or recovery. Only two studies reported statistically significant differences. One trial found a 42% reduction in muscle soreness (p < 0.05), though with inadequate control for protein intake and confounders. Biochemical changes included: increase 140% valine (p < 0.01), low plasma glucose (p < 0.01), increase free fatty acids (p < 0.001), and raise 25% protein synthesis post-exercise (95% CI: 20-30%, p = 0.01). Mental performance improved after 12 km and 30 km runs (p < 0.05), but no functional performance gains were consistently observed.

CONCLUSION: BCAA and leucine supplementation do not result in meaningful improvements in endurance performance or muscle recovery. Despite biochemical alterations, current evidence – limited by low methodological quality, surrogate outcomes, and risk of bias – does not support the use of BCAA as an effective strategy for endurance athletes.

PMID:41655197 | DOI:10.1080/00913847.2026.2627863

Environ Geochem Health. 2026 Feb 8;48(3):148. doi: 10.1007/s10653-026-03037-7.

ABSTRACT

This study was conducted to investigate the presence of microplastics (MPs) in individuals of Hyla orientalis and Hyla savignyi, two tree frog species naturally distributed in Türkiye, to determine the qualitative and quantitative distribution of these particles in their gastrointestinal tracts (GITs) and to analyze their morphological (color, shape, size) and chemical (polymer type) properties in detail. A total of 276 individuals were examined within the scope of the research, 76 of which belonged to H. orientalis and 200 to H. savignyi. A total of 192 microplastic particles were detected in their GITs, and the average size of these particles was determined to be 206.56 ± 12.88 µm. The most common microplastic type was PET (67.20%), its shape was fiber (76.00%), and its color was navy blue (25.50%). The highest proportion of microplastic-containing individuals was observed in H. savignyi (56.50%), and microplastic was found in only 11.84% of H. orientalis individuals. No statistically significant difference was found between the two species in terms of polymer type, microplastic shape, and color (p > 0.05). Data obtained from 24 different provinces across Türkiye indicate that microplastic contamination has a wide geographical distribution. The highest microplastic amount was recorded from Hatay-Hassa (44 pieces), followed by Kilis and Bitlis provinces. Significant differences were found between provinces in terms of color, shape, and polymer type (p < 0.001). These findings suggest that microplastic pollution is widespread in terrestrial vertebrates and may vary among species and geographic regions, suggesting that amphibians may be important bioindicators for monitoring ecosystem health.

PMID:41655173 | DOI:10.1007/s10653-026-03037-7

Arch Gynecol Obstet. 2026 Feb 8;313(1):83. doi: 10.1007/s00404-026-08335-0.

ABSTRACT

PURPOSE: To characterise the effect of polycystic ovary syndrome (PCOS) on embryo morphokinetics via time-lapse imaging, including absolute time points, relative time intervals, and ratios representing cleavage synchronicity.

METHODS: This single-centre retrospective observational study examined patients aged 18-45 years undergoing in vitro fertilisation/intracytoplasmic sperm injection with time-lapse imaging (09/2016-12/2019; n = 1433 two-pronuclear oocytes). A group with PCOS (n = 48 embryos) was compared to a control group with uterine, tubal factor or idiopathic infertility (n = 400 embryos). Times from the two-cell stage to blastocyst expansion, eight intervals for embryonic cell cycle (ECC) duration and synchronicity and four cleavage synchronicity (CS) and DNA replication time ratios were analysed.

RESULTS: PCOS patients were younger (P = 0.023) with higher anti-Müllerian hormone levels (P < 0.001) than controls. No statistically noticeable influence of PCOS on absolute times was observed. The intervals from the 3- to 4-cell (synchronicity of cell cycle 2, s2; P = 0.013), the 5- to 8-cell (synchronicity of cell cycle 3, s3; P = 0.032) and the 4- to 8-cell stage (ECC3; P = 0.043) were longer in the PCOS group. The relative CS ratio from the 2- to 8-cell stage (CS2-8) was lower (P = 0.003) and from the 2- to 4-cell stage (CS2-4) was higher (P = 0.001) in PCOS embryos.

CONCLUSION: Whilst absolute times remained unaffected, relative morphokinetic intervals and ratios, potentially indicating poorer cleavage synchronicity, were altered in PCOS embryos. This is the first study examining the influence of PCOS on relative morphokinetic ratios.

PMID:41655163 | DOI:10.1007/s00404-026-08335-0

EJNMMI Phys. 2026 Feb 8. doi: 10.1186/s40658-026-00845-9. Online ahead of print.

ABSTRACT

BACKGROUND: Monitoring the external dose rate (EDR) attenuation serves as a key consideration in supporting discharge decisions for patients with differentiated thyroid cancer (DTC) who have undergone radioiodine therapy. We aimed to study the EDR attenuation and its related factors in DTC patients during I-131 therapy.

METHODS: This study enrolled 886 DTC patients who first underwent I-131 therapy at the Third Bethune Hospital of Jilin University, China. We measured the EDR at approximately 2, 24, 48, and 72 h post-therapy. Two formulas were established to represent the EDR decay with time: 1) EDR =[Formula: see text] and EDR_% = [Formula: see text], where EDR is the absolute external dose rate (µSv/h), EDR_% is the percentage EDR relative to the initial EDR (100%), SI (speed index, μSv/h²) is the absolute decay rate of I-131 with the time, SI_% (%/h) is the relative decay rate with the time, and b is a constant.

RESULTS: The finally fitted SI and SI_% from patients’ data were -0.020 μSv/h² and -0.026%/h, respectively. EDR_% exhibited a stronger correlation with administration time than EDR (R²: 0.951 vs. 0.829). Body mass index (BMI), smoking, history of type 2 diabetes mellitus, Follicular Thyroid Carcinoma (FTC) subtype, increasing residual thyroid tissue grading, FT3 and Tg levels positively associated with SI. The factors negatively associated with SI were female sex, a higher N stage and a higher I-131 dose. SI_% was positively associated with smoking history, history of type 2 diabetes mellitus, and FTC pathological subtype, and negatively with female sex and higher I-131 dose.

CONCLUSIONS: EDR_% had better correlation than EDR with I-131 administration time. The related factors for SI and SI_% included I-131 dose, sex, BMI, thyroid cancer pathology, medical history and thyroid function. These findings provide a reference for radiation protection officers in evaluating radioactive activity during I-131 therapy.

PMID:41655156 | DOI:10.1186/s40658-026-00845-9

Radiol Phys Technol. 2026 Feb 8. doi: 10.1007/s12194-026-01016-2. Online ahead of print.

ABSTRACT

This study evaluated dose differences to the heart, left anterior descending coronary artery (LADCA), and left main coronary artery (LMCA) between diastolic and systolic heart phases in radiation therapy for left-sided breast cancer using deep inspiration breath-hold (DIBH). Diastolic and systolic doses to the heart, LADCA, and LMCA were analyzed using electrocardiogram-gated cardiac computed tomography images from 15 women. Radiation therapy plans were created for a total dose of 50 Gy in 25 fractions. Parameters assessed included volume, D_mean, D_2%, V_5Gy, V_10Gy, V_20Gy, and V_25Gy for the heart; D_mean, D_2%, V_5Gy, V_10Gy, and V_20Gy for the LADCA; and D_mean and D_2% for the LMCA. The D_mean of the heart was 5.10 ± 3.04 Gy and 5.03 ± 3.05 Gy for diastole and systole, respectively (mean ± 1 standard deviation), and D_2% was 37.44 ± 16.03 Gy and 36.15 ± 16.76 Gy. Statistically significant differences were found in the D_mean. LADCA doses showed no significant differences, possibly due to anatomical variations. The D_mean of the LMCA was 1.88 ± 0.23 Gy and 2.02 ± 0.28 Gy for diastole and systole, and D_2% was 2.05 ± 0.28 Gy and 2.21 ± 0.30 Gy, with both parameters being statistically significantly higher during systole. Although small, cardiac-phase-dependent dose variations under DIBH were statistically significant, confirming that current non-ECG-gated DIBH remains adequate for cardiac dose management.

PMID:41655146 | DOI:10.1007/s12194-026-01016-2