Category: Nevin Manimala

Front Med (Lausanne). 2026 Apr 20;13:1799752. doi: 10.3389/fmed.2026.1799752. eCollection 2026.

ABSTRACT

BACKGROUND: The transition from hospital to home is a high-risk period for patients with Inflammatory Bowel Disease (IBD). This study aimed to develop and preliminarily validate a structured discharge planning program for patients with IBD by applying the Team STEPPS framework.

METHODS: This study employed a sequential two-phase, mixed-methods design. First, a Team STEPPS-based discharge planning program was rigorously developed using Delphi method between August and October 2023. Subsequently, a randomized controlled trial was conducted from October 2023 to March 2024 to validate the program. Ninety eligible inpatients were randomly assigned to an intervention group (n = 45) receiving the structured Team STEPPS program or a control group (n = 45) receiving standard care. The primary outcome was discharge readiness, assessed at the time of discharge. Secondary outcomes included the quality of discharge teaching, measured at discharge, and health-related quality of life, evaluated at baseline, discharge, and 30-day follow-up. Longitudinal outcomes analyzed via linear mixed-effects models.

RESULTS: All 90 enrolled participants completed the study. The Delphi process successfully achieved expert consensus, resulting in a structured discharge program with all items meeting predefined criteria (mean importance ≥ 4.0, coefficient of variation ≤ 0.25). In the subsequent randomized controlled trial, baseline characteristics were well-balanced. At discharge, the intervention group exhibited statistically superior outcomes, including significantly higher discharge readiness (103.0 ± 7.3 vs. 94.9 ± 4.7, P < 0.001) and quality of discharge teaching scores (183.6 ± 6.4 vs. 172.7 ± 5.0, P < 0.001). Longitudinal analysis of health-related quality of life revealed a significant group-by-time interaction effect (P < 0.001), with the intervention group demonstrating a greater magnitude of improvement. The model estimated an incremental benefit of the intervention of 9.2 points (95% CI: 5.7-12.7) at the 30-day follow-up compared to standard care.

CONCLUSION: A Team STEPPS-based discharge planning program was successfully developed and shown to be effective, significantly improving discharge readiness, the quality of discharge teaching, and health-related quality of life in patients with IBD.

CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn/index.html, identifier ChiCTR2501113716.

PMID:42089069 | PMC:PMC13135976 | DOI:10.3389/fmed.2026.1799752

Front Med (Lausanne). 2026 Apr 20;13:1706737. doi: 10.3389/fmed.2026.1706737. eCollection 2026.

ABSTRACT

BACKGROUND AND OBJECTIVE: The phase IV Fasenra Safety Trial in India (FAST) assessed the safety and effectiveness of benralizumab for a period of 24 weeks in adult Indian patients with severe eosinophilic asthma.

METHODS: This phase IV, single-arm, multicenter, prospective, interventional study (NCT05384938) included benralizumab-naïve adult patients (18-75 years) with a physician-confirmed diagnosis of severe asthma with an eosinophilic phenotype. Patients received 30 mg of benralizumab subcutaneously once every 4 weeks for the first three doses and then 30 mg once every 8 weeks thereafter as part of routine clinical care. The primary outcomes included adverse events (AEs), treatment-emergent adverse events (TEAEs), and serious TEAEs, along with the nature, incidence, and severity of AEs, including unexpected adverse drug reactions and AEs leading to treatment discontinuation or dose modifications. The secondary outcomes included time to first asthma exacerbation, annualized exacerbation rate, treatment outcome, and changes in absolute eosinophil count.

RESULTS: Of the 155 patients screened, 138 (89.0%) who received at least one dose of benralizumab were included in the safety and effectiveness analysis. At baseline, the median number of asthma exacerbation events per year was 2.0, and the median absolute eosinophil count was 375.0 cells/mm³ (range: 70.0-7352.8). Overall, 31.2% of the patients (43) experienced TEAEs; the most common TEAEs were pyrexia (16.7%), dyspnea (5.1%), productive cough (4.4%), cough (2.9%), and nasopharyngitis (2.2%). Serious TEAEs were reported in 5 (3.6%) patients and included dyspnea and productive cough (reported in 4 patients each), pyrexia (3), and constipation, H1N1 influenza, and back pain (1 each). No TEAEs leading to study drug discontinuation or death were reported. Nineteen (13.8%) patients experienced asthma exacerbation during the 24 weeks, with a median (range) time to first exacerbation event of 100.0 (41-184) days. A total of 61.5% of the patients (83/135) had well-controlled asthma, while 33.3% (45/135) had partly controlled asthma. A statistically significant decrease was observed in the mean asthma exacerbation events per year (from baseline to Week 24; 2.0 vs. 0; p < 0.0001) and peripheral blood eosinophil counts (from baseline to Weeks 4, 16, and 24; p < 0.001).

CONCLUSION: The findings of this prospective, single-arm, multicenter, phase IV study in Indian patients with severe eosinophilic asthma demonstrated that benralizumab showed an acceptable and expected safety profile with consistent efficacy.

CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT05384938, identifier NCT05384938.

PMID:42089065 | PMC:PMC13136968 | DOI:10.3389/fmed.2026.1706737

Front Med (Lausanne). 2026 Apr 20;13:1814834. doi: 10.3389/fmed.2026.1814834. eCollection 2026.

ABSTRACT

OBJECTIVE: To systematically evaluate and compare the relative effectiveness of different core muscle training modalities in alleviating pain and improving function in individuals with chronic non-specific low back pain (CNLBP).

METHODS: Chinese and English language databases were systematically searched for randomized controlled trials involving individuals with CNLBP. Intervention groups received core training either alone or combined with other therapies, while control groups received usual rehabilitation or other exercise interventions. Primary outcomes were pain intensity and disability scores. Risk of bias was assessed using the Cochrane RoB 2.0 tool. A random-effects meta-analysis was performed using RevMan 5.4 software, with subgroup analyses conducted to examine the moderating effects of intervention type and intervention duration. Forest plots and funnel plots were generated using MATLAB-R2024.

RESULTS: Fifteen randomized controlled trialswere included. Meta-analysis revealed that core training significantly improved pain (SMD = -0.56, 95% CI: -1.08 to -0.03) and function (SMD = -0.81, 95% CI: -1.38 to -0.25). subgroup analyses indicated that combined interventions significantly improved function (SMD = -0.96, P = 0.002), although the test for subgroup differences between combined and single-modality interventions was not statistically significant (P = 0.96), and intervention durations of ≥ 8 weeks were associated with more pronounced analgesic effects. The overall quality of evidence was rated as “low,” primarily due to risk of bias and high heterogeneity.

CONCLUSION: Current direct comparative evidence suggests that augmenting core training with additional rehabilitative components may confer greater benefits for functional improvement, while extending the intervention duration beyond eight weeks may optimize pain relief. Clinical decisions regarding training modality selection should be individualized based on the patient’s primary treatment goal. Further high-quality research is warranted to strengthen the evidence base for comparisons between specific training modalities.

SYSTEMATIC REVIEW REGISTRATION: [https://www.crd.york.ac.uk/PROSPERO/view/CRD420251031252], identifier [CRD420251031252].

PMID:42089060 | PMC:PMC13136016 | DOI:10.3389/fmed.2026.1814834

Front Med (Lausanne). 2026 Apr 20;13:1797225. doi: 10.3389/fmed.2026.1797225. eCollection 2026.

ABSTRACT

BACKGROUND/OBJECTIVES: Meibomian gland dysfunction (MGD) constitutes a highly prevalent ocular surface condition and is a major etiological factor in tear film instability and evaporative dry eye disease. Although MGD can be objectively identified based on structural and functional abnormalities of the meibomian glands, epidemiological studies rarely differentiate between symptomatic and asymptomatic disease. Asymptomatic meibomian gland dysfunction, characterized by structural or functional gland alterations in the absence of self-reported ocular symptoms, may constitute an early and frequently overlooked phase within the disease spectrum. The objective of this systematic review and meta-analysis was to quantify the prevalence of asymptomatic MGD among adult populations.

METHODS: A comprehensive literature search was performed across PubMed, Web of Science, Scopus, ScienceDirect, and Google Scholar in accordance with the PRISMA guidelines. The review protocol was registered in PROSPERO (CRD420261283795). Cross-sectional and observational studies reporting the prevalence of asymptomatic MGD in adult populations were included. Data extraction and study selection were performed independently by two reviewers. A random-effects meta-analysis of proportions with logit transformation was applied using R software. Interstudy heterogeneity was quantified using the I² statistic, and possible contributors to variability were investigated through sensitivity analyses and meta-regression. Methodological quality and risk of bias were assessed using a modified version of the Newcastle-Ottawa Scale, while the overall certainty of the evidence was evaluated according to the GRADE approach.

RESULTS: Eight cross-sectional studies published between 2012 and 2023 were included, comprising a total of 3,637 participants and 1,313 cases of asymptomatic MGD. The combined prevalence of asymptomatic MGD was 72.86% (95% CI: 19.33-96.78%), with substantial heterogeneity across studies (I ² = 98.8%). Sensitivity analyses identified one influential study; however, the overall finding of a high prevalence remained consistent. Meta-regression showed that sex distribution significantly contributed to between-study heterogeneity, while no association with year of publication was observed. The level of certainty for the pooled prevalence estimate was classified as low.

CONCLUSION: Asymptomatic MGD is highly prevalent among adult populations worldwide. These findings indicate that reliance on symptom-based assessment alone may underestimate the burden of early MGD. Early identification of asymptomatic gland abnormalities may support preventive approaches to reduce progression to symptomatic dry eye disease, although further standardized and prospective studies are required.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261283795, CRD420261283795.

PMID:42089056 | PMC:PMC13137810 | DOI:10.3389/fmed.2026.1797225

Front Med (Lausanne). 2026 Apr 20;13:1782062. doi: 10.3389/fmed.2026.1782062. eCollection 2026.

ABSTRACT

INTRODUCTION: Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of reproductive age. This study aimed to determine self-reported prevalence of physician-diagnosed PCOS among young medical students at King Saud University and to compare it with reported rates from Western and international populations of similar age. In addition, it assessed the awareness among female medical students at King Saud University.

METHODS: A cross-sectional study was conducted using a structured self-administered questionnaire distributed to female medical students at King Saud University between December 2024 and March 2025. The survey contained sociodemographic data, PCOS-related signs and symptoms, past medical history, lifestyle factors, knowledge about PCOS and its complications. Statistical analyses included bivariate analysis and multivariable logistic regression.

RESULTS: We collected 303 responses. The self-reported prevalence of physician-diagnosed PCOS was 18.5%. Common symptoms included hair loss (60.7%), acne (49.8%), and weight gain (32%). PCOS diagnosis was significantly associated with age group (p = 0.015), BMI (p = 0.038), menstrual irregularities (p < 0.001), hirsutism (p < 0.001), weight gain (p = 0.004), diabetes mellitus (p < 0.001), and family history (p < 0.001). Multivariable logistic regression identified hirsutism (OR = 4.36, p = 0.005) to be significantly associated with self-reported physician-diagnosed PCOS.

CONCLUSION: The observed prevalence in young medical students in this study was higher than that reported in several Western populations of similar age. Recognition of contributing factors such as genetic susceptibility and lifestyle patterns is essential. Greater emphasis on early screening and targeted health education is recommended.

PMID:42089054 | PMC:PMC13136107 | DOI:10.3389/fmed.2026.1782062

Front Med (Lausanne). 2026 Apr 20;13:1817376. doi: 10.3389/fmed.2026.1817376. eCollection 2026.

ABSTRACT

BACKGROUND: Inhaled therapy is critical for treating chronic airway diseases, yet the competency of respiratory nurses in providing guidance remains inconsistent. Few studies have explored the systemic competency disparities that are driven by a hierarchical distribution of healthcare resources. The aim of this study is to assess self-reported inhaled therapy guidance (ITG) competency among respiratory nurses across multiple-tier healthcare institutions, as well as to explore factors that affected such competency.

METHODS: A total of 962 respiratory nurses at multilevel hospitals in Jiangsu Province, Eastern China were investigated. We developed an ITG competency scale and evaluated its reliability and validity. Nurses rated themselves on a structured questionnaire that was designed to collect data on ITG competency in this population. The associated factors were determined using a descriptive statistical analysis, a correlation analysis, and a hierarchical multiple regression analysis. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.

RESULTS: The ITG competency average score for respiratory nurses was (73.90 ± 9.42). Significant competency disparities were observed across all hospital tiers (p < 0.001), with the primary hospitals demonstrating higher rates of poor and lower proportions of good ratings than secondary/tertiary hospitals. For the knowledge dimension, tertiary hospitals had the fewest poor ratings, while primary hospitals exhibited the highest prevalence of poor ratings, although the proportion of good skill ratings remained comparable across all tiers (p > 0.05). Educational attainment, hospital grade, and training methodologies were associated with respiratory nurses’ competency at ITG.

CONCLUSION: The respiratory nurses exhibited moderate levels of ITG competency, with a notable gap between their knowledge and skills. This gap was more pronounced in primary hospitals, suggesting an association with institutional resource contexts. These results highlight the need for training strategies tailored to each hospital tier, as well as enhanced resource support from tertiary centers to primary care. This would help promote more standardized training programs and reduce competency disparities across hospital tiers.

PMID:42089050 | PMC:PMC13135959 | DOI:10.3389/fmed.2026.1817376

Contemp Oncol (Pozn). 2026;30(1):40-46. doi: 10.5114/wo.2026.159586. Epub 2026 Feb 27.

ABSTRACT

INTRODUCTION: The study was aimed to analyse the impact of the tumour type and other patient- and disease-related baseline parameters in a consecutive cohort managed with best supportive care (BSC) in northern Norway.

MATERIAL AND METHODS: This is a retrospective analysis of 149 patients managed with BSC without any systemic cancer-directed therapy or local brain-directed measures (2007-2024). Eleven patients were originally supposed to start active treatment and 12 had received prior prophylactic whole-brain irradiation (WBRT). Uni- and multivariate analyses of prognostic factors for survival were performed.

RESULTS: Median survival after radiological diagnosis was 1.3 months (95% CI: 1.08-1.52) for all 149 patients combined. The 3- and 6-month survival rates were 20% and 1%, respectively. Neither prior WBRT nor upfront intention to treat were associated with survival. Steroid responders survived significantly longer than non-responders. The multivariate Cox model suggested that survival mainly depends on Karnofsky performance status (< 70 vs. ≥ 70), extracranial metastases (present/absent), and primary tumour type (better in renal cell cancer/malignant melanoma vs. all others combined), p ≤ 0.01 for all three predictors of survival.

CONCLUSIONS: All prognostic strata in our study had median survival times < 2.5 months, indicating an inevitable poor outcome, despite presence of statistically significant differences, e.g. for the primary tumour type. The clinical impact of prognostic scores would thus be very limited. Median survival was similar in historical studies of BSC. Best supportive care is a reasonable choice in patients with brain metastases and very short life expectancy, as also evident from prospective research.

PMID:42089035 | PMC:PMC13137425 | DOI:10.5114/wo.2026.159586

Contemp Oncol (Pozn). 2026;30(1):68-76. doi: 10.5114/wo.2026.159587. Epub 2026 Feb 27.

ABSTRACT

INTRODUCTION: The aim of this study was to assess the inflammatory status of patients with pancreatic cancer (PC) prior to the initiation of the first course of chemotherapy and to ascertain the most precise systemic inflammation index for predicting overall survival (OS).

MATERIAL AND METHODS: A single-centre retrospective analysis involving 310 pa- tients with PC was conducted. Blood samples were collected from patients during chemotherapy qualification, either on the first day of chemotherapy or the day before the first chemotherapy dose. The following inflammatory indices were calculated: systemic immune-inflammation index, systemic inflammation response index, and inflammatory benchmark index (IBI). Statistical analyses were performed utilizing appropriate tests (e.g., the log-rank test).

RESULTS: All parameters were significant predictors of mortality; however, their area under the curve indicated only a moderate ability to differentiate mortality risk. Among the indices analysed, IBI was the sole metric that predicted OS in adjuvant (p < 0.05) and palliative (p < 0.001) cohorts, alongside disease-free survival (p < 0.04) and progression-free survival (p < 0.009). In the multivariate analysis, only IBI was proven to be statistically associated with OS (p < 0.043). Furthermore, IBI well stratified the tumour stage.

CONCLUSIONS: All analysed indices related to inflammation and immune response may function as prognostic markers; however, additional studies are required to determine their precise cut-off value. In our investigation, IBI exhibited a distinctive protective effect, culminating in a 65% reduction in mortality, thereby underscoring the importance of C-reactive protein in patient stratification.

PMID:42089034 | PMC:PMC13137428 | DOI:10.5114/wo.2026.159587

Contemp Oncol (Pozn). 2026;30(1):47-55. doi: 10.5114/wo.2026.159311. Epub 2026 Feb 13.

ABSTRACT

INTRODUCTION: Radiodensity of subcutaneous adipose tissue (SAT), measurable on routine computed tomography (CT), may reflect metabolic status and cachexia, both of which influence cancer outcomes. However, its prognostic role in metastatic non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICI) remains unclear. This study aimed to evaluate the prognostic value of SAT radiodensity in this patient population.

MATERIAL AND METHODS: The retrospective analysis included 92 patients with stage IV NSCLC receiving ICI. Subcutaneous adipose tissue radiodensity (Hounsfield units) was measured from pre-treatment CT at the L3 level and categorized into quartiles. Kaplan- Meier analysis, log-rank test, and Cox proportional hazards models were used. Nonlinear associations were assessed using restricted cubic splines. Cox models were? adjusted for demographic, clinical, and treatment factors. A p-value < 0.05 was considered statistically significant.

RESULTS: Median overall survival for Q1, Q2, Q3, and Q4 was 13.4, 26.3, 18.4, and 14.2 months, respectively (log-rank p = 0.0226). Compared with Q1, Q2 showed a significantly reduced mortality risk across all models (fully adjusted hazard ratios = 0.32, 95% CI: 0.15-0.64, p = 0.002). Q3 and Q4 were not significantly different from Q1. Restricted cubic spline analysis revealed a mild U-shaped relationship (p for nonlinearity = 0.0094), with intermediate SAT density linked to best outcomes. Programmed death ligand 1 expression significantly modified the SAT-survival association (p for interaction < 0.0001).

CONCLUSIONS: Moderate SAT radiodensity was associated with improved survival in metastatic NSCLC patients on ICI, potentially reflecting an optimal metabolic-immune balance. Subcutaneous adipose tissue density, easily obtained from routine imaging, warrants further prospective validation as a scalable prognostic biomarker.

PMID:42089030 | PMC:PMC13137427 | DOI:10.5114/wo.2026.159311

Front Digit Health. 2026 Apr 20;8:1764371. doi: 10.3389/fdgth.2026.1764371. eCollection 2026.

ABSTRACT

Panic attacks (PAs) are acute anxiety episodes that are pervasive, with one in 10 individuals having experienced a PA in the past year. PAs impair daily functioning and are associated with an increase in emergency room visits and suicide attempts. Despite their impact, the unpredictable nature of PAs makes them challenging to manage. PAs are transdiagnostic, occurring in individuals across and without a mental health diagnosis. However, prior work has largely focused on PA indications within individuals with panic disorder. This study identifies PA risk factors from over 6 months of passive sensing data recorded by Oura Rings in 182 young adults with and without adverse childhood experiences and psychiatric diagnoses, beyond just panic disorder. Our findings reveal that changes in Oura Ring-derived measures are associated with next-day PAs, with distinct associations observed across different mental health diagnoses. For individuals with panic disorder, the likelihood of PA increases with time spent inactive. For those with depression, the likelihood of PA increases with decreased variation in nightly respiratory rate, decreased rapid eye movement sleep, and increased time spent in high-intensity activity. For those without a mental health diagnosis, the likelihood of PA increases with decreased heart rate variability. Data aggregation window sizes that capture the associations with PA risk vary by diagnosis and the type of feature, suggesting that cumulative physiological patterns from windows up to 7 days before a PA contribute to onset. These findings point to the possibility that continuous monitoring of panic attack risk could one day support preventive mental health intervention.

PMID:42089029 | PMC:PMC13136185 | DOI:10.3389/fdgth.2026.1764371