Nevin Manimala

J Ethnopharmacol. 2026 Apr 2:121622. doi: 10.1016/j.jep.2026.121622. Online ahead of print.

ABSTRACT

ETHNOPHARMACOLOGICAL RELEVANCE: Polygonum multiflorum (P. multiflorum) is the dried root tuber of P. multiflorum Thunb., a perennial herbaceous plant belonging to the Polygonaceae family. Traditionally, it is believed to possess effects such as nourishing blood, replenishing yin, and moistening the intestines to relieve constipation. Research indicates that the processing procedure significantly alters the chemical composition, pharmacological activity, and hepatotoxicity of substances; however, the underlying mechanisms responsible for attenuating toxicity and enhancing efficacy remain to be clarified. Traditional experience suggests that with an increase in the number of processing cycles (e.g., nine-time processing), their properties shift from purgative to tonic, yet a systematic comparison of the specific differences among samples subjected to varying processing cycles is still lacking.

AIM OF THE STUDY: Based on the central hypothesis that processing alters the chemical composition profile of P. multiflorum and thereby synergistically regulates its toxicity and efficacy, this study established the fingerprint profiles of samples subjected to different processing cycles (0, 3, 6, and 9 times). It systematically compared the hepatotoxicity and efficacy differences between the raw product and its processed products, and focused on identifying the key bioactive components and potential mechanisms responsible for the distinct toxicity and efficacy between the raw product and the nine-steamed-nine-dried product (9x-P. multiflorum) using spectrum-effect relationship analysis.

MATERIALS AND METHODS: High-performance liquid chromatography (HPLC) was first employed to establish the chemical fingerprints of the raw P. multiflorum and its processed products after 3, 6, and 9 cycles of steaming with black bean juice (three-steamed-three-dried product, 3x-P. multiflorum; six-steamed-six-dried product, 6x-P. multiflorum; 9x-P. multiflorum), to characterize the dynamic changes in chemical constituents during processing. Zebrafish models of liver injury, intestinal peristalsis, anemia, and immunosuppression were used to systematically compare the hepatotoxicity and efficacy of samples with different processing cycles, with a focus on the toxicity-efficacy shift between raw P. multiflorum (0 cycles) and 9x-P. multiflorum. Hematoxylin and eosin (H&E) staining was performed to observe histopathological changes and evaluate liver injury. Each group contained 10 zebrafish larvae, and data were statistically analyzed using one-way analysis of variance (ANOVA) followed by Tukey’s post hoc test. Furthermore, a spectrum-effect relationship model was constructed using grey relational analysis (GRA) combined with the entropy weight method (EWM), to correlate common chemical constituents with hepatotoxicity and efficacy indicators. Finally, network pharmacology and molecular docking were integrated to systematically predict and verify the targets and molecular mechanisms of the screened potential active components, especially those that differed significantly between raw P. multiflorum and 9x-P. multiflorum.

RESULTS: Compared with the control group, raw P. multiflorum significantly decreased the liver area-to-lateral body area ratio (LA/BA) by 29% and increased hepatocyte apoptosis by 72.5%, indicating marked hepatotoxicity. H&E staining revealed hepatocyte swelling, vacuolar degeneration, and focal necrosis. In contrast, 9x-P. multiflorum caused no significant increase in apoptosis and increased the LA/BA by 15.5%. Raw P. multiflorum exerted a strong pro-peristaltic effect, reducing the mean gastrointestinal fluorescence intensity (GI FI) by 31.2%, whereas 9x-P. multiflorum decreased it by only 5.7%. For tonic effects, 9x-P. multiflorum increased red blood cell staining intensity by 203% and macrophage count by 82.5%, which was significantly superior to raw P. multiflorum. Spectrum-effect analysis showed that Peak 5 (emodin-8-O-glucoside, EmG), Peak 7 (emodin, Emo), Peak 6 (physcion-8-O-β-D-glucoside, PhG), and Peak 8 (physcion, Phys) were closely correlated with hepatotoxicity and purgative activity. Peak 4 (2,3,5,4′-tetrahydroxystilbene-2-O-β-D-glucoside, TSG) and Peak 7 (Emo) exhibited stronger correlations with tonic effects. Activity validation confirmed that Emo, Phys, and their glucosides showed varying degrees of hepatotoxicity; Emo and Phys displayed significant purgative effects; while TSG and Emo exerted obvious blood-tonifying activity, verifying the reliability of the spectrum-effect analysis. Network pharmacology identified 28 common targets associated with P. multiflorum-induced liver injury, and protein-protein interaction (PPI) network analysis recognized Estrogen Receptor 1 (ESR1) as a hub target. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment revealed significant enrichment in the PI3K-Akt, mitogen-activated protein kinase (MAPK), and estrogen signaling pathways. Molecular docking confirmed that EmG binds strongly to core targets including ESR1 and epidermal growth factor receptor (EGFR) (binding energy < -7.0 kcal/mol).

CONCLUSIONS: This study verified the central hypothesis: raw P. multiflorum exhibits prominent hepatotoxicity and purgative effects, whereas processing with black bean juice achieves detoxification and enhances blood-tonifying and immune-enhancing efficacy. Emo, Phys, and their glycosides are the main material basis for hepatotoxicity and purgation, while TSG and Emo mediate the tonic effects. Network pharmacology and molecular docking further revealed that conjugated anthraquinones may synergistically disrupt liver-protective pathways via multiple targets such as ESR1 and EGFR. Processing reduces conjugated anthraquinone content and rewires the regulatory targets from a toxicity network toward a tonic network. These findings provide modern scientific evidence for the traditional Chinese medicine (TCM) theory that “raw P. multiflorum purges while processed P. multiflorum tonifies”, and demonstrate the value of integrating spectrum-effect-toxicity correlation with network pharmacology in the mechanistic study of Chinese herbal medicine processing.

PMID:41935648 | DOI:10.1016/j.jep.2026.121622

Int J Infect Dis. 2026 Apr 2:108672. doi: 10.1016/j.ijid.2026.108672. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare secondary SARS-CoV-2 transmission detected through RT-PCR screening in childcare and school-aged settings during the Omicron wave.

METHODS: We analyzed Okinawa School PCR Project events from January 1 to March 11, 2022, in which secondary cases were ascertained through school-based RT-PCR screening conducted after the last exposure. Index cases were classified as child/student or teacher/staff. Secondary cases were defined as RT-PCR-confirmed infections detected through school-based screening. We estimated the proportion of events with ≥1 secondary case and the mean number of secondary cases per event (R_event).

RESULTS: Among 897 events with known index case role, 73.1% detected no secondary cases. In nurseries/kindergartens, secondary cases were detected in 32.3% of teacher/staff-index events (R_event 0.62; 95% CI 0.53-0.72), compared with 12.8% in elementary and secondary schools (R_event 0.15; 95% CI 0.06-0.33). No secondary infections were detected after teacher/staff-index events in junior high (n=11) or high schools (n=6).

CONCLUSIONS: Childcare worker-index events in nurseries and kindergartens generated secondary cases in ≈30% of events, whereas teacher/staff-index events in elementary and secondary schools infrequently generated secondary cases under mitigation measures. Prioritizing screening and prevention resources toward childcare workers may improve efficiency when diagnostic capacity is constrained.

PMID:41935615 | DOI:10.1016/j.ijid.2026.108672

Hip Int. 2026 Apr 4:11207000261426459. doi: 10.1177/11207000261426459. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine factors associated with lag screw slide following fixation of intertrochanteric hip fractures with 1 type of cephalomedullary nail.

METHODS: Retrospective review of patients operatively treated for intertrochanteric hip fractures (OTA/AO 31A1 and 31A2) with a single cephalomedullary nail (CMN) at a single academic medical centre between November 2014 and November 2023. CMN lag screw was placed in “dynamic” mode to allow for controlled collapse, or screw “slide.” Screw slide was defined as the difference in lateral prominence of the lag screw at latest follow up compared to its initial position. Patients were grouped based on the amount of screw slide (<5 mm, 5-15 mm, >15 mm) and correlation analysis was performed.

RESULTS: 614 intertrochanteric hip fracture patients were identified (mean age 80.76 years; 72.3% female) with mean 6.2 months follow-up. Mean amount of slide was 3.77 ± 4.79 mm. 66.3% of patients had <5 mm of slide, while 31.3% had 5-15 mm and 2.4% had >15 mm. Univariate analysis demonstrated that slide >15 mm was associated with increased patient BMI (p = <0.001), use of some anti-osteoporotic medications (p = 0.021) and more than 5 mm of immediate postoperative prominence (p = 0.016). Although not statistically significant, patients with >15 mm of slide were only taking vitamin D and calcium whereas those with <15 mm slide more often took bisphosphonates, denosumab and teriparatide (p = 0.163). Multivariate regression demonstrated that only BMI (OR 1.14, 95% CI, 1.04-1.24; p = 0.002) was associated with >15 mm screw slide.

CONCLUSIONS: Excessive lag screw slide (>15 mm) was associated with higher patient BMI. Patients with higher BMIs should be monitored to identify excessive slide. Surgeons should attempt to keep the lag screw as close to the lateral cortex as possible. While the use of anti-osteoporotic therapy was associated with more slide, this was almost exclusively seen in patients only prescribed vitamin D and calcium.

PMID:41934208 | DOI:10.1177/11207000261426459

Womens Health (Lond). 2026 Jan-Dec;22:17455057261437261. doi: 10.1177/17455057261437261. Epub 2026 Apr 4.

ABSTRACT

BACKGROUND: Pregnancy and substance use disorders (SUD) for incarcerated individuals often overlap, but their management varies greatly between jails. A better understanding of pregnancy management across jails is needed to better guide policy and practice recommendations.

OBJECTIVES: To examine the current state of pregnancy management across North Carolina jails, including current practices, challenges, and gaps in pregnancy management in jails.

DESIGN: This is a qualitative analysis within a mixed-methods study assessing the scope of perinatal incarceration and the capacity of North Carolina jails to manage perinatal SUD.

METHODS: We conducted in-depth interviews with North Carolina jail staff using a semi-structured interview guide between October 2022 and September 2023. We used the ideal-type analysis approach to systematically compare pregnancy management and SUD management practices across facilities.

RESULTS: We completed 26 interviews with jail staff. Pregnancy management approaches were unevenly distributed across three ideal types: (1) exclusive use of internal prenatal care resources (n = 2), (2) exclusive use of external prenatal care resources (n = 16), and (3) hybrid use of both internal and external prenatal care resources (n = 8). Within ideal types, SUD management was highly variable.

CONCLUSION: The heavy reliance on external resources for prenatal and SUD care highlights the chronic underfunding and staffing challenges faced by these facilities. There is an urgent need for standardized policies governing prenatal care in jail facilities to help reduce disparities in care quality and ensure that all pregnant individuals receive adequate support, regardless of the jail’s resources. Alternatives to incarceration during pregnancy should be prioritized.

PMID:41934195 | DOI:10.1177/17455057261437261

Gynecol Endocrinol. 2026 Dec 31;42(1):2650027. doi: 10.1080/09513590.2026.2650027. Epub 2026 Apr 4.

ABSTRACT

OBJECTIVES: This retrospective study compares pregnancy outcomes in polycystic ovary syndrome (PCOS) patients across different controlled ovarian stimulation (COS) protocols-specifically GnRH antagonist and GnRH agonist cycles-combined with various frozen embryo transfer(FET) preparation methods, such as hormone replacement therapy (HRT) and ovulatory cycles. Despite the known variations in COS and FET protocols, the optimal combination for improving pregnancy outcomes in this population remains unclear.

METHODS: We analyzed the first FET cycles of 2510 patients with PCOS at our center between January 2017 and September 2024. Baseline characteristics and pregnancy outcomes were compared using the Kruskal‒Wallis test, the chi-square (χ²) statistic, the Bonferroni correction for multiple comparisons, and inverse probability of treatment weighting (IPTW) adjustment.

RESULTS: After IPTW adjustment, no significant differences were observed in live birth rates or other key reproductive outcomes among the four protocol combinations (all P > 0.05). Exploratory analyses revealed nonsignificant trends, suggesting two patterns: 1) GnRH agonist (vs. antagonist) COS protocols were associated with lower point estimates for the risks of preterm PROM and HDP; 2) ovulation (vs. HRT) cycles for FET preparation were similarly associated with lower point estimates for these risks.

CONCLUSIONS: For PCOS patients, live birth success is equivalent regardless of COS/FET protocol combination, supporting flexible treatment personalization. Clinical decision-making involves a critical trade-off: GnRH agonist protocols and ovulation FET cycles may be associated with a trend toward lower obstetric morbidity, potentially linked to the promotion of a more physiological ovulatory milieu. This balance between immediate iatrogenic risk and long-term pregnancy health warrants further study.

PMID:41934169 | DOI:10.1080/09513590.2026.2650027

J Oncol Pharm Pract. 2026 Apr 4:10781552261437734. doi: 10.1177/10781552261437734. Online ahead of print.

ABSTRACT

BackgroundPediatric patients undergoing chemotherapy often need to take multiple medications. Consequently, they may experience drug-related problems (DRPs), including adverse drug reactions, drug interactions, and various medication errors.MethodsA prospective observational study was conducted over three months in the Pediatric Haemato-oncology department of a cancer specialty hospital of Nepal following ethical approval. DRPs were identified from patient medical records and the literature and, recorded according to the Pharmaceutical Care Network Europe V9.1 tool. Data were collected and analyzed using IBM SPSS Statistics V20 and Microsoft Excel 2013 to present the findings.ResultsAmong the 30 enrolled patients, 211 DRPs were identified in 28 patients (93.3%), averaging 7.5 DRPs per patient, all validated through case-by-case review. Treatment safety was the predominant DRP type (n = 131; 62.09%), followed by treatment ineffectiveness (n = 79; 37.44%). Drug selection (n = 116; 51.76%) and dispensing issues (n = 51; 22.77%) were the leading causes, with anti-infective drugs (n = 41; 35%) and antineoplastic agents (n = 24; 20.5%) most frequently implicated.ConclusionDRPs were prevalent among pediatric patients with cancer, with treatment safety being the most significant issue and drug selection being the primary cause. Anti-infective drugs were most frequently involved in DRPs, followed by antineoplastic and immunomodulating agents.

PMID:41934159 | DOI:10.1177/10781552261437734

J Trop Pediatr. 2026 Feb 9;72(2):fmag022. doi: 10.1093/tropej/fmag022.

ABSTRACT

Factors associated with severe dehydration from cholera among children in the community is still not fully understood. We analyzed the characteristics of the pediatric cases who were hospitalized in the community cholera treatment centers in the capital Lusaka between October 2023 and May 2024. Presence of underlying conditions (e.g. human immunodeficiency virus (HIV) infection, severe acute malnutrition), specific catchment areas (e.g. low-income residential areas), and an early phase of the outbreak was associated with increased numbers of severe cases in the community by multivariate analysis. Our study highlighted the importance of mobilization of resources and efforts aimed at enhancing surveillance, risk communication, and case management in the early phase of the outbreak for children living in high-risk areas and those with underlying conditions, in order to reduce severe cases of cholera among children in the community.

PMID:41934155 | DOI:10.1093/tropej/fmag022

J Intensive Care Med. 2026 Apr 4:8850666261424210. doi: 10.1177/08850666261424210. Online ahead of print.

ABSTRACT

PurposeSerratia marcescens is a well-recognized hospital-acquired pathogen frequently implicated in outbreaks in neonatal and pediatric intensive care units. We compared clinical characteristics of infants with Serratia bloodstream infections (BSI) to those with non-Serratia gram-negative BSI.MethodsA retrospective case-control study comparing infants (0-2 y/o) hospitalized at our referral pediatric cardiac intensive care unit (PCICU), who acquired gram-negative blood cultures, during 2012-2022. Patients were categorized into two groups: S. marcescens BSI versus non-Serratia gram-negative BSI. Demographic and clinical data were extracted from our medical databases.ResultsOf 112 patients meeting inclusion criteria, 40 (36%) had Serratia BSI and 72 (64%) non-Serratia gram-negative BSI. Blood stream infection with Serratia occurred later postoperatively (median 15 vs 7 days, p < .01), were associated with less pre-infection inotropic support (median VIS 0 vs 5, p < .01) and higher rates of multisite involvement (35% vs 18%, p = .04). Duration of indwelling vascular catheters at time of infection was longer in the Serratia group (median 10 vs 7 days, p = .03). No associated mortality was attributed to Serratia BSI, as compared to a 5.6% mortality rate in the non-Serratia group.ConclusionsSerratia BSI in the PCICU tends to develop later during hospitalization, involves more multiple infection sites, and is associated with longer vascular catheters dwell durations at the time of infection. Serratia infections appeared sporadically throughout the year without seasonal clustering. This supports the importance of stringent infection control practices and warrants prospective studies on prevention strategies.

PMID:41934153 | DOI:10.1177/08850666261424210

Breast J. 2026;2026(1):e8459253. doi: 10.1155/tbj/8459253.

ABSTRACT

BACKGROUND: Breast conservation surgery (BCS) is considered to be a low-morbidity procedure; however, postoperative complications may adversely affect the quality of life of breast cancer survivors. Social determinants of health have previously been shown to impact postoperative outcomes in various other medical conditions. However, there is a paucity of literature that comprehensively examines the social determinants that impact BCS complications or how race influences specific surgical outcomes. This study thus seeks to address this gap by analyzing the impact of these factors within our diverse patient population in the Bronx.

METHODS: A retrospective chart review was conducted that examined patients who underwent BCS between January 2016 and December 2022 at a single institution. Patient information, such as comorbidities, Distressed Communities Index (DCI), BMI, race, insurance status, age, pathology, surgery details, adjuvant therapy, and complications, was collected. Univariate and multivariate analyses were utilized to determine the relationship between these variables and postoperative complications.

RESULTS: A total of 627 patients were included in the study. Of these patients, 512 (81.5%) were either Hispanic or African American, 46 patients (7.3%) were White, and 69 (11%) belonged to other races. There was a delay in 37 (6.2%) patients receiving adjuvant therapy. Our study found that higher DCI quintile and higher BMI were associated with a statistically significant increase in overall complication rate (p = 0.044, p = 0.05, respectively). Race had an association with persistent pain (p = 0.003). Former smokers (OR = 3.44, 95% CI [1.419, 8.34], p = 0.0062), hypertensive patients (OR = 3.846, 95% CI [1.13, 13.12], p = 0.0314), and patients who received adjuvant chemotherapy (OR = 2.756, 95% CI [1.117, 6.801], p = 0.0278) had higher odds of developing any complication. Patients who developed any complication were more likely to have a delay in adjuvant therapy than patients who did not have complications (OR = 6.452, CI [2.696, 15.44], p < 0.001).

CONCLUSION: BCS is generally a safe procedure with minimal complications; however, patient-specific factors are associated with increased complication rates which can lead to delays in adjuvant therapy. Future studies with larger sample sizes are needed to adequately compare outcomes among minority racial groups to a larger reference population.

PMID:41934150 | DOI:10.1155/tbj/8459253