Nevin Manimala

Osteoporos Int. 2026 Feb 2. doi: 10.1007/s00198-025-07834-1. Online ahead of print.

ABSTRACT

We compared two methods to describe adherence to osteoporotic drugs after fragility fractures. While both similarly predicted refracture risk, a novel approach using sequence analysis provided a clearer picture of patient behavior, helping clinicians better understand and address adherence issues in osteoporosis care.

BACKGROUND: Fragility fractures are common among individuals with osteoporosis, causing significant morbidity, mortality, and healthcare costs. Although effective pharmacological treatments exist, underdiagnosis and poor treatment adherence remain pervasive in clinical practice.

METHODS: In order to select an effective methodology to describe and visually represent treatment adherence and correctly stratify patients with fragility fractures according to their adherence patterns, a conventional method using average PDC was compared to an alternative method, given by the state sequence analysis (SSA) and clustering procedure. Data on patients aged 50 or older who experienced fragility fractures between 2012 and 2017 were retrieved from healthcare utilization databases in Lombardy, Italy. Fine and Gray’s model was employed to analyze the association between adherence (calculated by conventional and alternative methods) and refracture risk. Finally, the discriminatory power to predict outcomes was calculated for each approach.

RESULTS: Out of the 8976 patients included in this observational study, four different adherence groups were considered using the conventional method (very poor, poor, intermediate, and optimal), while three clusters (non-adherence, short-term adherence, and long-term adherence) were obtained from the SSA. Compared with non-adherent patients, those with long-term adherence were found to have a significantly reduced risk of combined death and refracture with both methods. Regarding discriminatory performance, the two approaches showed similar AUC, 0.646 and 0.644 for conventional and alternative methods, respectively.

CONCLUSIONS: Based on the SSA and cluster analysis, the alternative method does not significantly modify the prediction of the refracture risk but enhances the description and visualization of the adherence patterns.

PMID:41622332 | DOI:10.1007/s00198-025-07834-1

Sci Rep. 2026 Feb 1. doi: 10.1038/s41598-025-31832-2. Online ahead of print.

ABSTRACT

Heat warning systems represent a critical health adaptation strategy under global boiling. This study evaluates the appropriateness of the existing criteria of heat warning categories, which were established based on climatology. The objectives were (1) to evaluate the association of the daily maximum temperature (Tmax) and multiple health outcomes (including emergency visits, hospitalization cases, and mortality of heat-related illness (HRI), cardiovascular, respiratory, diabetes, and renal diseases) considering both the lag and cumulative effects, and (2) to identify vulnerable groups (considering their demographic, occupation, geographic, and health status) and areas of heat-health impacts. Weather and health records in Taiwan from May to October from 2000 to 2019 were analyzed using generalized additive models. The results show that HRI was the most sensitive health outcome, and the relative risk (RR) was 1.81 (confidence interval (CI): 1.51 – 2.18) and 2.99 (CI: 1.99 – 4.49) for emergency visits and hospitalizations, respectively, when Tmax was ≥ 34 °C. The corresponding RRs were 2.00 (CI: 1.67 – 2.39) and 2.39 (CI: 1.44 – 3.95) when Tmax was ≥ 32 and ≥ 31 °C for three consecutive days, respectively. The morbidity risks of cardiovascular, respiratory, diabetes, and renal diseases all increased at different temperature thresholds. Significant associations between Tmax and health outcomes occurred at thresholds lower than the current warning thresholds, indicating the need for revision. Both lag and cumulative effects need to be considered in heat-health warning systems. People with hypertension, hyperglycemia, or hyperlipidemia were found to be more vulnerable, as they had higher RRs for pneumonia, COPD, and stroke than the general population. Among different occupations, farmers were found to be most vulnerable. This study demonstrates a methodology considering both lag and cumulative effects that can be applied in other countries to assist in the establishment of evidence-based heat-health warning systems.

PMID:41622278 | DOI:10.1038/s41598-025-31832-2

Eur Arch Otorhinolaryngol. 2026 Feb 1. doi: 10.1007/s00405-025-09958-w. Online ahead of print.

ABSTRACT

BACKGROUND: Cerebrospinal fluid (CSF) rhinorrhea is a clinically significant condition resulting from abnormal communication between the subarachnoid space and the nasal cavity. Although multiple surgical techniques have been developed, their long-term outcomes remain inadequately defined. Our systematic review and meta-analysis aimed to assess the long-term efficacy and safety of surgical interventions used to manage CSF rhinorrhea.

METHODS: A comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted from database inception to March 2025. Studies evaluating any surgical interventions for managing CSF rhinorrhea and following the patients for at least one year were included. Our study outcomes were success, recurrence, and complication rates. All statistical analyses were performed using STATA 18 BE.

RESULTS: Our review encompassed 114 studies involving 4187 patients with CSF rhinorrhea. The endoscopic repair demonstrated a high primary success rate, estimated at 93% (1-2 years), 92% (2-5 years), and 91% (more than 5 years). Recurrence after endoscopic repair remained low, varying from 7% to 11%. Complications were uncommon, with meningitis reported in 1-2% of cases, sinusitis estimated at 1%, and headache from 1 to 3%. The craniotomy approach achieved a high primary success rate, reaching 95% at 1-2 years, then dropping to 75% at 2-5 years, and increasing again to 98% at > 5 years. Additionally, the risk of recurrence (5-22%) and complications were generally higher after craniotomy (3-6%).

CONCLUSION: Endoscopic repair demonstrated excellent long-term outcomes with minimal morbidity, supporting its role as the standard approach for most CSF rhinorrhea cases. Although craniotomy carries a higher risk of recurrence and complications, it remains appropriate for complex or frontal defects. Surgical management should be individualized according to defect site, CSF flow, and patient-specific factors to optimize outcomes. Nevertheless, we have some limitations as most included studies were observational and retrospective, and there was heterogeneity in study design and outcome reporting.

PMID:41622274 | DOI:10.1007/s00405-025-09958-w

Eur Arch Otorhinolaryngol. 2026 Feb 1. doi: 10.1007/s00405-026-10011-7. Online ahead of print.

ABSTRACT

OBJECTIVE: Ménière’s disease (MD) is characterized by episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness. As vertigo is a cardinal symptom, evaluating vestibular function is essential for disease assessment. However, the relationship between vestibular function and the degree or location of endolymphatic hydrops (EH), as well as the stages of Ménière’s disease (MD), remains unclear.

METHODS: Patients diagnosed with definite Unilateral Ménière’s disease (UMD) underwent a comprehensive vestibular function evaluation, including cervical and ocular vestibular evoked myogenic potentials (cVEMP, oVEMP), video head impulse test (vHIT), caloric test, and sensory organization test (SOT). Inner ear gadolinium-enhanced MRI (Gd-MRI) was performed to the assessment of endolymphatic hydrops(EH).Vestibular function parameters were compared across MD stages and EH categories. Fisher’s exact test was used for statistical analysis.

RESULTS: cVEMP and oVEMP non-response rates increased significantly with advancing MD stage and were significantly higher in Stages III-IV compared to Stages I-II. vHIT abnormalities were predominantly observed in Stage IV. Caloric test abnormalities were significantly lower in Stage I but showed no significant differences among later stages(II, III, IV). No significant differences were found in SOT-derived balance function (BF) or vestibular function (VF) across MD stages. Furthermore, there was no linear correlation between vestibular test results and overall endolymphatic hydrops level(EHL). Similarly, vestibular dysfunction rates did not differ significantly among patients with isolated cochlear, isolated vestibular, or both cochlear and vestibular EH.

CONCLUSION: Vestibular function changes in UMD are stage-dependent, with early involvement of otolithic and low-frequency semicircular canal function, while high-frequency canal dysfunction appears later. However, these changes do not consistently correlate with EH severity or anatomical distribution. Central compensation and functional-structural mismatch may underlie these discrepancies. Multimodal and longitudinal approaches are needed to better understand vestibular pathophysiology in MD.

PMID:41622266 | DOI:10.1007/s00405-026-10011-7

BMC Sports Sci Med Rehabil. 2026 Feb 2. doi: 10.1186/s13102-026-01560-9. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this randomized controlled trial was to determine the effects of a four-week running-based high-intensity interval training (HIIT) intervention on the reactive strength index (RSI) and motor abilities in youth football players. In this context, the contributions of the running-based HIIT protocol HIIT protocol, implemented in addition to regular football training, were evaluated on performance indicators such as speed, back strength, change of direction (COD), and countermovement jump (CMJ). This study aims to contribute to the development of scientifically grounded training programs to support performance improvement in youth football players.

METHODS: A quantitative research design was employed in this study, specifically a randomized pretest-posttest controlled experimental design. Twenty male youth football players, aged 11-13 years, who voluntarily participated in the study were randomly allocated to either the experimental group (EG; n = 10) or the control group (CON; n = 10). The EG participated in a running-based HIIT program three times per week for four weeks by replacing a low-to-moderate-intensity technical-tactical segment of their regular football training, whereas the CON continued with only regular football training during this period without any additional training volume. The players underwent RSI, 10 m, 20 m, and 30 m sprint tests, back strength tests, the Illinois Agility Test, and CMJ tests both before the training sessions and at the end of the four-week intervention.

RESULTS: According to the repeated-measures ANOVA results, pretest values did not differ significantly between the groups (p > .05). Over the 4-week period, significant improvements with large effect sizes were observed in RSI, sprint performance (10, 20, 30 m), back strength, COD, and CMJ tests (p < .05; ηp² = 0.29-0.55). Significant group × time interactions were also detected for all variables, again with large effect sizes (p < .05; ηp² = 0.20-0.30), indicating greater improvements in the EG compared to the CON. However, despite these favourable within-group changes, between-group post-test comparisons did not reach statistical significance.

CONCLUSIONS: This study revealed that a 4-week HIIT intervention applied to youth male football players had positive effects on the RSI and motor abilities, as evidenced by large within-group improvements and significant group × time interactions, despite the absence of statistically significant between-group post-test differences. These findings suggest that HIIT protocols should be integrated into training programs as an effective strategy to improve explosive strength, COD, and overall functional performance in young athletes.

TRIAL REGISTRATION: This randomized controlled trial was retrospectively registered with ISRCTN (ISRCTN45188963) on 16 July 2025 due to administrative delays during ethics approval and registry processing.

PMID:41622262 | DOI:10.1186/s13102-026-01560-9

Sci Rep. 2026 Feb 1. doi: 10.1038/s41598-026-35544-z. Online ahead of print.

ABSTRACT

The United Nations (UN)’s 2030 Agenda for 17 Global Sustainable Development Goals (SDGs) is a critical framework for advancing environmental sustainability and human development. Official Development Assistance (ODA) serves as a key source of financing for the SDGs, particularly in developing countries. This study investigates the impact of ODA on various aspects of SDG performance, emphasizing the need for a holistic approach that accounts for the diverse needs, uneven progress, and spatial interdependencies among UN member states between 2000 and 2021. Our findings show that ODA statistically significantly supports basic goals such as SDG 1 (no poverty) and SDG 2 (zero hunger), but has limited, or in some cases negative, effects on other goals, including SDG 8 (decent work), SDG 9 (industry and innovation), SDG 15 (life on land), and SDG 16 (peace and institutions). The results also reveal substantial heterogeneity across country groups, underscoring the need for ODA to broaden its focus to underfunded areas and adopt more context-specific strategies that recognize spatial dynamics, manage trade-offs, and prioritize SDG pathways aligned with country-specific capacities and priorities.

PMID:41622259 | DOI:10.1038/s41598-026-35544-z

Nat Commun. 2026 Feb 2. doi: 10.1038/s41467-026-68732-6. Online ahead of print.

ABSTRACT

Accurately predicting disease progression remains a major challenge in Alzheimer’s disease (AD). Here we show that a biomarker-integrated prognostic staging system can stratify progression risk across the disease course by jointly incorporating cognitive status, established risk factors, plasma biomarkers, and neuroimaging measures. In the K-ROAD cohort (N = 1,263), the dominant prognostic contributors varied by clinical context-GFAP in cognitively unimpaired individuals, hippocampal volume in mild cognitive impairment, and age in dementia-while plasma phosphorylated tau-217 provided consistent secondary prognostic information across stages. Outcome-specific staging captured clinically meaningful gradients of progression risk and informed construction of a unified six-stage framework (Stage 0-IVB) with distinct inflection points of accelerated decline. External validation in the ADNI cohort (N = 290) demonstrated consistent patterns of worsening prognosis, particularly in early and intermediate stages. This system provides a clinically interpretable approach to risk stratification and may serve as an exploratory framework for biomarker-integrated prognostic stratification in AD.

PMID:41622252 | DOI:10.1038/s41467-026-68732-6

Sci Rep. 2026 Feb 1. doi: 10.1038/s41598-025-23977-x. Online ahead of print.

ABSTRACT

Chilli, as a vegetable and spice, is an important constituent of Indian food. The major constraint that hampers chilli production is Chilli leaf curl disease (ChiLCD). It often leads to heavy yield losses as a result of which the farmers do not prefer chilli cultivation. Therefore, the present investigation has been undertaken to screen and evaluate chilli germplasm conserved in National genebank of India and identify lines resistant to ChiLCD. We screened 500 chilli accessions for four consecutive years (2021-2024) to identify the resistant lines. In the 2021 screening, 16 accessions were found highly resistant, 40 resistant, 33 moderately susceptible, 23 susceptible, and 388 highly susceptible. Accessions showing symptoms of Chilli leaf curl disease in each season were discarded, whereas resistant accessions were retained for repeated screening. From the advanced screening and validation during 2022-2024, some promising accessions were identified as EC771555, IC643853, EC772795, EC787119, EC769427, and IC607252 which maintained low disease incidence (≤ 5% PDI) and severity score one. Another 28 accessions were found resistant to ChiLCD. Quantitative PCR also confirmed very low viral titres (0.1-0.3-fold) in resistance accessions. The identified promising accessions can be used as donors in chilli improvement programs to develop resilient varieties that express good yield and quality under high disease pressure, reducing reliance on chemical controls. They also offer genetic resources for studying resistance mechanisms and molecular markers development for sustainable agriculture which leads to reduced production costs.

PMID:41622247 | DOI:10.1038/s41598-025-23977-x

Acta Epileptol. 2026 Feb 2;8(1):3. doi: 10.1186/s42494-025-00236-0.

ABSTRACT

BACKGROUND: Diagnosing functional seizures can be challenging, and the semiology may vary between pediatric and adult age groups. Identifying those variabilities may be of diagnostic value. This study aimed to compare the semiological characteristics of functional seizures in both the pediatric and adult populations.

METHODS: All video ictal electroencephalogram (EEG) recordings at Cairo University Epilepsy Unit (CUEU) from January 2021 to December 2023 were retrospectively reviewed for adults or children with functional seizures. Detailed semiological characteristics of the ictal events were analyzed independently by at least two epileptologists. Each event was listed under the classification system as either major motor, minor motor, dialeptic, non-epileptic aura, or mixed type.

RESULTS: A total of 54 pediatric and 65 adult video ictal EEG studies were evaluated. Minor motor type was the most common clinical semiology among adult and pediatric groups, yet more prevalent in pediatric than adult patients (61.1% vs. 40.0%, P = 0.022). In comparison, the major motor events were significantly higher in adults than in pediatrics (25 event [38.5%] vs. 9 events [16.7%], P = 0.009). No statistically significant differences were found between pediatrics and adults regarding pelvic thrusting (3.7% vs. 9.2%), back arching (7.4% vs. 4.6%), clenched fists (9.3% vs. 15.4%), ictal pain (13.0% vs. 18.5%), ictal fear (5.6% vs. 3.1%), or ictal crying (7.4% vs. 4.6%), respectively.

CONCLUSIONS: The semiology of functional seizures varies between pediatric and adult age groups; minor motor events predominate in pediatric patients, while the major motor type is more common in adults.

PMID:41622241 | DOI:10.1186/s42494-025-00236-0

BMC Glob Public Health. 2026 Feb 2;4(1):12. doi: 10.1186/s44263-026-00243-4.

ABSTRACT

BACKGROUND: Group antenatal care (G-ANC) is an emerging service delivery model that integrates clinical assessments, health education, and peer support within group sessions. While evidence supports its effectiveness in pilot settings, less is known about its feasibility and impact when integrated into routine public health systems in low-resource settings.

METHODS: We conducted a registry-based observational cohort study (January 2023-November 2024) across six government facilities in Geita Region, Tanzania (two hospitals, two health centers, and two dispensaries). Pregnant women with gestational age ≥ 20 weeks were enrolled into G-ANC cohorts. Data was abstracted from routine antenatal care (ANC), labor and delivery, and cohort records. Descriptive statistics summarized ANC attendance and service uptake; associations with adverse birth outcomes were examined using a binomial-logit generalized linear mixed model (GLMM).

RESULTS: A total of 5936 women in 149 cohorts were enrolled. Overall, 93.9% completed ≥ 4 ANC visits (ANC4 +); 76.1% received ≥ 3 doses of malaria intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp3 +); 92.6% received iron-folate supplementation; and 96.2% delivered in health facilities. Only 8.5% initiated ANC in the first trimester, consistent with the ≥ 20-week threshold for G-ANC entry. In multivariable GLMM, completing ≥ 4 ANC visits was associated with lower odds of adverse birth outcomes (adjusted odds ratio [aOR] = 0.122, 95% CI 0.06-0.24; p < 0.001). Attendance at hospital-level facilities was associated with higher odds (aOR = 2.91, 95% CI 1.37-6.18; p = 0.005), likely reflecting referral of high-risk pregnancies. First-trimester initiation showed no significant association (aOR = 1.04, 95% CI 0.27-3.93).

CONCLUSIONS: In routine settings, G-ANC was associated with high ANC attendance, strong uptake of essential interventions, and positive birth outcomes. Integration appears feasible within public systems, though adaptations are needed to promote earlier initiation and alignment with the WHO eight-contact model. Further research should examine costs, feasibility, scalability, and long-term impact.

PMID:41622235 | DOI:10.1186/s44263-026-00243-4