Category: Nevin Manimala

Clin Transplant. 2026 May;40(5):e70552. doi: 10.1111/ctr.70552.

ABSTRACT

BACKGROUND: Cytomegalovirus (CMV) infection remains one of the most prevalent and consequential post solid organ transplant (SOT) infections. Treatment is often challenging, especially when dealing with refractory and resistant CMV infections.

METHODS: We performed a retrospective multicenter cohort study of SOT recipients with clinically significant CMV infection (csCMVi) during 2010-2016. The primary outcome was early refractory CMV infection and secondary outcomes were drug resistance, CMV recurrence, and mortality. Analysis was done with Kaplan-Meier, univariable logistic regression analysis, and multivariable Cox regression.

RESULTS: We included 145 SOT recipients with csCMVi, majority were liver transplant (49%). Most common induction was an anti-IL-2 antibody (43.9%). The majority (n = 82; 56.5%) were CMV D+/R- mismatch and presented asymptomatic infection (50.3%). After the initial 3 weeks of antiviral therapy, 13 (8.9%) patients had probable refractory csCMVi; most of them (10 [76.9%]) were CMV D+/R- mismatch. Longer time after transplant had lower risk (OR 0.68; CI 0.48-0.95, p = 0.029) while lower absolute lymphocyte count (ALC) had a higher risk of early refractory csCMVi (OR 1.54; CI 1.01-2.44, p = 0.048). Drug-resistant csCMVi occurred in 7 patients (4.8%); a high initial CMV DNA level was associated with resistant csCMVi (OR 2.00; CI 1.08-3.93, p = 0.031). 25 patients (17.2%) experienced recurrent csCMVi within 6 months. 30 patients (20.7%) died; refractory, resistant or recurrent CMV infections were not associated with mortality.

CONCLUSION: Refractory csCMVi is associated with a low ALC and an earlier onset after transplant. Resistant csCMVi is associated with high initial CMV DNA levels. Recurrence of csCMVi is common and potentially associated with low ALC at the end of antiviral treatment.

PMID:42053990 | DOI:10.1111/ctr.70552

Reprod Fertil. 2026 Apr 29:RAF-25-0193. doi: 10.1530/RAF-25-0193. Online ahead of print.

ABSTRACT

ABSTRACT: High-risk fertility behavior is a leading contributor to adverse maternal and child health outcomes. This study assessed the prevalence and determinants of high-risk fertility behavior among reproductive-age women in sub-Saharan Africa. We conducted a secondary analysis of Demography and Health Survey data from eight sub-Saharan African countries with extremely high or very high maternal mortality. A weighted sample of 78,353 reproductive-age women who had given birth in the five years preceding the survey was included. A multilevel mixed-effects binary logistic regression model was used to identify individual- and community-level factors associated with high-risk fertility behavior, accounting for the hierarchical nature of the data. Statistical significance was determined using AOR with a 95% CI and a p-value ≤ 0.05. The overall prevalence of high-risk fertility behavior was 71.46% (95% CI: 71.14%, 71.77%)), with the highest prevalence observed in Chad (87.75%) and the lowest in Lesotho (40.49%). Key individual-level determinants included women’s and husbands’ education, religion, wealth status, child sex, marital status, mobile phone and internet use, antenatal care attendance, history of pregnancy termination, and contraceptive use. At the community level, low poverty was associated with a reduced likelihood of high-risk fertility behavior. The prevalence of high-risk fertility behavior remains high in countries with extremely high and very high maternal mortality countries, highlighting a need to address it through urgent and concerted interventions. Policymakers and planners should prioritize interventions targeting the key determinants high-risk fertility behavior to curb its occurrence and improve maternal and child health outcomes.

LAY SUMMARY: High-risk fertility behavior (HRFB) is defined as having children at very young or older ages, having many births, or spacing pregnancies too closely, which can lead to serious health problems for mothers and children. This study aimed to determine the magnitude of high-risk fertility behaviors and the factors that affect the behavior among women in eight sub-Saharan African countries with very high maternal mortalities. Using data from over 78,000 women, we analyzed both individual and community-level characteristics linked to HRFB. This study found that about 71% of women had HRFB. The highest rates were in Chad, and the lowest were in Lesotho. Factors such as low education, poverty, limited use of antenatal care, lack of contraception, and reduced access to mobile phones or the internet increased the likelihood of HRFB. Communities with lower poverty showed lower rates. These findings underscore the need for targeted policies and programs to reduce HRFB and improve maternal and child health.

PMID:42053982 | DOI:10.1530/RAF-25-0193

Can J Public Health. 2026 Mar;117(Suppl 1):125-135. doi: 10.17269/s41997-025-01118-1. Epub 2026 Apr 29.

ABSTRACT

SETTING: In France, participation rates in breast cancer screening have been decreasing, along with socio-territorial inequalities. To enhance women’s access to breast cancer screening, an interventional research project was implemented to assess the effectiveness, efficiency, and optimal modalities of a mobile mammography unit for women living remotely in Normandy.

INTERVENTION: The randomized cluster trial was directed towards rural women. Before deploying the mobile unit, an intervention theory was developed. The principles of action to reduce inequalities, the definition and standardization of interventions, and the link to behavior change theories to establish causal mechanisms were integrated into a single model. We aimed to produce new knowledge on these mechanisms and develop intervention evaluations.

OUTCOMES: Using the key function/implementation/context model, the key functions of the expected intervention were listed, linked to the behavior change technique and theoretical domain framework, and finally to the capability, opportunity, motivation-behavior model components. The mechanisms and levers that can improve access to breast cancer screening are also described. This approach also allowed the standardization of stakeholders’ implications and their corresponding actions. Concrete interventions implemented included scheduling appointments at the mobile unit and implementing a suite of measures to improve the information provided to women regarding breast cancer screening.

IMPLICATIONS: This theoretical framework should be compared with interventions carried out during the deployment of mobile units. Various elements interact dynamically with and alter originally planned interventions. This experiential feedback may inform decisions on the transferability of mobile mammography units to other contexts. TRIAL REGISTRATION : This study was registered at ClinicalTrials.gov (registration date: December 21, 2021; registration number: NCT05164874).

PMID:42053923 | DOI:10.17269/s41997-025-01118-1

Can J Public Health. 2026 Mar;117(Suppl 1):94-103. doi: 10.17269/s41997-025-01105-6. Epub 2026 Apr 29.

ABSTRACT

OBJECTIVES: Compared to the general population, persons with intellectual disability (ID) have a similar cancer rate, but cancer is often discovered at a later stage. Adults with ID show lower participation in organized screenings for breast, cervical, and colorectal cancer. Here we tested an intervention to increase cancer screening knowledge and intention to participate among persons with ID.

METHODS: An open-label cluster randomized controlled trial was co-constructed with people having ID. Participants with ID underwent interventions about cancer screening or oral hygiene, using PowerPoint presentations, booklets, dice games, workshops, films, and discussions. Both groups completed a questionnaire two weeks before the intervention and at 15 min, three months, and one year after the intervention, which evaluated their knowledge gain and intention to participate in cancer screenings.

RESULTS: At 15 min, three months, and one year after the intervention, participants in the cancer group showed significantly improved cancer screening knowledge (p < 0.001). The intention to participate in screenings was increased on the intervention date (p < 0.001), but this change was non-significant three months later, and observed as a trend at one year (p = 0.068). A steering group of persons with ID gave advice regarding participant recruitment, conducting sessions, and modifying the film scenario, PowerPoint presentation, and questionnaire. Persons with ID co-constructed the booklet on cancer screening and acted in the film.

CONCLUSION: Participation of persons with ID greatly improved the study efficacy. This research provides strong evidence supporting direct interventions for people with intellectual disability to increase their participation in organized cancer screening.

PMID:42053920 | DOI:10.17269/s41997-025-01105-6

Can J Public Health. 2026 Mar;117(Suppl 1):41-44. doi: 10.17269/s41997-025-01053-1. Epub 2026 Apr 29.

ABSTRACT

Some occupational cancers appear decades after exposure. Diseases are therefore often detected during the retirement period. This disconnect raises the question of how to best protect the occupational health of retirees who are no longer in the workplace and are unlikely to have routine health monitoring by occupational physicians, even though they carry an increased risk of cancer resulting from past occupational exposure. Some countries and jurisdictions are already working to address these challenges. Since 1995, France has had a post-professional monitoring system, which has been the subject of the Rispop29 research since 2021. The results of this research serve as a basis for investigating the possibility of such a system in Ontario, where a register of workers exposed to asbestos already exists and could serve as a basis for ongoing monitoring in the retirement years. The results suggest that such an initiative would be of interest from an epidemiological and medical point of view, and that it would go beyond the single case of asbestos exposure.

PMID:42053918 | DOI:10.17269/s41997-025-01053-1

Eur Arch Paediatr Dent. 2026 Apr 29. doi: 10.1007/s40368-026-01212-z. Online ahead of print.

ABSTRACT

PURPOSE: This multicentre pilot study examined whether intraoral scanners (IOS) enhance oral health competence in paediatric patients and their caregivers compared with conventional verbal oral health instructions (OHI).

METHODS: Sixty children aged 6-14 years and their caregivers from three European university centres were randomly assigned to a control group (verbal OHI) or an intervention group (verbal OHI + IOS visualisation). Children were stratified into age groups: (6-8, 9-11, 12-14 years). Calibrated dentists performed standardised examinations and delivered OHI. In the intervention arm, an IOS scan was obtained and the 3D model was used to explain individual clinical findings. Comprehension of clinical findings was assessed after the consultation using age-adapted questionnaires. Children in the intervention group additionally rated their IOS experience using a visual analogue scale (VAS, 0-100%). Statistical analysis included descriptive statistics and Kruskal-Wallis tests.

RESULTS: Children in the intervention group achieved higher comprehension scores (4.40 ± 1.61 vs. 3.33 ± 1.81; p = 0.019). Caregivers also scored higher in the intervention group (5.03 ± 1.25 vs. 4.10 ± 1.37; p = 0.008). Benefits were greatest in children aged 6-11 years. VAS ratings indicated acceptance: scanning was perceived as “fun” (83.8%), “informative” (81.3%) and “enjoyable to watch” (88.6%). Tip size was rated appropriate (68.7%), whilst agreement with “boring” (25.9%) and “painful” (24.1%) was low. The dentist’s explanation was rated as clear (94.8%).

CONCLUSION: IOS improved communication and understanding of oral health findings in paediatric dentistry, particularly amongst younger children and their caregivers.

PMID:42053901 | DOI:10.1007/s40368-026-01212-z

Clin Transplant. 2026 May;40(5):e70546. doi: 10.1111/ctr.70546.

ABSTRACT

INTRODUCTION: Kidney transplantation (KT) improves survival and quality of life for older adults with kidney failure, yet older adults may be referred less often. We aimed to compare KT referral, waitlist activation, and transplantation rates by age in a contemporary Canadian cohort.

METHODS: We examined adult patients with kidney failure (initiating maintenance dialysis or referred for preemptive KT) in Nova Scotia from 2010 to 2020. Transplant-eligible patients aged 18-80 years were categorized by age (≤60, >60-70, and >70-80 years). Multivariable Fine and Gray subdistribution hazard and logistic regression models assessed time to transplant referral, odds of waitlist activation, and time to transplantation, adjusting for demographics, comorbidities, and frailty.

RESULTS: Of 1153 patients, 785 were potentially eligible for KT. Adjusted subdistribution hazard ratios (aSHR) for transplant referral were significantly lower for older groups (aSHR 0.73, 95% confidence interval [CI]: 0.57-0.93 for >60-70 years and aSHR 0.24, 95% CI: 0.17-0.34 for >70-80 years). There were no significant differences in odds of waitlisting if referred (odds ratio 0.76, 95% CI: 0.45-1.29 for >60-70 years and 0.74, 95% CI: 0.30-1.86 for >70-80 years) or in time to transplantation if waitlisted (aSHR 0.79, 95% CI: 0.55-1.13 for >60-70 years and aSHR 0.55, 95% CI: 0.28-1.08 for >70-80 years).

CONCLUSION: Older adults in Nova Scotia, Canada, experience significantly lower kidney transplant referral rates, with no differences in waitlist activation or time to transplant. Interventions to improve access to transplant for older individuals should focus on improving KT referral.

PMID:42053900 | DOI:10.1111/ctr.70546

Saudi Pharm J. 2026 Apr 29;34(2):23. doi: 10.1007/s44446-026-00078-y.

ABSTRACT

The optimal management strategy for hypertriglyceridemia-induced acute pancreatitis (HTGAP) remains uncertain, despite widespread use of treatment modalities including insulin therapy, heparin infusion, and plasmapheresis. Current evidence supporting the effectiveness and safety of these interventions is limited, leading to ongoing debate about their role in HTGAP treatment. This study aimed to synthesize the available evidence on the efficacy and safety of various management strategies for HTGAP. Following PRISMA guidelines for systematic reviews, we conducted a comprehensive search of the following electronic databases from their inception until October 2024: PubMed, EMBASE, Science Direct, Cochrane library, ProQuest, and Scopus. Studies were included if they were human-based quantitative study design involving a comparison group. The quality assessment tools applied were Jadad scale and CASP tool. Fourteen eligible studies were included in this review were the majority of which were cohort studies (n = 12) with (n = 10) followed a retrospective observational study design. Plasmapheresis significantly reduced triglyceride levels in six studies, while hemofiltration showed similar effectiveness in two studies. Plasmapheresis also demonstrated a statistically significant reduction in length of hospital stay across four studies. The majority of the studies (n = 12) reported no statistically significant effect on mortality. Safety reporting was notably limited, with only four studies documenting treatment-related adverse events. Plasmapheresis and hemofiltration show potential benefits in HTGAP management, but definitive conclusions regarding efficacy and safety remain challenging due to heterogeneous data and limited high-quality studies. Further robust research is needed to establish a well-informed consensus on optimal treatment strategies.

PMID:42053867 | DOI:10.1007/s44446-026-00078-y

Int J Comput Assist Radiol Surg. 2026 Apr 29. doi: 10.1007/s11548-026-03673-5. Online ahead of print.

ABSTRACT

PURPOSE: Patient-specific templates (STs) are widely adopted to guide drilling and cutting in orthopaedic procedures. Their intraoperative placement typically relies on visual and tactile assessment, without feedback on positioning accuracy. This work proposes a minimal, low-cost augmented reality (AR) method for intraoperative verification of template placement, designed for the brief and constrained nature of this task.

METHODS: A miniature camera is rigidly mounted on the surgical template and preoperatively calibrated. During placement, live images are augmented with virtual renderings of the patient’s bone model, generated from preoperative CT/MR data and displayed from the same fixed viewpoint. Correct alignment occurs only when the template reaches its planned pose, without requiring tracking systems, registration procedures, or head-mounted displays. Template placement was evaluated on a patient-specific phantom by thirteen participants, with and without AR guidance. Feasibility was further assessed through ex vivo tests on animal tissue involving seven users.

RESULTS: In phantom experiments, AR guidance was associated with improved placement accuracy (mean error 2.23 mm vs. 3.62 mm without AR, p = 0.0093). In ex vivo trials, all AR-guided osteotomy lines remained within ±2 mm of the planned trajectory suggesting experimental feasibility. However, the difference between conditions did not reach statistical significance.

CONCLUSION: Current literature lacks simple, inexpensive, and workflow-compatible methods for verifying the placement of surgical templates. The proposed approach may provide a simple method for intraoperative visual feedback without tracking hardware or complex AR systems, potentially supporting more consistent template positioning. However, its effectiveness may depend on surgical exposure and anatomical context.

PMID:42053864 | DOI:10.1007/s11548-026-03673-5

Mol Neurobiol. 2026 Apr 29;63(1):596. doi: 10.1007/s12035-026-05896-8.

ABSTRACT

Chronic fatigue is a debilitating symptom linked to mitochondrial dysfunction which lacks comprehensive genetic insights. This study aims to investigate mitochondrial-related genes associated with chronic fatigue and explores therapeutic targets. We conducted summary-data-based Mendelian randomization (SMR) and Bayesian colocalization analyses using blood eQTL data (n = 31,684) and fatigue GWAS data (n = 449,019). Mitochondrial-related genes were sourced from MitoCarta3.0. Two-sample Mendelian randomization (TSMR) analysis and gene expression detection in rat models of fatigue were employed to enhance the robustness of our findings. Drug-gene interactions were screened via Drug SIGnatures (DSigDB) database and DrugBank database, followed by molecular docking and phenome-wide association study (PheWAS) for safety and pleiotropic effects evaluation. SMR identified nine mitochondrial-related genes, with AKAP10 (OR = 1.012) and MTHFD1L (OR = 1.027) showing robust colocalization and causal links to chronic fatigue. TSMR analysis also indicated significant causal relationships of AKAP10 (OR = 1.017, 95% CI = 1.011-1.023, p = 8.15e-08) and MTHFD1L (OR = 1.046, 95% CI = 1.002-1.091, p = 0.041) with chronic fatigue. Consistently, in fatigue model rats, the expression levels of Akap10 and Mthfd1l were significantly upregulated in both hippocampal and quadriceps tissues (p = 0.021, p = 0.003, p = 0.027, p = 0.001, respectively). Molecular docking revealed strong binding affinities (below -7.0 kcal/mol) between AKAP10, MTHFD1L and repurposed drugs (e.g., irinotecan, digoxin). PheWAS indicated that both AKAP10 and MTHFD1L exhibit no significant associations with other traits at the gene level. Mitochondria-related genes AKAP10 and MTHFD1L are promising targets for the treatment of chronic fatigue. Structural modification of existing drugs targeting these genes may lead to novel therapeutic approaches, which warrants further molecular and pharmacological validation to confirm their potential application in fatigue treatment.

PMID:42053855 | DOI:10.1007/s12035-026-05896-8