Nevin Manimala

Front Parasitol. 2026 Apr 7;5:1749169. doi: 10.3389/fpara.2026.1749169. eCollection 2026.

ABSTRACT

Malaria remains a major public health concern in Cameroon, with Plasmodium falciparum responsible for most morbidity and mortality, particularly among children under five. In response to rising cases, Cameroon began implementing the RTS,S/AS01 malaria vaccine in early 2024. Given the vaccine’s strain-specific efficacy, understanding haplotypic diversity is critical for evaluating long-term impact. We analyzed 100 P. falciparum-positive dried blood spots collected in Mapoussere, Kaele Health District (2022-2023). Using the 4CAST amplicon sequencing assay, we targeted four genes: csp (circumsporozoite protein), ama1 (apical membrane antigen 1), sera2 (serine repeat antigen 2), and trap (thrombospondin-related anonymous protein). Haplotypes were identified using SeekDeep, and diversity metrics including heterozygosity (He), nucleotide diversity (π), and selection statistics (Tajima’s D, Fu and Li’s D*, F*) were computed. We successfully genotyped csp in 35% of samples, identifying 22 haplotypes (He = 0.908; π = 0.021). The vaccine-matched haplotype was present in 20% of genotyped infections. The T cell TH2 and TH3 epitopes of csp showed signs consistent with balancing selection. Both ama1 and sera2 exhibited higher genotyping success and diversity, with ama showing significant Tajima’s D values. Within-participant haplotype counts were highest for ama1 (mean = 2.8), followed by sera2 (2.1), csp (1.3), and trap (1.2). This study provides a baseline of P. falciparum haplotype diversity in a vaccine-targeted region. The presence of vaccine-matched strains and high diversity in TH2/TH3 epitopes in csp may influence vaccine efficacy. Continued molecular surveillance is essential to monitor antigenic shifts and guide future strategies.

PMID:42023409 | PMC:PMC13097004 | DOI:10.3389/fpara.2026.1749169

Clin Ophthalmol. 2026 Apr 17;20:576990. doi: 10.2147/OPTH.S576990. eCollection 2026.

ABSTRACT

PURPOSE: To understand the efficiency, safety, and patient acceptability of using an artificial intelligence-based conversational agent Dora R2 (Ufonia Limited, UK) in the cataract pathway.

PATIENTS AND METHODS: This mixed methods cohort-based service evaluation included both prospective and retrospective data collection from two UK public hospitals: Oxford University Hospitals National Health Service (NHS) Foundation Trust and Buckinghamshire Healthcare NHS Trust. Patients undergoing cataract surgery of mixed complexity were included. All patients who had postoperative calls with Dora R2 between October 2022 and April 2023 were included. Dora R2 calls patients three weeks after routine cataract surgery to assess symptoms and answer patient queries. Patient demographics and clinical outcomes were reviewed, and statistical analyses were performed to identify any differences based on age, gender and ethnicity.

RESULTS: Of 1580 eligible patients, 1269 (78%) completed the Dora R2 call. About 767 (63%) had “no clinical concerns” identified by Dora. The median patient age was 77 years, with 84% identifying as white. There were no significant differences in call outcomes based on demographic factors (at 5% significance level). The Net Promoter Score for patient acceptability was 47, indicating high satisfaction. Regarding safety, only 0.3% of patients required unplanned management changes within two weeks of a Dora call with a “no concerns identified” outcome.

CONCLUSION: Dora R2 effectively supports postoperative follow-up for cataract surgery, demonstrating high efficiency, safety, and patient acceptability. The technology successfully supports clinicians in identifying uncomplicated cases, reduces the need for clinician-led consultations, and does not exacerbate digital inequalities, showing promise for broader implementation.

PMID:42023401 | PMC:PMC13098554 | DOI:10.2147/OPTH.S576990

Res Pract Thromb Haemost. 2026 Mar 24;10(3):103418. doi: 10.1016/j.rpth.2026.103418. eCollection 2026 Mar.

ABSTRACT

BACKGROUND: Hemophilia carriers (HCs) and women with von Willebrand disease (VWD) receive specialized obstetric care because of a higher chance for postpartum bleeding and potential bleeding in the neonates. It is unknown what their postpartum quality of life (QoL), childbirth satisfaction, and experience are and how this differs from the general population.

OBJECTIVES: This study assessed QoL, childbirth satisfaction and experience in HCs and women with VWD at week 1 and 6 postpartum. These outcomes are compared with those from retrospective studies of the general population.

METHODS: Participants completed 3 patient-reported outcome measures postpartum: the Short Form-36 at week 1 and 6 measuring QoL, the Mackey Childbirth Satisfaction Rate Scale at week 1 for childbirth satisfaction, and the Labor and Delivery Index at week 6 for childbirth experience. Descriptive statistics were used.

RESULTS: In total, 85 HCs and 81 women with VWD completed ≥1 questionnaire. Pain and physical functioning improved over time (both moderate to fairly well; P < .001). Six weeks postpartum, QoL was lower in both groups than those in the general population. Over 88% of both cohorts reported “at least satisfied” on the Mackey Childbirth Satisfaction Rate Scale, significantly higher than the general population (>61%; P < .001). Mean Labor and Delivery Index scores (1.3-1.9 points) indicated an adequate childbirth experience. HCs reported more child-related worries than the general population (37.3% vs 72.2%; P < .001).

CONCLUSION: HCs and women with VWD recover less between week 1 and 6 postpartum than the general population. HCs report more worries about their child during childbirth than women with VWD and the general population.

PMID:42023400 | PMC:PMC13098571 | DOI:10.1016/j.rpth.2026.103418

Res Pract Thromb Haemost. 2026 Mar 26;10(3):103433. doi: 10.1016/j.rpth.2026.103433. eCollection 2026 Mar.

ABSTRACT

BACKGROUND: Intracranial hemorrhage (ICH) is a fatal complication of leukemia; however, mechanisms underlying its development, particularly central nervous system (CNS) involvement and vascular injury, remain unclear.

OBJECTIVES: We aimed to investigate the histopathologic features of cerebral vessels in leukemia and the expression of hemostasis-related factors in leukemia cells.

METHODS: We conducted an autopsy-based study including 37 leukemia cases and 20 matched controls. Histopathologic analysis of CNS tissues was performed to evaluate ICH, leukemia cell localization, and vascular injury. Immunohistochemistry was performed to assess expression of vascular endothelial growth factor (VEGF), cathepsin G, tissue-type plasminogen activator, urokinase-type plasminogen activator, urokinase-type plasminogen activator receptor, and tissue factor in leukemia cells. Vascular integrity was evaluated using stains for smooth muscle actin, collagen, fibrin, and von Willebrand factor.

RESULTS: ICH was identified in 68% of leukemia cases and was associated with fatal brain herniation in 40%. CNS involvement was observed in 54% of cases, often without a clinical diagnosis. The leukemia cell infiltration of meninges and vascular walls was frequently associated with changes in smooth muscle cells and adventitial collagen. CNS vascular injury was frequently associated with ICH in the presence of leukemia cell infiltration. VEGF and urokinase-type plasminogen activator were highly expressed in leukemia cells. VEGF was associated with meningeal invasion, while cathepsin G was predominantly expressed in myeloid leukemia and linked to vascular damage.

CONCLUSION: VEGF and cathepsin G may serve as markers of meningeal invasion and cerebral vascular damage in leukemia, respectively.

PMID:42023399 | PMC:PMC13098595 | DOI:10.1016/j.rpth.2026.103433

J Family Med Prim Care. 2026 Feb;15(2):659-667. doi: 10.4103/jfmpc.jfmpc_1330_25. Epub 2026 Mar 20.

ABSTRACT

BACKGROUND: Electronic cigarettes (e-cigarettes) have become a popular alternative to traditional smoking, especially among youth. However, their impact on respiratory health is underexplored in the Saudi university context. The aim is to assess the prevalence of e-cigarette use and its association with adverse respiratory symptoms among students at Imam Mohammad Ibn Saud Islamic University (IMSIU) in Riyadh, Saudi Arabia.

METHODS: A cross-sectional online survey was conducted from August to October 2024 among 404 undergraduate students at IMSIU. A validated, bilingual questionnaire (in Arabic and English) was distributed via social media. Descriptive statistics and Pearson’s Chi-square or exact tests were used to assess associations between e-cigarette use and respiratory symptoms.

RESULTS: Among 404 respondents, 27.2% were current e-cigarette users, and 76.5% of them had used e-cigarettes in the past five days. E-cigarette use was significantly associated with adverse respiratory symptoms. Bronchitis was reported in 41.7% of nonusers who had abstained in the past 30 days, compared to 16.3% and 12.5% among users who vaped for one to five days and six to 30 days, respectively (P = .048). Chronic cough, chest congestion, wheezing, and breathlessness were significantly more prevalent among current and former users than never users (P < .05 across multiple symptoms).

CONCLUSION: E-cigarette use is prevalent among Saudi university students and is linked to increased respiratory symptoms, including bronchitis, wheezing, and fatigue. These findings highlight the urgent need for public health strategies, educational programs, and regulatory actions to address the health risks of vaping in young populations.

PMID:42023384 | PMC:PMC13098866 | DOI:10.4103/jfmpc.jfmpc_1330_25

J Family Med Prim Care. 2026 Feb;15(2):817-823. doi: 10.4103/jfmpc.jfmpc_1899_25. Epub 2026 Mar 20.

ABSTRACT

CONTEXT: Diabetes is a chronic disease leading to multiple complications. Diabetes foot led to significant morbidity and mortality. Therefore, it is recommended to do screening foot exam in patients with diabetes on annual basis.

AIM: Investigate diabetic foot screening practice and risk factors associated with foot complications.

SETTINGS AND DESIGN: This is a cross-sectional study was conducted at the Adult Endocrinology Outpatient Clinics, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods and Material: Demographic data, clinical and laboratory variables, documentation of foot exam, and foot complications were collected from the medical records of a sample of patients with diabetes attending endocrinology/diabetes clinics from January 2020 to December 2024. Statistical Analysis: Descriptive statistics summarized participant characteristics. Associations between variables were assessed using Chi-square or Fisher’s Exact test as appropriate.

RESULTS: The study included 202 patients, 56% female. Foot exam was done in 41% of the study sample and 12% had foot complications. Around 33% of those who did not have foot complaints were examined. Males were more likely to have foot complications than females (18% vs. 7%, P = 0.017). Education about foot care provided more frequently in patients, who had foot examination (61% vs. 10%, P < 0.001). Foot complications were present in 18% of patients with other diabetes-related complications, compared with 3% of those without diabetes-related complications (P = 0.001).

CONCLUSION: Foot examination was performed in less than half of the patients. Foot complications were more in men, and those with other diabetes complications.

PMID:42023382 | PMC:PMC13098882 | DOI:10.4103/jfmpc.jfmpc_1899_25

J Family Med Prim Care. 2026 Feb;15(2):961-967. doi: 10.4103/jfmpc.jfmpc_868_25. Epub 2026 Mar 20.

ABSTRACT

BACKGROUND: Youth in India face increasing vulnerability to hypertension, obesity, anxiety, and depression, necessitating urgent, and integrated health interventions.

METHODS: This cross-sectional survey sampled 4,852 youth aged 15-30 using stratified cluster sampling with probability proportionate to size (PPS). Data on depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), non-suicidal self-injury (NSSI), suicidal ideation, hypertension, obesity, and sleep issues were collected through standardized tools via a smartphone application. Data analysis was conducted using IBM SPSS Statistics Version 30.0.1.1, with weighted estimates accounting for sampling probabilities.

RESULTS: Findings revealed 11.5% of youth screened positive for depression, 10.9% for anxiety, and 9.5% for hypertension. Obesity was more prevalent among females (24.4%), while underweight was common in males (31.2%). Poor sleep quality affected 26.9%, with higher rates observed in urban areas. Additionally, 2.4% reported NSSI. The study highlights alarming health concerns among youth, with 1 in 10 experiencing depression, anxiety, and cell phone addiction. Elevated risks of suicidal behaviour, sleep issues, and non-communicable diseases were evident. Targeted interventions, psychosocial support, and stronger health system responses are essential to mitigate these risks.

CONCLUSION: Youth face overlapping health challenges, including mental disorders, obesity, hypertension, and injuries. Prioritizing youth-focused interventions and stronger collaboration between healthcare and education systems is crucial to address these issues.

PMID:42023380 | PMC:PMC13098857 | DOI:10.4103/jfmpc.jfmpc_868_25

J Family Med Prim Care. 2026 Feb;15(2):530-539. doi: 10.4103/jfmpc.jfmpc_1142_25. Epub 2026 Mar 20.

ABSTRACT

Patients diagnosed with cancer remain at risk of developing subsequent primary malignancies due to genetic predisposition, environmental factors, and improved survival associated with advances in diagnosis and treatment. Understanding the pattern of dual primary malignancies is essential, yet evidence from low-resource regions such as Kashmir is scarce. This retrospective study analyses the frequency, clinical patterns, and histopathological profiles of second primary malignancies (SPMs) among patients treated at a tertiary cancer centre in northern India. Medical records of 5,731 patients seen at the Department of Radiation Oncology, Government Medical College, Srinagar, between January 2020 and December 2024 were reviewed using Warren and Gates criteria. Thirty-five patients were identified with SPMs, yielding an incidence of 0.611%. Of these, 60% were synchronous and 40% metachronous, occurring 10 months to 19 years after the first tumour. The median age at initial diagnosis was 58 years, with peak incidence in the sixth and seventh decades. Males predominated overall, although females were more likely to present with synchronous cancers, while males formed the majority of metachronous cases. Gastrointestinal cancers were the most common primary tumours, followed by breast and genitourinary malignancies, and this distribution was largely mirrored in secondary cancers. Notably, over 80% of patients had at least one gastrointestinal tumour, and more than half of breast cancer patients developed thyroid cancer as the second primary. Most patients received curative treatment for both malignancies. The findings highlight the need for sustained clinical vigilance and long-term follow-up to enable early detection and optimal management of SPMs.

PMID:42023376 | PMC:PMC13098840 | DOI:10.4103/jfmpc.jfmpc_1142_25

J Family Med Prim Care. 2026 Feb;15(2):793-800. doi: 10.4103/jfmpc.jfmpc_1800_25. Epub 2026 Mar 20.

ABSTRACT

INTRODUCTION: Standard evaluation protocols for mild traumatic brain injury (mTBI), the same as concussion, support cost-effective care and successful outcomes. While clinical guidelines endorse these in young populations (ages <65), evidence is limited for older adults (ages ≥65), particularly regarding self-reported measures and provocation testing. This study aims to assess mTBI-specific protocols, including provocation tests, in older adults with and without mTBI.

METHODS: This pilot study was conducted in an academic research laboratory, in which 13 community members aged ≥65 with or without a history of mTBI were enrolled. Participants completed: 1) a participant-reported Health History Form, a Patient-Specific Functional Scale (PSFS), and a Post Concussion Symptom Scale (PCSS); and 2) physical provocation testing using the Motion Sensitivity Quotient (MSQ) and a modified submaximal protocol of the Buffalo Concussion Bike Test (BCBT-M). Descriptive and Mann-Whitney U tests were used for statistical analysis.

RESULTS: This study was safely completed by all participants (n = 13) in one session. Findings (95%CI, P < 0.05) included no differences between the group (non-mTBI = 9, mTBI = 4) median (Mdn) in age (Mdn = 73; U = 17; P = 0.940), and BCBT-M level of completion (Mdn = 7; 5.3-8.5; U = 13.5; P = 0.472). The PSFS (Mdn = 6.3; 5.8-7.1; U = 4.0; P = 0.034), the PCSS (Mdn = 42.5; U = 0.00; P = 0.003), and the MSQ (Mdn = 16.0; U = 3.0; P = 0.020) had significant differences between mTBI and non-mTBI groups.

CONCLUSIONS: This pilot study demonstrated that older adults with and without mTBI fully engaged in standard guidelines of self-reported and physical provocation measures, with differences between the mTBI and non-mTBI groups. These early findings may inform baseline status among older adults with mTBI.

PMID:42023375 | PMC:PMC13098812 | DOI:10.4103/jfmpc.jfmpc_1800_25

J Family Med Prim Care. 2026 Feb;15(2):586-591. doi: 10.4103/jfmpc.jfmpc_1139_25. Epub 2026 Mar 20.

ABSTRACT

CONTEXT: Health literacy is considered as a tool in public health to reduce health disparities. This is considered an important issue among adolescents since investing during these formative years will result in informed decision making and healthier lifestyle choices in adulthood.

AIMS: To assess the health literacy level and associated factors among rural adolescents in Pondicherry.

SETTINGS AND DESIGN: A community-based cross-sectional study was conducted in the rural field practice area of a private medical college.

METHODS AND MATERIAL: A cross-sectional study was conducted among 250 rural adolescents residing in the rural field practice area of a private medical college using simple random sampling. Modified HLS-EU-Q16 (Short version of the European Health literacy survey) questionnaire was used to assess health literacy.

STATISTICAL ANALYSIS USED: Chi-square test and logistic regression.

RESULTS: The mean age of the study participants was 14.33 ± 2.81. The prevalence of inadequate health literacy was 82%. There was significant association between the health literacy scores and socioeconomic status (P = 0.004), father’s occupation (P < 0.001), education of the parents (P < 0.001), and school class of the children (P < 0.001). There was a significant increase in health literacy scores with an increase in age.

CONCLUSIONS: This study has revealed that the majority of adolescents in rural areas of Pondicherry have inadequate health literacy. Therefore, targeted interventions are required to empower adolescents to make informed decisions regarding their health for them to lead healthier lives.

PMID:42023371 | PMC:PMC13098801 | DOI:10.4103/jfmpc.jfmpc_1139_25