Nevin Manimala

J Clin Endocrinol Metab. 2026 Mar 20:dgag126. doi: 10.1210/clinem/dgag126. Online ahead of print.

ABSTRACT

BACKGROUND: Lipodystrophy syndromes (LD) are a group of rare conditions characterised by the generalised or partial absence and/or dysfunction of adipocytes. Due to the lack of fat storage capacity, excess lipid accumulates in other tissues, leading to severe insulin resistance. At present, effective therapeutic options remain limited, with metreleptin currently the only specific licensed treatment. To this end, we evaluated the therapeutic impact of tirzepatide in people with partial lipodystrophy (PLD).

METHODS: This was a single-centre, retrospective, observational study, including all patients with PLD treated with tirzepatide between January 2022 and September 2025.

RESULTS: 40 patients with PLD were included (FPLD1 like =26 (65%), FPLD2 =4 (10%), FPLD3 =7 (17.5%), FPLD7=1 (2.5%), APLD=1 (2.5%), Unclassified=1 (2.5%)). 87.5% (n=35) were female with a median age of 47 years (IQR 39 – 59) and a median BMI of 31.5 kg/m2 (IQR 27.3 – 35.5). After a median 9.5 month follow-up (IQR 7 – 11), marked reductions were seen in body weight from 91.0kg (IQR 75.0 – 106.0) to 82.8kg (IQR 69.0 – 93.4; p<0.0001), in HbA1c from 65 mmol/mol (IQR 54.5 – 85) to 52 mmol/mol (IQR 39 – 62; p<0.0001) and in serum triglycerides from 2.80 mmol/L (IQR 1.6 – 3.7) to 1.83 mmol/L (IQR 1.0 – 2.9; P=0.0005). Daily insulin requirements fell from 177.5 IU (IQR 101.3 – 213.8) to 58.0 IU (IQR 0 – 112.5; P=0.0028).

CONCLUSION: In patients with partial lipodystrophy, tirzepatide use resulted in substantial statistically significant reductions in weight, glycaemic control, serum triglycerides and daily insulin requirement. We recommend further prospective studies to support these findings and to evaluate its impact earlier in the course of the disorder.

PMID:41866320 | DOI:10.1210/clinem/dgag126

J Clin Endocrinol Metab. 2026 Mar 20:dgag124. doi: 10.1210/clinem/dgag124. Online ahead of print.

ABSTRACT

CONTEXT: BPA is a synthetic chemical used in consumer goods that has been linked to type 2 diabetes in observational studies. No human experimental studies have examined whether BPA reduces peripheral insulin sensitivity.

PURPOSE: To determine the effects of oral BPA administration on peripheral insulin sensitivity over 5 days.

METHODS: Forty sedentary, but otherwise healthy adults (22 F, 18 M; 21.3 ± 2.1 yr; 22.1 ± 2.3 kg/m2; 85% Non-Hispanic White) completed a 2-day baseline energy-balanced diet low in BPA during which urine, blood, and peripheral insulin sensitivity via 120 min euglycemic hyperinsulinemic clamp technique (40 mU/m2/min; 90 mg/dL) were assessed. In a double-blind fashion, participants were randomly assigned to receive 5 days of oral BPA administration at 50 μg/kg body weight (BPA-50) or placebo (PL). All participants were fed the same energy-balanced diet. Outcomes were assessed using a two-way repeated-measures ANOVA adjusted for baseline sex, BMI, physical activity, and ethnicity.

RESULTS: After treatment, urine BPA levels were significantly higher in BPA-50 compared to PL (+ 268,700 ± 63983 vs. PL: + 8893 ± 6786 pg/mL, P = 0.009). After treatment, body weight and fasting glucose were not statistically different between PL and BPA-50 (P > 0.05). However, BPA significantly decreased peripheral insulin sensitivity by 0.02 ± 0.01 mg/kg/min/uU/ml compared with an increase observed following PL by 0.02 ± 0.01 mg/kg/min/uU/ml (P = 0.01).

CONCLUSION: BPA administration decreased peripheral insulin sensitivity after 5 days. These data provide the first experimental evidence in humans that BPA administration may reduce insulin sensitivity.

PMID:41866316 | DOI:10.1210/clinem/dgag124

Healthc Policy. 2026 Feb;21(2):37-48. doi: 10.12927/hcpol.2026.27799.

ABSTRACT

Physicians require timely access to patient information to provide effective care. However, in Canada, most of this information is siloed in unconnected systems, limiting access at the point of care. This paper analyzes the current state of electronic access to and exchange of patient information among Canadian physicians, using data from the 2024 Infoway-Canadian Medical Association survey of physicians. Using descriptive analysis, the paper reveals an imbalance between the growing adoption of digital health solutions (notably electronic medical records and electronic health records) and advancements in interoperability. To achieve a more connected digital health ecosystem, the paper calls for policy efforts, data-sharing frameworks and incentive strategies.

PMID:41866311 | DOI:10.12927/hcpol.2026.27799

World J Surg. 2026 Mar 22. doi: 10.1002/wjs.70319. Online ahead of print.

ABSTRACT

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have demonstrated substantial benefits in improving postoperative outcomes. However, in low-resource settings such as Ethiopia, ERAS adoption remains limited, necessitating pragmatic context-sensitive implementation approaches. The perspectives of frontline perioperative providers who are central to implementation have rarely been systematically assessed. This study aimed to evaluate acceptance, perceived benefits, implementation challenges, and readiness for sustained adoption of a pragmatic triple enhanced recovery after surgery (T-ERAS) protocol, comprising early oral intake, early ambulation, and early urinary catheter removal, among healthcare workers participating in a multisite ERAS trial in Ethiopia.

METHODS: A descriptive cross-sectional survey was conducted among 20 perioperative care providers, including surgeons, obstetricians, anesthetists, and nurses, from five public hospitals involved in the ERAS implementation trial. A structured questionnaire administered via Google Forms captured demographic characteristics, ERAS knowledge and exposure, perceived benefits and challenges, and willingness to adopt ERAS practices. Data were analyzed using descriptive statistics and thematic summaries.

RESULTS: Twenty perioperative care providers participated, of whom 13 (65.0%) were male, and 15 (75.0%) were affiliated with tertiary-level public hospitals. Twelve respondents (60.0%) reported being very familiar with ERAS protocols, although only 11 (55.0%) had directly participated in implementation. Sixteen participants (80.0%) believed ERAS improves patient outcomes; however, adherence varied, with 8 (42.1%) reporting rarely applying the protocol. Key implementation challenges included limited resources (85.0%), insufficient staff training (70.0%), resistance to change (50.0%), and inadequate patient education (50.0%). Despite these barriers, 17 participants (85.0%) expressed willingness to adopt ERAS practices permanently, and all (100.0%) were open to further training. The T-ERAS components were viewed favorably, with 15 participants (75.0%) rating each as effective.

CONCLUSION: This study demonstrates high awareness and willingness among perioperative professionals in Ethiopian public hospitals to adopt ERAS principles, while highlighting persistent system-level barriers to consistent implementation. Strengthening institutional support, expanding training, and promoting locally led context-sensitive ERAS pathways such as T-ERAS may facilitate sustainable scale-up in low-resource settings.

PMID:41866292 | DOI:10.1002/wjs.70319

Arab J Gastroenterol. 2026 Mar 21:S1687-1979(26)00003-1. doi: 10.1016/j.ajg.2026.01.003. Online ahead of print.

ABSTRACT

BACKGROUND AND STUDY AIM: Bowel preparation is a crucial step in ensuring the success of pediatric colonoscopy. This study aimed to investigate the effects of adding Senna alkaloid syrup to laxative agents for bowel preparation in children scheduled for colonoscopy.

PATIENTS AND METHODS: This double- blind controlled trial study compared two bowel preparation methods in children attending the gastrointestinal ward at Namazee Hospital, affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. The study was conducted in 2024. Eligible patients were randomized into two groups: one receiving conventional laxative agents and the other receiving conventional agents plus polyethylene glycol-3350 (PEG-3350) syrup. Efficacy was analyzed using the Aronchick Scale, alongside safety evaluations.

RESULTS: A total of 64 children completed the study: 32 patients (17 girls, 15 boys) in the Senna group and 32 patients (11 girls, 21 boys) in the control group. The mean age of participants was 11.03 ± 4.60 years (range: 1 to 18 years). There was a statistically significant difference in colon cleansing between the Senna group and the conventional group based on Aronchick Scale (p < 0.001). The Senna group had no children requiring repeat bowel preparation. No side effects were reported in either group.

CONCLUSION: These findings suggest that incorporating Senna into routine bowel preparation protocols may improve outcomes and could become standard practice for pediatric colonoscopy. (Clinical trial number: IRCT20250426065473N1).

PMID:41866261 | DOI:10.1016/j.ajg.2026.01.003

Z Med Phys. 2026 Mar 21:S0939-3889(26)00022-X. doi: 10.1016/j.zemedi.2026.03.009. Online ahead of print.

ABSTRACT

Myocardial Perfusion Imaging is widely used to evaluate left ventricular perfusion in patients with ischemic heart disease. Semi-quantitative scores, such as Total Perfusion Deficit (TPD), are frequently used for the assessment of extent and severity of disease. TPD scores are based on a frequentist analysis of tracer distribution in perfusion polar maps, which are 2D polar representations of radiopharmaceutical tracer uptake in the left ventricular cardiac wall. In this paper, we propose a novel quantification method for MPI examinations. Our method approaches the problem from an inverse perspective to TPD, allowing the assessment of the severity and extension of abnormal perfusion from the synergetic contribution of all the left ventricular tracer uptake in a polar map. We analytically demonstrate that TPD can be viewed as a specific instance of a broader approach. Furthermore, we explore how to establish the quantitative analysis in a general approach. To test our new method, we leveraged a standard deep learning architecture for the prediction of abnormal perfusion and used gradient-based class activation maps as a measure of the abnormal perfusion territory, which facilitated the quantification of both the severity and extent of the perfusion deficit. In the absence of ground-truth data such as survival rates or major adverse cardiovascular events (MACE) criteria, our results demonstrate both statistical and visual consistency with the conventional TPD.

PMID:41866260 | DOI:10.1016/j.zemedi.2026.03.009

Zhonghua Xin Xue Guan Bing Za Zhi. 2026 Mar 24;54(3):273-282. doi: 10.3760/cma.j.cn112148-20251130-00838.

ABSTRACT

Objective: To investigate the association between baseline cumulative atherogenic index of plasma and the risk of new-onset cardiovascular disease in middle-aged and young populations. Methods: A total of 35 212 populations under 60-years old with complete physical examination in 2006 and 2010 from the Kailuan Study were retrospectively enrolled. Complete atherogenic index of plasma data were extracted and populations were grouped by cumulative atherogenic index of plasma quartile: Q1 group (<-0.80, n=8 803), Q2 group (-0.80-<-0.19, n=8 803), Q3 group (-0.19-<0.49, n=8 803), Q4 group (≥0.49, n=8 803). The study subjects were followed up, with the endpoint defined as the occurrence of new-onset cardiovascular disease, defined as myocardial infarction and stroke. The follow-up period began after the physical examination in 2010 and ended at the date of the endpoint event or December 31, 2022, whichever came first. Cox proportional hazard regression model was used to analyze the impact of cumulative atherogenic index of plasma on the risk of new-onset cardiovascular disease and its subtypes, with trend tests conducted. Stratification was performed based on hypertension status, diabetes status, and low-density lipoprotein cholesterol (LDL-C) levels (<3.4 mmol/L or ≥3.4 mmol/L) to examine multiplicative interactions with the cumulative atherogenic index of plasma, and Cox proportional hazards regression analysis was subsequently conducted. Results: Among 35 212 participants, 26 636 (75.6%) were male, with an age of (45.4±8.3) years. Cardiovascular disease occurred in 2 075 cases (5.9%), of which 390 (1.1%) had myocardial infarction and 1 725 (4.9%) had stroke. During a follow-up of (11.5±2.0) years, the incidence densities of new-onset cardiovascular disease from Q1 to Q4 groups were 3.08, 4.70, 5.55 and 7.23 per 1 000 person-years, respectively. Cox proportional hazard regression model showed that, compared with the Q1 group, after adjusting for confounding factors, the HRs(95%CIs) of cardiovascular disease in Q2, Q3 and Q4 groups were 1.27 (1.10-1.48), 1.33 (1.14-1.56), 1.43 (1.19-1.72), respectively, the differences were statistically significant (all P<0.05). The risk of cardiovascular disease showed an increasing trend across the Q1 to Q4 groups (P_trend<0.001). In the endpoint-specific analyses for myocardial infarction and stroke, stroke demonstrated a similar trend (P_trend=0.002), while no statistically significant difference was observed for myocardial infarction (P_trend=0.465). Subgroup analysis showed that there were potential multiplicative interactions between different levels of LDL-C, the presence or absence of hypertension or diabetes, and the cumulative atherogenic index of plasma (all P for interaction<0.05). In a low-risk population with LDL-C<3.4 mmol/L, non-hypertensive, or non-diabetic, the cardiovascular disease risk in the Q4 group increased by 48%, 59%, and 49% compared to the Q1 group (all P<0.05), respectively. Conclusions: In the middle-aged and young populations, a high level of cumulative atherogenic index of plasma is associated with an increased risk of cardiovascular disease. This elevated risk is independent of the effects of traditional risk factors and remains significant even among low-risk populations.

PMID:41866207 | DOI:10.3760/cma.j.cn112148-20251130-00838

Zhonghua Fu Chan Ke Za Zhi. 2026 Mar 25;61(3):227-235. doi: 10.3760/cma.j.cn112141-20251126-00578.

ABSTRACT

Objective: To investigate the oncological outcomes of patients with malignant transformation of ovarian mature cystic teratoma (OMCT) and the reproductive outcomes of young patients undergoing fertility sparing surgery (FSS). Methods: Clinicopathological data of 39 patients with malignant transformation of OMCT enrolled at the First Affiliated Hospital of Zhengzhou University from August 2011 to December 2024 were retrospectively collected. Their oncological outcomes were analyzed. Univariate and multivariate Cox proportional hazards regression models were used to identify factors associated with disease free survival (DFS) and overall survival (OS). Reproductive outcomes were analyzed in patients under 45 years old who underwent FSS. Furthermore, the clinicopathological data and oncological outcomes of 8 concurrently enrolled patients of OMCT with carcinoid tumor were analyzed and compared. Results: (1) The mean age of patients with malignant transformation of OMCT was (52.7±14.0) years, and the mean maximum tumor diameter was (10.8±0.8) cm. Surgical treatment was performed in all patients, intraoperative tumor rupture occurred in 8 patients (21%, 8/39). The pathological types included squamous cell carcinoma in 29 cases (74%, 29/39), mucinous adenocarcinoma in 9 cases (23%, 9/39), and malignant melanoma in 1 case (3%, 1/39).27 patients (69%, 27/39) were classified as stage Ⅰ, 4 patients (10%, 4/39) as stage Ⅱ, and 8 patients (21%, 8/39) as stage Ⅲ. (2) The median follow-up duration for these patients was 86.0 months. During follow-up, recurrence was observed in 12 patients (31%, 12/39), all of whom died. In addition, one patient died of non-cancer causes. At the last follow-up, 13 patients (33%, 13/39) died; while the remaining patients were alive with no evidence of disease. The 5-year disease free survival (DFS) and overall survival (OS) rates were 67% and 65%, respectively. Cox regression analysis identified a maximum tumor diameter≥13 cm, stageⅡ-Ⅲ and intraoperative tumor rupture as independent risk factors for both DFS and OS (all P<0.05). (3) Among the 5 patients under 45 years old with malignant transformation of OMCT who underwent FSS, 4 were staged as Ⅰa and 1 as Ⅱ. Three of the patients with Ⅰa stage successfully conceived naturally and delivered at full term within 1-2 years after surgery. The patient with stage Ⅱ died due to disease progression, while the remaining 4 patients were alive with no evidence of disease.(4) The mean age of the 8 patients of OMCT with carcinoid tumor was (42.4±18.0) years, the mean maximum tumor diameter was (15.0±9.1) cm. No recurrence was observed during follow-up, and all patients were alive with no evidence of disease at the last follow-up date on May 30, 2025. Survival analysis indicated no statistically significant difference in OS between patients with malignant transformation of OMCT and those of OMCT with carcinoid tumors (P=0.102). Conclusions: The maximum tumor diameter≥13 cm, intraoperative tumor rupture and stage Ⅱ-Ⅲ are unfavorable prognostic factors for patients with malignant transformation of OMCT. FSS may be a viable option for young patients with stage Ⅰa malignant transformation of OMCT who wish to preserve their fertility, close postoperative follow-up is required.

PMID:41866202 | DOI:10.3760/cma.j.cn112141-20251126-00578

Zhonghua Fu Chan Ke Za Zhi. 2026 Mar 25;61(3):203-210. doi: 10.3760/cma.j.cn112141-20250822-00394.

ABSTRACT

Objective: To evaluate the cumulative live birth rate (CLBR) based on oocyte retrieval cycles in patients with diminished ovarian reserve (DOR) after repeat in vitro fertilization (IVF) and to explore the related influencing factors. Methods: Data from 3 740 DOR patients (8 386 IVF cycles) treated at Reproductive Medicine Center, Henan Provincial People’s Hospital from January 2017 to December 2022 (follow-up until December 31, 2023) were collected. Kaplan-Meier curves analysis was used to assess the trend of CLBR, and Cox proportional hazards regression model was applied to identify factors influencing CLBR. Results: Among 3 740 patients with DOR, 981 cases achieved at least one live birth, CLBR was 26.23% (981/3 740). CLBR increased with the number of oocyte retrieval cycles, reaching 35.49% in the 3rd cycle and 50.40% in the 7th cycle. However, the CLBR growth rate declined after the 3rd cycle, with 92.35% (906/981) of live births occurring in the first 3 cycles. Factors associated with reduced CLBR included advanced maternal age, higher basal follicle stimulating hormone level, and a history of recurrent miscarriage (all P<0.01). Conversely, higher anti-Müllerian hormone (AMH) and antral follicle count were positively correlated with CLBR (all P<0.001). Notably, patients with AMH<0.68 μg/L had a significantly reduced CLBR (P<0.001). Conclusions: Adhering to three IVF cycles significantly improves CLBR in DOR patients, with younger individuals benefiting particularly significantly. Factors such as age≥40 years, AMH<0.68 μg/L, and a history of recurrent miscarriage are associated with poorer CLBR. Beyond three cycles, the incremental gain in CLBR generally declines. It is recommended that younger patients persist with IVF treatment, while older patients should seek individualized counseling and consider alternative options.

PMID:41866199 | DOI:10.3760/cma.j.cn112141-20250822-00394

J Epidemiol. 2026 Mar 21. doi: 10.2188/jea.JE20250559. Online ahead of print.

ABSTRACT

BACKGROUND: Long-term trends in cancer incidence were reported until 2015 in Japan, but recent data have been limited since the launch of the National Cancer Registry (NCR) in 2016. We analyzed 30-year trends in cancer incidence and mortality, emphasizing the NCR’s establishment.

METHODS: Cancer incidence data were obtained from high-quality population-based cancer registries in three prefectures (Yamagata, Fukui, and Nagasaki) from 1985 to 2015, and the NCR extracted data from these prefectures between 2016 and 2021. National cancer mortality data from 1979 to 2023 were obtained from published vital statistics. Trends in age-standardized rates (ASR) calculated using the 1985 Japan Standard Population were examined using joinpoint regression analysis.

RESULTS: The ASR incidence in 2016 (the first year of the NCR) was the highest ever recorded. All-cancer incidence (for both sexes) increased between 1985 and 2021 (annual percentage change, 0.9%; 95% confidence interval [95% CI]: 0.8 to 1.0). For males, all-cancer incidence stabilized after increasing until 2017, whereas for females, it increased after 2002 (1.7%; 95% CI: 1.4 to 2.3). All-cancer mortality (for both sexes) declined between 1997 and 2023 (-1.5%; 95% CI: -1.5 to -1.4), mainly due to decreases in stomach, lung, and liver cancers.

CONCLUSIONS: The NCR’s launch and the sharp rise in incidence in 2016 may have influenced trend interpretation and should be considered with caution. A longer observation period is needed before clear secular trends can be established under the NCR data system.

PMID:41866192 | DOI:10.2188/jea.JE20250559