Nevin Manimala

J Neurooncol. 2026 Jun 12;178(2):61. doi: 10.1007/s11060-026-05661-w.

ABSTRACT

PURPOSE: To estimate the pooled incidence of symptomatic radiation necrosis (RN) following intracranial brachytherapy and explore associations between clinical and technical variables and RN risk.

METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched from 1954 – 2024 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible human studies reported symptomatic RN after intracranial brachytherapy. RN ascertainment was secondarily classified as clear, partial, or unclear based on reproducibility of diagnostic criteria. A random-effects generalized linear mixed model was used to pool incidence rates, with subgroup analyses by tumor type, implant technique, isotope, dose rate, and prior radiation. Study quality was assessed using National Institutes of Health tools.

RESULTS: Eighty-three studies encompassing 3,666 patients were included. The pooled incidence of symptomatic RN was 5.67% (95% CI: 3.84%-8.29%; I² = 75.7%). RN ascertainment was clear in 25 studies, partial in 43, and unclear in 15. In sensitivity analyses, pooled symptomatic RN incidence was 8.71% among studies with clear RN definitions and 7.48% among studies with clear or partial definitions. Subgroup RN rates were 3.72% for low-grade gliomas, 8.44% for high-grade gliomas, 2.07% for brain metastases, and 8.98% for meningiomas. Isotope-specific rates were 5.83% for Iodine-125, 7.61% for Iridium-192, and 2.07% for Cesium-131. No statistically significant subgroup differences were observed.

CONCLUSIONS: Symptomatic RN occurs in approximately 5.7% of patients following intracranial brachytherapy, within the range reported for other focal radiation therapies. Subgroup findings were not statistically significant and should be interpreted in the context of clinical and methodological heterogeneity.

PMID:42283986 | DOI:10.1007/s11060-026-05661-w

Discov Ment Health. 2026 Jun 12;6(1):110. doi: 10.1007/s44192-026-00509-1.

ABSTRACT

BACKGROUND: Anxiety disorders are among the most prevalent mental disorders worldwide and impose a substantial burden on public health systems. This study aimed to comprehensively assess the global burden of anxiety disorders, examine long-term temporal trends, explore their associations with human resources for health (HRH), and project future disease burden.

METHODS: Data were obtained from the Global Burden of Disease (GBD) 2021 study. We first described the global burden of anxiety disorders in 2021 and its geographical distribution across countries and regions. We then analyzed temporal trends in incidence, prevalence, and disability-adjusted life years (DALYs) from 1990 to 2021. In addition, correlations between anxiety disorder burden and HRH were assessed. Finally, future trends from 2022 to 2050 were projected using multiple statistical models.

RESULTS: In 2021, anxiety disorders accounted for 53.91 million incident cases worldwide, with an age-standardized incidence rate of 678.25 per 100,000 population. The global number of prevalent cases reached 359.21 million, and the total number of DALYs was 42.51 million. China had the highest absolute number of cases, whereas Portugal had the highest age-standardized prevalence rate. Correlation analyses showed moderate associations between several HRH categories and the burden of anxiety disorders; traditional and complementary medicine practitioners were weakly negatively correlated with DALYs. Model-based projections suggest that the global burden of anxiety disorders may continue to increase over the next 25 years.

CONCLUSION: Anxiety disorders remain a major global public health challenge. These findings provide updated evidence on their epidemiological burden and may help inform health resource allocation and long-term mental health planning.

PMID:42283985 | DOI:10.1007/s44192-026-00509-1

Behav Res Methods. 2026 Jun 12;58(7):195. doi: 10.3758/s13428-026-03075-0.

ABSTRACT

Duration discrimination data collected with single-presentation tasks (e.g., bisection or temporal generalization tasks) or dual-presentation tasks (e.g., greater-less or same-different tasks) are usually analyzed by fitting psychometric functions. The independent variable in these functions is test duration measured in seconds or milliseconds. In contrast, the independent variable is log stimulus magnitude in psychometric functions for discrimination in other sensory modalities, most often because of the applicability of Weber’s law. We report a study aimed at determining empirically whether duration discrimination data are best described by psychometric functions of duration or log duration. We first conducted a simulation study to identify the design (type of task, number of test durations, number of trials, etc.) with which the generating psychometric function (of duration or log duration) fit the data substantially better than the impostor function. Based on these results, we conducted an empirical study with the same-different task that adaptively administered 1,200 trials over 11 test durations around the standard duration. We collected 45 datasets and fitted both types of psychometric function in each case. By the loglikelihood-ratio statistic, psychometric functions of duration fitted the data better in only 7 of 45 cases (15.6%), in agreement with simulation results obtained when data were generated by psychometric functions of log duration. Analysis of data from 69 published papers (totaling 17,000+ psychometric functions) also indicated better fit of psychometric functions of log duration in the expected proportion given the typically small numbers of trials per function.

PMID:42283983 | DOI:10.3758/s13428-026-03075-0

Saudi Pharm J. 2026 Jun 12;34(3):36. doi: 10.1007/s44446-026-00095-x.

ABSTRACT

BACKGROUND AND AIM: In the community pharmacy sector the concept of service quality is important. Pharmacists working in these settings provide useful services that go beyond merely dispensing medications. This study aimed to translate the short Perceived Service Quality Scale (PSQS-SF) to Arabic and to use this scale to assess the determinants of service quality of community pharmacies in relation to competitively priced high quality service and loyalty intention.

METHODS: A pre-validated short Perceived Service Quality Scale (pSQS-A-SF) was translated from English to Arabic, validated and approved by the original authors. The scale consisted of six questions assessing pharmacy service quality, two questions evaluating the perception of price competitiveness, and three questions measuring loyalty intentions. All of the items were rated on a 5-point Likert scale. Community pharmacy users have been approached to answer the survey and descriptive statistics were reported.

RESULTS: The pSQS-SF was successfully translated and culturally adapted to Arabic context (pSQS-A-SF) with minor modifications. A total of 207 respondents completed the survey. Perceived service quality was rated highly across most items, whereas perceptions of price competitiveness were lower. In confirmatory factor analysis, the measurement model showed improved fit after minor modification (deletion of one service-quality item), with acceptable factor loadings and composite reliability, although average variance extracted was marginal. Service quality was strongly correlated with loyalty intentions. In the structural model, higher perceived service quality predicted greater patronage loyalty (β=0.26, p=0.023) and prescription loyalty (β=0.41, p=0.002), while price competitiveness did not significantly predict loyalty outcomes; private health insurance showed a small positive association with patronage loyalty (β=0.156, p=0.022).

CONCLUSION: The Arabic version of the perceived service quality short-form demonstrates preliminary evidence of construct validity and reliability and can support evaluation of patient experience in Saudi community pharmacies. Perceived service quality-rather than price competitiveness-was linked with self-reported patronage loyalty in this sample. Further research should strengthen validation (including discriminant validity and broader sampling) and assess performance across settings and subgroups.

PMID:42283965 | DOI:10.1007/s44446-026-00095-x

Int Ophthalmol. 2026 Jun 12;46(1):262. doi: 10.1007/s10792-026-04128-1.

ABSTRACT

PURPOSE: To characterize the demographic characteristics, clinical features, and severity of thyroid eye disease (TED) in paediatric patients with Graves’ disease for comparison with an adult cohort in the Kingdom of Bahrain.

METHODS: Paediatric patients (≤ 18 years) with Graves’ disease were screened for TED in Bahrain between October and December 2025. Paediatric endocrinologists across government, military, university, and private sectors participated. Patients were identified from physician-provided lists and verified using diagnostic codes and medical records from four nationwide centres. Comprehensive ophthalmic and orbital examinations were performed, and patients were classified into TED and non-TED groups. TED was diagnosed using the Bartley criteria and graded according to the European Group on Graves’ Orbitopathy (EUGOGO) classification. Findings were compared with an adult Graves’ disease cohort (> 18 years) from the same population referred between September 2023 and December 2025.

RESULTS: Among 22 paediatric patients with Graves’ disease (median age 14 years, interquartile range [IQR] 10-16 years; female-to-male ratio 4:1), 11 (50%) were diagnosed with TED. No statistically significant differences were observed between patients with and without TED regarding demographic characteristics, smoking exposure, Graves’ disease duration, family history of autoimmune thyroid disease, or hyperthyroidism treatment. However, parental consanguinity was significantly more common among patients with TED. Among paediatric TED patients, 54.5% had bilateral disease and 81.8% had mild TED. None had sight-threatening disease or diplopia. All patients were symptomatic, most commonly with periorbital bulging or swelling (81.8%). Lid retraction (72.7%) and proptosis (63.6%) were the most frequent objective findings, whereas extraocular motility restriction was uncommon (18.2%). Compared with adults (n = 81), mild disease was more frequent in paediatric patients (81.8% vs 48.1%; P = 0.04), whereas lid lag was more common in adults (64.2% vs 18.2%; P = 0.01).

CONCLUSION: This study provides the first regional data on paediatric TED in the Gulf region, demonstrating that TED is common among children with Graves’ disease and is predominantly mild in severity. Eyelid involvement and proptosis were the most frequent manifestations. Parental consanguinity was more common among children with TED, suggesting a possible genetic contribution. These findings emphasize the importance of routine ophthalmic screening in paediatric Graves’ disease and highlight age-related differences in clinical presentation.

PMID:42283964 | DOI:10.1007/s10792-026-04128-1

Adv Ther. 2026 Jun 12. doi: 10.1007/s12325-026-03655-8. Online ahead of print.

ABSTRACT

INTRODUCTION: This study compared the efficacy of tezepelumab with other approved biologics and endoscopic sinus surgery (ESS) using indirect treatment comparisons (ITCs) in adults with severe, uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP).

METHODS: Randomized controlled trials (RCTs) identified via a systematic literature review (SLR) were synthesized in a network meta-analysis (NMA). Outcomes included change from baseline in nasal polyp score (NPS), nasal congestion/obstruction score (NCS/NOS), difficulty with sense of smell (DSS), Sino-Nasal Outcome Test-22 (SNOT-22) score, Lund Mackay score (LMS), time to nasal polyposis (NP) surgery decision, proportions requiring NP surgery or systemic corticosteroids (SCS), time to SCS use, and the University of Pennsylvania Smell Identification Test (UPSIT). Mean differences, hazard ratios, and odds ratios with 95% credible intervals were estimated for available treatments at 52 weeks. Not all endpoints were reported across trials; comparisons were conducted only where both treatments reported the outcome.

RESULTS: At 52 weeks, tezepelumab showed comparable efficacy to dupilumab across all evaluated endpoints, apart from the proportion of patients requiring surgery, where tezepelumab was associated with a lower surgery rate than dupilumab. Tezepelumab consistently outperformed mepolizumab, depemokimab, and placebo. In analyses of < 30-week endpoints, tezepelumab outperformed omalizumab for all outcomes except SNOT-22, where no difference was observed. Sensitivity analyses including ESS showed benefits for tezepelumab across endpoints except for NPS, for which ESS ranked highest.

CONCLUSION: Tezepelumab achieved similar efficacy to dupilumab across all evaluated endpoints with the exception of the proportion of patients requiring surgery, where tezepelumab demonstrated a numerically greater reduction compared with dupilumab. Results consistently favoured tezepelumab and dupilumab over depemokimab, mepolizumab, and omalizumab.

PMID:42283959 | DOI:10.1007/s12325-026-03655-8

Ther Innov Regul Sci. 2026 Jun 12. doi: 10.1007/s43441-026-00986-0. Online ahead of print.

ABSTRACT

BACKGROUND: Bioequivalence (BE) is the fundamental regulatory requirement for the approval of generic drug products. Despite global harmonization efforts, such as the ICH M13A guideline, subtle differences in statistical modeling-specifically the treatment of “subject” as a Fixed vs. Random effect-persist between the EMA and US-FDA frameworks.

OBJECTIVE: This study provides a comprehensive evaluation of these two statistical paradigms on Type I Error (TIE) and Statistical Power (Type II Error) across varying sample sizes, intra-subject variability (CV), and inter-period correlations.

METHODS: 1.89 million Monte Carlo simulations were conducted for a standard 2-sequence, 2-period (2 × 2) crossover design. Parameters included: sample size (n = 12, 24, 32), intra-subject CV (15%, 25%, 30%), inter-period correlation ($r$: 0.30, 0.60, 0.90), and geometric mean ratios (GMR: 1.00-1.10). Data were generated using MNORMAL software assuming log-normal distribution. Analysis followed EMA (Fixed) and FDA (Random) ANOVA specifications.

RESULTS: Both models effectively controlled Type I error within the nominal 5% level; however, statistical power was significantly higher under the FDA Random Effect model than under the EMA Fixed Effect model in borderline scenarios (GMR 1.03-1.05). Notably, increasing inter-period correlation substantially amplified statistical power, with effects comparable to doubling the sample size, underscoring its critical role in crossover bioequivalence study design.

CONCLUSION: Understanding these model discrepancies is vital for global drug development in the ICH M13A (2025) era. The study highlights that the FDA’s model is slightly more permissive, reducing manufacturer risk without compromising patient safety. Accounting for inter-period correlation in power calculations is highly recommended for efficient trial design.

PMID:42283939 | DOI:10.1007/s43441-026-00986-0

J Egypt Public Health Assoc. 2026 Jun 12;101(1):18. doi: 10.1186/s42506-026-00226-1.

ABSTRACT

BACKGROUND: Human metapneumovirus (hMPV) is a significant respiratory pathogen that remains underrecognized and often co-circulates with respiratory syncytial virus (RSV) and influenza. Despite its clinical impact, awareness among healthcare professionals remains poorly understood, particularly in Africa. This study assessed the awareness of hMPV among healthcare professionals in Libya.

METHODS: A cross-sectional study was conducted among 385 healthcare professionals, including doctors, nurses, pharmacists, and medical technicians in Libya. A structured, self-administered questionnaire developed de novo was used to assess demographic characteristics and awareness of hMPV, including transmission, clinical manifestations, prevention, and management. Awareness levels were categorized as low (≤ 59%), moderate (60-79%), or high (≥ 80%) using modified Bloom’s cut-off points. Ordinal logistic regression was used to analyze associations between awareness levels and demographic factors.

RESULTS: Among the 385 healthcare professionals, 13.2% demonstrated high awareness of hMPV, 13.8% had moderate awareness, and 73.0% had low awareness according to modified Bloom’s criteria. Only 35.8% correctly identified hMPV as an RNA virus, and 28.1% recognized that ELISA is not the gold standard for diagnosis. In the multivariate ordinal logistic regression, fellowship degree holders had significantly higher odds of awareness compared to those with a bachelor’s degree (AOR: 8.84; 95% CI: 2.42-38.7; p = 0.002), while nurses showed significantly lower awareness than doctors (AOR: 0.09; 95% CI: 0.01-0.36; p = 0.003). A trend toward lower awareness was observed among participants from Tobruk (AOR: 0.13; 95% CI: 0.01-1.39; p = 0.086) and Tripoli (AOR: 0.09; 95% CI: 0.01-1.26; p = 0.075) compared with Al Bayda. Working in a private hospital approached statistical significance (AOR: 2.47; 95% CI: 0.99-6.15; p = 0.050).

CONCLUSION: The findings underscore critical awareness gaps regarding hMPV among Libyan healthcare professionals and highlight the urgent need for targeted educational interventions. Integrating emerging infectious diseases into curricula and continuing medical education is vital to improving diagnostic acumen and public health preparedness in resource-limited settings.

PMID:42283925 | DOI:10.1186/s42506-026-00226-1

Int Ophthalmol. 2026 Jun 12;46(1):263. doi: 10.1007/s10792-026-04104-9.

ABSTRACT

PURPOSE: To evaluate the relationship between visual acuity (VA) improvement and vision-related quality of life in patients with keratoconus using rigid gas-permeable (RGP) and scleral contact lenses (CLs).

METHODS: This observational study was designed as a cross-sectional study with retrospective collection of pre-contact lens clinical data. The best-corrected visual acuity (BCVA) before and after CL use was recorded. Pre-contact lens BCVA values were obtained retrospectively from medical records, which may introduce potential documentation bias. After CL usage, vision-related quality of life and CL adaptation were assessed using a validated Turkish version of the National Eye Institute Visual Function Questionnaire (VFQ-25) and a study-specific questionnaire developed by the investigators to explore practical aspects of contact lens use such as handling, adaptation, comfort, and concerns related to long-term use. The correlations between BCVA improvement and questionnaire responses were analyzed statistically.

RESULTS: A total of 26 patients (mean age 39.7 ± 13.6 years) were included. Mean BCVA improved significantly from 0.21 ± 0.20 to 0.83 ± 0.16 with contact lenses (p = 0.001). The VA improvement showed significant positive correlations with perceived visual improvement (p = 0.032) and vision-related quality-of-life enhancement (p = 0.007). These associations should be interpreted cautiously given the relatively small sample size and exploratory nature of the correlation analyses. The patients continued to express concerns regarding the long-term use of CL, despite the observed improvement in VA.

CONCLUSION: The rigid contact lens use was associated with improvements in both visual acuity and vision-related quality of life in keratoconus. However, due to the limited sample size and cross-sectional design, the findings should be considered preliminary and interpreted as exploratory observations that may inform future prospective studies.

PMID:42283912 | DOI:10.1007/s10792-026-04104-9

Childs Nerv Syst. 2026 Jun 12;42(1):251. doi: 10.1007/s00381-026-07334-5.

ABSTRACT

PURPOSE: To explore the technical methods and advantages of prenatal diagnosis of fetal intraspinal lipomas.

METHODS: This was a prospective study. From August 2018 to August 2024, 315 fetuses suspected of having spinal neural tube malformations after conducting prenatal ultrasound were treated at the Neurosurgery Outpatient Department of the First Medical Center of the PLA General Hospital. Fetal magnetic resonance imaging (MRI) examinations were performed within 72 h after the ultrasound diagnosis. A total of 186 singleton pregnancies where fetuses have already been born were selected. MRI was performed within 1 month after birth. Using postnatal MRI as the gold standard, 58 fetuses diagnosed with intraspinal lipoma through postnatal MRI were selected. The diagnostic coincidence rates of prenatal ultrasound and fetal MRI in the prenatal diagnosis of intraspinal lipomas were analyzed.

RESULTS: Prenatal ultrasound correctly diagnosed 35 cases (35/58, 60.3%), and fetal MRI correctly diagnosed 49 cases (49/58, 84.5%). This difference was statistically significant (P = 0.004). Among the 58 cases of fetal intraspinal lipomas, 11 were of caudal type (11/58,19.0%), eight of dorsal type (8/58, 13.8%), ten of transitional type (10/58, 17.2%), 23 of mixed type (23/58, 39.7%), and six of lipoma myelomeningocele type (6/58, 10.3%). Among these, ten cases (10/58, 17.2%) were correctly diagnosed by prenatal ultrasound and 25 (25/58, 43.1%) using fetal MRI. This difference was statistically significant (P = 0.002).

CONCLUSIONS: Fetal MRI can accurately diagnose intraspinal lipomas and has diagnostic value for different types of intraspinal lipomas.

PMID:42283911 | DOI:10.1007/s00381-026-07334-5