Nevin Manimala

Radiol Med. 2026 Jul 13. doi: 10.1007/s11547-026-02260-7. Online ahead of print.

ABSTRACT

PURPOSE: Clinical application of late iodine enhancement (LIE) for myocardial scar identification is limited by low contrast-to-noise ratio (CNR). Photon-counting detector-CT (PCD-CT) can improve image quality providing spectral information and low image noise. The aim of the study was to assess the impact of spectral analysis and reconstruction parameters on LIE image quality using PCD-CT.

MATERIAL AND METHODS: This single-center retrospective study included 74 patients undergoing PCD-CT between May 2024 and July 2025 for myocardial scar evaluation. Images from patients with visible LIE were reconstructed using four parameter combinations (Qr40 and Qr36 kernels; 0.4-mm and 2-mm slice thickness) and analyzed at monoenergetic levels (40-120 keV, 10 keV increment) using a dedicated workstation. CNR and signal-to-noise ratio (SNR) were calculated for each reconstruction.

RESULTS: Among 74 patients, 41 (55%) had myocardial scar (M:F 32:9; 62 years [IQR,56-71]) and 24/41 (59%) had an implantable cardioverter defibrillator (ICD). Scars were predominantly transmural (21/41, 51%). A 40-keV VMI achieved the highest CNR and SNR, regardless of reconstruction parameters (p < 0.05), with median CNR of 5.36 [IQR, 4.07-6.88] using 2-mm slice thickness and Qr36 kernel. Scar pattern, ICD, and BMI did not significantly affect either CNR or SNR (p > 0.05). In the exploratory subgroup of 16 patients undergoing LGE-MRI, CNR is not statistically different between LIE-CT at 40 keV with 2-mm slice thickness from LGE-MRI (5.36 [IQR,4.07-6.88] vs. 8.04 [IQR,6.67-9.89]; p = 0.178).

CONCLUSION: PCD-CT LIE demonstrated the highest CNR at 40-keV VMI with 2-mm slice thickness, regardless of scar pattern, BMI, or ICD presence.

PMID:42440227 | DOI:10.1007/s11547-026-02260-7

Bull Math Biol. 2026 Jul 13;88(8):135. doi: 10.1007/s11538-026-01702-7.

ABSTRACT

This paper provides a rigorous mathematical resolution of the open global stability problem for a “shock-and-kill” model of HIV-1/SIV infection in brain reservoirs recently formulated by Roda et al. (2021). The model explicitly incorporates the effects of latency-reversing agents and enhanced immune clearance of reactivated cells. We derive an explicit formula for the basic reproduction number $R_0$ , which serves as the sole threshold parameter governing viral eradication versus persistence and integrates infection pathways from both productive and latent compartments. By combining the next-generation matrix approach with an extended graph-theoretic Lyapunov method for multigraphs with parallel arcs, we rigorously establish that the disease-free equilibrium is globally asymptotically stable when $R_0\le 1$ , whereas a unique productive equilibrium exists and is globally asymptotically stable when $R_0>1$ . To resolve the sign-indefinite quadratic perturbations induced by structurally distinct parallel transmission arcs-a fundamental bottleneck of classical graph-theoretic Lyapunov schemes-we develop a refined composite Lyapunov framework equipped with hierarchically calibrated parameters. Systematic asymptotic scaling and multi-parameter tuning eliminate indefinite cyclic quadratic interactions, securing strict negative definiteness of the Lyapunov derivative and overcoming key limitations of conventional graph-based methods. These global stability results provide a definitive mathematical answer to whether therapeutic interventions guarantee viral eradication or lead to persistent brain-reservoir infection. Furthermore, they furnish a rigorous theoretical foundation for the “shock-and-kill” strategy and establish mathematically precise conditions to guide the design of safe, effective interventions for eliminating HIV-1/SIV from CNS reservoirs.

PMID:42440225 | DOI:10.1007/s11538-026-01702-7

Eur J Clin Microbiol Infect Dis. 2026 Jul 13. doi: 10.1007/s10096-026-05593-3. Online ahead of print.

ABSTRACT

BACKGROUND: Cellulitis is a common cause of hospital admission, yet the clinical relevance and predictors of bacteremia remain incompletely characterized. Identifying patients at risk of bloodstream infection may help optimize diagnostic strategies and clinical management.

METHODS: We conducted a retrospective observational study at a tertiary-care hospital including all consecutive patients hospitalized with cellulitis between January 2019 and December 2024. Patients without blood cultures were excluded. Clinical severity was stratified using the CREST classification. Microbiological data, antibiotic therapy, hospital outcomes, and follow-up at 1 and 3 months were analyzed.

RESULTS: Among 311 episodes included, bacteremia was confirmed in 46 cases (14.8%). Patients with bacteremia showed significantly higher clinical severity at admission, with CREST grades III-IV present in 56.5% compared with 36.6% in non-bacteremia patients (p < 0.001). Sepsis occurred in 65.2% of bacteremia cases versus 24.5% of non-bacteremia cases (p < 0.001). Bacteremia was associated with longer hospital stay (18 ± 18.3 vs 13 ± 9.7 days; p = 0.003) and more frequent antibiotic modifications during admission (p = 0.023). Streptococcal species and Staphylococcus aureus showed a higher propensity for bloodstream invasion. In-hospital mortality was higher among bacteremia patients (13.0% vs 7.9%), although the difference was not statistically significant. Three-month mortality reached 14.3% in the bacteremia group compared with 9.9% in non-bacteremia patients.

CONCLUSION: Bacteremia complicating cellulitis is uncommon but associated with greater clinical severity, longer hospitalization, and increased therapeutic complexity. Severity stratification tools such as CREST may assist in identifying patients at increased risk of bacteremia; however, given their limited discriminatory performance, they should not be used in isolation to guide blood culture collection or other clinical decisions.

PMID:42440220 | DOI:10.1007/s10096-026-05593-3

Discov Ment Health. 2026 Jul 13. doi: 10.1007/s44192-026-00536-y. Online ahead of print.

ABSTRACT

BACKGROUND: Mental health disorders including depression, anxiety, and substance use disorders affect an estimated 150 million people across Africa, yet services remain grossly under-resourced and largely inaccessible. In many settings, including Nigeria, limited awareness, stigmatizing attitudes, and suboptimal mental health practices further compound the burden. This study assessed knowledge, attitudes, and practices (KAP) toward mental health among adults in northwest Nigeria.

METHODS: We conducted a community-based cross-sectional study in Jigawa State, northwest Nigeria, guided by the classical Knowledge-Attitude-Practice (KAP) framework. A total of 398 adults were recruited using a multistage sampling technique. Data were collected through a combination of online surveys and interviewer-administered questionnaires. Statistical analyses were performed using IBM SPSS version 22.0, with significance set at p ≤ 0.05.

RESULTS: Participants had a mean age of 34.5 ± 8.2 years (range: 18-65), with 83.9% aged 25-45 years. Although 70.9% demonstrated adequate mental health knowledge, attitudes and practices were considerably poorer. Less than half expressed willingness to interact comfortably with individuals living with mental illness (43.2%), believed they could lead productive lives (44.2%), or had ever sought professional help for mental or emotional concerns (43.7%). Only 34.7% rejected the notion that individuals with mental illness are inherently dangerous, and just 20.4% would permit their children to interact with someone experiencing mental illness. Overall, 48.5% exhibited positive attitudes, and 46.7% reported satisfactory practices. Female sex independently predicted both knowledge and attitudes. Females were twice as likely as males to have adequate knowledge (aOR = 2.0; 95% CI: 1.1-3.6) and nearly twice as likely to demonstrate positive attitudes (aOR = 1.9; 95% CI: 1.1-3.5). Prior hospitalization and known family history of mental illness were significantly associated with more favorable attitudes. Residence in the southwest senatorial zone independently predicted satisfactory practices (aOR = 0.4; 95% CI: 0.2-0.9), while absence of prior mental illness was associated with lower odds of appropriate practices (aOR = 0.4; 95% CI: 0.2-0.9). Knowledge scores demonstrated moderate positive correlations with both attitudes (r = 0.4, p < 0.001) and practices (r = 0.4, p < 0.001).

CONCLUSION: Despite relatively adequate levels of knowledge, attitudes and practices toward mental health remain suboptimal among adults in northwest Nigeria. Consistent with the classical KAP framework, knowledge was positively associated with both attitudes and practices. Strengthening community-level mental health literacy, reducing stigma, and expanding accessible services are urgently needed to translate knowledge gains into improved behavioral outcomes.

PMID:42440215 | DOI:10.1007/s44192-026-00536-y

Drugs Real World Outcomes. 2026 Jul 13. doi: 10.1007/s40801-026-00568-4. Online ahead of print.

ABSTRACT

BACKGROUND: Rare cases of myocarditis and pericarditis following mRNA coronavirus disease-19 (COVID-19) vaccination have been reported, primarily among males under 30 years of age. Although the underlying mechanisms remain unclear, cardiovascular risk factors such as hypertension, diabetes, dyslipidemia, and obesity have been hypothesized as potential contributors. Using the Vaccine Adverse Event Reporting System (VAERS), this study investigated whether these comorbidities were disproportionately reported among young adult males with myocarditis or pericarditis following mRNA COVID-19 vaccination compared with vaccinated and general populations. Additionally, this study represents a novel application of disproportionality principles in spontaneous reporting databases to explore, beyond signal detection, the factors that might be associated with the occurrence of an adverse event.

METHODS: An observed-versus-expected analysis was conducted using reports of myocarditis or pericarditis following mRNA COVID-19 vaccination among males aged 18-30 recorded in VAERS between 2021 and 2022. The prevalence of hypertension, diabetes, dyslipidemia, and obesity among reported cases was compared with prevalence estimates derived from epidemiological studies of vaccinated populations and national population statistics. In addition, disproportionality analyses were performed using comparator groups consisting of reports associated with other vaccines and other adverse events following immunization (AEFIs) within VAERS.

RESULTS: A total of 859 eligible reports of myocarditis/pericarditis following mRNA COVID-19 vaccination were identified among males aged 18-30. The prevalence of hypertension, diabetes, dyslipidemia, and obesity was 0.35%, 0.58%, 0.81%, and 1.75%, respectively and was significantly lower than those reported in vaccinated and prepandemic general populations. In disproportionality analyses, myocarditis/pericarditis reports following mRNA vaccination showed higher prevalence of dyslipidemia and obesity, but lower prevalence of hypertension, compared with selected VAERS comparator groups. However, absolute comorbidity prevalence remained low across all groups.

CONCLUSIONS: No evidence of a modifying role for hypertension, diabetes, dyslipidemia, or obesity was observed for the increased reporting of myocarditis/pericarditis among young adult males following mRNA COVID-19 vaccination. Despite the limitations inherent to spontaneous reporting systems, this study highlights a novel application of disproportionality-based approaches within VAERS to explore potential risk modifiers of vaccine-related adverse events in a hypothesis-generating manner.

PMID:42440199 | DOI:10.1007/s40801-026-00568-4

Biometrics. 2026 Jul 1;82(3):ujag126. doi: 10.1093/biomtc/ujag126.

ABSTRACT

Emerging technologies enable continuous monitoring of temporal exposures to disease risk factors, leading to complex exposure processes characterized by subject-specific numbers and durations of exposure episodes. A key scientific question is how the number and duration of such episodes influence disease risk. Existing methods typically rely on scalar summaries or time-indexed representations and are not naturally suited to model duration-dependent risk accumulation at the episode level. We introduce the FLexible Accumulation ModEl (FLAME), a semiparametric model for risk accumulation at the level of individual exposure episodes, with duration as the primary driver of risk. FLAME is motivated by and applied to quantifying the association between the duration of intraoperative hypotension and acute kidney injury (AKI) following cardiac surgery. The estimated risk accumulation function reveals that, although 60 one-minute hypotensive episodes are associated with an AKI probability of 0.24, a single sustained 60-minute episode increases that probability to 0.33, representing a 38% increase despite identical total duration. These findings provide actionable insights for intraoperative hemodynamic management and demonstrate the importance of accounting for episodic exposure patterns. While motivated by cardiac surgery, FLAME is broadly applicable to other settings involving high-resolution temporal exposures. An R package, flameRisk, is provided to facilitate the application of the method in practice.

PMID:42439082 | DOI:10.1093/biomtc/ujag126

Biometrics. 2026 Jul 1;82(3):ujag125. doi: 10.1093/biomtc/ujag125.

ABSTRACT

Dynamic systems involving a population of subjects often feature significant variability among the individual trajectories. Mixed-effects ordinary differential equations (ODEs) provide a natural modeling framework for such systems, where subjects share the same functional form for the ODEs but have subject-specific parameters. However, inference for nonlinear mixed-effects ODE models remains challenging, particularly in settings where the system is only partially observed or the trajectories are highly sensitive to the model parameters. In pharmacokinetic modeling, for example, the observed data also tend to be sparse and noisy. To address these challenges, we propose an extension of manifold-constrained Gaussian processes for inference of general mixed-effects ODE models within a Bayesian statistical framework. We evaluate our method on simulated examples, demonstrating its ability to provide fast and accurate inference for parameters and trajectories using nested optimization. To illustrate the practical efficacy of the proposed method, we provide a real data analysis of a pharmacokinetic model used for an HIV combination therapy study.

PMID:42439081 | DOI:10.1093/biomtc/ujag125

J Pediatr Gastroenterol Nutr. 2026 Jul 13. doi: 10.1002/jpn3.70497. Online ahead of print.

ABSTRACT

OBJECTIVES: To describe national patterns of management, outcomes, and prognostic factors in infants with biliary atresia (BA) in Italy.

METHODS: This retrospective study used data from the Italian BA Registry from January 2012 to December 2021. Overall, 309 infants with BA were identified. Clearance of jaundice (CoJ) was defined as total bilirubin <1.2 mg/dL within 6 months. Univariate and multivariate analyses were used to identify prognostic factors for native liver and patient survival.

RESULTS: Kasai portoenterostomy (KPE) was performed in 272 infants (88%) at a median age of 68.5 days (interquartile range 52-83). The CoJ rate after KPE was 39%. Multivariate analysis confirmed that CoJ was significantly associated with younger age and lower total bilirubin at referral (p = 0.0446 and p = 0.0144, respectively), younger age at KPE (p = 0.0345), and postoperative corticosteroid use (p = 0.0036). Multiple logistic regression confirmed the major effect of steroid use: the odds ratio for steroid use was 2.51 (95% confidence interval 1.38-4.58; p = 0.0027), whereas the odds ratio for age at KPE was 0.987 (95% CI: 0.975-0.999; p = 0.0371). Liver transplantation was performed in 212/309 patients, and overall 5-year actuarial patient survival was 97.4%.

CONCLUSIONS: This retrospective analysis confirms that age at KPE and postoperative corticosteroid use are key favorable factors for successful CoJ, with steroid use showing the strongest association. The excellent overall patient survival highlights the critical role of management in expert centers, even within a decentralized model.

PMID:42439064 | DOI:10.1002/jpn3.70497

Ann Clin Transl Neurol. 2026 Jul 13. doi: 10.1002/acn3.70479. Online ahead of print.

ABSTRACT

BACKGROUND: Recent randomized trials (CREST-2, SPACE-2, and ECST-2) have compared carotid revascularization (carotid endarterectomy [CEA] or carotid artery stenting [CAS]) plus contemporary medical therapy (CMT) versus CMT alone in asymptomatic carotid stenosis. ECST-2 included both asymptomatic and low-risk symptomatic patients, introducing clinical heterogeneity. Individual trials reported low event rates and limited statistical power.

OBJECTIVE: To evaluate whether carotid revascularization reduces long-term ipsilateral stroke (> 30 days) compared with CMT alone and to assess periprocedural complications.

METHODS: Phase 3/4 randomized controlled trials published after 2020 were included. The primary outcome was long-term ipsilateral stroke excluding periprocedural events. Periprocedural complications (30-day stroke, myocardial infarction, or death) were analyzed separately. Random-effects models were used. Subgroup analyses by modality (CEA vs. CAS) included CREST-2 and SPACE-2. Sensitivity analyses excluding ECST-2 and using split-control methodology for SPACE-2 were performed.

RESULTS: Three trials (5 arms; 3438 patients) were included. Median follow-up was 4.0 years in CREST-2, 5.0 years in SPACE-2, and 2.0 years in ECST-2. In the primary pooled analysis including ECST-2, revascularization showed a nonsignificant reduction in long-term ipsilateral stroke (RR 0.51; 95% CI 0.21-1.29; p = 0.16; I² = 70%) and a borderline increase in periprocedural complications (RR 2.78; p = 0.06). Sensitivity analyses excluding ECST-2 suggested reduced long-term ipsilateral stroke with revascularization (RR 0.35; 95% CI 0.21-0.58; p < 0.0001; I² = 0%; ARR 2.74%; NNT = 37) but increased periprocedural complications (RR 4.54; p = 0.004; I² = 0%; ARI 1.45%; NNH = 69). Subgroup analyses suggested a possible benefit with CAS, whereas CEA showed a nonsignificant trend; however, subgroup analyses were underpowered. Split-control sensitivity analyses for SPACE-2 yielded directionally similar findings with wider confidence intervals.

CONCLUSION: The primary pooled analysis was inconclusive and demonstrated substantial heterogeneity. Sensitivity analyses restricted to purely asymptomatic populations suggested that carotid revascularization may reduce long-term ipsilateral stroke but increase periprocedural complications. Contemporary medical therapy remains the foundation of management for asymptomatic carotid stenosis, while revascularization should be reserved for carefully selected patients after individualized risk assessment and shared decision-making.

PMID:42439053 | DOI:10.1002/acn3.70479

Laryngoscope. 2026 Jul 13. doi: 10.1002/lary.70728. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether compensatory inferior turbinate (CIT) intervention performed during septorhinoplasty (SRP) independently improves postoperative nasal airway function and patient-reported symptoms.

METHODS: Eighty-four patients with nasal obstruction, septal deviation, external nasal deformity, and Grades 2-3 compensatory inferior turbinate hypertrophy were prospectively enrolled. Patients were randomized into two groups: SRP combined with CIT radiofrequency ablation and turbinate lateralization (SRP + IT, n = 42) or SRP alone (SRP, n = 38). Subjective nasal obstruction was evaluated using the Nasal Obstruction Symptom Evaluation (NOSE) scale, while objective nasal airflow was assessed with Peak Nasal Inspiratory Flow (PNIF). Assessments were performed preoperatively and at 6 months postoperatively. Multivariate regression analysis excluding baseline outcome scores was conducted to identify predictors of postoperative improvement.

RESULTS: Both groups demonstrated significant improvement in NOSE scores at 6 months compared with preoperative values (p = 0.001). PNIF values increased postoperatively in both groups. However, no significant differences were observed between the groups in postoperative NOSE score reduction or PNIF gain on the deviated side, turbinate side, or bilateral measurements. When baseline outcome scores were excluded from regression models to avoid floor effect bias, preoperative bilateral PNIF and sex were individually associated with postoperative NOSE improvement, and preoperative NOSE score with PNIF gain; however, neither overall model reached statistical significance (R² = 0.117 and R² = 0.066, respectively). CIT treatment was not an independent predictor of postoperative functional improvement in either model.

CONCLUSION: Concomitant CIT radiofrequency ablation and turbinate lateralization during SRP does not independently improve postoperative nasal airway function or symptom outcomes. Multivariate analysis excluding baseline outcome scores confirmed that CIT treatment was not an independent predictor of functional recovery. Although preoperative bilateral PNIF and sex showed limited associations with postoperative NOSE improvement, and preoperative NOSE score with PNIF gain, overall model fit was limited in both analyses, suggesting that functional recovery after SRP is multifactorial and not driven by any single clinical variable.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT07481045. The study was retrospectively registered because trial registration was not required by the institutional ethics committee at the time of study initiation.

PMID:42439048 | DOI:10.1002/lary.70728