Nevin Manimala

Front Cardiovasc Med. 2026 Apr 21;13:1673478. doi: 10.3389/fcvm.2026.1673478. eCollection 2026.

ABSTRACT

BACKGROUND: The aim of this study was to establish sex- and age-specific reference values for ramp cycle-ergometer and treadmill cardiopulmonary exercise testing (CPET) in patients with Tetralogy of Fallot (ToF). Despite successful surgical repair, residual pulmonary regurgitation remains common in repaired ToF (rToF), often leading to right or left ventricular dysfunction and reduced exercise capacity. CPET is a reliable tool for evaluating cardiopulmonary function. Although both treadmill and cycle ergometer protocols are used interchangeably, reference value ranges for each method in this population remain unclear.

METHOD: CPET data were collected from asymptomatic rToF patients who had undergone cardiac magnetic resonance imaging (CMR) and performed CPET on a treadmill or cycle ergometer between 2020 and 2024. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ).

RESULTS: Among 290 patients, median age at CPET was 21.6 years (15.9-29.3), and median BMI was 22.5 kg/m² (20.0-24.9). Nearly all participants (99%) were in NYHA class I. Physical activity was classified as sedentary in 29%, moderate in 61%, and high in 9%. Median VO₂ peak was 26.4 mL/min/kg (23.0-31.5), corresponding to 72.9% predicted (62.4-83.2). Median oxygen pulse at peak was 9.9 mL/beat (8.2-12.0), with 76.9% predicted (68.0-87.5). Median VE/VCO₂ slope at the respiratory compensation point was 29.0 (26.0-32.6), and median oxygen uptake efficiency slope (OUES) was 1,792.5 mL/min/log(L/min) (1,535.0-2,181.5). VO₂ peak and percent-predicted VO₂ were significantly higher with treadmill testing in both sexes (p < 0.05); oxygen pulse was higher only in females. VE/VCO₂ slope and OUES were unaffected by modality. When stratified by age (<18 vs. ≥18 years), treadmill-related differences in VO₂ peak and percent-predicted VO₂ remained significant in both sexes ≥18 years, and in females <18 years. Oxygen pulse was significantly higher with treadmill only in females ≥18 years. VE/VCO₂ slope and OUES remained unchanged across modalities and age groups.

CONCLUSION: This study provides CPET values stratified by modality and sex in a large cohort of asymptomatic rToF patients, offering valuable reference data for clinical assessment. Future studies should validate pediatric normative CPET values through prospective, inclusive, statistically powered cohorts using standardized protocols and cross-center comparability.

PMID:42095152 | PMC:PMC13139358 | DOI:10.3389/fcvm.2026.1673478

Front Cardiovasc Med. 2026 Apr 21;13:1803696. doi: 10.3389/fcvm.2026.1803696. eCollection 2026.

ABSTRACT

BACKGROUND: The relationship between gastric cancer and cardiovascular traits, including hypertension and coronary artery disease (CAD), remains incompletely understood. Observational studies are prone to confounding and reverse causation, and genetic evidence may help clarify the nature of these associations.

METHODS: We conducted a bidirectional two-sample Mendelian randomization (MR) analysis using publicly available genome-wide association study (GWAS) summary statistics to investigate the relationships between gastric cancer, hypertension, and CAD. Multiple MR methods and sensitivity analyses were applied to assess robustness. To provide supplementary clinical context, we additionally conducted a small retrospective clinical analysis of 45 individuals, including gastric cancer cases and non-cancer controls, using logistic regression adjusted for age and sex.

RESULTS: MR analyses showed no evidence that genetic liability to gastric cancer was associated with the risk of hypertension or CAD. In contrast, genetic predisposition to hypertension was inversely associated with gastric cancer risk. These findings were consistent across sensitivity analyses. In the retrospective cohort, hypertension was not significantly associated with gastric cancer risk.

CONCLUSIONS: This study provides genetic evidence supporting an inverse association between hypertension liability and gastric cancer risk. However, the supplementary retrospective clinical analysis was limited by its small sample size and did not provide independent validation of the MR findings. Larger observational studies are needed. Further studies are warranted to clarify the underlying biological mechanisms.

PMID:42095144 | PMC:PMC13138934 | DOI:10.3389/fcvm.2026.1803696

Access Microbiol. 2026 May 5;8(5):000945.v5. doi: 10.1099/acmi.0.000945.v5. eCollection 2026.

ABSTRACT

Background. Antibiotic misuse, influenced by urbanization and limited healthcare access, has accelerated antibiotic resistance, impacting global health. Surveillance in Sri Lanka’s National Strategic Plan for Combating Antimicrobial Resistance (2017-2022) shows significant multidrug resistance in hospitals, with 12.7% of the health budget (3.3 billion) spent on antimicrobials. This resistance complicates treatment and increases patient management costs, particularly in the Western Province, a focal area for analysing antibiotic misuse. Objectives. To assess public awareness of antibiotic misuse and antimicrobial resistance in the Western Province of Sri Lanka. Methodology. A cross-sectional study was conducted on 200 adults in the Western Province from 23 December 2023 to 16 January 2024, using in-person interviews and a Google form questionnaire. Descriptive statistics were applied to analyse the data, and a binary logistic regression analysis was conducted to identify predictors of antimicrobial resistance (AMR) knowledge among participants. The model included sociodemographic, behavioural and awareness-related variables, with statistical significance set at P<0.05. Results. Of the respondents, 83% knew antibiotics combat bacterial infections, while 71.5% adhered to completing antibiotic courses. However, 28.5% opposed doing so, with 65.5% stopping antibiotics once they felt better. Regarding antimicrobial resistance, 60.5% recognized the term, and 61% acknowledged that unnecessary antibiotic use could increase bacterial resistance. Participants from the Kalutara District had nearly nine times more good AMR knowledge (AOR=9.10, P=0.005), while those earning LKR 20,000-75,000 had almost 11 times more good knowledge (AOR=11.10, P=0.033) and those who followed the advice of a health professional had even more knowledge (AOR=851.08, P=0.016). Poor knowledge was observed from the rural population (AOR=0.15, P=0.006) and those who had ever been infected (AOR=0.21, P=0.023). Good knowledge was also present among those who had been divorced or widowed (AOR=12.21, P=0.029), had used antibiotics privately and without prescriptions (AOR=4.67, P=0.027) or who had heard of AMR but could not remember the source (AOR=51.60, P<0.001). Conclusion. Most participants understood antibiotics’ role, though gaps in correct use and awareness of misuse consequences persisted. While there was a positive attitude towards antimicrobial resistance, further educational efforts are essential to address knowledge gaps, as recent studies show high resistance levels and limited progress in awareness.

PMID:42095137 | PMC:PMC13143338 | DOI:10.1099/acmi.0.000945.v5

J Build Phys. 2025 Oct 17;49(6):829-851. doi: 10.1177/17442591251367436. eCollection 2026 May.

ABSTRACT

Low-cost indoor air quality (IAQ) sensors offer new opportunities for real-time monitoring in the built environment by occupants and researchers. However, their performance can vary substantially depending on the environmental conditions. This study presents a comprehensive evaluation of carbon dioxide (CO₂) and fine particulate matter (PM_2.5) measurements from two consumer-grade low-cost sensors (the Airthings View Plus for CO₂ only and Air Gradient Pro for CO₂ and PM_2.5) through co-location tests with two reference instruments, Graywolf DSII-8 for CO₂ and Lighthouse Handheld 3016 for PM_2.5. Using time-series analysis, linear regression, Pearson correlation, Root-Mean Squared Error (RMSE), Bland-Altman test, and paired t-tests, we assess the precision and accuracy of these sensors. At a 5-minute sampling interval, the Air Gradient sensor had a higher coefficient of determination (R ²), stronger Pearson correlation, and narrower range of limits of agreement (LoAs), but higher bias (i.e. the mean difference) and RMSE, suggesting higher precision but lower accuracy when compared to Airthings. As a result, it can perform well for tracking the relative changes in CO₂, though less ideal for absolute concentrations without calibration. For PM_2.5, the Air Gradient also had relatively high R ² (0.79), moderately strong Pearson correlation (ρ = 0.69, p < 0.05), and a narrow range of LOAs (30.1 μg/m³) and low RMSE (5.8 μg/m³). Averaging the 5-minute measurements over 30-minute intervals generally improved the accuracy and precision of both sensors. However, statistically significant differences from the reference instruments remained for both sensors. Overall, this study offers a multi-metric assessment of consumer-grade sensors and highlights the need for in-situ calibration prior to long-term deployment.

PMID:42095132 | PMC:PMC13143174 | DOI:10.1177/17442591251367436

JB JS Open Access. 2026 May 6;11(2):e25.00315. doi: 10.2106/JBJS.OA.25.00315. eCollection 2026 Apr-Jun.

ABSTRACT

BACKGROUND: Surgical skill assessment in orthopaedic trauma surgery still relies on subjective expert ratings, which limits consistency and scalability. While digitalization offers a path toward objective and scalable assessment, the highly manual and haptic nature of surgery makes tool use difficult to capture digitally, keeping such approaches underdeveloped. This study introduces a digital assessment framework for orthopaedic trauma training that derives digital behavioral metrics (DBM) from tracked surgical tool motion. Specifically, it investigates (1) which DBM indicate technical proficiency and (2) to what extent these DBM are capable of predicting expert-rated surgical performance.

METHODS: Twenty-eight participants performed 3 standardized fracture fixations on synthetic bone models of the radius, ulna, and fibula. Tool motion was captured and transformed into a digital twin from which metrics such as path length, smoothness, and task duration were derived. These metrics were statistically compared with the average Global Rating Scale (GRS) obtained from 4 experts who rated each surgical performance. (1) Correlation analysis identified skill-relevant metrics and (2) a predictive model was trained to estimate performance from DBM evaluating its accuracy against the individual expert ratings.

RESULTS: (1) Several DBM were found to be indicative of surgical performance. Measures based on tool path length and time per activity showed strong correlations with expert ratings, reaching coefficients of up to 0.6. Correlation strength varied across tools and procedures. (2) The predictive model achieved a mean absolute difference of 3.8 points from the average GRS score (scale range: 28-70), outperforming the mean interexpert difference of 4.6 points.

CONCLUSION: DBM were identified as valid indicators of surgical skill. The study further demonstrated their predictive value, showing closer alignment with experts’ average GRS score than individual expert ratings. These findings highlight the feasibility of objective, expert-independent performance assessment in orthopaedic trauma surgery training.

PMID:42095124 | PMC:PMC13138458 | DOI:10.2106/JBJS.OA.25.00315

JB JS Open Access. 2026 May 6;11(2):e25.00303. doi: 10.2106/JBJS.OA.25.00303. eCollection 2026 Apr-Jun.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) is the treatment of choice for end-stage knee osteoarthritis in many patients. In younger patients with predominantly medial compartment disease, high tibial osteotomy (HTO) is performed as a joint-preserving treatment. However, concerns remain regarding potentially compromised outcomes of TKA after previous HTO given the axial deviation, osteotomy site, secondary surgery, previous hardware, and instrumentation. Therefore, this study compared long-term implant survival, revision, and infection rates, and patient-reported outcomes between patients undergoing TKA after HTO and matched TKA-only controls.

METHODS: Postoperative complications and revision surgeries were prospectively recorded in patients who underwent TKA from 2000 to 2023 at a single academic center. Patients with previous ipsilateral HTO formed the study group and were propensity matched 1:2 to TKA-only patients without a previous osteotomy based on age, sex, and body mass index. Knee Society Scores (KSS) were collected prospectively. Implant survivorship was analyzed using Kaplan-Meier survival curves and Cox proportional hazards models.

RESULTS: The study included 134 HTO-TKA and 268 matched TKA-only patients, with a mean follow-up of 10.5 ± 6.4 years (range: 0-24 years) after TKA. Both groups showed significant postoperative improvements in KSS (p < 0.02) with comparable clinical outcomes (HTO-TKA: 79.0 (6.0), TKA-only: 79.0 (11.8)). Revision arthroplasty rates were 5.2% for HTO-TKA and 4.5% for TKA-only (p = 0.69); the mean time to revision was 8.1 ± 8.7 years vs. 4.4 ± 3.5 years, respectively (p = 0.30). Infection rates were 2.2% and 1.1%, respectively (p = 0.74).

CONCLUSIONS: Revision and infection rates were comparable between HTO-TKA and matched TKA-only patients, with no statistically significant differences. Our findings demonstrate comparable patient-reported outcomes in both groups. These findings indicate that a previous HTO does not adversely affect TKA implant longevity or clinical outcomes when compared with matched primary TKA patients within the US population.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:42095123 | PMC:PMC13138463 | DOI:10.2106/JBJS.OA.25.00303

RSC Adv. 2026 May 5;16(25):23177-23189. doi: 10.1039/d6ra03291e. eCollection 2026 Apr 29.

ABSTRACT

Severe, gap-type peripheral nerve injuries often require surgical intervention in the form of a nerve autograft or synthetic nerve guidance scaffold to promote axonal regeneration and functional recovery. In this study, nerve guidance conduits (NGCs) were fabricated from aligned polycaprolactone (PCL) nanofibres with or without encapsulated glial cell line-derived neurotrophic factor (GDNF), and a fibrin sealant-based hydrogel. These constructs were evaluated in a murine sciatic nerve transection model using Thy1-YFP-H mice, allowing regenerating axons to be visualised in transverse sections throughout the constructs. Both PCL + GDNF and PCL-only conduits facilitated Schwann cell migration and successful axonal regeneration across the site of injury. Nerve autografts, the positive control, demonstrated the highest regenerating axon count in the distal stump, although statistical significance was not observed between groups. These results demonstrate that NGCs fabricated using aligned PCL nanofibres reliably facilitate nerve regeneration across nerve gaps to a degree, but require further investigation for application in peripheral nerve repair. Future studies that optimise growth factor delivery and conduit design would be beneficial to improve regenerative outcomes.

PMID:42095107 | PMC:PMC13141687 | DOI:10.1039/d6ra03291e

Rural Remote Health. 2026 May;26(2):9803. doi: 10.22605/RRH9803. Epub 2026 May 7.

ABSTRACT

INTRODUCTION: Child malnutrition remains a critical public health challenge in low- and middle-income countries, significantly contributing to morbidity and mortality among children less than age 5 years. In Northern Nigeria, persistent nutritional deficiencies, compounded by socioeconomic disparities and regional variations, demand urgent attention. This study examines trends and determinants of stunting, wasting, and underweight from 2013 to 2018.

METHODS: A cross-sectional research design was used for this study. Household and anthropometric secondary data were extracted from the 2013 and 2018 Nigeria Demographic and Health Surveys, focusing on 39,720 mother-child pairs in Northern Nigeria. Anthropometric measurements were converted into Z-scores, with stunting, wasting, and underweight defined as scores less than &minus;2 standard deviations. Chi-squared analyses were used to assess associations between malnutrition and various factors. Analyses were performed using IBM Statistical Package for the Social Sciences (v28.0), with statistical significance set at p<0.05.

RESULTS: Findings reveal that stunting increased from 39.4% to 44.7% (p<0.001) over the study period, whereas wasting declined markedly from 17.0% to 8.1% (p<0.001) and underweight decreased from 30.0% to 27.5% (p<0.001). Significant disparities emerged across regions, with the North-West exhibiting the highest malnutrition rates, and rural areas showing greater vulnerability than urban settings. Rural children had higher malnutrition rates than urban children. Higher maternal education and greater household wealth were strongly associated with a reduced risk of malnutrition.

CONCLUSION: This study contributes to the literature by showing that regional disparities and conflict-related instability exacerbate child malnutrition in Northern Nigeria. The findings revealed subnational variations that mirrored patterns in other crisis-affected regions, yet with distinct local drivers. The divergent trends in wasting (improved) and stunting (worsened) challenge the assumption that short-term interventions alone can address malnutrition in fragile settings. For practitioners in rural and remote health, these results emphasize the need for localized, multisectoral approaches. Such strategies must combine immediate nutritional support with long-term investments in maternal education, economic empowerment, and health systems adapted to the unique challenges of rural contexts, such as limited infrastructure and access to care.

PMID:42092302 | DOI:10.22605/RRH9803

Am J Surg. 2026 Apr 28;258:117013. doi: 10.1016/j.amjsurg.2026.117013. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative abdominal and shoulder pain, nausea, and vomiting are among the most common complications following laparoscopic surgery, often necessitating increased use of analgesics and antiemetics. This study aimed to compare the effects of nitrous oxide (N₂O) and positional maneuvers on pain intensity, incidence of nausea and vomiting, and analgesic requirements after laparoscopic surgery.

MATERIALS AND METHODS: This double-blind randomized clinical trial was conducted on 126 elective patients scheduled for laparoscopic cholecystectomy. The patients were randomly assigned into three groups of 42 individuals each: one group received N₂O, another received a combination of positional maneuver and pulmonary recruitment, and the third served as the control group. Pain intensity, nausea, vomiting, and time to first analgesic request were assessed at 6, 12, and 24 h postoperatively. Data were analyzed using ANOVA, Chi-square, and Fisher’s exact tests. A p-value of less than 0.05 was considered statistically significant. All analyses were performed using SPSS software, version 24.

RESULTS: The results showed that the N₂O group experienced the lowest intensity of abdominal and shoulder pain at all time points, and the time to first analgesic request was significantly longer in this group than the others (p < 0.05). Additionally, the incidence of nausea and vomiting was lower in the intervention groups than in the control group, and this difference was statistically significant (p < 0.05). Among the demographic variables, gender was the only factor associated with the occurrence of complications; females experienced vomiting more frequently than males.

CONCLUSION: Both nitrous oxide and positional maneuvers effectively reduced postoperative pain and gastrointestinal complications, with N₂O showing greater efficacy in minimizing symptoms and delaying analgesic need.

PMID:42092289 | DOI:10.1016/j.amjsurg.2026.117013

Int J Nurs Knowl. 2026 May 6:20473087261443267. doi: 10.1177/20473087261443267. Online ahead of print.

ABSTRACT

IntroductionFrailty among older adults is a critical issue in Japan’s super-aged society. Although potentially reversible, frailty may progress to disability if left unaddressed. Home-visit nursing plays a key role, yet outcome evaluation remains limited. This study examined the effectiveness of care for older adults with frailty using a six-step nursing process based on standardized nursing terminologies NANDA-I, NOC, and NIC.MethodsNine older adults diagnosed with Elder frailty syndrome received individualized home-visit nursing a six-step NNN process over three months. NOC indicators were defined as each participant’s “best possible state” and were evaluated monthly. Data were recorded in Excel and analyzed using EZR. Ethical approval was obtained, and informed consent was independently managed.ResultsAll nine participants completed the study. Most showed improvement in NOC indicators, and some demonstrated resolution of frailty-related symptoms. One participant showed improvement in the initially selected NOC indicators, but new nursing diagnoses emerged and other frailty-related indicators worsened, resulting in no overall improvement in frailty status. Six NOC outcomes showed statistically significant improvement (p < .05), with several demonstrating large effect sizes (Cohen’s d > 0.8). Nurses reported that using NNN helped clarify care focus and promoted team collaboration. In some cases, reassessment shifted the diagnostic framework from Elder frailty syndrome to Readiness for Enhanced Healthy Aging.ConclusionThe NNN-based six-step nursing process may support frailty improvement by visualizing individualized outcomes and guiding targeted care. It may also support collaboration and structured evaluation in home-visit nursing.Practical ImplicationsAlthough preliminary, NNN-based care shows potential for addressing frailty through individualized assessment. Defining NOC outcomes as the “best possible state” may reflect diverse aging trajectories. Visualizing care transitions may promote team knowledge sharing. Future implementation requires standardized documentation and practitioner training.

PMID:42092257 | DOI:10.1177/20473087261443267