Nevin Manimala

Clin Ter. 2026 Mar-Apr;177(2):239-248. doi: 10.7417/CT.2026.2001.

ABSTRACT

BACKGROUND: Endoscopic papillary significant balloon dilatation (EPLBD) has become a convenient method of treating challenging common bile duct (CBD) stones, but predictors of success remain unresolved.

AIM: To analyse clinical, laboratory, radiological, and anatomical effects on a single session of CBD stone clearance with EPLBD.

METHODS: It was a Prospective pilot clinical trial that enrolled 25 adult patients with tough CBD stones who had undergone conventional ERCP procedures in vain. Limited biliary sphincterotomy and EPLBD with 12-18 mm balloons were done on all patients. Clinical, biochemical, radiological, and anatomical parameters were evaluated prior to the procedure. The main result was the total clearance of CBD in one session. The secondary outcomes were complications, biliary stenting necessity, duration of procedures, and length of stay.

RESULTS: The complete clearance of the stone through a single session of complete CBD was reported in 16 out of 25 patients (64%). The complications associated with the procedure were minimal and affected three patients (12%), and were mild in nature; there were no cases of perforation or excessive bleeding. Multi-variable analysis revealed that the independent variables associated with procedural success were larger CBD diameter (OR 1.48 per mm increase, p = 0.012), better distal CBD angulation 135° and above (OR 3.92, p = 0.038), and large balloon size (OR 1.67 per mm increase, p = 0.008). There was no statistically significant correlation between demographic variables and laboratory baseline parameters and EPLBD outcomes.

CONCLUSION: EPLBD is safe and can be highly applied to challenging CBD stones. Some of the main determinants of success are anatomical and procedural factors, and not clinical or laboratory variables.

PMID:41773362 | DOI:10.7417/CT.2026.2001

Clin Ter. 2026 Mar-Apr;177(2):209-217. doi: 10.7417/CT.2026.1997.

ABSTRACT

BACKGROUND: This study aimed to assess the effectiveness of data analysis using a hybrid method in predicting and diagnosing cardiovascular diseases compared to standard methods. Methods. The study involved 200 patients diagnosed with cardiovascular diseases (arterial hypertension, ischemic heart disease, heart failure) in Moscow, Russia. Patients were randomly assigned to two equal groups. Group A underwent analysis of clinical data using random forest, support vector machines, and linear regression methods. Group B was subjected to hybrid method analysis. For Group B, patient survival was higher by 5%, and complication frequency was lower by 3%. The hybrid method demonstrated superior forecasting and treatment efficacy (p < 0.001) compared to similar indicators in Group A.

RESULTS: PCA analysis revealed that principal components explained over 70% of the variability among clinical parameters. Kaplan-Meier survival curves showed a statistically significant influence of cholesterol levels on survival and complication frequency (p < 0.05). Correlation analysis identified an inverse relationship between cholesterol levels and survival (p < 0.05). A hybrid data analysis method proves more effective than standard methods in predicting cardiovascular treatment outcomes and improving patient survival. The use of a hybrid method demonstrates the success of new data processing techniques in clinical practice, enabling the optimization of therapies and improving the quality of care for patients with cardiovascular disease.

CONCLUSION: The use of a hybrid method demonstrates the success of new data processing techniques in clinical practice, enabling the optimization of therapies and improving the quality of care for patients with cardiovascular disease.

PMID:41773358 | DOI:10.7417/CT.2026.1997

Health Soc Care Deliv Res. 2026 Feb;14(5):1-23. doi: 10.3310/GJCC0605.

ABSTRACT

BACKGROUND: Identifying clinical deterioration is a global health priority. Sepsis is a leading cause of deterioration, responsible for around 46,000 deaths annually in the United Kingdom. Early warning scores based on patients’ vital signs can be embedded into electronic patient records to digitally alert clinicians to those at risk. Rapid identification and treatment – particularly with targeted intravenous antibiotics – are critical to improving outcomes in sepsis patients.

RESEARCH QUESTION: This study aimed to evaluate the effectiveness of digital alerts in improving outcomes for patients with sepsis. Using routine electronic patient record data from four United Kingdom National Health Service acute trusts, we investigated how digital alert systems influence patient outcomes and explored mechanisms and mediators of their effectiveness.

OBJECTIVES: Map the types of digital alerts currently in use across United Kingdom hospitals for identifying patients at risk of sepsis (Workstream 1). Evaluate the impact of digital alerts on patient outcomes (Workstream 2). Examine how the implementation process affects alert performance, guided by the consolidated framework for implementation research (Workstream 3). Provide recommendations on alert effectiveness and implementation strategies using systems modelling and mediation analysis (Workstream 4).

METHODS: A mixed-methods approach was employed. A national survey assessed the use of digital sepsis alerts in English National Health Survey hospitals (Workstream 1). Qualitative interviews and focus groups explored the implementation process and its influence on alert performance (Workstream 3). A natural experiment with multilevel interrupted time series analysis examined the impact of sepsis screening tools and digital alerts on outcomes, primarily in-hospital mortality (Workstream 2). Routinely collected clinical data were processed following National Institute for Health Research-Health Information Collaborative standards. Combining quantitative and qualitative data enabled us to link implementation processes with patient outcomes.

RESULTS: All four trusts experienced reduced mortality rates among patients with serious infections following the introduction of digital sepsis screening tools. After adjustment for patient case-mix, admission patterns and pre-existing trends, one trust showed a statistically significant decrease in mortality linked to digital alert implementation. In two trusts, older patients experienced greater mortality reduction than younger ones following alert introduction. Qualitative findings highlighted factors contributing to more effective use of digital alerts: deployment in general wards rather than intensive care units; use by clinicians familiar with similar technologies; availability of 24/7 emergency outreach teams; robust technological infrastructure and alerts that were user-friendly, non-intrusive and not part of multiple competing alert systems.

CONCLUSIONS: The effectiveness of digital sepsis screening tools varies and may depend on patient’s age and care setting. Our findings suggest that digital alerts should leverage a wider range of electronic patient record data and be tailored to specific patient groups. Different trusts and patient populations may require distinct indicators, thresholds and treatment protocols. These findings align with healthcare practitioners’ calls for more sophisticated, patient-centred sepsis screening tools targeted at relevant clinical teams.

FUTURE WORK AND LIMITATIONS: The study involved four National Health Service Trusts with strong data collaboration, but noted limitations include reliance on simple algorithms and varied case-mix and implementation processes. Future research should focus on robust evaluation methods, leveraging granular electronic patient record data and establishing a public registry of digital alert tools.

FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR129082.

PMID:41773349 | DOI:10.3310/GJCC0605

Afr J Reprod Health. 2026 Mar 2;30(4):105-114. doi: 10.29063/ajrh2026/v30i4.10.

ABSTRACT

The study employs descriptive and econometric methods in examining the contribution of women’s participation to the economic growth of Nigeria from 1990 to 2022. Data sources employed were World Bank Development Indicators. Through examination of the data, the study finds that industry remains the largest employer of women in Nigeria, followed by the agricultural sector. Besides, the contribution of female employment in agriculture, services, and manufacturing sectors on Nigerian economic growth was found to be negative although statistically insignificant. Similarly, the female labor participation rate also does not have any significant effect on the economic growth of the nation. In response to these findings, the study recommends that Nigerian policymakers and other stakeholders’ direct investment to the industrial, service, and agricultural sectors in order to promote SDG 8-inclusive economic growth-through increased involvement of women in the working population. Gender balance also must take center stage in recruitment exercises in these sectors as a method of reducing discrimination against women in jobs.

PMID:41773343 | DOI:10.29063/ajrh2026/v30i4.10

Orthop Surg. 2026 Mar 3. doi: 10.1111/os.70279. Online ahead of print.

ABSTRACT

INTRODUCTION: Complex lumbar disc herniation (CLDH), including huge, migrated, and calcified variants, poses surgical challenges due to factors such as deep-seated lesions, irregular morphology, and adhesion to neural structures. This study aimed to compare the clinical outcomes of two minimally invasive endoscopic approaches-percutaneous endoscopic interlaminar discectomy (PEID) and percutaneous endoscopic transforaminal discectomy (PETD)-in the management of CLDH.

METHODS: In this retrospective cohort study, 270 patients with CLDH treated between January 2020 and January 2024 were analyzed. Patients were categorized into three CLDH subtypes and were further divided into PEID and PETD groups based on preoperative imaging findings. Surgical parameters, perioperative data, and complications were recorded. Functional outcomes were evaluated using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. Imaging measurements included the cross-sectional area of facet joints (CSA-FJ) and dural sac (DSCA). Statistical analyses were performed using the chi-square test, Wilcoxon rank-sum test, Shapiro-Wilk test, independent-samples t-test, and two-way repeated-measures ANOVA.

RESULTS: All procedures were successfully completed. PEID showed shorter operative time and significantly fewer fluoroscopy exposures compared to PETD (p < 0.05). PETD was associated with a higher facet joint resection rate (p < 0.05), though DSCA improvements were similar between groups. Both groups demonstrated significant reductions in VAS and ODI scores at all follow-up points (p < 0.05), with no statistically significant differences between approaches. Over 80% of patients achieved excellent or good outcomes according to modified MacNab grading. Complications were uncommon and included dural tears (n = 3), epidural hematoma (n = 1), nerve root injury (n = 1), and recurrent herniation (n = 2).

CONCLUSION: Both PEID and PETD are effective and safe surgical options for treating CLDH. PEID offers reduced operative time and radiation exposure, while PETD requires more extensive facet resection. This study further outlines tailored surgical strategies for different CLDH subtypes, supporting individualized endoscopic treatment selection.

PMID:41773328 | DOI:10.1111/os.70279

Afr J Reprod Health. 2026 Mar 2;30(4):83-93. doi: 10.29063/ajrh2026/v30i4.8.

ABSTRACT

This descriptive cross-sectional study aimed to examine the association between health anxiety, attitudes toward menopause, and sexual function in menopausal women. The participants’ mean total scores were 38.67 ± 11.16 for the Attitudes Toward Menopause Scale (ATMS), 21.12 ± 6.63 for the Short Health Anxiety Inventory (SHAI-18), and 15.01 ± 5.50 for the Female Sexual Function Index (FSFI-6). A negative correlation was found between ATMS scores and both SHAI-18 and its “Bodily Symptom Hypersensitivity” subscale (p<0.05). Additionally, a negative association was observed between SHAI-18 and FSFI-6 scores (p<0.05). Regression analysis revealed that ATMS had a statistically significant effect on SHAI-18 (p<0.001), with a 1-point increase in SHAI-18 associated with a 0.160-point decrease in ATMS scores. Furthermore, ATMS scores were found to explain 7% of the observed differences in SHAI-18 scores. In conclusion, increased health anxiety in menopausal women negatively affects their attitudes toward menopause, leading to psychosexual difficulties.

PMID:41773319 | DOI:10.29063/ajrh2026/v30i4.8

J Biophotonics. 2026 Mar;19(3):e70235. doi: 10.1002/jbio.70235.

ABSTRACT

Analysis of sequential alterations in body fluid constituents, such as serum, is vital for assessing inflammation. Attenuated Total Reflectance-Fourier Transform Infrared (ATR-FTIR) spectroscopy was used to monitor biomolecular changes in a Dextran Sodium Sulfate (DSS) mouse colitis model. Serum samples collected on days 0, 3, and 7 post- (3% DSS) administration showed stepwise changes in lipid, protein, and carbohydrate regions. Statistically significant (SS) changes (p < 0.05) were detected at the initial stage of colitis (day 0 to 3) in six spectral biomarkers (SBMs), including the integral ratio of α-helix to β-sheet (Amide I) and the β-sheet (Amide I) to Tyrosine (Amide II). Changes intensified from day 3 to 7, with the most prominent differences from day 0 to 7, even when the initial changes (day 0 to 3) were not SS. These results highlight the potential of ATR-FTIR as a minimally invasive pre-screening tool for monitoring colitis progression.

PMID:41773309 | DOI:10.1002/jbio.70235

Mov Disord. 2026 Mar 2. doi: 10.1002/mds.70234. Online ahead of print.

ABSTRACT

BACKGROUND: Long-term exposure to air pollution has been linked to Parkinson’s disease (PD) incidence, yet evidence is mixed, partly because of challenges with PD diagnosis and definition. We examined this association in a nationwide administrative cohort.

METHODS: We followed 3,280,190 Danish residents ≥30 years old from January 1, 2000 until December 31, 2018 for PD incidence, defined as either first hospital contact for primary PD or redeemed prescription of PD medication, as recorded in the Danish National Patient Registry or Prescription Registry, respectively. We assigned annual mean air pollution exposure concentrations at baseline residential address using the hybrid land-use regression model (fine particulate matter [PM_2.5], nitrogen dioxide [NO₂], ozone [warm-season, O₃w], black carbon [BC]) rendered at 0.1 × 0.1 km. We used Cox proportional hazard models adjusting for age, sex, individual-level, and area-level socioeconomic factors.

RESULTS: During a mean (standard deviation) follow-up of 15.7 (5.6) years, 36,665 participants developed PD. Median (interquartile range [IQR]) exposure levels of PM_2.5, NO₂, O₃w, and BC were 12.4 (2.0), 20.2 (7.9), 80.2 (4.3) μg/m³, and 1.01 (0.4) × 10^-5/m, respectively. Hazard ratios (95% confidence intervals) for associations between air pollutants (per IQR) and PD incidence were: 1.05 (1.03, 1.07) for PM_2.5; 1.03 (1.01, 1.05) for NO₂; 0.98 (0.97, 1.00) for O₃w; and 1.04 (1.02, 1.06) for BC.

CONCLUSIONS: In a representative nationwide cohort, we find that long-term exposure to air pollution is associated with PD incidence. This unique study, with access to incidence data from administrative health registers, provides new evidence supporting air pollution as a PD risk factor. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

PMID:41772748 | DOI:10.1002/mds.70234

Plant Genome. 2026 Mar;19(1):e70208. doi: 10.1002/tpg2.70208.

ABSTRACT

“Cytosine methylation plays an important role in the regulation of gene expression in plants.” Some iteration of this statement can be found in most papers centered on plant epigenetics and has become a widely accepted textbook claim. However, our generalized understanding of how DNA methylation exerts control over transcription is now challenged by observations demonstrating that transcriptional levels of most genes are unresponsive to DNA methylation changes. On a genome-wide scale, associations between DNA methylation and transcription are usually statistically weak. Even when correlations are found, the cause and effect can be difficult to identify, as methylation changes sometimes follow rather than precede transcriptional changes. While a growing number of studies explore a possible connection between differentially expressed genes (DEGs) and differentially methylated genes (DMGs), we demonstrate here that DEG-DMG overlaps are often significantly smaller than what could be expected by chance. This indicates that, contrary to expectations, changes in DNA methylation and changes in transcription sometimes avoid one another. Here, we discuss such observations and their implications for the hypothesis of a widespread control of gene expression directly by DNA methylation. While there are well-documented examples where DNA methylation regulates transcription, we argue that such cases represent a minority of genes, and we opine that approaches of reverse epigenetics are therefore unlikely to find broad application in breeding.

PMID:41772747 | DOI:10.1002/tpg2.70208

Diagn Progn Res. 2026 Mar 3;10(1):5. doi: 10.1186/s41512-026-00220-3.

ABSTRACT

BACKGROUND: Adverse pregnancy outcomes (APOs), such as gestational diabetes, preeclampsia, and placental abruption, are major contributors to maternal and fetal morbidity and mortality, with implications for individual long-term health and health system performance. Existing prediction models for APOs rely primarily on clinical or biomarker data, with few incorporating social, behavioral, or environmental determinants that are critical for shaping perinatal outcomes. This study describes the development and validation protocol for the Adverse Pregnancy Outcomes Population Risk Tool (PregPoRT), a novel, population-based prediction model designed to estimate APO risk using population-based and routinely collected survey and administrative data in Canada.

METHODS: PregPoRT will be developed using a retrospective cohort of female-identifying individuals, aged 15-49, who participated in the Canadian Community Health Survey (CCHS) between 2000 and 2017, and had a subsequent delivery hospitalization within two years recorded in the Discharge Abstract Database (DAD). Pre-pregnancy predictors were selected according to a health equity-informed framework by Kramer and colleagues (2019), and include biomedical, behavioral, social, and environmental variables from the CCHS, the Canadian Marginalization Index (CAN-Marg), the Canadian Urban Environmental Health Research Consortium (CANUE), and the Canadian Active Living Environments (Can-ALE) dataset. The primary outcome is a composite measure of APOs (gestational diabetes, preeclampsia, or placental abruption), identified using validated ICD codes. A Weibull accelerated failure time model will be used to estimate the risk of experiencing an APO. Continuous variables will be modeled with restricted cubic splines. Variable selection will be performed using the Least Absolute Shrinkage and Selection Operator (LASSO), and model performance will be assessed via discrimination, calibration, and overall accuracy. Validation strategies include split-sample, bootstrap, and temporal validation using later CCHS cycles. Survey weights will be applied throughout to ensure national representativeness.

DISCUSSION: PregPoRT will be the first Canadian prediction model for APOs that leverages nationally representative, linked survey and administrative data and explicitly integrates social, behavioral, and environmental determinants of health, domains that have been largely absent from prior models. By incorporating modifiable and socially patterned risk factors, the tool is designed to support public health planning, resource allocation, and maternal health equity monitoring.

PMID:41772741 | DOI:10.1186/s41512-026-00220-3