Nevin Manimala

AJPM Focus. 2026 May 22;5(5):100517. doi: 10.1016/j.focus.2026.100517. eCollection 2026 Oct.

ABSTRACT

INTRODUCTION: Catechins, a type of flavonoid and a major component of green tea, are expected to serve as a complementary preventive measure against COVID-19. However, to date, clinical evidence has not been established. This study aimed to evaluate the preventive effects of green tea gargling against COVID-19 in a multicenter RCT.

METHODS: A total of 1,012 adults aged 18-70 years who provided written informed consent and met the eligibility criteria were randomly assigned to either a green tea or a water gargling group. Participants gargled 3 times a day for 12 weeks from December 2023 to February 2025 using commercially available green tea powder according to the package instructions. Background characteristics, incidence of COVID-19, and other preventive measures were assessed using self-administered questionnaires. Group differences were analyzed using multivariate logistic regression and Cox proportional hazards models.

RESULTS: The incidence of COVID-19 in the full analysis population was 5.4% (27 of 503) in the green tea gargling group and 5.4% (27 of 500) in the water gargling group. In the per-protocol set population with a gargling adherence ≥80%, the incidence was 4.4% (17 of 386) in the green tea group and 5.7% (23 of 403) in the water group. Multivariate logistic regression adjusted for preventive measures showed an OR of 0.818 (95% CI=0.422, 1.556), and Cox proportional hazards analysis yielded a hazard ratio of 0.824 (95% CI=0.439, 1.546). Pneumonia and hospitalization occurred in 1 participant in the water group. No gargling-related adverse events were observed during the 12-week intervention.

CONCLUSIONS: In the per-protocol set population, green tea gargling showed a 22.8% relative reduction in COVID-19 incidence compared with water gargling, although the difference was not statistically significant. Further studies are needed to confirm the preventive effects of optimizing gargling frequency and catechin concentration.

PMID:42548902 | PMC:PMC13430259 | DOI:10.1016/j.focus.2026.100517

Iran J Public Health. 2025 Dec;54(12):2608-2622. doi: 10.18502/ijph.v54i12.20814.

ABSTRACT

BACKGROUND: Parasitic diseases, including food-borne and vector-borne infections, remain a significant burden, especially with the increased migration from underdeveloped to developed regions. We aimed to estimate the prevalence of parasitic infections among migrant workers in the Middle East.

METHODS: This systematic review and meta-analysis followed the PRISMA protocol. A search was conducted across major databases (Scopus, PubMed, Web of Science, Google Scholar) for studies on parasitic infections among migrant workers in the Middle East from April 1, 1993, to November 15, 2024. Data were analyzed using Comprehensive Meta-Analysis software (CMA), and 25 studies were included.

RESULTS: The overall prevalence of parasitic infections in this study was estimated at 16.5%. (95% CI 2.7 to 58.5%). The prevalence based on microscopic diagnostic methods was 19.4% (95% CI 13.5% to 27.5%), and molecular diagnosis was 15.2% (95% CI 6.4% to 32.4%). The P-value in Egger’s test was 0.5343, indicating no statistically significant evidence of publication bias. The pooled prevalence varied across countries: 34.7% in Iraq (n = 1 study), 19.6% in Saudi Arabia (n = 12 studies), 16.8% in the UAE (n = 4 studies), 13.2% in Qatar (n = 7 studies), and 4.2% in Kuwait (n = 1 study).

CONCLUSION: The prevalence of parasitic infections among migrant workers in the Middle East was estimated at 16.5%. Given this rate, routine mandatory screening is recommended along with targeted health education to reduce exposure risk and improve health. These findings highlight the public health concern that infected migrant workers may contribute to the spread of parasitic diseases in destination countries.

PMID:42548888 | PMC:PMC13429956 | DOI:10.18502/ijph.v54i12.20814

Iran J Public Health. 2025 Dec;54(12):2595-2607. doi: 10.18502/ijph.v54i12.20813.

ABSTRACT

BACKGROUND: We aimed to evaluate the efficacy of preventative strategies targeted at lowering these injections.

METHODS: A comprehensive assessment of electronic databases (PubMed, Web of Science, and Cochrane Library) was carried out to discover relevant papers published from 2013-2024. Inclusion criteria were randomised controlled trials, quasi-experimental studies, and observational research on therapy for intravenous injection and catheter-related infections. The primary outcome examined was the incidence or prevalence of infections caused by intravenous injections. According to preliminary data from 31 studies, preventive interventions dramatically reduce the incidence of intravenous injection and catheter-related infections. Subgroup analyses indicate effectiveness differences depending on intervention type and patient variables.

RESULTS: Chlorhexidine-based therapies can lower infection risk by 29% (Risk Ratio: 0.71), but taurolidine provides a statistically significant 53% benefit (RR = 0.47). The total risk ratio varies from 0.71 to 0.84, indicating a 29% reduction in infection rates in nations having Needlestick Safety and Prevention Acts. In contrast, the absence of such regulation may result in a 6% to 8% rise in infection rates (RR = 0.96).

CONCLUSION: Preventative interventions, notably chlorhexidine and taurolidine, can considerably reduce the risk of intravenous injection and catheter-related infections. Chlorhexidine may lower the risk of infection by 29%, whereas taurolidine reduces it by 53%. Nations with Needlestick Safety and Prevention Acts may expect a one-third reduction in infection rates. Conversely, the absence of such laws may result in a significant rise in infection rates.

PMID:42548866 | PMC:PMC13429968 | DOI:10.18502/ijph.v54i12.20813

Front Cardiovasc Med. 2026 Jul 20;13:1893975. doi: 10.3389/fcvm.2026.1893975. eCollection 2026.

ABSTRACT

OBJECTIVE: Although triple therapy has been recommended as foundational therapy for heart failure with preserved ejection fraction (HFpEF), residual risk remains high in affected patients. The efficacy of beta-blockers in HFpEF remains controversial.

METHODOLOGY: This single-center retrospective cohort study included 600 patients with HFpEF who received triple therapy (as defined per the study protocol) at Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, between January 2018 and January 2025. A 1:1 propensity score matching (PSM) approach was used to balance baseline confounding factors. The efficacy and safety of quadruple therapy were compared with those of triple therapy alone. The primary endpoint was the composite of heart failure hospitalization or cardiovascular death.

RESULTS: After PSM, 360 patients were matched, with 180 patients in each group. During a median follow-up of 37.8 months, the incidence of the primary endpoint was significantly lower in the quadruple therapy group than in the triple therapy group [17.8% vs. 25.0%, hazard ratio (HR) = 0.678, 95% confidence interval (CI): 0.432-0.967, P = 0.035]. The quadruple therapy group had significantly lower rates of first heart failure hospitalization (14.4% vs. 20.6%, HR = 0.672, P = 0.030) and recurrent heart failure hospitalization (0.217 vs. 0.325 events per person-year, HR = 0.654, P = 0.015). Subgroup analyses showed that patients with concomitant coronary artery disease (HR = 0.591, P = 0.047) and baseline heart rate ≥70 beats per min (HR = 0.572, P = 0.045) derived greater benefit from quadruple therapy. A trend toward benefit was observed in patients with baseline LVEF of 50%-59%, but no significant interaction was detected. The overall safety profiles were comparable between the two groups.

CONCLUSION: In this real-world observational cohort of patients with HFpEF receiving triple therapy, quadruple therapy was associated with a lower risk of the composite of heart failure hospitalization or cardiovascular death, driven primarily by a reduction in heart failure hospitalizations. No statistically significant difference in cardiovascular or all-cause mortality was observed. The association appeared more prominent in patients with concomitant coronary artery disease and higher baseline heart rate in exploratory subgroup analyses. Given the observational design, these hypothesis-generating findings cannot establish causality and require prospective validation.

PMID:42548862 | PMC:PMC13429833 | DOI:10.3389/fcvm.2026.1893975

Iran J Public Health. 2025 Dec;54(12):2579-2594. doi: 10.18502/ijph.v54i12.20812.

ABSTRACT

BACKGROUND: Bivalirudin is increasingly used as an alternative to heparin in patients undergoing percutaneous coronary intervention (PCI) due to its potential for reducing adverse clinical outcomes. This meta-analysis aimed to compare the effectiveness and safety of bivalirudin versus heparin across various clinical outcomes.

METHOD: A total of 27 studies were included, comprising 63,624 patients: 30,492 received Bivalirudin, and 33,132 received Heparin. Key endpoints analyzed include net adverse clinical events (NACE), major adverse clinical events, major bleeding, mortality, stroke, and stent thrombosis. Data were pooled using a random-effects model, and heterogeneity was assessed using the I² statistic. Publication bias was evaluated using Begg’s and Egger’s tests.

RESULTS: Bivalirudin significantly reduced the risk of major bleeding (MD=-0.4445, 95% CI [-0.6276, -0.2615], P<0.0001, I²=76.79%) compared to Heparin. However, no significant differences were found for major adverse clinical events (MD=-0.0993, P=0.3194) or mortality (MD=-0.1959, P=0.0893). There was moderate heterogeneity in most analyses, particularly for NACE (I²=68.24%) and stent thrombosis (I²=55.33%). No significant differences were observed for stroke prevention or stent thrombosis. Subgroup analyses demonstrated significant reductions in major bleeding with Bivalirudin, particularly in STEMI patients (log OR=-0.37, P<0.0001), though no differences in MACE or stent thrombosis were observed. High heterogeneity in NSTEMI populations (I²=81.4%) underscores the need for individualized therapy.

CONCLUSION: Although bivalirudin significantly lowers major bleeding compared with Heparin, it shows no clear advantage in mortality or other major clinical outcomes. Substantial heterogeneity across studies indicates variability in patient populations and procedural settings. Further research is needed to define its optimal role in specific PCI subgroups.

PMID:42548857 | PMC:PMC13429960 | DOI:10.18502/ijph.v54i12.20812

Front Sports Act Living. 2026 Jul 20;8:1879308. doi: 10.3389/fspor.2026.1879308. eCollection 2026.

ABSTRACT

Non-Olympic sports play important cultural, social, and community roles, yet their position within national sport policy frameworks remains under-examined. This study investigates the structural position of non-Olympic sports in Israel through the perspectives of coaches, many of whom also hold managerial responsibilities. Using a cross-sectional online survey, data were collected from coaches across diverse non-Olympic sports. Quantitative analyses assessed group differences by employment status and managerial role using descriptive statistics, one-way ANOVA, and eta squared (η ²) effect sizes, while open-ended responses were analyzed using content analysis. Findings indicate that non-Olympic sports are perceived to occupy a peripheral position within a hierarchically organized sport system characterized by unequal access to funding, facilities, professional personnel, and media exposure, despite comparable levels of professional commitment. Drawing on sociological theories of capital, the results suggest that policy frameworks privileging Olympic performance concentrate economic and symbolic resources in recognized disciplines, reinforcing core-periphery dynamics. Although strong intrinsic motivation sustains engagement, responses to a hypothetical career-choice scenario warrant closer attention. By foregrounding governance structures and policy incentives, the study contributes to debates on stratification, sustainability, and access to resources and opportunities within sport systems, with implications extending beyond the studied context.

PMID:42548853 | PMC:PMC13429750 | DOI:10.3389/fspor.2026.1879308

Front Cardiovasc Med. 2026 Jul 20;13:1841870. doi: 10.3389/fcvm.2026.1841870. eCollection 2026.

ABSTRACT

BACKGROUND: The first 2-3 months after discharge for acute or decompensated chronic heart failure (HF) constitute a “vulnerable phase” marked by high risks of rehospitalization and death. Symptom fluctuations during this period may be associated with adverse outcomes, yet evidence on post-discharge symptom trajectories is limited. This study applied a latent class trajectory model to characterize KCCQ symptom evolution and its association with early cardiovascular events.

METHODS: In this prospective cohort study, 1,109 patients with chronic HF admitted to a tertiary hospital in Nanchang, China (August 2020-July 2025), completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) at six time points: day 3 after admission, at discharge, and 1, 2, 3, and 6 months post-discharge. Symptom trajectories were identified using latent class trajectory modeling. Associations between trajectory groups and major adverse cardiovascular events (MACEs) were analyzed using multivariable logistic regression, and an exploratory mediation analysis was conducted to examine whether trajectory patterns partly accounted for the association between KCCQ scores and MACEs.

RESULTS: During follow-up, 207 patients (18.7%) experienced MACEs. Latent class trajectory analysis identified four distinct groups: persistently declining, slowly improving, stable-moderate, and stable-high. Relative to the stable-moderate group, patients in the persistently declining group had higher odds of MACEs (OR = 2.242, 95% CI: 1.073-4.718, P = 0.032). The exploratory mediation analysis suggested a statistically significant indirect association through trajectory patterns (β=-0.007, P < 0.001).

CONCLUSIONS: Symptom recovery after HF hospitalization is heterogeneous and was associated with cardiovascular outcomes. Persistently worsening symptoms predict the highest risk, while stable or improving trajectories indicate favorable recovery. Tracking KCCQ trajectories may support early risk stratification and personalized management during the vulnerable phase.

PMID:42548830 | PMC:PMC13429835 | DOI:10.3389/fcvm.2026.1841870

Front Med (Lausanne). 2026 Jul 20;13:1879189. doi: 10.3389/fmed.2026.1879189. eCollection 2026.

ABSTRACT

PURPOSE: To assess intensive care unit (ICU) nurses’ and respiratory therapists’ knowledge and practice regarding airway pressure release ventilation (APRV) use in acute respiratory distress syndrome (ARDS) patients and identify barriers to its implementation in China.

METHODS: A multicenter cross-sectional survey. Between June 22, 2024, and August 10, 2024, an online cross-sectional survey of ICU nurses and respiratory therapists from five cities in Sichuan Province, China, was conducted. Descriptive statistics were used to analyze the data.

RESULTS: Among 239 valid responses from ICU nurses and respiratory therapists in Sichuan Province, 55.2% (132/239) respondents reported no prior didactic APRV training, and 54.4% (130/239) had never used APRV for ARDS. While 97.9% (234/239) correctly identified ARDS as an indication, substantial variability was observed in the alignment of parameter settings with evidence-based recommendations. Key barriers to APRV use included lack of guidelines/standardized protocols (56.5%, 135/239), insufficient training (57.3%, 137/239), and lack of awareness (45.2%, 108/239).

CONCLUSION: Considerable variability in APRV knowledge and practice was observed among ICU nurses and respiratory therapists, coupled with a lack of standardized training and institutional protocols, highlighting a critical need for targeted educational interventions. The lack of guidelines or standardized protocols is the most common impediment to APRV use.

PMID:42548807 | PMC:PMC13429676 | DOI:10.3389/fmed.2026.1879189

Front Artif Intell. 2026 Jul 20;9:1844254. doi: 10.3389/frai.2026.1844254. eCollection 2026.

ABSTRACT

Patient subtyping is significantly challenged by intra-sample heterogeneity, which limits the effectiveness of traditional multi-class classification approaches enforcing mutually exclusive labels. Despite recent promising results in the transition from multi-class to multi-label classification, this process is not straightforward and proves hard to systemize, especially when working with datasets of small dimensions. Here, we design a novel approach, implemented in a computational framework, leveraging machine learning models and an original nested conformal prediction strategy for small datasets to enable a rigorous transition to multi-label classification. Conformal prediction can indeed offer a statistically sound approach for robust subtype predictions; yet, so far, it has been limited to be exploited only in large datasets, not often available in real biomedical scenarios. We evaluate our approach using breast cancer patient RNA-seq data from The Cancer Genome Atlas, with subtypes originally defined via the PAM50 classifier. From a methodological standpoint, our innovative nested strategy enables the successful application of conformal prediction, which commonly requires large datasets, to a relatively small sample size. Specifically, conformal prediction is adapted and applied both to the reference PAM50 classification and to multiple machine learning models to test coherence and compare the obtained multi-label predictions. Our results reveal subtype- and sample-specific complexity and highlight consistent patterns of ambiguity across models. Importantly, we distinguish between robust, inherently heterogeneous, and weak assignments, providing deeper insight into clear subtype confirmations and complexity, but also critical incoherent predictions. Thus, overall, this work demonstrates the utility of our framework for uncertainty-aware sample subtyping, particularly in small and highly unbalanced sample settings.

PMID:42548800 | PMC:PMC13429844 | DOI:10.3389/frai.2026.1844254

Mayo Clin Proc Innov Qual Outcomes. 2026 Jul 27;10(5):100739. doi: 10.1016/j.mayocpiqo.2026.100739. eCollection 2026 Oct.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of Tofersen in patients with superoxide dismutase 1 gene (SOD1-ALS) patients in France in a real-world setting, using disease progression within patient comparisons and with a historical cohort.

PATIENTS AND METHODS: Patients with SOD1-ALS were included from across 19 French FILSLAN network centers. Baseline was defined as the treatment initiation date. Main endpoints were the ALSFRS-R progression rate and plasmatic neurofilament light chain (NfL) levels at baseline and 12 months after baseline.

RESULTS: In the Tofersen Cohort (N=46), within-group comparisons showed that the mean ALS functional rating scale revised (ALSFRS-R) progression rate slowed from 0.53 ± 0.5 at baseline to 0.22 ± 0.3 point/month at 12 months (P=.006). NfL levels significantly decreased from 89.0 ± 9.0 pg/ml at baseline to 29.2 ± 19.5.5 at 12 months (P=.004). Exploratory comparisons with a propensity score (PS) matched historical cohort (39 matched pairs) using a mixed-effects model, ALSFRS-R progression rate at baseline, 6 months, and 12 months after baseline, showed no statistically significant differences between groups P=.30, whereas longitudinal ALSFRS-R scores differed significantly between groups (time-treatment interaction P=.006). The mean survival of the PS matched population was longer in the Tofersen Cohort (42.6 months) than the Historical Cohort (31.8 months) P=.004. Time-dependent adjusted cox analysis showed that Tofersen was associated with a reduction in mortality risk (adjusted HR=0.34; 95% CI, 0.12-0.91; P=.03).

CONCLUSION: Tofersen seems to be associated with slower functional decline and reduced NfL levels. While limitations of retrospective design and ALSFRS-R sensitivity must be acknowledged, these findings provide real-world evidence suggesting a clinical benefit of Tofersen.

PMID:42548788 | PMC:PMC13429897 | DOI:10.1016/j.mayocpiqo.2026.100739