Nevin Manimala

BMC Oral Health. 2026 Jun 29;26(1):1128. doi: 10.1186/s12903-026-08971-7.

ABSTRACT

BACKGROUND: This study was designed to inspect the effects of vitamin D₃ overdose on the submandibular salivary gland of Albino rats and to investigate the possible protective role of vitamin K₁ after one month, as few studies have addressed its histopathological effects.

METHODS: This study was carried out on 60 adult male Albino rats, and they were divided into three groups. Group I (control): received physiological saline. Group II (vitamin D₃ overdose): received 1 ml/kg/day cholecalciferol (200 IU) for 30 days. Group III (vitamin D₃ + vitamin K₁): received the same vitamin D₃ dose plus vitamin K₁ (15 mg/kg/day) for 30 days. Blood samples were analyzed for baseline and terminal levels of total and ionized calcium. Specimens were examined using Hematoxylin and eosin, alizarin red stain, transmission electron microscopes, and histomorphometric analysis. Statistical analysis was performed using analysis of variance, followed by a post hoc test for pairwise comparisons, and paired t-test for intra-group comparison between baseline and terminal values.

RESULTS: examination of group II revealed pronounced structural alterations, notably acinar atrophy, which was statistically validated by a significant reduction in acinar circumference (p-value = 0.024*), alongside ductal degeneration, vascular congestion, and tissue calcification as detected by alizarin red stain. These histopathological changes correlated with elevated serum calcium levels (p-value = 0.001**). In contrast, co-treatment with vitamin K₁ in group III substantially mitigated these pathological effects, demonstrating preservation of acinar and ductal structures, attenuation of calcific deposits, and partial normalization of serum calcium levels (p-value = 0.004*).

CONCLUSIONS: Chronic administration vitamin D₃ overdose triggered degenerative, inflammatory, and calcific changes in the SMG. Also, co-administration of vitamin K₁ diminished vitamin D₃-induced histopathological changes and hypercalcemia.

PMID:42366346 | DOI:10.1186/s12903-026-08971-7

BMC Womens Health. 2026 Jun 29. doi: 10.1186/s12905-026-04637-2. Online ahead of print.

ABSTRACT

BACKGROUND: Cervical cancer remains a major cause of morbidity and mortality among women in Uganda. Although the Human Papillomavirus (HPV) vaccine is highly effective in preventing cervical cancer, completion of the recommended two-dose schedule remains low, particularly in rural settings. Rukiga District was selected for this study due to persistently low HPV second-dose (HPV2) completion rates compared with national targets. This study assessed health facility-level barriers influencing HPV vaccine completion among adolescent girls aged 9-14 years in rural Uganda.

METHODS: A mixed-methods cross-sectional study was conducted between June and September 2022 in selected Health Centre II (HC II), Health Centre III (HC III), and Health Centre IV (HC IV) facilities in Rukiga District. A household survey involving 292 caregivers of eligible adolescent girls was conducted using systematic random sampling. The primary outcome was completion of the two-dose HPV vaccination schedule (HPV2). Quantitative data were analysed using logistic regression to identify factors associated with vaccine completion. In addition, 21 key informant interviews involving 11 healthcare workers and 10 Village Health Team (VHT) members were conducted and analysed thematically to explore contextual barriers affecting HPV vaccine uptake and completion.

RESULTS: The HPV vaccine completion rate was 23.49%, indicating low coverage. In multivariable analysis, vaccine stock-outs and cold-chain challenges (adjusted odds ratio [AOR] = 1.75, 95% confidence interval [CI]: 1.04-2.93; p = 0.004) and understaffing of healthcare workers (AOR = 1.97, 95% CI: 1.05-3.68; p = 0.006) were the only statistically significant predictors of HPV vaccine completion. Although limited healthcare worker knowledge (AOR = 0.94, 95% CI: 0.70-1.24) and absence of government programmes targeting out-of-school girls (AOR = 0.97, 95% CI: 0.73-1.29) were not statistically significant in the adjusted model, qualitative findings highlighted them as important contextual barriers. Additional challenges identified included weak outreach systems, transportation constraints, misconceptions about HPV vaccination, and limited community awareness.

CONCLUSION: HPV vaccine completion in rural Uganda remains low and is strongly influenced by health system constraints, particularly vaccine supply-chain disruptions and human resource shortages. Strengthening vaccine logistics, improving staffing levels, enhancing healthcare worker capacity, and expanding outreach strategies targeting underserved populations are essential for improving vaccine completion and achieving national immunisation targets.

PMID:42366344 | DOI:10.1186/s12905-026-04637-2

BMC Complement Med Ther. 2026 Jun 29. doi: 10.1186/s12906-026-05447-7. Online ahead of print.

ABSTRACT

BACKGROUND: A recent report showed that Stephania japonica chloroform fraction has potential anticholinesterase and antioxidant activities and is able to improve learning and memory in mice. Therefore, the aim of the present study was to isolate and identify compounds from the chloroform fraction with cholinesterase inhibitory and antioxidant activity that may be useful as new candidates for the treatment of AD.

METHODS: Chromatographic methods were used for isolation of compounds and the isolated compounds were analyzed by spectroscopic methods for structure elucidation. Acetyl- and butyryl-cholinesterase inhibitory activity were evaluated for by Ellman’s method and the antioxidant activity by several in vitro models such as DPPH and hydroxyl radicals scavenging, reducing power, total antioxidant activity, and inhibition of brain lipid peroxidation. The interaction of cholinesterase enzymes and isolated compounds were examined by molecular docking studies.

RESULTS: Bioactivity guided approach led to the isolation of four compounds from the chloroform fraction and identified as aknadinine, aknadilactam, aknadicine and stephisoferuline on the basis of their ¹H-NMR and ¹³C-NMR spectral data. All the compounds were of hasubanan type. They showed significant inhibition against acetylcholinesterase and butyrylcholinesterase, with at least two fold increased affinity for butyrylcholinesterase than acetylcholinesterase. The IC₅₀ values of the alkaloids were in the range of 9.36-14.89 µg/mL against acetylcholinesterase and 3.97-6.66 µg/mL against butyrylcholinesterase. Kinetic analysis revealed that all the four compounds exhibited mixed type of inhibition against both acetylcholinesterase and butyrylcholinesterase. The interaction of compounds with several amino acids of enzymes was supported by molecular docking studies. All the hasubanan alkaloids showed antioxidant activity in all in vitro assays and inhibited peroxidation of brain lipid. The IC₅₀ values of the compounds for scavenging of DPPH and hydroxyl radicals, and lipid peroxidation inhibition were found to be in the range of 5.1-40.91, 10.44-19.41, and 20.60-31.72 µg/mL, respectively.

CONCLUSION: The hasubabanan alkaloids isolated from S. japonica may represent a new class of anti-cholinesterase compounds. The multitargeted activity of hasubanan alkaloids may lead to new candidates for the treatment of AD.

PMID:42366338 | DOI:10.1186/s12906-026-05447-7

Cardiovasc Diabetol. 2026 Jun 28. doi: 10.1186/s12933-026-03270-5. Online ahead of print.

ABSTRACT

BACKGROUND: Hemorrhagic stroke (HS), including non-traumatic intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), accounts for approximately 30% of all stroke cases and over 40% of stroke-related deaths. With high mortality and disability rates, HS imposes a heavy global health burden. As a core metabolic disorder, insulin resistance (IR) has been proven to be associated with all-cause mortality (ACM) in patients with ischemic stroke in previous studies. Nevertheless, its prognostic value remains unclear in critically ill HS patients admitted to the intensive care unit (ICU). Given the markedly higher mortality and morbidity of HS compared with ischemic stroke, it is essential to explore this association. This study aimed to investigate the correlations between multiple surrogate markers of insulin resistance and all-cause mortality among critically ill HS patients in the ICU setting.

METHODS: Data were extracted from the public eICU-CRD database. Patients with severe HS were identified based on the International Classification of Diseases (ICD)-9/10 diagnostic codes. A total of 1538 ICU-admitted patients with severe HS were enrolled and stratified according to quartiles of various IR surrogate markers. The primary endpoint was in-hospital mortality. Cox regression analysis, Kaplan-Meier survival curves, restricted cubic splines (RCS) and receiver operating characteristic (ROC) curves were adopted for statistical analyses.

RESULTS: Among the 1538 enrolled patients, males accounted for 54.6%, and the overall in-hospital all-cause mortality was 26.59%. Multivariate Cox regression analyses revealed that all IR surrogate markers were significantly correlated with all-cause mortality in severe HS patients. SPISE was negatively correlated with all-cause mortality, while other indicators showed positive correlations. Restricted cubic spline analyses demonstrated non-linear relationships between TyG, SPISE, TG_HDL, METS_IR, TyG_BMI, TyG_RC and mortality. No significant effect modification was observed in interaction analyses. ROC curve analysis indicated that TyG exhibited the highest predictive accuracy.

CONCLUSION: In conclusion, insulin resistance surrogate markers were significantly associated with all-cause mortality in critically ill HS patients. Despite their weak-to-moderate discriminative performance, these indices may serve as auxiliary prognostic references for risk stratification. Clinical application of these indicators is expected to optimize therapeutic strategies and disease progression management. Furthermore, this study enriches current evidence regarding the association between insulin resistance surrogate markers and hemorrhagic stroke, and clarifies their roles in predicting mortality across different stroke subtypes.

PMID:42366337 | DOI:10.1186/s12933-026-03270-5

BMC Geriatr. 2026 Jun 29. doi: 10.1186/s12877-026-07895-9. Online ahead of print.

ABSTRACT

BACKGROUND: Falls are a major public health concern among older adults and contribute substantially to disability, reduced quality of life, and increased healthcare burden. Fall prevention-related health literacy practices, reflecting the application of health literacy skills in daily life, may influence an individual’s ability to recognize risk factors and adopt appropriate preventive behaviors. This study aimed to examine factors associated with fall prevention-related health literacy practices among community-dwelling older adults in Northern Thailand.

METHODS: A community-based cross-sectional study was conducted among 415 older adults residing in Chiang Rai Province, Thailand, between February to May 2025. Participants were selected using a multi-stage stratified sampling approach. Data were collected through structured questionnaires assessing sociodemographic characteristics, fear of falling, and fall prevention-related health literacy. Functional mobility was evaluated using the Timed Up and Go (TUG) test. Data were analyzed using IBM SPSS Statistics for Windows, Version 29.0 (IBM Corp., Armonk, NY, USA). Multivariable logistic regression analyses were performed to identify factors independently associated with adequate fall prevention-related health literacy and its subdomains. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.

RESULTS: Most participants were female (58.3%), and 61.9% were aged 60-69 years. Overall, 88.70% demonstrated inadequate fall prevention-related health literacy. Housing characteristics (AOR = 3.166, 95% CI: 1.505-6.660) and TUG performance (AOR = 0.352, 95% CI: 0.163-0.761) were significantly associated with adequate fall prevention-related health literacy. Housing characteristics were consistently associated with access (AOR = 1.959, 95% CI: 1.168-3.284), cognitive (AOR = 2.055, 95% CI: 1.203-3.511), communication (AOR = 2.125, 95% CI: 1.233-3.665), and self-management skills (AOR = 1.830, 95% CI: 1.095-3.059). TUG performance was significantly associated with access and cognitive literacy. Additionally, cognitive literacy was significantly associated with marital status and fear of falling, while education level was significantly associated with self-management (AOR = 0.504, 95% CI: 0.296-0.861) and media literacy (AOR = 0.342, 95% CI: 0.211-0.556).

CONCLUSIONS: A substantial proportion of community-dwelling older adults had inadequate fall prevention-related health literacy. Environmental and functional factors were consistently associated with health literacy across multiple domains, with additional associations for marital status, educational attainment, and fear of falling. These findings highlight the need for community-based fall prevention strategies incorporating adapted health communication, environmental modification, mobility assessment, and targeted interventions to strengthen preventive capacity among older adults.

TRIAL REGISTRATION: Not applicable.

PMID:42366333 | DOI:10.1186/s12877-026-07895-9

J Cancer Educ. 2026 Jun 29. doi: 10.1007/s13187-026-02932-y. Online ahead of print.

ABSTRACT

Case-based learning (CBL) is widely used in undergraduate medical education, with demonstrable benefits for students across multiple domains. There is a paucity of data in the post-graduate setting. A robust training program is essential for specialty trainees in medical oncology, yet dedicated educational opportunities are limited by a busy clinical environment. This study aimed to evaluate the feasibility of a post-graduate trainee-led CBL program within a Medical Oncology Department at a major cancer centre in Australia. All eligible participants (3 registrars, 1 clinical fellow, 2 nurse practitioners (NPs), 1 post-graduate student NP) were invited to attend weekly CBL sessions over a 20-week period. Session parameters, such as attendance and duration, were recorded. Feasibility was assessed using 4 of Bowen’s key areas: acceptability, demand, implementation and practicality. A questionnaire was completed by each participant following each session and on conclusion of the program. Researchers performed statistical analysis using Mann-Whitney U tests and conducted thematic analyses on qualitative data. Of 20 scheduled sessions, 14 (70%) ran without cancellation. Attendance rate was 66%, with most absences being attributed to leave. Mean session duration was 61.4 min, with mean preparation time of 24.2 min per participant. Participant perceived value was high (9.1/10) and significantly higher with faculty medical oncologist attendance (9.7 vs. 8.8, p = 0.001). Acceptability scores were excellent (9.4/10). CBL sessions were rated significantly higher than concurrent educational opportunities (9.1 vs. 8.1, p < 0.001). Coding of the qualitative data within participant surveys identified the following themes: CBL sessions (1) stimulated relevant and beneficial discussion, (2) were perceived positively, (3) were negatively affected by other clinical commitments, (4) were enhanced by the presence of a faculty medical oncologist, (5) generated a safe space for collaborative learning, (6) were time-efficient and (7) provided self-study opportunities. A postgraduate, trainee-led CBL program in medical oncology is feasible and was well received at our centre. It offers a promising complement to traditional teaching in a rapidly evolving field where faculty oncologist-led educational opportunities may be limited. Future studies could focus on the potential for virtual implementation to allow for collaboration between centres, to the benefit of rural medical oncology trainees.

PMID:42366331 | DOI:10.1007/s13187-026-02932-y

Accid Anal Prev. 2026 Jun 28;235:108642. doi: 10.1016/j.aap.2026.108642. Online ahead of print.

ABSTRACT

Due to the perceptual challenges created by obstructed sight lines, drivers in beyond-line-of-sight (BLOS) scenarios often fail to detect hazards until insufficient stopping distance remains, making these situations particularly hazardous for young drivers with limited hazard anticipation capabilities. While vehicle-to-everything (V2X)-based warning systems offer a promising countermeasure, precisely quantifying the system effectiveness remains a challenge, as previous studies often rely on associational methods with limited ability to isolate causal effects or characterize treatment effect heterogeneity. This study aimed to apply a causal machine learning framework to estimate the effect of a V2X-based BLOS warning system on young driver response and explore potential sources of treatment effect heterogeneity in a data-driven manner. Based on data from a randomized within-subject driving simulator experiment for causal identification, double/debiased machine learning (DML) was used to estimate the average treatment effect, with the estimates further examined through robustness analyses. The analysis revealed that the BLOS warning had a positive and statistically significant effect on overall response quality. Among trials with identifiable response initiation, the warning was also associated with shorter reaction times. To explore treatment effect heterogeneity, a causal forest implemented within the DML framework was applied to estimate the conditional average treatment effects. An exploratory analysis utilizing Shapley additive explanations (SHAP) suggested that the estimated treatment effects were highly state-dependent. The heterogeneity patterns were more strongly associated with drivers’ instantaneous vehicle control states than with other variables, such as static driver characteristics. A subgroup analysis further revealed that the warning benefits were statistically reliable primarily for observations characterized by stable longitudinal control and more active steering correction behavior. These findings highlight the value of incorporating real-time vehicle control states into the design of adaptive advanced driver-assistance systems to improve warning system effectiveness.

PMID:42365749 | DOI:10.1016/j.aap.2026.108642

Eur J Radiol. 2026 Mar 15;203:112755. doi: 10.1016/j.ejrad.2026.112755. Online ahead of print.

ABSTRACT

CONTEXT: There is little published population-based information on variations in the anatomical dimensions of lumbar and thoracic intervertebral discs observed in lateral projection.

PURPOSE: To document the simplified anatomy in lateral projection of intervertebral discs and its association with disability or disease in twenty-four male and female European Populations aged over fifty years.

STUDY SETTING: Within the published European Prospective Osteoporosis Study of Vertebral deformities and fractures.

PATIENT SAMPLES: population-based samples of 10,026 men and women aged over fifty years from fourteen European centres.

OUTCOME MEASURES: dimensional and dimension-free measures from lateral radiographs of the anatomical characteristics of three lumbar and six thoracic intervertebral discs per subject, retrieved trigonometrically from previous digitisations of vertebral body heights measured twice per subject (after excluding subjects with interval vertebral fractures). Each subject also completed at recruitment a nurse-supervised questionnaire that included questions about self-assessed health (5-point scale) and activities of daily living (3-level, 12-point scale).

METHODS: Each participant had two interval lateral radiographs of the thoracic and lumbar spine. Six thoracic discs between thoracic vertebra (T) 4 and T9 and three lumbar discs between L1 and L4 were measured. Disc dimensions were adjusted for magnification when tube-film distance was known. Associations were evaluated between anatomical disc characteristics and the self-reported health outcomes quality of life and activities of daily living.

RESULTS: After adjustment for magnification, there were large variations between populations (as well as between participants) in the disc dimensions anterior, mid- and posterior disc height as well as width. The calculated dimension-free disc indices aspect ratio, wedge angle and convexity also varied significantly between countries as well as between subjects. Indices of spine sinuosity (curvature in the AP plane) calculated separately for discs and vertebrae also varied between countries; whereas sex had smaller effects on sinuosity after allowing for differences in body size between men and women. In contrast to vertebral fractures, none of these dimension-free vertebral disc indices was significantly associated with self-assessed quality of life or activities of daily living in men and women, even when restricted to those over 65 years of age.

CONCLUSIONS: These data showed substantial variations across the continent in the geometric characteristics of the inter-vertebral discs that have implications for future study design. These variations associated more with geographic location than with sex or age. Variations in radiological disc anatomy had no significant statistical associations with two widely used health indices in those over (or under) 65 years.

ADVANCES IN KNOWLEDGE: This is the first large scale descriptive population-based multi-centre anatomical study of admittedly simplified European intervertebral disc anatomy. Its main implications are that the dimensional measures studied vary geographically and (within the ranges commonly encountered) are not common determinants of disability in older people. Nevertheless, for future anatomical case-control studies of intervertebral disc disease, it would be wise to recruit controls who are geographically local to cases to avoid statistical confounding.

PMID:42365740 | DOI:10.1016/j.ejrad.2026.112755

Leg Med (Tokyo). 2026 Jun 19;84:102896. doi: 10.1016/j.legalmed.2026.102896. Online ahead of print.

ABSTRACT

This study aims to evaluate suicide statistics from the Turkish Statistical Institute (TURKSTAT) from 2015 to 2024 in terms of demographic and sociocultural characteristics, while also providing a forensic medicine perspective through comparison with the literature. Suicide data were obtained from TURKSTAT’s “Cause of Death Statistics” database and classified according to age group, sex, marital status, educational level, cause, and method of suicide. The annual crude suicide rate in Türkiye ranged between 3.94 and 5.22 per 100,000 population, with males consistently exhibiting a substantially higher mortality risk than females (6.84 vs. 2.14). Across specific age cohorts, sex-specific suicide rates peaked among young adult males aged 25-29 (11.27) and elderly males aged over 75 (11.98), whereas the highest rate among females was observed in the 15-19 age bracket (4.76). Disease-related factors represented the leading category among specified administrative causes (peaking at 1.31), while hanging emerged as the predominant method, accounting for 47.03% of all cumulative cases. By educational attainment, the highest longitudinal suicide rates over the decade were consistently documented among individuals with lower secondary (up to 8.32) and upper secondary education (up to 7.67). These findings suggest that suicide mortality in Türkiye is associated with a complex interplay of systemic health problems, socioeconomic stressors, and distinct sociodemographic vulnerabilities rather than isolated psychiatric conditions. Consequently, integrating macro-level epidemiological insights and sociocultural dimensions into forensic medical evaluations can support the development of targeted public health interventions and evidence-based preventive policies.

PMID:42365733 | DOI:10.1016/j.legalmed.2026.102896

Int J Nurs Stud. 2026 Jun 15;182:105620. doi: 10.1016/j.ijnurstu.2026.105620. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative thirst in the post-anesthesia care unit is a common symptom that can have adverse physiological and psychological effects. Although various cooling and moisturizing interventions have been shown to alleviate postoperative thirst, their relative effectiveness remains unclear.

OBJECTIVE: To compare the effects of cooling and moisturizing interventions on postoperative thirst relief in patients in the post-anesthesia care unit.

DESIGN: A systematic review and network meta-analysis.

INFORMATION SOURCES: PubMed, Web of Science, CINAHL, EMBASE, and Scopus were systematically searched from inception to January 16, 2026.

METHODS: Two reviewers independently conducted study screening, quality assessment, and data extraction. A random-effects network meta-analysis was undertaken to compare the relative effects of oral cooling and moisturizing interventions on postoperative thirst.

RESULTS: A total of eleven RCTs involving 3098 participants and eight oral interventions were included. The network meta-analysis showed that, compared with the nil by mouth (NPO) control group (i.e., no oral intake or oral intervention), the interventions showing the largest reductions in postoperative thirst intensity were menthol ice (MD = -4.84; 95% CI, -6.42 to -3.26), followed by ice (MD = -4.17; 95% CI, -5.82 to -2.51) and water (MD = -4.07; 95% CI, -5.36 to -2.78). In contrast, citric acid spray, aromatic solution spray, water spray, wet gauze, and wet cotton swab did not show statistically significant reductions in postoperative thirst intensity.

CONCLUSIONS: Menthol ice, ice, and water emerged as the most promising options for reducing postoperative thirst intensity. However, the current evidence remains limited, and further high-quality studies with standardized protocols are needed to confirm these findings.

REGISTRATION: https://www.crd.york.ac.uk/prospero/ CRD42024610113, registered 4/11/2024.

PMID:42365725 | DOI:10.1016/j.ijnurstu.2026.105620