Nevin Manimala

J Med Toxicol. 2026 Aug 3. doi: 10.1007/s13181-026-01148-2. Online ahead of print.

ABSTRACT

INTRODUCTION: Medetomidine, an alpha-2 adrenergic agonist, emerged as a U.S. drug adulterant in 2022. In May 2024, the Chicago Department of Public Health identified a cluster of opioid overdoses with unusual clinical features linked to medetomidine.

METHODS: We performed a retrospective chart review of patients presenting to three Chicago emergency departments with suspected opioid-involved overdoses during May 11-17, 2024. We classified cases as confirmed, probable, or suspected based on independent clinical criteria and laboratory screening results. We performed descriptive statistics and exploratory logistic regression to assess the association between case status and hospital outcomes.

RESULTS: Out of 181 patients presenting with suspected opioid-involved overdoses during the one-week window, 15 patients identified during the initial phase of the outbreak underwent supplemental testing, yielding 12 laboratory-confirmed cases of medetomidine exposure. In patients with confirmed medetomidine exposure (n = 12), all exhibited persistent altered mental status despite naloxone administration and demonstrated marked hypertension at presentation. Bradycardia was present in 9 patients (75%). Compared to suspected cases, confirmed or probable cases had a higher odds of experiencing asymptomatic markedly elevated blood pressure (OR = 3.2, 95% Cl = 1.5-6.9), hospital admission (OR = 3.2, 95% Cl = 1.4-7.3), and admission to intensive care (OR = 4.0, 95% Cl = 1.4-11.8).

CONCLUSION: Patients with confirmed medetomidine exposure demonstrated a toxidrome characterized by initial asymptomatic markedly elevated blood pressure, bradycardia, and a prolonged altered mental status requiring clinical stabilization. The increased likelihood of hospital and intensive care unit admission observed in this outbreak highlights the need for heightened clinical awareness and preparedness.

PMID:42547711 | DOI:10.1007/s13181-026-01148-2

J Racial Ethn Health Disparities. 2026 Aug 3. doi: 10.1007/s40615-026-03118-4. Online ahead of print.

ABSTRACT

Although school quality is associated with greater educational attainment and better health in population-wide studies, it remains unclear whether these effects are experienced similarly across racial and ethnic groups in the USA. To explore this question, we used the nationally representative National Longitudinal Study of Adolescent to Adult Health to examine the association between four individual school quality indicators (student promotion rates, teacher retention, average daily attendance, parental involvement) in Wave I (grades 7-12th, age 12-19), with adult health outcomes in Wave V (age 32-42), stratified by race/ethnicity (White, Black, Latinx). The primary outcomes were self-rated health and depressive symptoms. Regression models adjusted for baseline health, individual, family, and school characteristics. Of 10,724 participants, approximately 50% identified as female, 63% White, 21% Black, 17% Latinx. School quality indicators were not statistically associated with adult depressive symptoms for White participants. Teacher retention was unrelated to self-rated health for any group, but was associated with greater depression symptoms in adulthood for Black and Latinx participants (β = 0.42-point higher score per 1 SD increase in teacher retention, 95% CI [0.153, 0.690], p = 0.002; β = 0.23-point higher score per 1 SD increase in teacher retention, 95% CI [0.003, 0.466], p = 0.047, respectively). Some conventional school quality indicators were associated with worse adult mental health for Black and Latinx participants. The findings suggest that more research is needed to understand what aspects of school quality may best promote life course health development for minoritized groups.

PMID:42547705 | DOI:10.1007/s40615-026-03118-4

Environ Monit Assess. 2026 Aug 4;198(9):907. doi: 10.1007/s10661-026-15756-6.

ABSTRACT

Incomplete groundwater level time series are common in monitoring networks and can bias homogeneity and trend analyses if not properly addressed. This study evaluates how different gap-filling strategies influence homogeneity detection and trend inference in groundwater level records from the Middle Sebaou Basin, northern Algeria. Four imputation approaches (Seasonal Trend decomposition with interpolation (STL), Kalman Smoothing, Moving Average Imputation, and Multiple Imputation by Chained Equations (MICE)) were assessed. Homogeneity and change-point behavior were examined using Pettitt and Buishand tests, while randomness was evaluated with the Von Neumann ratio test. Trend analyses were conducted using autocorrelation-corrected Mann-Kendall, Sen’s slope estimator, and Innovative Trend Analysis. Results demonstrate that imputation choice substantially affects homogeneity outcomes and trend significance. MICE preserved temporal variability and reduced artificial change-point detection, whereas smoothing-based methods tended to dampen variability. The study highlights the necessity of selecting imputation methods consistent with groundwater system dynamics and provides a transferable framework for trend analysis in data-scarce aquifers.

PMID:42547670 | DOI:10.1007/s10661-026-15756-6

J Neurol. 2026 Aug 3;273(8):503. doi: 10.1007/s00415-026-14048-w.

ABSTRACT

BACKGROUND: There is a global epidemic of obesity and in this context, the development of novel agents for weight loss has been timely. There have been emerging reports of peripheral nerve complications and this study aimed to systematically review all reported cases associated with medications used for weight loss.

METHODS: A systematic search of PubMed, Embase and CINAHL databases from inception to 30 June 2026 was performed to identify studies that report new-onset or worsening peripheral nerve complications. Independent screening was conducted by two authors. Data including demographics, medications, weight-loss parameters, neurological presentation and investigations. Descriptive statistics were used.

RESULTS: There were 19 studies, comprising 31 cases and one cohort (103 individuals) identified. All bar one were published from 2024. Of 31 individual cases median weight loss achieved was 20.4 kg (IQR 15.2) or 21.8% (IQR 16.4) of starting body weight. Median rate of weight loss was 3.7 kg/month (IQR 1.7), with symptom onset at 150 days (IQR 135). Semaglutide or tirzepatide were implicated in the majority (83%), and 67% had pre-diabetes/diabetes. Neurological presentations included fibular neuropathy (n = 10), lumbosacral radiculoplexus neuropathy (n = 9) and distal symmetric polyneuropathy (n = 7). Electrodiagnostic and imaging data were supportive of diagnosis.

CONCLUSIONS: There is a recent increase in peripheral nerve disorders associated with medical treatment of diabetes and obesity. To reduce the risk, it is recommended to ensure adequate nutritional status and avoid ultrarapid HbA1c and weight loss. Prospective studies are needed to determine incidence and confirm safe rates of weight loss and glycemic correction.

PMID:42547656 | DOI:10.1007/s00415-026-14048-w

Neurosurg Rev. 2026 Aug 4;49(1):509. doi: 10.1007/s10143-026-04436-1.

ABSTRACT

BACKGROUND: Brainstem cavernous malformations (BCMs) are high-risk vascular lesions characterized by a significant tendency for recurrent hemorrhage and devastating neurological morbidity. While open microsurgery is the traditional gold standard, purely endoscopic approaches have emerged as minimally invasive alternatives. This study aims to systematically review the surgical effectiveness, safety, and clinical outcomes of purely endoscopic BCM resection.

METHODS: Following PRISMA guidelines, a systematic search was conducted across Web of Science, MEDLINE, Scopus, and Embase for all eligible studies published from database inception until October 21, 2025. Data on patient demographics, lesion characteristics, surgical corridors, extent of resection (EOR), and complications were extracted. Risk of bias was assessed using the Joanna Briggs Institute tool. Descriptive statistical pooling and data stratification by surgical approach corridors were performed using R software to calculate pooled clinical frequencies and symptom recovery rates.

RESULTS: Twenty-six studies (22 case reports, 4 case series) involving 37 patients were included. The cohort was predominantly female (64%, n = 23 of 36 with documented gender), with a mean age of 41 years. Lesions were primarily located in the pons (76%, n = 28). The endoscopic endonasal transclival approach (EEA-TC) was the most frequent corridor (75.7%, n = 28), followed by various transcranial endoscopic routes. Preoperative diffusion tensor imaging (DTI) was utilized in a subset of cases, consistently demonstrating corticospinal tract displacement. Gross total resection (GTR) was achieved in 89.2% of the cohort (n = 33). Postoperative neurological improvement was documented in 91.9% of patients (n = 34), with no instances of re-bleeding during follow-up. The most significant complication was postoperative cerebrospinal fluid (CSF) leakage, occurring in 16.2% of patients (n = 6), with revision surgery required in 8.1% (n = 3). Other complications included transient neurological worsening and aseptic meningitis.

CONCLUSION: Purely endoscopic resection of BCMs is a technically feasible and effective treatment modality, particularly for ventral and ventromedial pontine lesions. It offers high GTR rates and favorable neurological recovery while avoiding the brain retraction associated with open microsurgery. However, the risk of CSF leakage remains a primary limitation of the endonasal corridor. Future prospective, multi-center registries are necessary to further define patient selection criteria and long-term comparative outcomes against traditional microsurgical standards.

PMID:42547654 | DOI:10.1007/s10143-026-04436-1

Environ Monit Assess. 2026 Aug 3;198(9):906. doi: 10.1007/s10661-026-15681-8.

ABSTRACT

Water quality in regulated tropical reservoirs is shaped by the interplay of seasonal hydrology, spatial habitat heterogeneity, land use, and climate variability, yet the relative importance of these drivers remains poorly quantified in African river basins. We aimed to partition the variance in water quality among temporal, spatial, land-use, and climate drivers across the Kainji-Jebba reservoir cascade in Nigeria and to identify sentinel parameters capable of consistently and timely detecting water-quality change. Monthly water-quality surveys were conducted at six sites spanning two dams and three habitat types (riverine, ecotonal, and lacustrine) from April 2024 to March 2025 (n = 72 samples). A modified National Sanitation Foundation Water Quality Index (WQI) was calculated for each sample. Variance partitioning using partial redundancy analysis (RDA), exploratory Granger causality testing, and six complementary changepoint detection methods were applied to disentangle the relative contributions of space, time, land use, and climate. Temporal variation (season and month) explained 28.3% of the variance in water quality, whereas spatial factors accounted for 1.8% and land-use effects for 0.4%. These results suggest that seasonal hydrological dynamics were the dominant structuring force within the study period, although the limited spatial extent of sampling (six sites across two reservoirs) should be considered when interpreting the comparatively weak spatial signal. After Benjamini-Hochberg false-discovery-rate correction, no climate-water-quality relationships were statistically significant across 480 stratified Granger causality tests; given the exploratory scope of the analysis and the 1-year dataset, this null result is treated as hypothesis-generating rather than conclusive. WQI, electrical conductivity (EC), and relative humidity (RH) showed the highest changepoint consensus detection rates (71.4% each) and are proposed as sentinel parameters for water-quality monitoring, although the role of RH warrants further investigation before operational adoption. These findings suggest that monitoring programmes in regulated tropical reservoir cascades may benefit from prioritising targeted seasonal windows, the wet-season runoff peak (June-July) and the black flood period (January-February), rather than expanding spatial coverage, pending validation across longer time series. The integrated analytical framework, combining WQI, variance partitioning, exploratory Granger causality, and multi-method changepoint detection, offers a transferable template for other data-poor tropical river systems where monitoring resources must be allocated efficiently.

PMID:42547643 | DOI:10.1007/s10661-026-15681-8

Surg Endosc. 2026 Aug 3. doi: 10.1007/s00464-026-13194-6. Online ahead of print.

ABSTRACT

BACKGROUND: Laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) is technically demanding. We developed a quantitative indocyanine green fluorescence imaging protocol (q-ICG) to assist LDPPHR and evaluated its clinical utility.

METHODS: We retrospectively analyzed 72 patients who underwent LDPPHR between 2019 and 2025. Patients were divided into a q-ICG group (n = 35) and a non-q-ICG group (n = 37). Baseline characteristics and perioperative outcomes were compared between groups.

RESULTS: Baseline characteristics were generally comparable between groups. All procedures were attempted laparoscopically, one required conversion to open surgery, and no 90-day mortality occurred. No Grade C postoperative pancreatic fistula (POPF) occurred. Compared with the non-q-ICG group, the q-ICG group had shorter operative time (P = 0.025), postoperative hospital stays (P < 0.001), and less intraoperative blood loss (P < 0.001). Bile leakage (2.9 vs. 27.0%; P = 0.007) and Grade B POPF rate (2.9 vs. 24.3%; P = 0.014) were also lower in the q-ICG group. The overall POPF rate was numerically lower in the q-ICG group, but this difference did not reach statistical significance (25.7 vs. 45.9%; P = 0.090).

CONCLUSION: q-ICG-assisted LDPPHR was feasible and was associated with improved perioperative efficiency and selected postoperative outcomes. Given the limited sample size and non-randomized design, prospective studies with standardized protocols are warranted to validate these findings.

PMID:42547636 | DOI:10.1007/s00464-026-13194-6

Eur Spine J. 2026 Aug 4. doi: 10.1007/s00586-026-10218-6. Online ahead of print.

ABSTRACT

PURPOSE: Prolonged smartphone use is frequently associated with poor neck posture and the development of Text Neck Syndrome (TNS). This study aimed to compare manual dexterity between university students with and without TNS and to investigate its relationship with neck disability and smartphone use. We hypothesized that university students with TNS would demonstrate significantly lower manual dexterity compared to those without TNS.

METHODS: This cross-sectional study included 280 university students from a public university. Manual dexterity was assessed using the Purdue Pegboard Test (PPT), while neck disability, smartphone addiction, and pain intensity were evaluated using the Neck Disability Index, Smartphone Addiction Scale-Short Version (SAS-SV), and Visual Analogue Scale (VAS), respectively. Group comparisons, correlation analyses, and multivariate regression were performed to examine the relationships between TNS and manual dexterity.

RESULTS: Participants with TNS demonstrated significantly higher neck disability scores compared to those without TNS (p<0.001). Significant impairments were observed only in non-dominant hand dexterity (p=0.025), whereas no significant differences were found in other dexterity parameters (p>0.05). Smartphone usage duration showed statistically significant weak negative correlations with manual dexterity parameters (p<0.05). After adjusting for age, sex, and smartphone usage duration, TNS was independently associated with reduced non-dominant hand dexterity (β=-0.138, p=0.020).

CONCLUSION: TNS is independently associated with non-dominant hand dexterity, particularly in non-dominant hand performance. Although the effect size was small (Cohen’s d = 0.274), these findings provide preliminary evidence of an association between TNS and reduced non-dominant hand dexterity.

PMID:42547610 | DOI:10.1007/s00586-026-10218-6

Diabetologia. 2026 Aug 3. doi: 10.1007/s00125-026-06821-3. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: Diabetic nephropathy is a leading cause of end-stage renal disease, with podocyte loss being a critical event in its progression. However, the dominant molecular mechanism driving podocyte loss remains elusive, hindering targeted therapy. We aimed to identify the key pathways of podocyte failure in human diabetic nephropathy and investigate metformin’s therapeutic potential.

METHODS: We employed an integrative multi-omics approach, including single-nucleus RNA-seq (snRNA-seq) of 156,043 human kidney nuclei from individuals with diabetic nephropathy and healthy control individuals, db/db mouse models of diabetic nephropathy, spatial metabolomics, in vitro podocyte cultures, and targeted urinary metabolomics in individuals with diabetic nephropathy and healthy control individuals.

RESULTS: snRNA-seq identified ferroptosis and fatty acid metabolic dysregulation as the most enriched pathways within podocytes, mechanistically linked to the MAPK14-solute carrier family 7 member 11 (SLC7A11)-glutathione peroxidase 4 (GPX4) axis. In murine diabetic nephropathy models and in vitro, metformin directly inhibited this MAPK14-SLC7A11-GPX4 axis, suppressed podocyte ferroptosis (including restoration of GPX4 and SLC7A11 expression and reduction of p-p38 and lipid peroxidation) and restored compartment-specific renal lipid accumulation as shown by spatial metabolomics. Clinically, we identified and validated a urinary fatty acid signature, with palmitoylcarnitine as a key biomarker (AUC 0.974, calculated from receiver operating characteristic curves), correlating with disease indices including blood glucose, eGFR, serum creatinine and blood urea nitrogen.

CONCLUSIONS/INTERPRETATION: Our study reveals podocyte ferroptosis to be a central pathogenic event in human diabetic nephropathy, repositioning metformin as a direct ferroptosis inhibitor that preserves podocyte integrity via the MAPK14-SLC7A11-GPX4 axis. Furthermore, we provide a high-performance urinary biomarker, offering a direct translational link toward targeted anti-ferroptosis therapies and non-invasive diagnostics for diabetic nephropathy.

PMID:42547585 | DOI:10.1007/s00125-026-06821-3

BJC Rep. 2026 Aug 3;4(1):39. doi: 10.1038/s44276-026-00237-7.

ABSTRACT

BACKGROUND: Recurrent/Metastatic (R/M) ACC is aggressive with few effective treatment options. The role of surgery after chemotherapy remains unclear. Moreover, prognostic factors in R/M ACC are not well defined.

METHODS: R/M ACC patients treated at Princess Margaret Cancer Centre (2002-2019) were retrospectively reviewed. Descriptive statistics were used to summarize clinical characteristics. OS was estimated by Kaplan-Meier method. Cox regression analysis was used to compute prognostic variables.

RESULTS: Among 83 patients with metastatic ACC [36.2% de novo and 63.8% recurrent], 49 (59.0%) received systemic therapy (ST) with which 15 (30.6%) had a partial response (PR) and 8 (16.3%) had stable disease (SD). 9 (18.4%) had surgery after ST (combined therapy group); 6 (66.6%) were rendered disease free with surgery. The median OS was 26 months (20.4-40.5) for entire cohort (f/up 18 months). OS for patients having combined therapy was 31.2 months (21.4-63.3) vs 24.7 months (17.7-35.2), p = 0.48 for patients receiving systemic therapy alone. Being disease free after surgery was associated with better OS [39.6 (24.8-not reached), vs 23.5 months (21.4-not reached), p = 0.02].

CONCLUSIONS: Selected patients with R/M ACC may achieve long term survival with surgery after chemotherapy. These data highlight the potential role for multimodal therapy in managing such patients.

PMID:42547523 | DOI:10.1038/s44276-026-00237-7