Nevin Manimala

Environ Monit Assess. 2026 May 25;198(6):647. doi: 10.1007/s10661-026-15445-4.

ABSTRACT

Aquatic environments receiving anthropogenic inputs can act as reservoirs for opportunistic microorganisms and antifungal resistance, representing a potential environmental and public health concern. This study evaluated microbial contamination and antifungal susceptibility patterns in surface waters along a rural-urban gradient in a subtropical watershed using an integrated environmental monitoring approach. Physicochemical parameters and conventional microbial (Escherichia coli, Enterococcus spp., and heterotrophic bacteria) were quantified, and yeast abundance was determined using CHROMagar™ Candida. A total of 327 yeast isolates were evaluated for susceptibility to itraconazole (ITZ) and fluconazole (FCZ) using the CLSI M27-A4 broth microdilution method. Urban sites exhibited markedly higher microbial contamination compared with rural areas, with Enterococcus spp. reaching 36,000 colony-forming units (CFU)/100 ml and E. coli 19,863 most probable number (MPN)/100 ml. Yeast densities reached up to 351 CFU/100 ml in urban samples, exceeding concentrations typically reported for oligotrophic aquatic systems. Antifungal susceptibility testing revealed a high frequency of resistance among environmental isolates, ITZ (44.3%) compared with FCZ (24.46%). Statistical analyses indicated no significant spatial or seasonal differences in resistance patterns (p > 0.05), whereas resistance to ITZ was significantly higher than to FCZ (p < 0.001). The results indicate that anthropogenic pressure in urbanized watersheds may contribute to increased microbial contamination and the occurrence of antifungal-resistant yeasts in surface waters. This suggests a potential environmental pathway for the dissemination of resistance traits. The integration of conventional microbial indicators, environmental yeast monitoring, and antifungal susceptibility profiling provides a practical framework for environmental surveillance.

PMID:42183952 | DOI:10.1007/s10661-026-15445-4

Arch Osteoporos. 2026 May 25;21(1):84. doi: 10.1007/s11657-026-01719-4.

ABSTRACT

Postmenopausal women with osteoporosis may show higher levels of orthorexic tendencies than healthy peers. These tendencies were associated with lower lumbar spine bone density but not with mood or body image measures. The findings suggest that maladaptive health-focused behaviors may be present in this population.

OBJECTIVE: This study aimed to evaluate orthorexic tendencies in postmenopausal women with osteoporosis compared to healthy controls and to investigate the associations between orthorexic tendencies, body appreciation, and mood-related symptoms.

METHODS: This cross-sectional study included 128 participants (64 postmenopausal women with osteoporosis and 64 healthy controls). Femoral neck and L1-L4 T-scores and bone mineral density (BMD) values were obtained from dual-energy X-ray absorptiometry (DXA) measurements performed within the previous six months. Orthorexic tendencies were assessed using the Orthorexia Nervosa Scale-11 (ORTO-11), symptoms related to depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale (HADS), and body satisfaction was assessed using the Body Appreciation Scale (BAS).

RESULTS: ORTO-11 scores were significantly lower in the osteoporotic group compared to healthy controls (p = 0.041), indicating more pronounced orthorexic tendencies. Although the prevalence of clinically significant orthorexic tendencies (ORTO-11 ≤ 27) was higher in the osteoporotic group (68.8%) than in controls (54.7%), this difference did not reach statistical significance. ORTO-11 scores showed positive correlations with lumbar spine T-scores (r = 0.202, p = 0.022) and BMD values (r = 0.210, p = 0.017), whereas no association was observed with femoral neck measurements. Orthorexic tendencies were not correlated with anxiety, depression, or body appreciation scores. In contrast, depressive and anxiety symptoms were negatively correlated with body appreciation.

CONCLUSION: Orthorexic tendencies may be more common in postmenopausal women with osteoporosis. These findings suggest that maladaptive healthy eating behaviors may be present in this population.

PMID:42183951 | DOI:10.1007/s11657-026-01719-4

Pharmacoecon Open. 2026 May 25. doi: 10.1007/s41669-026-00660-z. Online ahead of print.

ABSTRACT

BACKGROUND: Survival data from pivotal clinical trials are critical for estimating quality-adjusted life years (QALYs). However, immature survival data require extrapolation beyond observed follow-up to project outcomes, introducing potential prediction error into QALY estimates used in economic evaluations. Immune checkpoint inhibitors (ICIs) present unique extrapolation challenges due to delayed responses and extended survival benefits. We therefore quantify the QALY prediction error of early extrapolations by benchmarking them against updated follow-up at a common time horizon.

METHODS: Using reconstructed individual patient data derived from published Kaplan-Meier curves of pivotal trials, this study assessed the accuracy of early survival extrapolations for ICIs approved in China by comparing early projections with QALYs obtained from updated data at the same horizon. A partitioned-survival framework using overall survival (OS) and progression-free survival (PFS) informed state occupancy, and QALYs were obtained via restricted mean survival time (RMST) integration of health-state utilities at the target horizon. Statistical analyses evaluated bias, precision, and agreement between extrapolated and updated QALY estimates. Linear regression and sensitivity analyses assessed the impact of target extrapolation horizon (T) on prediction error.

RESULTS: In total, 14 randomized controlled trials (4839 patients) were included for analysis. The mean deviation between extrapolated and observed QALYs was – 0.01 (95% CI – 0.03 to 0.01), with a mean absolute error (MAE) of 0.03 (95% CI 0.01 to 0.04). Strong agreement existed between extrapolated and updated QALYs (Spearman’s ρ = 0.98, 95% CI 0.94 to 0.99, P < 0.001). Consistently, OS extrapolations showed minimal deviation (MAE: 0.56 months), while PFS tended to be underestimated (MAE: 1.91 months). Moreover, predictive error increased significantly with longer extrapolation periods for QALY (MAE increase: 0.011 QALY/year, P = 0.004) and OS (MAE increase: 0.342 months/year, P = 0.010).

CONCLUSIONS: Near-horizon QALY prediction error was modest on average but increased with longer target extrapolation horizons. These findings support transparent reporting of extrapolation uncertainty and suggest that structured evidence reassessment may be particularly valuable as longer follow-up becomes available.

PMID:42183942 | DOI:10.1007/s41669-026-00660-z

Oncologist. 2026 May 21:oyag201. doi: 10.1093/oncolo/oyag201. Online ahead of print.

ABSTRACT

BACKGROUND: Ruxolitinib (JAK1/JAK2 inhibitor) is indicated for adults with intermediate or high-risk myelofibrosis; however, a subset of patients may exhibit a suboptimal response due to persistent PI3K/AKT activation. The phase 3, randomized, double-blind, placebo-controlled LIMBER-304 study (NCT04551053) investigated the efficacy and safety of add-on parsaclisib (highly selective PI3Kδ inhibitor) in patients with myelofibrosis and suboptimal or declining response to stable ruxolitinib monotherapy.

PATIENTS AND METHODS: Adults with primary or secondary myelofibrosis who received ruxolitinib with palpable spleen and Myelofibrosis Symptom Assessment Form (MFSAF) total symptom score (TSS) ≥10 were eligible. Primary end point was proportion of patients achieving ≥25% spleen volume reduction (SVR; baseline to Week 24); key secondary end point was proportion of.

PATIENT: s with ≥50% MFSAF-TSS reduction (baseline to Week 24).

RESULTS: In total, 90 patients received parsaclisib/ruxolitinib; 87 received placebo/ruxolitinib. At Week 24, 16.7% of patients receiving parsaclisib/ruxolitinib achieved ≥25% SVR versus 9.7% for placebo/ruxolitinib; this difference was not statistically significant. By Week 24, ≥50% reduction in MFSAF-TSS was observed in 17.1% of patients receiving parsaclisib/ruxolitinib versus 14.1% for placebo/ruxolitinib. Higher rates of infections (including cytomegalovirus) and gastrointestinal disorders were observed with parsaclisib/ruxolitinib. Grade ≥3 treatment-emergent adverse events occurred in 60.0% of patients receiving parsaclisib/ruxolitinib versus 42.5% with placebo/ruxolitinib. The study was terminated early based on efficacy findings.

CONCLUSIONS: Study results suggested adding parsaclisib to stable-dose ruxolitinib was unlikely to offer clinically meaningful benefits. Further research is needed on the potential of JAK and PI3K inhibitor-based combination therapy for patients with myelofibrosis.

PMID:42179186 | DOI:10.1093/oncolo/oyag201

BJPsych Open. 2026 May 25;12(3):e144. doi: 10.1192/bjo.2026.11051.

ABSTRACT

BACKGROUND: In low- and middle-income countries, four out of five people with mental illness do not receive specialised treatment. Utilising non-specialist frontline workers to deliver basic mental health services at the community level therefore warrants exploration.

AIMS: This study assessed improvement in the knowledge and skills of frontline community workers in identifying symptoms of anxiety and depression, making appropriate referrals and providing psychosocial counselling, in a rural district of Pakistan.

METHOD: Project mPareshan developed a training manual to enhance the mental health literacy of government-employed lady health workers (LHWs) and lady health supervisors (LHSs). Content was adapted from the World Health Organization’s Mental Health Gap Action Programme 2.0 intervention guide to suit the local context. A total of 72 participants (36 LHSs and 36 LHWs) from the Badin District, Sindh, Pakistan, received the training. Pre- and post-tests were conducted to assess changes in knowledge and skills, using the Wilcoxon signed-rank test.

RESULTS: There was a statistically significant improvement in both knowledge (p < 0.01, r = 0.85) and competency (p < 0.01, r = 0.81) median scores following the mPareshan training. LHSs demonstrated higher percentage increase in knowledge and competencies in domains requiring practical application, such as coping mechanisms, psychosocial support and referral pathways, compared with LHWs, highlighting the importance of their supervisory role and support in mental health service delivery.

CONCLUSIONS: The mPareshan mental health training has the potential to improve the knowledge and competencies of community health workers. Such initiatives can be scaled up to enable frontline workers to function as an effective workforce in the absence of specialist mental health services.

PMID:42179177 | DOI:10.1192/bjo.2026.11051

Physiother Res Int. 2026 Jul;31(3):e70243. doi: 10.1002/pri.70243.

ABSTRACT

BACKGROUND AND PURPOSE: This study aims to investigate the effects of increasing handgrip strength by applying Kinesio taping to the wrist extensors on the functional level in patients undergoing lower extremity surgery who ambulate with a walker.

METHODS: This retrospective study analyzed data from 100 patients aged 65 years and older who underwent lower extremity surgery and ambulated with a walker. The patients were divided into two groups: a control group (CG) that was kept under the standard rehabilitation program and a Kinesio taping group (KT) in which Kinesio taping was applied to the forearm extensor muscles in addition to the group being under standard rehabilitation program. The patients’ handgrip strength (HGS), pain, and functional levels (Functional Independence Measurements (FIM), Iowa Level of Assistance Scale (ILAS), and Iowa Walking Speed Scale (IWSS)) were retrospectively assessed before treatment and at discharge.

RESULTS: Compared to the CG group, the right and left HGS, functional levels, and IWSS of the patients increased significantly in the KT group, and their activity-related pain levels decreased significantly (p < 0.005). A significant positive correlation was observed between the change in HGS and the change in ILAS and FIM scores, and a statistically significant negative correlation was found between the change in HGS and the change in activity-related pain and IWSS (p < 0.05).

DISCUSSION: Our findings suggest that Kinesio taping application is a simple and cost-effective method that increases HGS in patients and is an effective method in controlling pain, improving walking speed, and enhancing functionality in patients undergoing lower extremity surgery.

TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT06072261.

PMID:42179169 | DOI:10.1002/pri.70243

Gerodontology. 2026 May 25. doi: 10.1111/ger.70093. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate caregiver-dentist agreement and inter-rater reliability of the Oral Health Screener (OHS) following its optimisation for use in long-term care and to examine the effect of different caregiver OHS training modalities.

METHODS: This prospective reliability and agreement study was nested within a 2-year cluster-randomised controlled trial in Flemish nursing homes (Belgium). Professional caregivers and dentists independently assessed residents’ oral health using the OHS every 6 months across five timepoints, blinded to each other’s assessments. Caregivers received either e-learning only (IG1) or e-learning combined with on-site training (IG2). Agreement was analysed using percent agreement, Cohen’s kappa, prevalence-adjusted bias-adjusted kappa (PABAK) and logistic generalised linear mixed models (GLMM).

RESULTS: Fifty-one caregivers from six facilities and eight dentists assessed 193 residents. Within groups, IG1 showed higher agreement with dentists for self-reported items (GLMM 0.46-0.58) than for inspection-based OHS items (GLMM 0.10-0.48), whereas this difference was less pronounced in IG2 (self-reported items: GLMM 0.45-0.95, inspection-based items: GLMM 0.35-0.92). Comparing groups, GLMM analyses indicated overall higher reliability in IG2 for most items, except for chewing difficulty. Exploratory analyses suggested that longitudinal patterns varied across items. Inter-caregiver reliability analyses were exploratory due to the limited number of paired assessments.

CONCLUSION: Non-dental professional caregivers showed acceptable agreement with dentists when assessing residents’ oral health using the OHS. Although agreement varied across items due to prevalence and marginal imbalances, the findings suggest the potential added value of training and support when using the OHS as a first-line screening tool in care-dependent older adults.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06536322 (July 23, 2024).

PMID:42179168 | DOI:10.1111/ger.70093

Br J Radiol. 2026 May 21:tqag075. doi: 10.1093/bjr/tqag075. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare virtual straight and bending rods Spatially Fractionated Radiation Therapy (SFRT) for cervical cancer brachytherapy delivery.

METHODS: CT scan datasets from ten patients with locally advanced cervical cancer who received brachytherapy were included. For each patient, two distinct plans were generated: one using straight virtual rods and the other using bending virtual rods. The total prescribed dose was 30 Gy in 5 fractions. All plans were created with 10XFFF beam. Dosimetric parameters, including D90, V100, V150, and V200 for high risk-clinical target volume (HRCTV), were evaluated. Additionally, dose constraints for OARs (bladder, rectum, sigmoid, and bowel D2cc) were compared. Plan delivery quality assurance was performed for using Mobius verification phantom, and gamma passing rate was analyzed.

RESULTS: Comparable CTV coverage was observed between the two configurations. D90 values showing no statistically significant difference (p > 0.05). In both plans, the D2cc ofbladder, rectum, sigmoid, and bowel were observed to be ≤ 23.75 Gy, ≤ 17.00 Gy, ≤ 19.50 Gy, and ≤ 17.00 Gy, respectively. The average hotspot in HRCTV was evaluated at 18.4% (±10.4) and 20.8% (±7.8) for V200%, respectively. The gamma passing rate was found to be greater than 90% for the 2%/2 mm criteria.

CONCLUSION: This in-silico study concludes that both virtual rod configurations provide comparable target coverage while effectively minimizing OAR exposure. Further clinical validation is recommended to confirm these findings.

ADVANCES IN KNOWLEDGE: This study demonstrates the feasibility of SFRT and the potential for future testing in patients who are unable to undergo brachytherapy.

PMID:42179164 | DOI:10.1093/bjr/tqag075

J Endourol. 2026 May 25:8927790261454506. doi: 10.1177/08927790261454506. Online ahead of print.

ABSTRACT

AIM OF THE STUDY: Epidemiological studies have shown that female patients are at higher risk of developing stone-related infectious complications and urosepsis than their male counterparts. However, this gender-based difference in outcomes has not been specifically explored in the context of obstructive uropathy. This study aimed to investigate gender-related predictors of sepsis in patients treated for obstructive uropathy for ureteral stones.

MATERIALS AND METHODS: We retrospectively analyzed clinical, laboratory, and radiological data from 291 consecutive patients presenting to the emergency department for obstructive uropathy because of ureteral stones and submitted to stent or nephrostomy tube decompression between 01/2016 and 10/2024. Comorbidities were assessed using the Charlson Comorbidity Index. Sepsis was defined as an acute increase in ≥2 sequenctial organ failure assesment points and documented blood or urine cultures. All patients underwent preoperative computed tomography. Clinical and stone characteristics were collected in each case. Descriptive statistics and logistic regression models were used to identify gender-specific factors associated with sepsis.

RESULTS: In males, sepsis is linked to older age, larger stones, higher white blood cells, and C-reactive protein (CRP). In females, sepsis is linked to older age, higher Charlson Index, creatinine, and CRP. Septic females had smaller stones and lower CRP and creatinine than males. CRP and age were strongest sepsis predictors, with lower thresholds in females. Limitations include single-center, retrospective design, missing data (e.g., antibiotic timing, hormonal status), and reduced power for sex-specific analyses. Larger, prospective studies needed.

CONCLUSIONS: Female patients with obstructive uropathy had a higher risk of sepsis than men. Clinical and laboratory predictors of sepsis are different according to gender. Female developed sepsis at lower inflammatory scores and smaller stone diameter than males, highlighting that a gender-based management strategy should be performed in patients with obstructive uropathy.

PMID:42179155 | DOI:10.1177/08927790261454506

Disabil Rehabil Assist Technol. 2026 May 25:1-13. doi: 10.1080/17483107.2026.2678549. Online ahead of print.

ABSTRACT

PURPOSE: Wheelchair users represent a population with significant and often permanent mobility impairment. Despite well-established links between disability and socioeconomic deprivation, the geographic relationship between wheelchair user concentration and area-level deprivation has not previously been examined at national scale. This study aimed to identify spatial clusters of wheelchair users across Wales and characterise their association with socioeconomic deprivation across domains of the Welsh Index of Multiple Deprivation (WIMD).

METHODS: This cross-sectional ecological study used 43,790 NHS-registered wheelchair users across all 1,917 Lower Layer Super Output Areas (LSOAs) in Wales. Local Moran’s I identified statistically significant High-High (HH) spatial clusters of wheelchair user counts. Chi-square goodness of fit tests, chi-square tests of association, and binary logistic regression quantified the association between WIMD deprivation quintile (Q1-5) and HH clustering across WIMD domain, with Benjamini-Hochberg false discovery rate correction applied throughout.

RESULTS: One-hundred-and-ten HH clusters were identified, with 41% in the most deprived WIMD Overall quintile. Significant deprivation gradients were observed across six domains; Health and Employment showed the strongest associations, with Q1:Q5 wheelchair user ratios of 1.747 and 1.738 and up to 20-fold greater odds of HH cluster membership in the most deprived quintile. Housing and Access to Services showed divergent patterns, with clusters concentrated in areas of moderate rather than extreme deprivation.

CONCLUSIONS: Wheelchair user spatial clustering in Wales is strongly associated with socioeconomic deprivation, but the association varies by WIMD domain. These findings provide actionable spatial evidence to support equitable NHS wheelchair service commissioning aligned with true geographic need.

PMID:42179143 | DOI:10.1080/17483107.2026.2678549