Nevin Manimala

Clin Rheumatol. 2026 Mar 30. doi: 10.1007/s10067-026-08064-4. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to investigate whether growth differentiation factor-15 (GDF-15) can serve as a potential biomarker for assessing subclinical inflammation during the attack-free (intercritical) period in patients with familial Mediterranean fever (FMF).

METHODS: In a single-center cross-sectional case-control study, 52 FMF patients in the attack-free period were compared with 52 age- and sex-matched healthy controls. ELISA measured serum GDF-15 levels; acute-phase reactants (CRP, ESR, SAA, fibrinogen) and various hematologic inflammation indices were evaluated. Statistical analyses included the Mann-Whitney U, chi-square, Kruskal-Wallis, Spearman correlation, and ROC curve methods.

RESULTS: Serum GDF-15 levels were significantly higher in the FMF group than in controls (p < 0.001). Subclinical inflammation, defined by SAA > 10 mg/L, was detected in 78.8% of FMF patients. GDF-15 correlated positively with CRP and SAA (p < 0.05). GDF-15 levels did not differ across MEFV mutation subgroups or by the presence of the M694V mutation. Patients with subclinical inflammation had significantly higher GDF-15 levels than those without. ROC analysis showed that GDF-15 had a statistically significant ability to distinguish FMF from controls (AUC = 0.78; p < 0.001) and to identify subclinical inflammation (AUC = 0.74; p = 0.014).

CONCLUSION: GDF-15 appears to be a potential biomarker reflecting ongoing subclinical inflammation during the attack-free period in FMF. Elevated GDF-15 levels in patients with SAA-defined subclinical inflammation suggest that GDF-15 may reflect low-grade inflammatory activity. Larger studies are needed to validate these findings. Key Points • Serum GDF-15 was significantly higher in the attack-free FMF patients than in controls, supporting its potential to reflect persistent low-grade (subclinical) inflammation. • GDF-15 showed moderate discriminative performance (AUC 0.783) and may complement conventional acute-phase reactants in assessing inflammatory burden during attack-free periods. • GDF-15 levels did not differ significantly across MEFV mutation subgroups or by M694V status in this cohort.

PMID:41910911 | DOI:10.1007/s10067-026-08064-4

Health Econ Rev. 2026 Mar 30. doi: 10.1186/s13561-026-00764-6. Online ahead of print.

NO ABSTRACT

PMID:41910908 | DOI:10.1186/s13561-026-00764-6

Intern Emerg Med. 2026 Mar 30. doi: 10.1007/s11739-026-04330-0. Online ahead of print.

ABSTRACT

Sepsis, a life-threatening infection-induced condition, is a leading cause of mortality worldwide, particularly among older adults. Survivors often experience long-term health complications, including decline in functional capacity, cognitive impairment, and worsening of chronic comorbidities. This study aimed to evaluate the impact of sepsis on frailty and functional status over 12 months in patients with community-acquired infections. 50 patients completed the follow-up and were analyzed: 24 in the sepsis group and 26 in the control group, matched by age, sex, and infection source. Functional status was assessed at baseline and 12 months using the Barthel Index, Lawton Scale, and FRAIL questionnaire. At 12 months, septic patients showed significant declines in both functional capacity and frailty. Specifically, there was a significant decline in functional independence as measured by the Lawton Scale, with 33.3% of septic patients exhibiting reduced ability in instrumental activities of daily living, compared to 11.7% in controls (p = 0.032). FRAIL scale showed significant worsening in the sepsis group (41.7% vs. 7.7%, p = 0.005). Notably, 33.3% of previously robust septic patients developed new frailty, compared to 0% in the control group (p = 0.025). The study also found a significant increase in comorbidity burden at 12 months within the sepsis group (p = 0.041), whereas between-group differences were not statistically significant. These results highlight the long-term impact of sepsis on functional capacity and frailty, emphasizing the need for targeted post-sepsis rehabilitation and management.

PMID:41910885 | DOI:10.1007/s11739-026-04330-0

Ear Nose Throat J. 2026 Mar 30:1455613261438070. doi: 10.1177/01455613261438070. Online ahead of print.

ABSTRACT

OBJECTIVE: YouTube is a video-sharing platform that patients frequently utilize. However, there are no objective assessments of the quality of information about otosclerosis on YouTube. Therefore, we aimed to assess the quality of YouTube videos for patient education via a cross-sectional study. We utilized 4 search phrases and analyzed them with 3 different scoring metrics, followed by statistical analysis.

RESULTS: Fifty videos were analyzed for the search terms “stapedectomy,” “stapedotomy,” “laser stapedotomy,” and “otosclerosis.” Most videos for “stapedotomy” (42%) and “otosclerosis” (41.2%) were intended for patients, while those for “stapedotomy” (48%) and “laser stapedotomy” (96%) were created for healthcare professionals or students. Higher modified DISCERN scores were associated with healthcare organization-produced videos for “otosclerosis” (P = .01964) and “stapedotomy” (P = .02842). Higher global quality score (P = .02964) and Journal of the American Medical Society scores (P = .01488) were significantly associated with videos made by verified users for “otosclerosis.”

CONCLUSION: The quality of YouTube videos may not be sufficient for patient education on stapedectomy and stapedotomy for otosclerosis. Only 2 search terms included most videos geared toward patient education, while the other 2 terms had more videos for healthcare professionals. Lower transparency and reliability scores may give concerns about bias.

PMID:41906985 | DOI:10.1177/01455613261438070

J Atten Disord. 2026 Mar 30:10870547261428864. doi: 10.1177/10870547261428864. Online ahead of print.

ABSTRACT

BACKGROUND: Emerging evidence suggests that dysregulated immune homeostasis may play a role in the pathophysiology of ADHD; however, comprehensive profiling of T-helper (Th) cell subsets and microglial regulatory cytokines remains limited.

METHODS: This cross-sectional study included adolescents aged 12 to 18 years with ADHD (n = 45) and healthy controls (n = 41). Serum levels of Th1 (IL-12 and IFN-γ), Th2 (IL-4), Th17 (IL-17 and IL-23), Treg (IL-10 and TGF-β), and microglia regulatory cytokines (IL-34 and CSF-1) were measured by ELISA. ROC curve and logistic regression analyses were performed to determine the diagnostic and predictive value of the parameters in distinguishing ADHD.

RESULTS: Significant increases in IL-12, IL-17, IL-23, IL-4, and IL-10 levels were observed in the ADHD group compared to the control group. IL-12 and IL-17 showed the highest diagnostic yield (AUC = 0.77). IL-12 remained a strong independent predictor in multivariate analysis (OR = 55.88, P = .015). IFN-γ and TGF-β did not differ significantly between the groups. CSF-1 levels did not differ between the groups, while IL-34 showed an increase that approached statistical significance in the ADHD group (P = .052; AUC = 0.622).

CONCLUSIONS: Our results reveal a profile of Th1/Th17-dominated proinflammatory activation, partially compensatory Th2/Treg modulation, and potentially IL-34-mediated microglial divergence in ADHD. IL-12 and IL-17 showed the highest discriminatory performance; however, their AUC values (~0.77) remained at a moderate level. Our findings highlight the need for multidimensional immunophenotyping and point toward novel immune-targeted therapeutic strategies.

PMID:41906980 | DOI:10.1177/10870547261428864

Pediatr Pulmonol. 2026 Apr;61(4):e71599. doi: 10.1002/ppul.71599.

ABSTRACT

BACKGROUND: Low-birth-weight percentile has been associated with impaired pulmonary function at adulthood. However, its impact on pulmonary function early in life remains less well established.

OBJECTIVE: To assess the impact of small-for-gestational-age (SGA) status on pulmonary function in infants 3 months to 2 years of age.

METHODS: We conducted a single-center retrospective cohort study evaluating infant pulmonary function tests (iPFTs) performed at Hadassah medical center between 2008 and 2023. Tests were performed as part of routine clinical evaluation following referral for respiratory symptoms. iPFTs results in infants born SGA were compared with infants born appropriate and large for gestation age (AGA/LGA). Excluded from the study were infants diagnosed with chronic diseases other than prematurity.

RESULTS: iPFT data from 161 SGA infants were compared with 545 AGA/LGA infants. No consistent significant differences were found between the groups (mean (SD); FEV_0.5 = 80.11 (18.40) %predicted vs. 81.55 (18.03) %predicted, P = 0.40; FVC = 84.24 (20.30) %predicted vs. 85.61 (20.22) %predicted, P = 0.47). SGA infants were not more likely to demonstrate restrictive (8.3% vs. 4.7%, P = 0.09) or obstructive (53.7% vs. 49.7%, P = 0.40) patterns. Findings were similar in analyses stratified by prematurity and term birth.

CONCLUSIONS: Our findings challenge the hypothesis that SGA is associated with impaired pulmonary function in infancy. While subtle differences were observed, they were not statistically or clinically significant. However, as this cohort consisted of symptomatic infants, the findings may not be generalizable to the broader infant population. Population-based studies are needed to further clarify the respiratory outcomes of intrauterine growth restriction.

PMID:41906950 | DOI:10.1002/ppul.71599

Perspect Biol Med. 2026;69(1):106-125. doi: 10.1353/pbm.2026.a985817.

ABSTRACT

Death certificates act as verified records concluding the administrative aspects of a person’s life. In the US, the death certificate includes essential biographical information about the decedent, including the manner and cause of death. To some, the cause of death may be a procedural step necessary to obtain a death certificate, and where there is not an ensuing forensic investigation, the cause of death may even seem immaterial. But specificity in determining the cause of death is crucial to epidemiological and public health initiatives and for the maintenance of accurate mortality records. This article argues that inaccuracies in cause of death determinations are harmful: they are detrimental to the professional commitments physicians owe their patients and distort the lived experiences of the deceased. Inaccuracy in vital statistics affects individuals and families by misrepresenting the physiological and biological processes leading to death and potentially altering the deceased person’s life story. While there is extensive literature exploring the challenges faced by clinicians in determining the cause of death, this article focuses on modifications made to the cause of death-whether consciously through deliberate intent to conceal, or unconsciously through error or omission-where the death may be socially stigmatizing.

PMID:41906895 | DOI:10.1353/pbm.2026.a985817

Jt Dis Relat Surg. 2026 May 1;37(2):552-562. doi: 10.52312/jdrs.2026.2769. Epub 2026 Mar 23.

ABSTRACT

OBJECTIVES: This study aims to evaluate the effects of topical creams containing mucopolysaccharide polysulfate (MPS) on wound healing using an experimental wound model.

MATERIALS AND METHODS: Standard full-thickness skin defects were created in 32 Wistar rats and monitored for 14 days under four different topical treatment protocols: Control (Group 1, n = 8), Hirudoid (Group 2, n = 8), Silverdin (Group 3, n = 8), and Hirudoid + Silverdin (Group 4, n = 8). Wound closure rates were quantified through photographic analysis, while histological and immunohistochemical healing characteristics were assessed using the Structure, Presence of Cells, Organization, and Tissue Integration (SPOT) score, additional histological indices, and the transforming growth factor-beta 1 (TGF-β1) H-score. Intergroup differences were analyzed using appropriate non-parametric statistical tests.

RESULTS: On Day 3, wound closure rates were higher in the Hirudoid, Silverdin, and Hirudoid + Silverdin groups compared to the control group (p < 0.01). By Day 14, this difference sustained only in the Silverdin and Hirudoid + Silverdin groups, indicating that the early advantage observed with Hirudoid alone was not maintained over time (p < 0.01). No significant differences in the general histological parameters were observed among the groups (p > 0.05). However, the TGF-β1 H-score was lower in the Silverdin group than in the control and Hirudoid groups (p < 0.01).

CONCLUSION: Our study results suggest that MPS may accelerate early wound closure, but does not significantly improve wound closure in later stages, and its combination with silver sulfadiazine offers no additional benefit compared to silver sulfadiazine alone.

PMID:41906850 | DOI:10.52312/jdrs.2026.2769

Jt Dis Relat Surg. 2026 May 1;37(2):519-530. doi: 10.52312/jdrs.2026.2655. Epub 2026 Mar 16.

ABSTRACT

OBJECTIVES: The aim of this study was to assess the healing effects of vericiguat at various concentrations on rat femur fractures through clinical and radiological and biomechanical and histopathological assessments.

MATERIALS AND METHODS: In this study, a total of 60 female Wistar-Albino rats were used. The study comprised of six rat groups with 10 rats in each group: Group 1 (normal controls), Group 2 (positive controls – only fracture), Group 3 (low-dose vericiguat – 3 mg/kg), Group 4 (high-dose vericiguat – 6 mg/kg), Group 5 (fracture + low-dose vericiguat), Group 6 (fracture + high-dose vericiguat). Under general anesthesia, standard closed fractures were created in the right femurs of rats in the fracture groups. Radiological examinations were performed on Days 7, 14, and 28. The Lane-Sandhu scoring system was used for radiological assessment. At the end of Day 28, the rats were sacrificed, and the fracture healing tissues were examined biomechanically and histologically using the Huo scale.

RESULTS: The 28^th day biomechanical assessment showed significant differences in maximum load values between the fractured groups (Group 2: 88.75 ± 23.25 N, Group 5: 83.54 ± 23.15 N, Group 6: 39.07 ± 10.38 N; p = 0.003). The stiffness values showed similar patterns (Group 2: 64.71 ± 45.52 N/mm, Group 5: 99.20 ± 43.82 N/mm, Group 6: 40.47 ± 19.27 N/mm; p = 0.088). In the histological evaluation according to the Huo scale, Group 5 showed the highest quality of healing (8.6 ± 1.14) and a significant difference was found between Group 2 and Group 5 (p = 0.009). Group 6 demonstrated necrosis in four out of 10 animals and severe inflammation in eight out of 10 animals. In the radiological evaluation on Days 7, 14, and 28, no statistically significant differences were observed between the groups according to the Lane-Sandhu scoring system (p = 0.811 on Day 14; p = 0.299 on Day 28).

CONCLUSION: Our study results suggest that soluble guanylate cyclase (sGC) activators show promise for fracture healing treatment when used at specific concentrations, but their therapeutic range remains limited and their toxic effects at high doses need careful consideration.

PMID:41906847 | DOI:10.52312/jdrs.2026.2655

Jt Dis Relat Surg. 2026 May 1;37(2):510-518. doi: 10.52312/jdrs.2026.2600. Epub 2026 Mar 17.

ABSTRACT

OBJECTIVES: This study aims to evaluate the outcomes of the flexor tenolysis cases with wide-awake local anesthesia no tourniquet (WALANT) and to compare them with cases with other anesthesia types.

PATIENTS AND METHODS: Between March 2004 and March 2024, a total of 104 patients with 150 fingers with flexor tenolysis (71 males, 33 females; mean age: 32.67 ± 11.64 years; range, 16 to 62 years) were included in the study. The WALANT group consisted of 41 patients with 53 fingers, while the conventional anesthesia group consisted of 63 patients with 97 fingers. Pre- and postoperative total active motion (TAM) gains were compared between the two groups and relevant factors were investigated.

RESULTS: Overall TAM gain was 47% in our study cohort. The TAM gain was 55% and 43% in the WALANT group and in the conventional anesthesia group, indicating a statistically significant difference (p = 0.005). The best TAM gains were observed in the clean-cut injury type. The TAM gains were better in the cases without fractures. Age was a significant factor in the tenolysis outcomes, and younger patients had improved outcomes.

CONCLUSION: Our study results indicate a significant difference in the TAM gain between the WALANT and conventional methods. Taken together, we believe that the application of WALANT in tenolysis of flexor tendon adhesions represents a significant advancement in hand surgery. The ability to perform the procedure under local anesthesia while allowing for immediate assessment of tendon function enhances the surgical precision and results.

PMID:41906846 | DOI:10.52312/jdrs.2026.2600