Nevin Manimala

BMC Prim Care. 2026 May 25. doi: 10.1186/s12875-026-03399-y. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to evaluate the hemoglobin, albumin, lymphocyte, and platelet (HALP) score as an exploratory adjunctive marker associated with reduced bone density, particularly in resource-limited settings.

METHODS: This cross-sectional study was conducted between October 2022 and October 2023 at the Physical Therapy and Rehabilitation Hospital in Trabzon, Türkiye. This study included 267 patients who had not been previously diagnosed with osteopenia or osteoporosis and had undergone a dual-energy X-ray absorptiometry (DEXA) scan within the previous year. The participants were categorized into the normal, osteopenic, and osteoporotic groups according to their DEXA results. Statistical analysis included receiver operating characteristic (ROC) curve assessment, sensitivity and specificity calculations, and multiple logistic regression analysis to evaluate the discriminative performance of the HALP score and its adjusted association with reduced bone density.

RESULTS: Patients with reduced bone density (osteopenia or osteoporosis) had substantially lower HALP scores than those with a normal bone density. The area under the curve (AUC) for the HALP score was 0.625, indicating a limited discriminative ability. The HALP score exhibited a sensitivity of 65.36% and a specificity of 55.26% for identifying reduced bone density. In multivariable analysis, higher HALP remained associated with lower odds of osteopenia/osteoporosis after adjustment (OR = 0.757, 95% CI 0.624-0.917, p = 0.004).

CONCLUSION: Given its limited discriminative ability, HALP should not be interpreted as a stand-alone screening test. At most, it may represent a low-cost exploratory adjunctive signal that could help support consideration of confirmatory DEXA in resource-limited settings, pending external validation.

TRIAL REGISTRATION: Not applicable.

PMID:42178515 | DOI:10.1186/s12875-026-03399-y

J Appl Clin Med Phys. 2026 May;27(5):e70635. doi: 10.1002/acm2.70635.

ABSTRACT

BACKGROUND: Conformity evaluation is essential for assessing radiotherapy plan quality, yet widely used indices such as the ICRU and Paddick Conformity Index do not distinguish between target underdosage and peripheral overdose. As clinical protocols differ in their target coverage definitions ICRU 50/62, ICRU 83, and RTOG/NRG direct comparisons of plan conformity across protocols remain challenging. Recently proposed metrics the Universal Conformity Index (CI) and Unconformity Indices (UCIu for underdose and UCIo for overdose) provide a decomposed, interpretable assessment of dose target relationships. However, protocol-specific optimal ranges for these indices and their clinical achievability have not been systematically established for pelvic radiotherapy.

PURPOSE: To determine protocol-specific optimal (p10-p90) ranges for CI, UCIu, and UCIo across pelvic sites under ICRU 50/62, ICRU 83, and RTOG/NRG frameworks, and to verify whether these optimal values are clinically achievable using modern IMRT plans.

METHODS: This study analyzed 40 anonymized pelvic cancer cases (20 prostate, 10 rectum, 10 endometrium). All cases were replanned under standardized dose prescriptions following ICRU 50/62, ICRU 83, and RTOG/NRG protocols. Two geometric configurations were evaluated: Target 1 (strict) and Target 2 (conservative). Stage 1: Using protocol-specific V95(%) definitions, theoretical optimal CI, UCIu, and UCIo bands (p10-p90) were calculated separately for each site and protocol under Target 1 and Target 2. Stage 2: All 40 cases were combined into a pooled pelvic dataset to derive region-wide optimal ranges and assess generalizability across sites. Stage 3: Clinical IMRT plans satisfying ICRU, RTOG, and QUANTEC constraints were generated for all patients, and clinical CI, UCIu, and UCIo values were compared against theoretical optimal bands. Statistical analysis included percentile bands, 95% Confidence Interval, p value, and effect size (η²).

RESULTS: Across all pelvic sites, CI values decreased progressively from ICRU 50/62 to ICRU 83 and RTOG/NRG (p < 0.001), while UCIu and UCIo increased systematically, reflecting protocol-driven differences in coverage tolerance. Margin expansion from Target 1 to Target 2 further reduced CI and increased UCIo. Pooled pelvic optimal ranges showed tight reproducibility with narrow 95% confidence intervals (± 0.006-0.016). Strong protocol effects were observed for CI (η² = 0.259-0.519), UCIu (η² = 0.997), and UCIo (η² up to 0.182). Clinically generated IMRT plans demonstrated high-quality target coverage (V95% ≥ 98.9%) and acceptable OAR doses. Clinical CI, UCIu, and UCIo values closely matched the optimal p10-p90 bands. Prostate and rectum plans aligned fully with all protocol-specific optimal ranges, while endometrium plans matched RTOG/NRG and Target-2 thresholds, with minor deviations under strict Target-1 geometry.

CONCLUSIONS: This study provides the protocol-specific and clinically achievable optimal ranges for CI, UCIu, and UCIo for pelvic radiotherapy across ICRU 50/62, ICRU 83, and RTOG/NRG frameworks. The combined theoretical, pooled, and clinical validation approach demonstrates that these decomposed conformity indices are robust, reproducible, and directly applicable to routine IMRT plan evaluation. The resulting optimal bands offer standardized benchmarks for assessing dose conformity and dose spill, improving cross-protocol comparability and supporting future development of quantitative conformity-based guidelines in radiotherapy.

PMID:42178514 | DOI:10.1002/acm2.70635

Head Neck. 2026 May 24. doi: 10.1002/hed.70327. Online ahead of print.

ABSTRACT

Squamous cell carcinoma of the head and neck (HNSCC) is a global public health issue. Traditionally diagnosed in individuals over 60 years old, there has been a rising incidence among young patients (< 45 years). This retrospective and descriptive study analyzes the epidemiological, clinical, and biochemical profiles of young patients diagnosed with HNSCC between 2015 and 2022 at the Cancer Hospital of Muriaé, Minas Gerais, Brazil. A comparative analysis between young and older patients revealed significant differences in inflammatory profiles and disease progression. Young patients showed higher counts of leukocytes, monocytes, and neutrophils compared to older patients, suggesting an exacerbated inflammatory response. The 60-month survival rate was 41.5% among young patients and 38.1% among older ones, with no statistically significant difference. A strong association between poor oral hygiene and HNSCC was observed, with 61.43% of young patients presenting poor hygiene-a factor that may contribute to increased local inflammation and tumor progression. These findings underscore the need for preventive strategies and early diagnosis.

PMID:42178490 | DOI:10.1002/hed.70327

J Crit Care. 2026 May 23;95:155617. doi: 10.1016/j.jcrc.2026.155617. Online ahead of print.

ABSTRACT

Ketamine has been shown to possess unique pharmacologic properties that make it an appealing adjunctive sedative for critically ill patients; however, its overall impact on key intensive care unit (ICU) outcomes remains uncertain. As such, this systematic review and meta-analysis was conducted to evaluate whether intravenous ketamine-based sedation improves mechanical ventilation duration (MVD), ICU length of stay (LOS), and delirium incidence in ICU patients compared with standard analgosedation. Following PRISMA guidelines, a comprehensive literature search was conducted across online databases through June 2025. Eligible studies included randomized or prospective controlled adult ICU trials comparing continuous intravenous ketamine or esketamine infusions with standard sedation regimens. Pooled mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Six studies comprising 903 ICU patients met inclusion criteria. MVD was reported in all six studies; ICU LOS was reported in five studies and delirium was reported in two studies. Ketamine-based sedation was associated with a significant reduction in ICU LOS and a significant decrease in delirium incidence (MD: -0.86; 95% CI: -1.51, -0.22 and OR: 0.55; 95% CI: 0.43-0.72, respectively). Although MVD trended shorter in the ketamine group, this difference did not reach statistical significance (MD: -0.30; 95% CI: -1.53, 0.92). These results support consideration of ketamine as an adjunct in multimodal ICU sedation strategies; however, the effect on ventilation duration remains uncertain. While this study’s findings offer valuable comprehensive evaluations, further large-scale trials are needed to optimize dosing and confirm long-term benefits.

PMID:42177858 | DOI:10.1016/j.jcrc.2026.155617

J Pharm Biomed Anal. 2026 May 14;279:117560. doi: 10.1016/j.jpba.2026.117560. Online ahead of print.

ABSTRACT

Adherence to hypertension treatment is crucial for therapeutic success, as noncompliance adversely affects quality of life and healthcare costs. Assessing adherence directly through plasma drug concentrations is particularly effective for patients with complex medication regimens. This study aimed to develop and validate an LC-MS/MS method for quantifying five antihypertensive drugs in dried capillary plasma obtained via a plasma separation device. The process involved incubating three 6 mm discs in 150 µL of 0.1% bovine serum albumin, followed by chloride analysis of a 20 µL aliquot after 45 min. The residual volume was precipitated using 25% trichloroacetic acid, then mixed with 500 µL methanol containing internal standards (losartan-D4 and atenolol-D7). The extract was dried, reconstituted with methanol, and combined with the supernatant from protein precipitation for analysis. An octadecylsilic column and gradient elution with 0.1% formic acid in water and acetonitrile were used, with positive electrospray ionization except for hydrochlorothiazide. The analytical run time was eight minutes, exhibiting linear ranges from 0.5 to 200 ng/mL for amlodipine and losartan and 5-2000 ng/mL for atenolol, hydrochlorothiazide, and losartan, with r² > 0.99 and 1/x weighting. Precision and accuracy were acceptable, with CV% ranging from 4.3% to 14.5% and accuracy from 86% to 112%, while extraction yields were between 75% and 101%. The analytes were stable at 23 ºC for 21 days in DPS samples. Comparison of drug concentrations in DPS and fresh plasma samples from 72 patients demonstrated high correlation (r = 0.93-0.98), indicating reliability in assessing therapy adherence. Lower concentrations of amlodipine, hydrochlorothiazide, and losartan were observed in patients exhibiting poor adherence (n = 21) compared to adherent patients (n = 51) with statistical significance (p < 0.05). The method is promising for assessing antihypertensive adherence using dried plasma spots.

PMID:42177855 | DOI:10.1016/j.jpba.2026.117560

Accid Anal Prev. 2026 May 24;234:108595. doi: 10.1016/j.aap.2026.108595. Online ahead of print.

ABSTRACT

Aggressive lane-changing behavior on highways can induce sharp lateral movements and significant speed variations, posing considerable traffic safety risks. Maximum lateral velocity effectively reflects both the vehicle’s lateral motion and the intensity of the driver’s lane-change maneuver, making it a key metric for analyzing lane-changing behavior. In this study, 1,646 lane-changing events were extracted from the real-world vehicle trajectory collected by CQSkyEyes, and their basic characteristics were analyzed using descriptive statistics. The Bayesian model was developed to examine how lane-change intensity varies under different environmental and driving conditions. The results indicate that under complex weather conditions, drivers tend to adopt more conservative lane-changing strategies, reflected in reduced maximum lateral velocity, especially when facing hazardous time-to-collision (TTC) levels. Moreover, lane change behavior is shaped by surrounding-vehicle interaction metrics; notably, the approach of a vehicle in the target lane increases the likelihood of aggressive maneuvers. These findings highlight maximum lateral velocity as a robust quantitative indicator of driver behavior, offering actionable implications for traffic safety management and autonomous driving system design.

PMID:42177847 | DOI:10.1016/j.aap.2026.108595

Food Chem. 2026 May 21;519:149758. doi: 10.1016/j.foodchem.2026.149758. Online ahead of print.

ABSTRACT

Meeting the food industry’s demand for safe, sustainable bioactive extraction, this research proposed an innovative “Parameter-Component” correlation strategy to clarify the mechanism of green extraction, using mechanochemical-assisted extraction (MCAE) of ginsenosides as a case. Via UPLC-Q-TOF-MS/MS, 92 ginsenosides were identified from ginseng. Deconstruction of key MCAE variables (i.e., particle size, pH, temperature), combined with untargeted metabolomics, multivariate statistical analysis, and quantitative validation of critical saponins, revealed a synergistic action of mechanical forces and chemical auxiliaries. This dual intervention disrupts cell walls efficiently while minimizing the degradation of heat-labile components. Different structured saponins showed specific parameter responses. MCAE at 25-40 °C balanced prototype ginsenoside dissolution and malonylated ginsenoside retention; composite processes (MCAE-HRE, MCAE-UAE) optimized functional component yield and production sustainability. This strategy provides a scientific basis for high-quality food-relevant extracts production and a scalable mechanistic study method.

PMID:42177844 | DOI:10.1016/j.foodchem.2026.149758

West Afr J Med. 2026 Apr 30;43(1):58-69.

ABSTRACT

BACKGROUND: Chronic heart failure is an increasing cause of morbidity and mortality across sub-Saharan Africa, yet contemporary data from large African cohorts remain limited.

OBJECTIVES: To characterise the clinical profile, management, and short-term outcomes of patients with chronic HF enrolled in the Ibadan Heart Failure Project.

METHODS: The Ibadan Heart Failure Project is a real-life, pragmatic, prospective, hospital-based cohort of adults with chronic heart failure being conducted at University College Hospital, Ibadan, Nigeria. The present report is based on participants recruited between September 1, 2016, and December 31, 2022. Baseline sociodemographic, clinical, and echocardiographic data were obtained, and participants were followed for six months. The primary outcomes were all-cause mortality and hospital readmission.

RESULTS: Among 1,290 patients (mean age 56.7 ± 15.4 years; 55.8% men), hypertensive heart disease was the leading cause, followed by dilated cardiomyopathy and rheumatic heart disease. Women were younger and more likely to have preserved or mildly reduced ejection fraction. The use of sodium-glucose cotransporter-2 inhibitors (3.3%) was low. The cumulative incidence of readmission, death, and a composite of these events at six months was 4.9%, 12.9%, and 17.8%, respectively. The use of beta blockers was associated with 43% reduction in the risk of readmission (HR-0.57, 95%CI-0.33-0.97), while the use of renin -angiotensin-aldosterone axis inhibitors was associated with 62% and 46% reduction in the risk of death and composite of readmission and death, respectively. A unit increase in serum creatinine is associated with 11% and 32% increase in readmission and death, respectively (HR-1.11, 95%CI-1.00-1.23 and HR-1.32, 95% CI-1.21-1.45, respectively) In addition, a unit increase in tricuspid annular plane systolic excursion is associated 64% and 53% lower risk of death and composite of readmission and death, respectively. (HR-0.36, 95%CI-0.22-0.60, HR-0.47, 95%CI-0.30-0.73 respectively). No significant sex or age-related differences were observed in adjusted risks of hospitalization or death.

CONCLUSIONS: Hypertensive heart disease remains the predominant cause of chronic heart failure in Nigeria. Despite similar short-term outcomes across sexes, suboptimal use of newer evidence-based therapies underscores the need for system-level interventions to improve HF care in sub-Saharan Africa.

PMID:42177830

West Afr J Med. 2026 Apr 30;43(1):42-52.

ABSTRACT

BACKGROUND: Sexual and Reproductive Health (SRH) literacy influences young people’s health behaviours and outcomes. Mobile health (mHealth) technologies are potential tools for the delivery of health education and services, but evidence on their effectiveness in strengthening SRH literacy is limited in the study setting. This study assessed the effect of an mHealth intervention on SRH literacy and service utilisation among in-school young people in Osun State, Nigeria.

METHODS: A quasi-experimental design was employed among undergraduate students aged 18 – 24 years in two tertiary institutions in Osun State. Participants were allocated by institution into intervention (n = 60) and control (n = 60) groups. The intervention group received a six-week mHealth SRH literacy programme delivered through a mobile application. Data was collected at baseline and post-intervention. Paired t-tests, analysis of covariance and regression analyses were done.

RESULTS: Post-intervention, the intervention group demonstrated a significant increase in mean SRH literacy scores compared with baseline (p = 0.018). The post-test SRH literacy scores were significantly higher in the intervention group than in the control group (p = 0.002), with a large effect size (partial η² = 0.84). The mHealth intervention independently increased the odds of good SRH literacy (AOR = 3.69; 95% CI: 1.54 – 8.86), SRH service utilisation (AOR = 6.25; 95% CI: 1.29-30.16), and the intention to use SRH services in the future (AOR = 2.86; 95% CI: 1.03 – 7.95).

CONCLUSION: The mHealth-based intervention significantly improved SRH literacy and service utilisation among young people. The deployment of mHealth interventions to strengthen health literacy competencies in the study setting should be considered.

PMID:42177811

West Afr J Med. 2026 Apr 30;43(1):35-41.

ABSTRACT

BACKGROUND: Asthma management prioritises symptom control, typically assessed using standardized questionnaires. However, comparative data on their performance and agreement remain scarce in Sub-Saharan Africa.

METHODS: In a cross-sectional study of 100 adults [79% females, mean age 38.1±14.6 years] with physician-diagnosed asthma at a Nigerian tertiary hospital, asthma control was evaluated using Global Initiative for Asthma (GINA), Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ-7), Royal Society of Physicians 3 Questions (RCP-3Qs) and Asthma Therapy Assessment Questionnaire (ATAQ). Agreement was measured with Cohen’s kappa statistics. Diagnostic accuracy for GINA-defined well-controlled asthma was analysed using ROC-derived thresholds, with GINA serving as the reference standard to assess the performance of ACT, ACQ, RCP-3Qs, and ATAQ.

RESULTS: The level of controlled asthma ranged from 73% to 83% across tools. Agreement among control tools was low; GINA showed slight agreement with others (κ = 0.018-0.107), while ACT and ACQ had moderate agreement (κ = 0.546). ACT, ACQ, and RCP-3Qs demonstrated strong diagnostic accuracy for identifying GINA-defined well-controlled asthma (AUC 0.90; 95% CI: ACT 0.76-0.95; ACQ 0.75-0.94; RCP-3Qs 0.78-0.92), whereas ATAQ performed poorly (AUC 0.5; 95% CI: 0.29-0.59). At pre-specified thresholds of >20, ≤1.57, ≤1 and 0.5, the specificity of ACT, ACQ, RCP-3Qs, and ATAQ was 92.6%, 70.4%, 70.4%, and 85.2%, respectively; while sensitivity was 73.7%, 94.7%, 100%, and 26.3%.

CONCLUSION: ACT, ACQ, and RCP-3Q effectively identified GINA-defined well-controlled asthma, while ATAQ showed poor diagnostic value. Low agreement among the tools suggests they are not interchangeable for assessing asthma control.

PMID:42177808