Nevin Manimala

Acta Orthop Belg. 2025 Sep;91(3):257-264. doi: 10.52628/91.3.10897.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the effectiveness of Intra-articular abdominal adipose-derived mesenchymal stem cell (AD-MSC) therapy in patients diagnosed with knee osteoarthritis and to compare its effectiveness in patients with grade 2 and grade 3 osteoarthritis.

MATERIAL AND METHOD: The study group comprised 48 patients over the age of 18 that were diagnosed with Grade II or Grade III (Kellgren-Lawrence) primary knee osteoarthritis. Two-way comparative knee radiography was performed for all patients before the procedure. Intra-articular abdominal adipose-derived mesenchymal stem cell (AD-MSC) therapy was applied to all patients. The patients were evaluated with the VAS and WOMAC index before the treatment and 3 months and 6 months after the treatment.

RESULTS: A statistically significant decrease was found in the six-month follow-up WOMAC and VAS scores compared to the pre-treatment scores regardless of the grade of their osteoarthritis (p <0.001).

CONCLUSION: In conclusion, it was observed that the intra-articular injection of the AD-MSCs provided satisfactory functional recovery and pain relief for patients with knee osteoarthritis at six-month follow-up. No procedure-related adverse events were observed during the follow-up period.

PMID:41766540 | DOI:10.52628/91.3.10897

Stroke. 2026 Mar 2. doi: 10.1161/STROKEAHA.125.053747. Online ahead of print.

ABSTRACT

BACKGROUND: Moyamoya disease (MMD) has a strong genetic basis, with the rare RNF213 variant (rs112735431) representing a major risk factor, while the broader genetic architecture and disease-relevant vascular cell types remain incompletely understood.

METHODS: We conducted a genome-wide association study in Japanese individuals (n=47 656; 401 MMD cases and 47 255 controls). Population-level features at MMD risk loci were examined by regional allele frequency and haplotype analyses. We performed single-nucleus RNA-seq of superficial temporal arteries from patients with MMD (n=3). Cell type-specific enrichment of genome-wide association study signals was assessed using the Single-Cell Disease Relevance Score. Endothelial signatures were validated by integration with publicly available single-cell data sets from controls (n=5) and immunohistochemistry for candidate markers (n=1).

RESULTS: Beyond rs112735431, we identified a genome-wide significant signal in the HDAC9-TWIST1 region (P=3.3×10^-14; odds ratio, 1.77). Conditional analysis on rs112735431 revealed a protective RNF213 missense variant, p.Asn1331Gly (rs8074015; P=3.7×10^–9; odds ratio, 0.53), whose minor allele was mutually exclusive with rs112735431-A on haplotypes. Population analysis revealed geographic variation and extended haplotype structure of the rs112735431-A allele in Japan. Single-nucleus RNA-seq identified a mesenchymal-like endothelial cell (MEC) population with selective FN1 expression. Genome-wide association study-prioritized disease genes were strongly enriched in MECs. MECs showed mesenchymal pathway activation with a regulatory program distinct from canonical endothelial states. The proportion of MECs was markedly increased in MMD (72% versus 28% in controls), and FN1 expression in endothelial regions was confirmed by immunohistochemistry.

CONCLUSIONS: Our findings identify a protective RNF213 variant that is mutually exclusive with the known rs112735431-A allele. Genetic risk converges on an MEC state markedly expanded in MMD.

PMID:41766532 | DOI:10.1161/STROKEAHA.125.053747

Int J Inj Contr Saf Promot. 2026 Mar 2:1-7. doi: 10.1080/17457300.2026.2635094. Online ahead of print.

ABSTRACT

The growing number of road accidents in India has been a concern over the years. Alcohol and mobile phone use while driving have been found to be important factors in road injuries. Although legislative changes, like ‘The Motor Vehicle (Amendement) Act, 2019’, introduced stricter penalties to control dangerous driving behavior, limited evidence exists regarding their real-world impact in low and middle-income countries (LMICs) like India. This study examines the impact of increased penalties on alcohol and mobile-related accidents in India using “Road Accidents in India” reports. Accident trends were assessed before and after the implementation of stricter penalties using year-on-year statistical testing for proportion differences. Drunk driving and mobile phone-related violations increased until 2019 but showed a significant decline following the introduction of higher penalties, sustained up until 2021. Findings show that while stricter penalties help, lasting impact depends on consistent enforcement, public awareness, and attitudinal changes toward road safety.

PMID:41766491 | DOI:10.1080/17457300.2026.2635094

Risk Anal. 2026 Mar;46(3):e70213. doi: 10.1111/risa.70213.

ABSTRACT

People’s risk perceptions are crucial for climate change adaptation, influencing individual decisions and policy effectiveness. Although many studies highlight the importance of social influences and social norms in this context, the mechanisms through which they shape individual risk perceptions and adaptation behavior remain unclear. To address this gap, we analyze cross-country survey data (N = 1612) from coastal areas in the Netherlands, United Kingdom, and the USA with a focus on flood risk and adaptation behavior. Our statistical analysis reveals several important patterns in social interactions, and the ways in which these social interactions influence individual risk perceptions. First, we find limited social engagement regarding risks and adaptation, with a significant portion of respondents (50%) reporting no interactions with peers on these topics. Among those who do engage, social interactions on flood risk and adaptation appear infrequent (fewer than five times per year). Second, contrary to common assumptions, individuals who discuss flood risk and adaptation, rarely do so with neighbors. Moreover, homophily-shared socio-demographic characteristics-is not the primary determinant of who interacts on the topic. Third, we see that those with hazard experience and those with higher risk perceptions are more likely to interact with others on the topics of these risks and climate adaptation, confirming that social amplifications might be in place. These findings provide unique insights into the social dynamics underlying the evolution of individual risk perceptions, offering the potential to refine models of social influence in climate change and social tipping points. They also highlight potential synergies between communication strategies and policy tools to support timely and, possibly transformational, adaptation.

PMID:41766472 | DOI:10.1111/risa.70213

Child Maltreat. 2026 Mar 2:10775595261430083. doi: 10.1177/10775595261430083. Online ahead of print.

ABSTRACT

School social workers (SSWers) play a central role in child abuse and neglect (CAN) reporting, yet few empirical studies have examined factors that influence SSWers’ reporting practices. Using data from a national survey of 455 SSWers, this study examined how training, bias awareness, and beliefs about child protective services (CPS) influence SSWers’ CAN reporting behavior. The role of individual-level and school-level demographic factors was also considered. Findings indicated that SSWers who were White (OR = 1.61, p = .034), OR = 0.77, p = .004), worked in a school serving higher proportions of low-income students (OR = 1.2, p = .002), and had higher levels of satisfaction with CPS (OR = 1.26, p = .013) and mandated reporting (OR = 0.74, p = .003) had significantly higher CAN reporting frequency. No statistically significant association was found between participants’ self-report that their prior mandated reporter (MR) trainings included some form of anti-bias content and participants’ awareness of their own biases. Results suggest individual-level factors impact reporting decisions; implications for research and training are addressed.

PMID:41766464 | DOI:10.1177/10775595261430083

Rural Remote Health. 2026 Mar;26(1):10113. doi: 10.22605/RRH10113. Epub 2026 Mar 2.

ABSTRACT

INTRODUCTION: End-stage kidney disease (ESKD) imposes a significant financial burden due to its long-term treatment and represents a growing health issue worldwide. Health inequalities arising from urban and rural geographic disparities remain pressing global issues. South Korea operates a universal and inclusive healthcare system aimed at achieving health equity, with catastrophic health expenditure (CHE) widely recognised as a key indicator for measuring the financial burden associated with diseases. This study aims to assess health equity between urban and rural individuals with ESKD by identifying health status, healthcare accessibility, household finances, financial burden, and CHE factors.

METHODS: This study utilised longitudinal data comprising 421 observations of ESKD from 105 individuals in the 7-year dataset of the Korea Health Panel (2012-2018). Non-parametric statistics were used for cross-sectional analyses to determine subject characteristics at baseline, and mixed-effects panel logistic regression and linear regression for longitudinal studies accounting for time-varying effects. Additionally, population-weighted analyses were conducted to address potential sampling bias in the panel data.

RESULTS: Among those with ESKD, 34.3% resided in rural areas. Over a 7-year period, the cumulative prevalence of CHE was 24.6% in urban areas, 30.6% in rural areas, and 26.7% overall. Over the 7-year panel data, no significant differences in health status or household financial indicators were identified between urban and rural areas. However, regarding healthcare accessibility, the adjusted odds ratio (AOR) for inpatient utilisation in rural compared to urban areas was 2.72 (95%CI 1.41-5.25). Conversely, the AOR for outpatient use was 0.14 (95%CI 0.02-0.80). After population weighting, the prevalence of CHE (AOR 1.40, 95%CI 1.39-1.42) and the prevalence of impoverishment (AOR 1.56, 95%CI 1.54-1.57) were significantly elevated in rural compared to urban areas. Factors associated with higher CHE prevalence included being female (AOR 1.83, 95%CI 1.02-3.16), lowest household income (AOR 6.55, 95%CI 1.67-25.72), inpatient utilisation (AOR 5.36, 95%CI 2.86-10.03), and being aged 65 years or older (AOR 1.71, 95%CI 0.88-3.31). In the population-weighted analysis, CHE was higher in rural areas than in urban areas (AOR 1.22, 95%CI 1.20-1.23).

CONCLUSION: Health status and household financial equity between urban and rural individuals with ESKD in South Korea demonstrate positive outcomes of a universal and inclusive healthcare coverage system. Nevertheless, regarding healthcare accessibility, living rurally exhibited lower outpatient and emergency room visits alongside higher inpatient utilisation, indicating greater challenges in CHE. Tailored adjustments to the healthcare system are needed to address the vulnerabilities of rural place.

PMID:41766405 | DOI:10.22605/RRH10113

J Palliat Med. 2026 Mar 1:10966218261425592. doi: 10.1177/10966218261425592. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine the frequency with which emergency medical services (EMS) clinicians recognize patients enrolled in hospice and describe their prehospital management.

METHODS: Observational cohort study of patients enrolled in hospice who were transported by EMS within a health system between May 5, 2018, and June 4, 2023. Two physicians reviewed each encounter to determine whether interventions were comfort-focused (hospice philosophy) or life-sustaining care. Interrater reliability was 100% (k = 1.0). Descriptive statistics are provided.

RESULTS: EMS clinicians identified hospice enrollment in 51% (n = 46) of 88 encounters. Most patients (90%, n = 79) received comfort-focused care. Life-sustaining care was provided to four patients identified as hospice-enrolled and included cardiopulmonary resuscitation, an advanced airway, and vasopressors (n = 1, 25%); spinal immobilization (n = 2, 50%), and naloxone (n = 1, 25%).

CONCLUSION: Most patients received care consistent with the philosophy of hospice. However, EMS clinicians may have only identified half of patients enrolled in hospice. This demonstrates an opportunity to improve recognition of patients’ care preferences, starting in the out-of-hospital setting.

PMID:41766378 | DOI:10.1177/10966218261425592

Psychol Med. 2026 Mar 2;56:e59. doi: 10.1017/S0033291726103341.

ABSTRACT

BACKGROUND: Poverty is associated with the severity of common mental health disorders and increased physical comorbidities. However, its effects on severe mental illness (SMI), beyond increasing their incidence, are less understood, especially in low- and middle-income countries. We here examined the relationship between baseline household income and subsequent mental and physical health outcomes in a large cohort of individuals diagnosed with schizophrenia or bipolar disorder in Colombia.

METHODS: Retrospective cohort and case-control study using electronic health records from over 5 million Colombians. We identified individuals diagnosed with schizophrenia or bipolar disorder and their baseline household income. Mental health outcomes included third-line antipsychotic treatments (clozapine or antipsychotic polypharmacy) and psychiatric hospitalizations. Physical outcomes included diagnoses of hypertension, type 2 diabetes, and HbA1c levels, compared with rates in individuals without SMI.

RESULTS: We included 12,216 (6,485 women) participants newly diagnosed with bipolar disorder or schizophrenia between 2019 and 2023. Compared to middle-income participants (between $700-1,750USD/month), patients on a low income (less than $700USD/month) were more likely to require third-line antipsychotic treatment (OR 1.84 [1.64, 2.08]) and psychiatric hospitalization (incidence rate ratio 1.30 [1.21, 1.41]). Low-income participants with SMI had hypertension and diabetes rates like middle-income participants without SMI who were 20 years older. However, the combined effect of SMI and low income together posed a less-than-additive risk. Lower income was associated with higher HbA1c levels in diabetes, while a diagnosis of SMI was associated with lower levels.

CONCLUSIONS: Low income at SMI onset is associated with worse mental and physical health outcomes.

PMID:41766372 | DOI:10.1017/S0033291726103341

Mol Oncol. 2026 Mar 1. doi: 10.1002/1878-0261.70218. Online ahead of print.

ABSTRACT

Transcriptional heterogeneity in pancreatic ductal adenocarcinoma (PDAC) arises not only from changes in gene expression but also from dynamic rewiring of gene-gene coordination. Using a divergent-edge framework applied to 77 155 malignant cells from 42 tumors, we identified four reproducible adaptive modules-integrated growth-energy (IGE), stress-adaptive transcription (SAT), IL-2-linked immune evasion (IL2), and multi-pathway collective invasion (MPC)-that cut across canonical PDAC states and reflect distinct regulatory programs. Integrating these modules with CRISPR-Cas9 dependency profiles and PRISM drug-response data revealed that adaptive behaviors collapse into two higher-order axes: a biosynthetic-metabolic IGE axis enriched for translational and DNA-repair dependencies, and a broader SAT-IL2-MPC stress-immune-invasion axis characterized by proteostasis, cytokine-linked, and cytoskeletal vulnerabilities. This architecture emerges only when divergent-edge modules are mapped into functional genomics space. Module activity also carried clinical relevance in PDAC. SAT-high tumors showed poorer survival, while MPC-high tumors exhibited a similar adverse trend; together, these modules defined a stress-immune-invasion poor-prognosis axis. In contrast, IGE activity showed no overall risk association, although an optimal-cut point-defined IGE-high subgroup displayed modestly improved survival.

PMID:41766370 | DOI:10.1002/1878-0261.70218

BJPsych Bull. 2026 Mar 2:1-7. doi: 10.1192/bjb.2026.10223. Online ahead of print.

ABSTRACT

AIMS AND METHOD: Treatment non-adherence is a well-established predictor of relapse in schizophrenia, yet its broader clinical impact remains unclear. This study examines the association between clinician-recorded treatment non-adherence and clinical outcomes during the first year following a schizophrenia diagnosis. Using a bespoke natural language processing algorithm applied to anonymised electronic health records, we classified the recorded treatment adherence status of 2667 patients. Multivariable and Poisson regression analyses were conducted to assess associations of recorded treatment non-adherence with clinical outcomes.

RESULTS: Compared with the remainder, those classified as non-adherent had greater increases in recorded symptoms and higher frequency and duration of in-patient admissions and crisis care episodes. They were also prescribed a greater number of different antipsychotics and developed a greater number of recorded physical health comorbidities.

CLINICAL IMPLICATIONS: Treatment non-adherence is associated with markedly poorer clinical outcomes, emphasising the importance of early identification and targeted interventions to support adherence.

PMID:41766367 | DOI:10.1192/bjb.2026.10223