Nevin Manimala

J Matern Fetal Neonatal Med. 2026 Dec;39(1):2681372. doi: 10.1080/14767058.2026.2681372. Epub 2026 Jul 26.

ABSTRACT

OBJECTIVE: Early onset fetal growth restriction (FGR) shares pathophysiologic origins and may precede the development of Hypertensive Disorder of Pregnancy (HDP). The aim of this study was to evaluate risk factors associated with the development of HDP in individuals with early onset FGR.

METHODS: This retrospective cohort included all consecutive patients who presented to our tertiary, university-affiliated medical center between 2011 and 2024 for suspected early-onset FGR, defined as onset before 32 weeks of gestation. Maternal and pregnancy information retrieved from hospital records included maternal age, BMI, smoking history, parity, gestational age (GA) at diagnosis, chronic hypertension, maternal cardiac disease, pre- or gestational diabetes, thrombophilia, chronic renal disease, history of major pregnancy complications, mode of conception, number of fetuses, premature contractions (PMC), ultrasound (US) measured abdominal circumference (AC), US measured estimated fetal weight (EFW), umbilical artery Doppler PI (UAPI) and middle cerebral artery Doppler PI (MCAPI). AC and EFW were classified as <5% and <3% respectively based on local population growth charts. UAPI and MCAPI percentiles were calculated per specific GA. We present maternal and pregnancy characteristics stratified by the development of HDP and investigated the association of these variables with development of HDP using univariate and multivariable logistic regression. The analyses were performed using R statistical software, and statistical significance was defined as p < 0.05.

RESULTS: During the study period 774 pregnant individuals were presented for suspected early-onset FGR. Among them, 79 (10.2%) subsequently developed HDP later in pregnancy. Using multivariate analysis UAPI above the 95^th percentile (OR 3.35, CI 1.55-7.20, p < 0.01), GA 24-28 weeks at diagnosis (OR 2.54, CI 1.20-5.36, p = 0.01) and AC below the 5^th percentile (OR 2.31, CI 1.10-4.86, p = 0.02), were significantly associated with the subsequent development of HDP.

CONCLUSION: Among pregnancies with suspected early-onset FGR, an elevated UAPI (>95th percentile) was the strongest predictor of developing HDP. Additional risk factors included earlier gestational age at FGR diagnosis and an AC below the 5th percentile. Women with these risk factors warrant intensified maternal surveillance. Future studies integrating these clinical predictors with circulating angiogenic biomarkers may further refine risk stratification.

PMID:42503443 | DOI:10.1080/14767058.2026.2681372

JNCI Cancer Spectr. 2026 Jul 7;10(4):pkag062. doi: 10.1093/jncics/pkag062.

ABSTRACT

BACKGROUND: As tobacco use patterns shift toward non-combustible tobacco products such as electronic cigarettes (ECs) and nicotine pouches, dual use with combustible products may undermine potential public health benefits. Herein we describe adult trends in exclusive and dual use of combustible and non-combustible products in the United States between 2015 and 2023.

METHODS: We analyzed annual National Health and Interview Survey data including all adults with valid data on tobacco use, age, and sex. Joinpoint regression estimated annual percentage change (APC) and 95% CIs overall and by age group and sex. All tests were 2-tailed (P < .05).

RESULTS: Exclusive combustible use remained 2-3 times higher than exclusive non-combustible use or dual use across all years. From 2015 and 2023, combustible use declined in both sexes, with the steepest drops in younger adults after 2020. Exclusive non-combustible use increased in all age groups after 2017, especially among younger adults and females. The most common dual use pattern was cigarettes plus ECs, which was stable over time.

CONCLUSIONS: Exclusive use of combustible tobacco, primarily cigarettes, is declining but remains the most common pattern, especially in older adults. In contrast, exclusive EC use is displacing combustible use among younger adults. Dual use patterns were low overall and stable across the study period.

PMID:42503418 | DOI:10.1093/jncics/pkag062

Am J Ophthalmol. 2026 Jul 26:S0002-9394(26)00413-7. doi: 10.1016/j.ajo.2026.07.034. Online ahead of print.

ABSTRACT

OBJECTIVE: To longitudinally compare changes in ocular surface signs and symptoms over two to three years in patients with isolated KCS (KCS-only) and those with concomitant SjD (KCS+SjD).

DESIGN: Prospective cohort study using data from the Sjögren’s International Collaborative Clinical Alliance (SICCA) registry. Participants were enrolled from 2003-2012 and invited for 2- to 3-year follow-up.

PARTICIPANTS: Participants with KCS (defined as ocular staining score [OSS] ≥ 5) who presented at both baseline and follow-up visits were included.

METHODS: Participants underwent standardized ocular surface testing, including OSS, Schirmer I, tear break-up time (TBUT), and Ocular Surface Disease Index-6 (OSDI-6), at baseline and follow-up visits. Multivariable linear regression models evaluated differences in longitudinal change in ocular metrics between KCS-only and KCS+SjD participants.

MAIN OUTCOME MEASURES: Changes in ocular metrics, including OSS, Schirmer I, TBUT, and OSDI-6, from baseline to follow-up.

RESULTS: This analysis included data from 427 participants (mean age: 54.4±12.8 years, 94.8% female), including 305 with KCS+SjD and 122 with KCS-only. Participants with KCS+SjD exhibited significantly more severe dry eye signs than those with KCS-only at both time points. After adjusting for covariates, the change score for OSS was 1.51 points higher (95% confidence interval [CI], 0.99-2.04; P <.001) in the KCS+SjD groups compared to the KCS-only group. Similarly, participants with KCS+SjD demonstrated greater longitudinal decline in TBUT (-1.10 sec, 95% CI: -1.56 to -0.65; P <.001) and in Schirmer I (-2.16 mm, 95% CI: -3.31 to -1.01; P <.001). The difference in OSDI-6 scores was not statistically significant (0.36, 95% CI, -0.60 to 1.33; P = .46).

CONCLUSIONS: Participants with KCS+SjD exhibited more severe baseline signs and greater longitudinal worsening of objective ocular findings compared to KCS-only participants. These findings support the hypothesis that KCS associated with SjD and isolated KCS may represent distinct clinical forms of dry eye disease and may help differentiate these dry eye subtypes.

PMID:42503399 | DOI:10.1016/j.ajo.2026.07.034

Exp Gerontol. 2026 Jul 27:113252. doi: 10.1016/j.exger.2026.113252. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Medication nonadherence among older adults with type 2 diabetes is common and contributes to preventable complications, especially in African American communities. MediTeddi is a new cognitive prosthetic in the form of a friendly talking electronic bear that delivers scheduled medication prompts, collects simple confirmations, and provides rolling statistical feedback based on Self-Determination Theory. This study evaluated its pilot efficacy and explored support for a cognitive prosthetic framework.

RESEARCH DESIGN AND METHODS: Two pilot studies were conducted with African American adults with poorly controlled type 2 diabetes. Study 1 was a 24-week randomized controlled trial (N = 16) comparing MediTeddi plus biweekly calls with calls alone. Study 2 was a 26-week repeated-measures trial (N = 50; n = 35 completers) examining within-person change with MediTeddi and biweekly calls. The primary behavioral outcome was medication adherence (MMAS-4), and the primary clinical outcome was hemoglobin A1c (HbA1c); secondary outcomes were depressive symptoms and diabetes-related distress.

RESULTS: In Study 1, the intervention group showed a greater reduction in HbA1c (mean decrease 0.88) than the control group (0.32), with a trend toward significance (p < .10). MMAS-4 adherence also improved more in the intervention group (mean increase 0.67 vs. 0.00). In Study 2, participants demonstrated large and statistically significant gains in adherence (MMAS-4 increase from 1.61 to 3.14), along with a 1.71-point reduction in HbA1c and significant reductions in depressive symptoms and diabetes distress.

DISCUSSION: These pilot trials suggest that a simple, socially engaging cognitive prosthetic can meaningfully improve adherence, glycemic control, and psychosocial outcomes in older African American adults with diabetes and warrant larger, theory-driven trials with objective adherence measures. (272 words).

PMID:42503366 | DOI:10.1016/j.exger.2026.113252

Am J Prev Med. 2026 Jul 26:108526. doi: 10.1016/j.amepre.2026.108526. Online ahead of print.

ABSTRACT

INTRODUCTION: British Columbia, Canada implemented a three-year pilot that decriminalized the personal possession of select illegal drugs beginning January 31, 2023. The policy was amended to prohibit drug possession in all public spaces starting May 7, 2024. The impacts of decriminalization and the subsequent decriminalization amendment on police-reported drug possession seizures were examined, which were identified on the basis of incidents in which drug possession offences were recorded as the most serious offence.

METHODS: Monthly, population-based crude rates of police-reported drug possession seizures of any quantity and police-reported drug possession seizures involving up to 2.5 grams were analyzed in an interrupted time series design using generalized additive models (January 2019-July 2025; Data collected and analyzed in 2026). The models tested level changes in the outcomes associated with the initial decriminalization policy and the subsequent decriminalization policy amendment relative to pre-decriminalization.

RESULTS: Decriminalization relative to pre-decriminalization was associated with a 68% decrease in police-reported drug possession seizures of any quantity (β [95% CI]: -1.1 [-1.4, -0.9]). However, police-reported drug possession seizures of any quantity increased after the decriminalization amendment, such that they were statistically indistinguishable from pre-decriminalization (β [95% CI]: -0.2 [-0.6, 0.1]). A similar pattern of findings was observed for police-reported drug possession seizures involving up to 2.5 grams: decriminalization relative to pre-decriminalization was associated with an 87% decrease (β [95% CI]: -2.0 [-2.5, -1.6]), while the decriminalization amendment relative to pre-decriminalization was not associated with significant changes (0.4 [-0.2, 1.0]).

CONCLUSIONS: Decriminalization was associated with decreases in police-reported drug possession seizures of any quantity and police-reported drug possession seizures involving up to 2.5 grams. The subsequent decriminalization amendment reversed this trend, as both types of police-reported drug possession seizures returned to comparable levels observed pre-decriminalization.

PMID:42503363 | DOI:10.1016/j.amepre.2026.108526

J Psychiatr Res. 2026 Jul 21;201:641-650. doi: 10.1016/j.jpsychires.2026.07.020. Online ahead of print.

ABSTRACT

BACKGROUND: Anorexia nervosa (AN) is a severe psychiatric disorder frequently associated with affective disturbances, particularly depression, and marked deficits in emotional awareness. Alexithymia has been identified as a core vulnerability factor in AN, however, its relationship with eating disorder symptomatology appears complex and may be influenced by depressive mood. Despite growing interest in transdiagnostic emotional processes, the mediating role of depression in the association between alexithymia and eating symptoms remains insufficiently explored, especially in young women and using comprehensive psychopathological assessment tools.

OBJECTIVES: The present study aimed to examine differences in alexithymia, emotion regulation, mood, personality-related psychopathology, and eating disorder symptoms between young women with and without restrictive AN; to investigate associations among these dimensions within each group; and to test the mediating role of depression in the relationship between alexithymia and eating disorder symptomatology.

METHODS: The sample consisted of 47 young women with restrictive AN and 48 non-clinical controls aged 16-30 years. Participants completed the Toronto Alexithymia Scale (TAS-20), Profile of Mood States (POMS), Emotion Regulation Questionnaire (ERQ), Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Eating Disorder Inventory-3 (EDI-3). Group comparisons were performed between the clinical and control groups. Correlational analyses and mediation models were conducted separately within each group.

RESULTS: Compared to controls, patients with AN showed significantly higher levels of psychopathology, depressive mood, alexithymia, and expressive suppression. Correlational analyses revealed partially different patterns across groups. Mediation analyses indicated that, in the clinical group, the association between alexithymia and eating disorder symptoms was fully accounted for by depressive symptoms, whereas in the control group both direct and indirect associations remained statistically significant.

CONCLUSIONS: These findings suggest that depressive symptoms may partially account for the observed association between alexithymia and eating disorder symptoms in AN. However, the cross-sectional design precludes causal inferences. Nevertheless, the results highlight the clinical relevance of assessing emotional awareness and depressive symptoms in young women with AN.

PMID:42503289 | DOI:10.1016/j.jpsychires.2026.07.020

Int J Pediatr Otorhinolaryngol. 2026 Jul 20;208:112954. doi: 10.1016/j.ijporl.2026.112954. Online ahead of print.

ABSTRACT

AIMS: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of press-needle therapy for allergic rhinitis in children.

METHODS: We comprehensively searched for relevant randomized controlled trials (RCTs) on press-needle therapy for pediatric AR. After strict screening of literature, data extraction and assessment of methodological quality, meta-analysis was performed using appropriate statistical methods. A random-effects model was adopted to synthesize the results, considering differences in follow-up duration and intervention period among included studies. Pre-specified further analyses were conducted for the primary outcome to compare press-needle plus medication vs medication alone, press-needle alone vs medication alone, and press-needle plus medication vs press-needle alone. The primary and secondary outcome measures included clinical efficacy, symptom and sign score, Visual Analogue Scale (VAS) score, Total Nasal Symptom Score (TNSS), Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) score, Eosinophil Ratio (EOSR), serum immunoglobulin E (IgE) levels, adverse drug reactions (ADRs) and recurrence rate.

RESULTS: 24 RCTs with 1625 participants were included. Press-needle therapy significantly improved clinical efficacy (OR = 3.75, 95 CI: 2.59-5.42; I² = 0%). Further analysis showed that press-needle plus medication was superior to medication alone (OR = 4.60, 95% CI: 3.08-6.86), whereas press-needle monotherapy did not show a significant advantage over medication alone. Significant reductions were observed in VAS (SMD = -1.30), TNSS (SMD = -0.74), PRQLQ (SMD = -1.16), and serum IgE (SMD = -2.06; based on only 3 studies, I² = 96%, interpret with caution). No significant differences were found in symptom and sign score, EOSR, or ADRs. Recurrence rate was significantly lower in the intervention group (OR = 0.37, 95% CI: 0.23-0.61).

CONCLUSION: Press-needle therapy, primarily as an adjunct to pharmacotherapy, may be a well-tolerated and potentially effective option for pediatric AR, improving clinical response, symptoms, quality of life, and recurrence without increasing adverse events. Evidence for press-needle monotherapy and for immunological outcomes (IgE, EOSR) remains limited. Multi-center, three-arm RCTs with standardized protocols and long-term follow-up are needed to isolate its independent effect.

SYSTEMATIC REVIEW REGISTRATION: The protocols for this meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO, https://www.crd.york.ac.uk/PROSPERO/view/CRD420261307545.).

PMID:42503260 | DOI:10.1016/j.ijporl.2026.112954

J Magn Reson Imaging. 2026 Jul 26. doi: 10.1002/jmri.70445. Online ahead of print.

ABSTRACT

BACKGROUND: Nasopharyngeal carcinoma (NPC) can be detected early on MRI, but adoption for screening is limited by a shortage of experienced specialists. MRI artificial intelligence (AI) algorithms for diagnosing NPC in the literature may address this, but most studies focus on routine clinical care, and their applicability in screening requires close examination.

PURPOSE: To (i) evaluate the diagnostic performance of AI for NPC detection, (ii) analyze the impact of study protocols, and (iii) assess the applicability of existing studies to NPC screening.

STUDY TYPE: Systematic review.

POPULATION: Thirty-eight studies were included, including a total of 23,398 patients (20,693 NPC and 2705 non-NPC).

FIELDSTRENGTH: 1.5 T to 3.0 T.

ASSESSMENT: Following PRISMA guidelines, PubMed, Scopus, and Embase records from January 1, 2009 to August 16, 2025 were screened by two independent reviewers for studies on NPC detection, localization, and/or diagnosis using MRI. Included studies were reviewed for applicability and risk of bias. Lesion-localization performance (Dice similarity score [DSC]) and NPC vs. non-NPC discrimination (sensitivity/specificity) were extracted and summarized. Subgroup analyses assessed the impact of intravenous contrast on AI performance.

STATISTICAL TESTS: Meta-analysis used standard random-effects univariate restricted maximum likelihood model and hierarchical summary receiver operator characteristics for performance pooling and subgroup analysis, taking p value < 0.05 as significance.

RESULTS: Pooled performance from 30 localization and 6 discrimination studies was DSC = 0.80 (CI: 0.78-0.82) and sensitivity/specificity = 97.1% (CI: 88.0%-99.3%)/87.8% (CI: 78.9%-93.2%), respectively. Intravenous contrast did not significantly affect AI performance for either task (p > 0.05). Only seven studies were fully applicable to screening.

DATA CONCLUSION: AI-driven NPC screening using MRI is feasible at high sensitivity. Using non-contrast MRI did not significantly impact AIs’ performance. However, applicability and the suboptimal ratio of NPC: non-NPC patients remain the weaknesses of existing studies, warranting further investigation with cohorts that better reflect the screening scenario.

SYSTEMATIC REVIEW REGISTRATION: The systematic review protocol of this system is registered with the Inplasy registry (Ref. INPLASY202570076).

PMID:42503234 | DOI:10.1002/jmri.70445

Cancer Med. 2026 Jul;15(7):e72116. doi: 10.1002/cam4.72116.

ABSTRACT

PURPOSE: Infectious complications in patients with cancer are contributors to hospitalisations, treatment disruption, and mortality. This study aimed to develop machine learning (ML) models for risk stratification of infection-related hospitalisations (IRHs) among patients with cancer.

METHODS: Adult patients diagnosed with and treated for lymphoma, multiple myeloma (MM), chronic lymphocytic leukaemia (CLL), colorectal, or lung cancer from 2013 to 2023 in the North Denmark Region were included. Data from national cancer registries and patient health records were used. Serious infections were defined as sepsis, positive blood culture, intensive care admission, or death during hospitalisation. Models were developed using multiple ML methodologies across three different data setups: ML-using data up to hospital admission; ML₄₈-using data up to 48 h after admission; and ML_48,reduced-a pruned version of ML₄₈ with fewer features. Data were split into training, validation and held-out test sets.

RESULTS: Among 9874 patients 2661 IRHs occurred, including 691 (21.5%) serious infections. On the held-out test set, ML achieved the best performance (ROC-AUC: 0.79) versus ML₄₈ (0.76), with ML₄₈ having higher specificity at matched sensitivity (50.9% vs 44.9% for sensitivity ~85%). ML_48,reduced reached a ROC-AUC of 0.75 (specificity 46.5% at sensitivity ~85%). Subgroup analysis showed the best performance for lymphoma (ROC-AUC: 0.86) and lowest for lung cancer (ROC-AUC: 0.73). The model performed better in patients with ECOG score 0-1 compared to ≥ 2 (ROC-AUC 0.88 vs. 0.77). SHAP analysis identified previous blood cultures, carbamide, and neutrophil counts as key predictive features across all models.

CONCLUSION: The ML models showed moderate performance in risk stratification of IRHs in patients with cancer. Such models could provide decision support in hospitalisation decisions and discharge.

PMID:42503233 | DOI:10.1002/cam4.72116

Chem Biodivers. 2026 Jul;23(7):e71511. doi: 10.1002/cbdv.71511.

ABSTRACT

The present study investigates the phytochemical composition, antioxidant potential, and preliminary in silico interactions of the methanolic root extract of Antigonon leptopus. Qualitative phytochemical screening suggested the presence of alkaloids, flavonoids, phenolics, tannins, saponins, and terpenoids. The extract exhibited moderate free radical scavenging activity in the DPPH assay, with an IC₅₀ value of 142.45 ± 3.05 µg/mL, compared with ascorbic acid (IC₅₀ = 18.09 ± 0.51 µg/mL). Statistical analysis using Student’s t-test indicated a significant difference between the extract and standard (p < 0.001). In addition, the extract exhibited a ferric reducing antioxidant power (FRAP) of 278.12 ± 0.65 µM Fe^{2 +}/g dry extract and contained appreciable levels of total phenolics (394.50 ± 3.77 mg GAE/g dry extract) and total flavonoids (55.33 ± 1.16 mg QE/g dry extract), suggesting that polyphenolic constituents contribute to the observed antioxidant activity. Molecular docking was conducted as an exploratory approach to predict potential interactions of selected phytochemicals with NADPH oxidase 2 (NOX2), but these results are considered preliminary and require further experimental validation. Overall, the findings suggest that A. leptopus roots contain bioactive secondary metabolites with moderate antioxidant activity, warranting further in-depth biological and mechanistic studies.

PMID:42503198 | DOI:10.1002/cbdv.71511