Nevin Manimala

Niger Med J. 2026 Mar 2;67(2):593-605. eCollection 2026 Mar-Apr.

ABSTRACT

BACKGROUND: Owing to the background physiologic derangements in critically ill patients, the risk of peri-intubation adverse events is higher than is seen in the operating room. Despite the burden of the problem, very little local data exists in Nigeria and sub-Saharan Africa. The objective of this study was to determine the incidence and risk factors for peri-intubation adverse events in the intensive care unit (ICU).

METHODOLOGY: This was a prospective, observational, multi-centre study involving critically ill adults requiring endotracheal intubation in the ICU between February and September 2024. The primary outcome measure was the incidence of peri-intubation adverse events (hypotension, hypoxia, cardiac arrest, and aspiration of gastric content) within 30 minutes of intubation. The secondary outcome measures included risk factors for these adverse events and their correlation with the length of ICU stay and 30-day in-hospital mortality. Data were analysed using SPSS version 25.

RESULTS: Fifty-one intubations involving 50 patients were included. Respiratory failure and neurological impairment were the major reasons for intubation (49.0% and 35.3%, respectively). The incidences of adverse events were hypotension (60%), severe hypoxia (32.6%), cardiac arrest (13.7%) and aspiration pneumonitis (17.8%). At least one adverse event was recorded in 74.8% of the intubations. We identified multiple intubation attempts as central to the occurrence of most adverse events. The probability of survival was higher in those with an adverse event, but it was not statistically significant.

CONCLUSION: Adverse events following intubation are common among critically ill patients in Nigeria. While hypotension was the most common complication, severe hypoxaemia emerged as the most lethal. Further research is needed on this subject.

PMID:42553977 | PMC:PMC13437006

Clin Orthop Surg. 2026 Aug;18(4):687-694. doi: 10.4055/cios25351. Epub 2026 Apr 1.

ABSTRACT

BACKGROUND: Superior labrum anterior to posterior (SLAP) lesions with paralabral cysts are uncommon. Although various procedures have been suggested, there is no consensus on the optimal choice. The purpose of this study was to compare clinical and radiological results between 2 procedures: SLAP repair with cyst decompression (RD group) and subpectoral biceps tenodesis with cyst decompression (TD group).

METHODS: Arthroscopic surgery for management of a paralabral cyst with a SLAP lesion was performed from January 2009 to January 2023 in 42 patients (RD group: 17, TD group: 25), who were available for a minimum 12-month follow-up. The visual analog scale (VAS) pain score, University of California, Los Angeles (UCLA) score, activities of daily living (ADL) score, and Subjective Shoulder Value (SSV) were evaluated. Postoperative magnetic resonance imaging (MRI) and manual muscle testing (MMT) were performed 6 months after surgery.

RESULTS: The mean age of patients in the RD group was 40.0 years and that of the TD group was 46.4 years (p = 0.014). Both groups showed significant improvement in the VAS pain score, UCLA score, ADL score, SSV score, and MMT after surgery. However, no significant difference was observed between the 2 groups. All but 1 patient in the RD group were able to return to work and sports at preoperative levels. This patient was diagnosed with brachial plexopathy after surgery and showed spontaneous improvement. Twenty-five of 42 patients (59.5%) underwent follow-up MRI 6 months after surgery, and there was no recurrence of the ganglion cyst with complete resorption.

CONCLUSIONS: Compared with cyst decompression and SLAP repair, cyst decompression combined with subpectoral biceps tenodesis demonstrated no statistically significant differences in clinical and radiographic outcomes in this retrospective cohort of patients with SLAP lesions and concomitant paralabral cysts. The findings of our study suggest that biceps tenodesis may be an effective surgical alternative for patients with compromised biceps integrity.

PMID:42553972 | PMC:PMC13437143 | DOI:10.4055/cios25351

Niger Med J. 2026 Mar 2;67(2):523-533. eCollection 2026 Mar-Apr.

ABSTRACT

BACKGROUND: Despite the formal launch of Nigeria’s Maternal and Perinatal Death Surveillance and Response (MPDSR) national guideline in 2016, limited data exist on actual practice among healthcare workers. This study assessed MPDSR practice and its determinants among healthcare workers in three referral hospitals in Edo State, Nigeria.

METHODOLOGY: A cross-sectional study was conducted among 221 healthcare workers in Central Hospital, Benin, University of Benin Teaching Hospital, and Irrua Specialist Teaching Hospital. MPDSR practice was assessed using three indicators: having received MPDSR training, having ever reported maternal death, and having attended maternal death reviews. Respondents who engaged in at least two of these three practices were classified as having good practice. Data were analyzed using IBM SPSS version 25, with the chi-square test and binary logistic regression. Statistical significance was set at p < 0.05.

RESULTS: Only 50 (22.6%) healthcare workers demonstrated good practice of MPDSR, while 171 (77.4%) had poor practice. Training coverage was critically low (8.6%), one-third (33.9%) had ever reported a maternal death, and 48.9% had attended maternal death reviews; of these, 91.7% were passive attendees only. Multivariate analysis identified older age, good knowledge, and positive attitude toward MPDSR as independent predictors of good practice, while female sex was independently associated with lower odds of good practice (all p < 0.05).

CONCLUSION: Poor MPDSR practice prevails in the selected hospitals, with critical deficits in training coverage, death reporting, and meaningful review participation. Improving practice requires scaled-up training, strengthened reporting systems, and targeted strategies addressing knowledge, attitudinal, and gender-related barriers.

PMID:42553968 | PMC:PMC13436998

Niger Med J. 2026 Mar 2;67(2):509-522. eCollection 2026 Mar-Apr.

ABSTRACT

BACKGROUND: Breast cancer is one of the most common cancers among women in Nigeria. Human epidermal growth factor receptor 2 (HER2) is an important prognostic and predictive biomarker that guides targeted therapy. The tumour grade is an important prognostic factor and is also important in the treatment of patients. In a resource-limited setting, cell block cytology may serve as an alternative for initial biomarker assessment and also as an initial diagnostic tool for planning definitive management. The study aims to compare HER2 overexpression of breast carcinoma using cell blocks and corresponding paraffin wax-embedded (FFPE) tissue blocks and to evaluate the concordance between both methods.

METHODOLOGY: This was a one-year prospective study involving 83 cases of breast carcinoma patients with both cell block and corresponding FFPE tissue specimens. HER2 immunohistochemistry was performed using the ASCO/CAP 2018 guideline. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated with 95% confidence intervals (CI). Concordance was assessed using Cohen’s kappa statistic. McNemar’s test was used for paired comparisons.

RESULTS: The mean age of the study participants was 43.1 ±13.1 years, with a peak age group of 40-49 years. IHC HER2 overexpression was done on both cell blocks and histological blocks. In cell blocks, HER2 expression showed 15 cases (18.1%), 65 cases (78.3%), 3 cases (3.6%) were positive, negative, and equivocal, respectively while from histologic tissues, 15 cases (18.1%), 63 cases (75.9%), 5 cases (6.0%) were also positive, negative and equivocal respectively. The overall concordance rate between the two methods was 93.5%, with concordance rates of 100% for HER2-positive cases, 96.9% for HER2-negative cases, and 60% for equivocal cases. Sensitivity and specificity of cell block HER2 assessment were 96.9% (95% CI: 82.9-99.9) and 100% (95% CI: 94.3-100.0), respectively. The PPV of HER2 assessment on cell block was 100.0% (95% CI: 78.2-100.0), and the NPV was 97.1% (95% CI: 89.9-99.6). The kappa coefficient for agreement was 0.935, indicating excellent agreement. McNemar’s test showed no statistically significant difference (p = 0.480). Equivocal (2+) cases were included without FISH confirmation. Most of the cases were invasive ductal carcinoma (NST), accounting for 97.6% (81 cases).

CONCLUSION: Cell block cytology demonstrates strong concordance with FFPE tissue for HER2 assessment and may serve as a reliable alternative for initial triaging in resource-limited settings, particularly where tissue is not readily feasible. However, confirmatory testing on tissue biopsy remains essential, particularly for equivocal cases.

PMID:42553962 | PMC:PMC13437011

Sci Rep. 2026 Aug 3;16(1):24004. doi: 10.1038/s41598-026-63542-8.

ABSTRACT

Understanding dengue dynamics from a spatiotemporal perspective has become increasingly relevant in recent years, as it allows the identification of factors influencing disease transmission, including climatic conditions, human behavior, and the distribution of Aedes aegypti, the primary vector responsible for dengue virus transmission in tropical and subtropical regions. This knowledge is essential for supporting public health decision-making and reducing the impact of dengue on vulnerable populations. This study proposes a spatio-temporal deep learning framework based on the U-Net++ architecture to generate high-resolution dengue risk maps in Colombia. The model integrates climatic, environmental, demographic, and socioeconomic information derived from satellite and census sources. Two spatial approaches were evaluated: a high-dimensional geography (HDG) approach at the national scale and a low-dimensional geography (LDG) approach applied to five departments with high dengue incidence. The model integrating climatic, social, and environmental information achieved the best performance in both approaches. In the HDG configuration, the best model (M9) reached a test mIoU of 0.6646 (validation mIoU = 0.7361). In the LDG configuration, the corresponding model achieved an average test mIoU of approximately 0.73 across departments. These results highlight the potential of integrating heterogeneous climatic, environmental, and socioeconomic data within a spatiotemporal deep learning framework to characterize dengue risk patterns and support high-resolution surveillance.

PMID:42552340 | DOI:10.1038/s41598-026-63542-8

Nat Commun. 2026 Aug 4;17(1):7559. doi: 10.1038/s41467-026-75655-9.

ABSTRACT

Linking abiotic forcing to coherent biotic responses over Phanerozoic time remains difficult to quantify because both environmental drivers and biological dynamics are heterogeneous, irregularly sampled, and affected by proxy and geochronological uncertainty. Here we introduce a regime-based description of the climate-carbon system in which Phanerozoic evolution is organized into a small number of recurring, long-lived mega-climate states separated by relatively sharp transitions. Using recurrence diagnostics on paired carbon and oxygen stable isotope records, together with complementary early-warning indicators, we identify five persistent regimes and their boundaries. We interpret the resulting structure with a conceptual climate-carbon cycle model that admits multiple coexisting equilibria, providing a mechanistic basis for state changes that switch between stable attractors under changing environmental forcings and perturbations. We connect these results to a biosphere vulnerability metric that incorporates biotic turnover with sample-standardized global diversity to show that vulnerability is systematically elevated near major regime transitions. These results suggest that transitions between persistent climate-carbon attractors provide a dynamical context for why some perturbation intervals coincide with heightened biospheric stress, beyond what is expected from more gradual background environmental changes alone.

PMID:42552311 | DOI:10.1038/s41467-026-75655-9

Environ Monit Assess. 2026 Aug 5;198(9):913. doi: 10.1007/s10661-026-15754-8.

ABSTRACT

Harmful algal blooms (HABs) are increasingly prevalent in freshwater ecosystems due to human activities and global warming. These blooms present severe environmental and public health risks, including the contamination of drinking water and the production of toxins harmful to humans and animals. Effective management requires a deep understanding of HAB formation mechanisms to transition from reactive treatment to proactive prevention. While nutrients, light, and temperature are recognized drivers, hydrodynamic conditions such as turbulence, flow velocity, and shear stress have gained significant research attention for their role in bloom dynamics. This study explores how these physical factors influence algal proliferation and highlights the utility of the CE-QUAL-W2 (a two-dimensional hydrodynamic and water quality model) for predictive management. Furthermore, it evaluates sustainable operational strategies, such as horizontal flushing and selective withdrawal, to control blooms in reservoirs. By integrating hydrodynamic modeling with innovative management practices, this research aims to provide a roadmap for advancing HAB control and guiding future ecological studies.

PMID:42552288 | DOI:10.1007/s10661-026-15754-8

Am J Physiol Heart Circ Physiol. 2026 Aug 4. doi: 10.1152/ajpheart.00517.2026. Online ahead of print.

ABSTRACT

Patients with chronic inflammatory disorders, including inflammatory bowel disease (IBD), carry an increased risk of cardiovascular disease. The 2022 ORAL Surveillance study reported that the pan-selective Janus kinase inhibitor (JAKi) tofacitinib was associated with increased risk of major adverse cardiovascular events (MACE) among patients with rheumatoid arthritis compared to anti-tumor necrosis factor (anti-TNF) therapy. This prompted guideline changes regarding the use of all JAKis, including upadacitinib, a JAK1-selective drug approved for use in chronic inflammatory conditions, including IBD. However, the mechanism underlying JAKi-related MACE outcomes and the significance of JAK selectivity relative to TNF inhibition remain unclear. Microvascular dysfunction (MVD) is a predictor of MACE. Flow-mediated dilation (FMD) is a measure of MVD. Using an established ex vivo model of resistance arterioles isolated from adipose tissue, we performed the first mechanistic comparison of anti-tumor necrosis factor (anti-TNF; infliximab), pan-JAK inhibitor (tofacitinib), and JAK1-selective (upadacitinib) therapies on human microvascular endothelial function. Arterioles were obtained from low-cardiovascular-risk subjects of both sexes. Isolated microvessels were incubated with drugs of interest. Flow-mediated dilation (FMD), an assessment of MVD, was measured before and after nitric oxide (NO) synthase inhibition or hydrogen peroxide (H₂O₂) scavenging. No therapy statistically altered FMD magnitude, yet underlying mechanisms differed. Control and infliximab-treated vessels maintained physiologic NO-mediated dilation. Tofacitinib induced a shift toward pathologic H₂O₂-mediated dilation. Upadacitinib impaired NO-dependent dilation without evidence of compensatory H₂O₂ signaling. In summary, anti-TNF therapy and selective versus non-selective JAKi differentially modulate endothelial mechanisms of vasodilation, suggesting unique microvascular phenotypes with potential implications for cardiovascular risk.

PMID:42552281 | DOI:10.1152/ajpheart.00517.2026

Support Care Cancer. 2026 Aug 4;34(8):828. doi: 10.1007/s00520-026-11064-4.

ABSTRACT

PURPOSE: Lymphedema is a chronic and progressive condition that significantly affects functional outcomes and quality of life. Social determinants of health (SDOH) contribute substantially to health disparities; however, their association with lymphedema severity and treatment adherence remains underexplored. This study aimed to evaluate the association between SDOH and both lymphedema severity and adherence to therapy.

METHODS: A retrospective chart review was conducted on 300 patients diagnosed with lymphedema (ICD-10: I89.0) who received care at the Georgia Cancer Center between March 2019 and December 2023. SDOH variables were categorized across five domains: economic stability, education, healthcare access, neighborhood environment, and social/community context. Lymphedema severity was assessed using the International Society of Lymphology staging system and dichotomized as moderate or less versus severe. Treatment adherence was measured as a composite score (0-100%) based on four components of complete decongestive therapy and categorized as low (< 50%) or high (≥ 50%). Multivariable logistic regression was used to examine associations.

RESULTS: Among 295 eligible patients included in the final analysis, transportation access, ethnicity, and gender were significantly associated with both lymphedema severity and treatment adherence (p < 0.05). Limited transportation access and lower socioeconomic indicators were associated with higher odds of severe lymphedema and lower adherence. African American ethnicity and male gender were also associated with worse outcomes.

CONCLUSIONS: SDOH significantly influences lymphedema severity and treatment adherence. Addressing barriers such as transportation and socioeconomic disparities is critical to improving outcomes and reducing inequities in lymphedema care.

PMID:42552279 | DOI:10.1007/s00520-026-11064-4

J Diabetes. 2026 Aug;18(8):e70260. doi: 10.1111/1753-0407.70260.

ABSTRACT

BACKGROUND: The combined prognostic value of continuous glucose monitoring (CGM) metrics and circulating glucose biomarkers for predicting mortality in type 2 diabetes has not been fully established, particularly regarding residual risk in patients achieving glycemic targets.

METHODS: This cohort study included 3677 patients with type 2 diabetes for a median of 7.4 years follow-up. Cox proportional hazards models evaluated the associations of baseline CGM-derived time in range (TIR) (target 70%) and serum 1,5-anhydroglucitol (1,5-AG) (threshold 6.0 μg/mL) with all-cause and cardiovascular mortality in the overall population. We further examined the relationship between 1,5-AG and mortality within TIR subgroups and compared its performance with metrics of glycemic variability derived from CGM.

RESULTS: During follow-up, 522 all-cause deaths and 181 cardiovascular deaths occurred. TIR and 1,5-AG were moderately correlated and independently predicted mortality, with concurrent low TIR (≤ 70%) and low 1,5-AG (< 6.0 μg/mL) yielding the highest risk (hazard ratio [HR] 1.82, 95% CI 1.40-2.37). In stratified analyses, reduced 1,5-AG was significantly associated with increased mortality risk in patients with TIR > 70% (HR 1.69, 95% CI 1.25-2.28), whereas no significant association was observed in those with TIR ≤ 70%. Adding 1,5-AG improved traditional risk prediction in the former subgroup. Compared with 1,5-AG, CGM-derived glycemic variability indices such as mean amplitude of glycemic excursions, coefficient of variation, and standard deviation of glucose showed no significant association with mortality.

CONCLUSIONS: TIR and serum 1,5-AG offer independent and complementary value, with low 1,5-AG identifying residual mortality risk despite achieving TIR targets.

PMID:42552233 | DOI:10.1111/1753-0407.70260