Nevin Manimala

J Investig Med. 2026 Jul 24:10815589261473281. doi: 10.1177/10815589261473281. Online ahead of print.

ABSTRACT

Obesity-related chronic inflammation, together with dyslipidemia, promotes gradually progressive microangiopathy all over the body. Retinal vascular network is a mirror for systemic diseases induced vascular complications. We aimed to explore the association between choroidal thickness and retinochoroidal microvascular changes and insulin resistance indices [Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and triglyceride glucose (TyG) index] in obese children. This exploratory pilot comparative study included 20 obese children (BMI >95th percentile) and 20 healthy normal weight children (BMI >5th, <85th percentile for age and sex) as controls. Optical coherence tomography angiography (OCTA) 6×6 mm scans was used to measure central macular thickness (CMT), choroidal thickness, foveal avascular zone, choriocapillaris flow area, and retinal superficial/deep vessel densities (SVD/DVD) in parafoveal and perifoveal sectors. Anthropometric measurements, lipid profile, HOMA-IR and TyG index were assessed and correlated to OCTA parameters. Obese children had significantly lower visual acuity and thinner choroid compared to normal weight children. OCTA showed significant reductions in SVD and DVD across multiple para-/perifoveal sectors in obese than normal weight children. There are statistically significant negative correlations between Waist/height ratio, insulin resistance indices and OCTA parameters particularly at DVD. Effect size analysis showed high difference in TyG index, whole and parafoveal DVD between obese and normal weight children. In conclusion, obesity may contribute to subclinical retinal and choroidal structural changes beginning at DVD particularly in those with central obesity and insulin resistance. OCTA provides a noninvasive tool for detection of subclinical retinal vascular changes in children with obesity.

PMID:42495759 | DOI:10.1177/10815589261473281

J Glob Health. 2026 Jul 24;16:04252. doi: 10.7189/jogh.16.04252.

ABSTRACT

BACKGROUND: The liver-kidney axis has been increasingly recognised as a potential pathway linking metabolic dysfunction to chronic kidney disease (CKD). However, longitudinal evidence from sub-Saharan African populations remains limited. We therefore aimed to prospectively investigate the association of baseline liver biomarkers with incident CKD and its components over six years in a transcontinental cohort of Ghanaians living in rural and urban Ghana and Amsterdam, the Netherlands.

METHODS: Using data from the prospective Research on Obesity and Diabetes among African Migrants cohort, we examined baseline liver biomarkers (gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and the fatty liver index (FLI) in relation to incident CKD over approximately six years among Ghanaians in rural and urban Ghana and Amsterdam, The Netherlands. CKD was defined according to the Kidney Disease: Improving Global Outcomes 2021 criteria using race-free CKD-EPI equations. We used Poisson regression with robust standard errors to estimate adjusted incidence rate ratios (aIRRs) per standard deviation increases, adjusting for demographic, lifestyle, metabolic, and clinical factors. In fully adjusted models, we additionally accounted for longitudinal change (Δ) in liver biomarkers to isolate the association of baseline hepatic dysfunction with subsequent CKD risk.

RESULTS: Among 1,832 participants free of CKD at baseline (mean age of 45.9 years, 63% female), the incidence of CKD was 11%, the incidence of albuminuria was 9.7%, and the incidence of decreased estimated glomerular filtration rate (eGFR) was 2.3% over the follow-up period. Incident CKD was independently associated with higher baseline GGT (aIRR = 1.12; 95% confidence interval (CI) = 1.01-1.23), ALT (aIRR = 1.27; 95% CI = 1.04-1.50), and AST (aIRR = 1.20; 95% CI = 1.04-1.34). Associations were primarily driven by albuminuria, while we observed no significant associations for decreased eGFR. In exploratory analyses, elevated FLI was associated with incident CKD (aIRR = 1.92; 95% CI = 1.14-3.18 and albuminuria (aIRR = 2.15; 95% CI = 1.24-3.68), suggesting a broader metabolic-hepatic phenotype linked to early renal injury. Effect estimates remained materially consistent after inverse probability weighting to address differential follow-up.

CONCLUSIONS: In our study, markers of liver cell injury were associated with increased risk of CKD over six years in the African population. Our findings support a potential link between hepatic metabolic dysfunction and early renal injury, highlighting the need for integrated cardiometabolic risk assessment in sub-Saharan Africa.

PMID:42495747 | DOI:10.7189/jogh.16.04252

J Investig Med. 2026 Jul 24:10815589261473287. doi: 10.1177/10815589261473287. Online ahead of print.

ABSTRACT

Cardiovascular disease is the leading cause of death in women, who also experience worse outcomes after a cardiovascular event. Lifestyle factors such as diet, physical activity, and smoking influence the process of vascular aging. Therefore, the aim of this study was to examine the associations between lifestyle behaviors and various vascular parameters in women. A systematic search was conducted in different databases (PubMed, Scopus, Cochrane, and Web of Science) from their inception to April 2025. Standardised mean differences and their corresponding 95% confidence intervals for each outcome are presented in forest plots to assess the relationships between lifestyle behaviours and vascular parameters in women. All the statistical analyses were conducted via STATA 15 software. Twenty studies were included in the umbrella review. Flow-mediated dilation significantly improved following dietary and physical exercise interventions, particularly aerobic exercise and high-intensity interval training, whereas tobacco use was associated with a marked reduction. No significant effects were observed in terms of the relationship between physical exercise and the intima-media thickness. In contrast, various types of physical activity resulted in significant reductions in pulse wave velocity. This umbrella review demonstrates that lifestyle behaviours influence vascular parameters such as flow-mediated dilation and pulse wave velocity in women. However, further research is needed to provide more specific findings.

PMID:42495746 | DOI:10.1177/10815589261473287

J Investig Med. 2026 Jul 24:10815589261473288. doi: 10.1177/10815589261473288. Online ahead of print.

ABSTRACT

BACKGROUND: Body image disturbance (BID) affects physical and mental health, particularly in vulnerable populations like refugees. Syrian refugees in Jordan face unique challenges, including displacement and limited healthcare access, which may exacerbate BID. This study investigates BID, weight perception, and health behaviors among Syrian refugees in the Zaatari camp.

METHODS: A cross-sectional study was conducted among 487 Syrian refugees (61.4% males, 38.6% females) in the Zaatari camp between September and December 2022. Data collection involved Stunkard’s silhouettes and a health and lifestyle questionnaire. Statistical analysis was performed using IBM SPSS version 27.

RESULTS: Males had higher rates of overweight (23.8%) and obesity (8.6%) than females (15.4% and 3.1%, respectively). Among overweight participants, 71 females (14.5% of the total sample) and 109 males (22.3% of the total sample) perceived themselves as having an average weight, indicating underestimation of their weight status. Physical inactivity (26.1% females, 44.15% males) and poor dietary adherence (37.4% females, 59.3% males) were prevalent. Smoking was reported by (22.1%) of participants, primarily cigarette use among smokers (71.3%). Regarding perceived social influence, 109 overweight males (22.3%) and 69 overweight females (14.17%) reported that they believed their parents perceived them as being of average weight.

CONCLUSION: Targeted health education and culturally sensitive interventions are needed to address BID and promote healthier behaviors among Syrian refugees. Expanding education and integrating psychiatric and nutritional counseling could mitigate BID’s effects. Future research should explore sustainable, community-driven health solutions.

PMID:42495745 | DOI:10.1177/10815589261473288

J Glob Health. 2026 Jul 24;16:04208. doi: 10.7189/jogh.16.04208.

ABSTRACT

BACKGROUND: While frailty is a major public health concern in ageing populations, evidence on its relationship with hobby engagement among older adults remains limited. Existing studies have largely been limited to single-country settings and specific hobby types, with little evidence on cross-national generalisability or whether engagement frequency is associated with additional benefit.

METHODS: We conducted secondary analyses of harmonised longitudinal data from four nationally representative ageing cohorts conducted across 15 countries between 2010 and 2023: the China Health and Retirement Longitudinal Study, the English Longitudinal Study of Ageing, the US Health and Retirement Study, and the Survey of Health, Ageing and Retirement in Europe. We included participants aged ≥65 with baseline data on hobby engagement, frailty, and covariates, and who had frailty assessed at follow-up using the frailty index (FI). We used linear mixed models and random-effects meta-analyses to estimate the association between hobby engagement and FI, with average marginal effects (AMEs) and their 95% confidence intervals (CIs) reported. We further examined whether this association varied across subpopulations and whether higher engagement frequency was associated with additional benefits, and performed sensitivity analyses to assess the robustness of our findings.

RESULTS: Overall, 43,346 participants from 15 countries were included in the binary hobby-engagement analysis. The hobby engagement frequency analysis included 31,538 participants from 14 countries, as harmonisable information on engagement frequency was unavailable in ELSA. Hobby engagement was associated with lower FI (pooled AME = – 0.044; 95% CI = -0.054, -0.034; P < 0.001). Similar associations were consistently observed across age, education, smoking history, alcohol drinking, and physical activity levels, with AMEs from -0.032 to -0.058 and P-values <0.05, with no statistically significant interactions detected. Analyses by frequency suggested that hobby engagement at least monthly was associated with a significantly lower FI compared with less than once per month (pooled AME = 0.003; 95% CI = -0.006, -0.001; P = 0.028), but higher frequencies, either weekly (P > 0.05) or daily (P > 0.05), did not provide any additional benefits. Sensitivity analyses confirmed the robustness of our findings.

CONCLUSIONS: Hobby engagement was associated with lower subsequent FI among adults aged ≥65 years. The association appeared to plateau beyond a modest engagement level, suggesting that hobby engagement at an appropriate frequency may represent a generalisable and low-cost behavior associated with frailty risk.

PMID:42495743 | DOI:10.7189/jogh.16.04208

Stroke. 2026 Jul 24. doi: 10.1161/STROKEAHA.126.056127. Online ahead of print.

ABSTRACT

BACKGROUND: The effect of postthrombectomy blood pressure (BP) management on the development of acute kidney injury (AKI) in patients with acute ischemic stroke remains largely unexplored.

METHODS: This secondary analysis of the OPTIMAL-BP trial (Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control) included patients with acute ischemic stroke due to large-vessel occlusion who achieved successful endovascular thrombectomy and had a systolic BP ≥140 mm Hg. Patients were randomized to intensive (target systolic BP <140 mm Hg) or conventional (target systolic BP 140-180 mm Hg) BP management for 24 hours. The outcomes were AKI within 7 days and within 2 days, defined according to the Kidney Disease: Improving Global Outcomes criteria. In addition, we examined the associations between AKI and functional independence at 3 months, defined as a modified Rankin Scale score of 0 to 2. Multivariable logistic regression analyses were performed with adjustment for age, sex, time from stroke onset to enrollment, baseline National Institutes of Health Stroke Scale score, and baseline estimated glomerular filtration rate.

RESULTS: Of 306 patients, 19 were excluded, and 287 patients were included in this analysis (mean age, 73.2 years; 117 [40.8%] women). AKI within 7 days occurred more frequently in the intensive management group than in the conventional group (20/147 [13.6%] versus 9/140 [6.4%]; adjusted odds ratio, 2.54 [95% CI, 1.10-6.35]). Most AKI events were stage 1 (20/29 [69.0%]). Early AKI within 2 days was also more common with intensive BP management. Patients with AKI had significantly lower rates of functional independence (4/29 [13.8%] versus 126/257 [49.0%]; adjusted odds ratio, 0.19 [95% CI, 0.05-0.55]) and higher stroke-related mortality at 3 months (11/29 [37.9%] versus 8/257 [3.1%]; adjusted odds ratio, 13.8 [95% CI, 4.14-49.64]). In a sensitivity analysis with equal creatinine ascertainment, the association with 48-hour AKI did not reach statistical significance (7/76 [9.2%] versus 2/66 [3.0%]; adjusted odds ratio, 4.20 [95% CI, 0.83-32.6]), although the absolute risk difference remained directionally consistent.

CONCLUSIONS: Intensive BP lowering after successful endovascular thrombectomy was associated with a higher risk of AKI, even when kidney injury was predominantly mild. In addition, AKI was associated with worse neurological outcomes. These findings suggest that AKI is an important marker of systemic hemodynamic vulnerability after aggressive postendovascular thrombectomy BP lowering.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04205305.

PMID:42495732 | DOI:10.1161/STROKEAHA.126.056127

J Arrhythm. 2026 Jul 22;42(4):e70366. doi: 10.1002/joa3.70366. eCollection 2026 Aug.

ABSTRACT

BACKGROUND: Electrical storm (ES) is a life-threatening manifestation of ventricular tachycardia (VT) associated with highmorbidity and mortality. Catheter ablation is an established therapy for VT, but the impact of ES on ablation outcomes remains uncertain.

METHODS: We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 to compare VT ablation outcomes in patients with and without ES. PubMed, Cochrane Library, and ScienceDirect were searched from inception through January 2026. Eligible studies were comparative cohorts reporting periprocedural or long-term outcomes. Random-effects models were used to pool odds ratios (ORs), hazard ratios (HRs), and mean differences (MDs), with heterogeneity assessed using the I² statistic.

RESULTS: Six observational cohort studies including 3531 patients (1183 with ES and 2348 without ES) were included. Acute procedural endpoints, including post-ablation VT non-inducibility and residual inducible VT, were similar between groups. Periprocedural or in-hospital mortality was significantly higher in the ES group (OR 4.71, 95% CI 2.76-8.06), whereas complication rates, procedural duration, radiofrequency ablation time, and need for hemodynamic support did not differ significantly. During follow-up, ES was associated with higher all-cause mortality (OR 1.67, 95% CI 1.19-2.35) and greater VT recurrence in both arm-based (OR 1.45, 95% CI 1.11-1.91) and time-to-event analyses (HR 1.35, 95% CI 1.16-1.57).

CONCLUSIONS: VT ablation showed comparable acute procedural success and procedural safety in patients with and without ES. However, ES was associated with higher early and long-term mortality and greater VT recurrence, supporting its role as a marker of adverse prognosis.

PMID:42495726 | PMC:PMC13392503 | DOI:10.1002/joa3.70366

Front Physiol. 2026 Jul 9;17:1835845. doi: 10.3389/fphys.2026.1835845. eCollection 2026.

ABSTRACT

INTRODUCTION: The plantar fat pad plays a key role in shock absorption and heel protection. In patients with controlled type 2 diabetes mellitus (cT2DM), advanced glycation end products (AGEs) may alter the structure of plantar tissue and affect its thickness and functionality. This study used ultrasound to compare the thickness of the plantar fat pad and plantar fascia between individuals with and without cT2DM and assessed the reliability of the ultrasound measurements.

METHODS: This prospective observational cross-sectional study examined 168 participants aged ≥60 years, including 84 with cT2DM and 84 without diabetes matched by sex. The plantar tissue thickness was measured in loaded and unloaded conditions using a portable ultrasound device. Intra-observer reliability was calculated using the intraclass correlation coefficient (ICC).

RESULTS: The ultrasound measurements showed excellent intra-observer reliability (ICC = 0.86-0.99). The groups showed no statistically significant differences in thickness of the heel plantar fat pad in loaded and unloaded conditions. However, the plantar fascia thickness showed significant differences between participants with diabetes and the control group in unloaded conditions (p = 0.040) and under load (p = 0.008). Differences between sexes were observed in height (p < 0.001) and weight (p < 0.001). Differences between the cT2DM group and the control group were also found in age (p = 0.001) and height (p = 0.010). After adjustment for age and height using linear regression analysis, the association between cT2DM and the plantar fascia thickness remained significant for only loaded conditions (p = 0.034).

DISCUSSION: Ultrasound demonstrated high intra-observer reliability, and the findings suggest a possible load-dependent association between cT2DM and plantar fascia thickness in the present study.

PMID:42495703 | PMC:PMC13392932 | DOI:10.3389/fphys.2026.1835845

Front Physiol. 2026 Jul 9;17:1838821. doi: 10.3389/fphys.2026.1838821. eCollection 2026.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the effects of exercise training following the American College of Sports Medicine (ACSM) guidelines on exercise capacity, quality of life, and left ventricular function in patients with heart failure with preserved ejection fraction (HFpEF).

METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched for randomized controlled trials (RCTs) comparing exercise interventions with usual care in patients with HFpEF. Primary outcomes included exercise capacity (6-MWT, Peak VO₂, quality of life (total score of MLHFQ), LVEF, and diastolic function indicator (E/e’ ratio). The included studies were subgrouped for analysis into a high-adherence group (≥70%) and a low/uncertain-adherence group based on their compliance with the ACSM exercise recommendations.

RESULTS: A total of 19 RCT involving 1490 participants were included in this meta-analysis. Pooled results demonstrated that exercise training compliant with ACSM guidelines significantly improved exercise capacity, including the 6-MWT (SMD = 0.82, 95% CI: 0.34 to 1.30, P = 0.0008) and Peak VO₂ (SMD = 0.63, 95% CI: 0.36 to 0.91, P < 0.00001). The intervention also markedly enhanced patients’ quality of life reflected by the MLHFQ total score (SMD = -0.52, 95% CI: -0.84 to -0.20, P = 0.05). Marginally significant improvements were observed in left ventricular ejection fraction (SMD = 0.19, 95% CI: 0.00 to 0.38, P = 0.05) and E/e’ ratio (SMD = -0.14, 95% CI: -0.29 to 0.00, P = 0.05).Subgroup analyses stratified by adherence to ACSM recommendations (≥70% vs. <70%) showed that the high-adherence group achieved statistically greater improvements in 6-MWT (P = 0.03) and peak VO₂ (P = 0.003). Although the high-adherence group obtained larger effect sizes for MLHFQ scores and LVEF, the between-group differences did not reach statistical significance. No significant intergroup differences were found in other diastolic function indicators.

CONCLUSION: This study indicates that implementing the ACSM-recommended exercise regimen with high adherence can effectively improve exercise capacity, quality of life, and certain left ventricular function parameters in patients with HFpEF. Stratified analysis by ACSM adherence enriches evidence for individualized HFpEF exercise rehabilitation and guides clinical exercise strategy optimization.

PMID:42495702 | PMC:PMC13391323 | DOI:10.3389/fphys.2026.1838821

Earth Planets Space. 2026;78(1):166. doi: 10.1186/s40623-026-02497-6. Epub 2026 Jul 23.

ABSTRACT

In recent decades, the monitoring of volcanoes has been revolutionized by the launch of Earth-observing satellites and advances in thermal infrared remote sensing. These developments have revealed a wide range of thermal responses of volcanic surfaces to subsurface processes, even demonstrating that eruptions are often preceded by measurable thermal anomalies. This recognition highlights the need for robust tools to systematically detect and track such anomalies, making full use of existing satellite datasets and maximizing the value of current instruments in orbit. To address this challenge, we present the Subtle Surface Thermal Anomalies Recognizer (SSTAR), a versatile and user-friendly application designed to analyze diffuse thermal anomalies, i.e., subtle thermal unrest (~ 1 K) across large areas (several km²). SSTAR leverages data from NASA’s Terra and Aqua satellites, which host the Moderate Resolution Imaging Spectroradiometers (MODIS), and builds upon a robust statistical framework. By processing pixel-level data, SSTAR tracks the temporal evolution of diffuse thermal anomalies at specific target sites and maps their spatiotemporal distribution across extended areas. Key features include filtering tools that distinguish between long-term (years) and short-term (weeks) anomalies, as well as uncertainty quantification using bootstrapping. The application is standalone, features an interactive interface for streamlined analysis, and is accessible to newcomers to satellite-based thermal remote sensing. At the same time, specialized users can customize the underlying scripts for other specific research needs. As a demonstration, we apply SSTAR to Shishaldin volcano (Alaska), revealing the emergence of significant thermal anomalies around the summit crater and flanks prior to eruptions. We envision SSTAR as a valuable resource for studying subtle thermal unrest at active volcanoes and hydrothermal systems, where the detection of faint and spatially coherent anomalies may help identify subsurface fluid pathways. Its flexible design enables integration with additional satellite datasets, positioning SSTAR as a forward-looking tool for advancing space-based volcanic thermal monitoring. Building on this capability, daily updated diffuse thermal anomalies are provided for target volcanoes through an open web platform hosted at Geosciences Barcelona-CSIC (https://sstar.geo3bcn.csic.es/), to support surveillance agencies and expert committees in alert-level assessments.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40623-026-02497-6.

PMID:42495693 | PMC:PMC13391715 | DOI:10.1186/s40623-026-02497-6