Nevin Manimala

Front Med (Lausanne). 2026 Apr 20;13:1797225. doi: 10.3389/fmed.2026.1797225. eCollection 2026.

ABSTRACT

BACKGROUND/OBJECTIVES: Meibomian gland dysfunction (MGD) constitutes a highly prevalent ocular surface condition and is a major etiological factor in tear film instability and evaporative dry eye disease. Although MGD can be objectively identified based on structural and functional abnormalities of the meibomian glands, epidemiological studies rarely differentiate between symptomatic and asymptomatic disease. Asymptomatic meibomian gland dysfunction, characterized by structural or functional gland alterations in the absence of self-reported ocular symptoms, may constitute an early and frequently overlooked phase within the disease spectrum. The objective of this systematic review and meta-analysis was to quantify the prevalence of asymptomatic MGD among adult populations.

METHODS: A comprehensive literature search was performed across PubMed, Web of Science, Scopus, ScienceDirect, and Google Scholar in accordance with the PRISMA guidelines. The review protocol was registered in PROSPERO (CRD420261283795). Cross-sectional and observational studies reporting the prevalence of asymptomatic MGD in adult populations were included. Data extraction and study selection were performed independently by two reviewers. A random-effects meta-analysis of proportions with logit transformation was applied using R software. Interstudy heterogeneity was quantified using the I² statistic, and possible contributors to variability were investigated through sensitivity analyses and meta-regression. Methodological quality and risk of bias were assessed using a modified version of the Newcastle-Ottawa Scale, while the overall certainty of the evidence was evaluated according to the GRADE approach.

RESULTS: Eight cross-sectional studies published between 2012 and 2023 were included, comprising a total of 3,637 participants and 1,313 cases of asymptomatic MGD. The combined prevalence of asymptomatic MGD was 72.86% (95% CI: 19.33-96.78%), with substantial heterogeneity across studies (I ² = 98.8%). Sensitivity analyses identified one influential study; however, the overall finding of a high prevalence remained consistent. Meta-regression showed that sex distribution significantly contributed to between-study heterogeneity, while no association with year of publication was observed. The level of certainty for the pooled prevalence estimate was classified as low.

CONCLUSION: Asymptomatic MGD is highly prevalent among adult populations worldwide. These findings indicate that reliance on symptom-based assessment alone may underestimate the burden of early MGD. Early identification of asymptomatic gland abnormalities may support preventive approaches to reduce progression to symptomatic dry eye disease, although further standardized and prospective studies are required.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261283795, CRD420261283795.

PMID:42089056 | PMC:PMC13137810 | DOI:10.3389/fmed.2026.1797225

Front Med (Lausanne). 2026 Apr 20;13:1782062. doi: 10.3389/fmed.2026.1782062. eCollection 2026.

ABSTRACT

INTRODUCTION: Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of reproductive age. This study aimed to determine self-reported prevalence of physician-diagnosed PCOS among young medical students at King Saud University and to compare it with reported rates from Western and international populations of similar age. In addition, it assessed the awareness among female medical students at King Saud University.

METHODS: A cross-sectional study was conducted using a structured self-administered questionnaire distributed to female medical students at King Saud University between December 2024 and March 2025. The survey contained sociodemographic data, PCOS-related signs and symptoms, past medical history, lifestyle factors, knowledge about PCOS and its complications. Statistical analyses included bivariate analysis and multivariable logistic regression.

RESULTS: We collected 303 responses. The self-reported prevalence of physician-diagnosed PCOS was 18.5%. Common symptoms included hair loss (60.7%), acne (49.8%), and weight gain (32%). PCOS diagnosis was significantly associated with age group (p = 0.015), BMI (p = 0.038), menstrual irregularities (p < 0.001), hirsutism (p < 0.001), weight gain (p = 0.004), diabetes mellitus (p < 0.001), and family history (p < 0.001). Multivariable logistic regression identified hirsutism (OR = 4.36, p = 0.005) to be significantly associated with self-reported physician-diagnosed PCOS.

CONCLUSION: The observed prevalence in young medical students in this study was higher than that reported in several Western populations of similar age. Recognition of contributing factors such as genetic susceptibility and lifestyle patterns is essential. Greater emphasis on early screening and targeted health education is recommended.

PMID:42089054 | PMC:PMC13136107 | DOI:10.3389/fmed.2026.1782062

Front Med (Lausanne). 2026 Apr 20;13:1817376. doi: 10.3389/fmed.2026.1817376. eCollection 2026.

ABSTRACT

BACKGROUND: Inhaled therapy is critical for treating chronic airway diseases, yet the competency of respiratory nurses in providing guidance remains inconsistent. Few studies have explored the systemic competency disparities that are driven by a hierarchical distribution of healthcare resources. The aim of this study is to assess self-reported inhaled therapy guidance (ITG) competency among respiratory nurses across multiple-tier healthcare institutions, as well as to explore factors that affected such competency.

METHODS: A total of 962 respiratory nurses at multilevel hospitals in Jiangsu Province, Eastern China were investigated. We developed an ITG competency scale and evaluated its reliability and validity. Nurses rated themselves on a structured questionnaire that was designed to collect data on ITG competency in this population. The associated factors were determined using a descriptive statistical analysis, a correlation analysis, and a hierarchical multiple regression analysis. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.

RESULTS: The ITG competency average score for respiratory nurses was (73.90 ± 9.42). Significant competency disparities were observed across all hospital tiers (p < 0.001), with the primary hospitals demonstrating higher rates of poor and lower proportions of good ratings than secondary/tertiary hospitals. For the knowledge dimension, tertiary hospitals had the fewest poor ratings, while primary hospitals exhibited the highest prevalence of poor ratings, although the proportion of good skill ratings remained comparable across all tiers (p > 0.05). Educational attainment, hospital grade, and training methodologies were associated with respiratory nurses’ competency at ITG.

CONCLUSION: The respiratory nurses exhibited moderate levels of ITG competency, with a notable gap between their knowledge and skills. This gap was more pronounced in primary hospitals, suggesting an association with institutional resource contexts. These results highlight the need for training strategies tailored to each hospital tier, as well as enhanced resource support from tertiary centers to primary care. This would help promote more standardized training programs and reduce competency disparities across hospital tiers.

PMID:42089050 | PMC:PMC13135959 | DOI:10.3389/fmed.2026.1817376

Contemp Oncol (Pozn). 2026;30(1):40-46. doi: 10.5114/wo.2026.159586. Epub 2026 Feb 27.

ABSTRACT

INTRODUCTION: The study was aimed to analyse the impact of the tumour type and other patient- and disease-related baseline parameters in a consecutive cohort managed with best supportive care (BSC) in northern Norway.

MATERIAL AND METHODS: This is a retrospective analysis of 149 patients managed with BSC without any systemic cancer-directed therapy or local brain-directed measures (2007-2024). Eleven patients were originally supposed to start active treatment and 12 had received prior prophylactic whole-brain irradiation (WBRT). Uni- and multivariate analyses of prognostic factors for survival were performed.

RESULTS: Median survival after radiological diagnosis was 1.3 months (95% CI: 1.08-1.52) for all 149 patients combined. The 3- and 6-month survival rates were 20% and 1%, respectively. Neither prior WBRT nor upfront intention to treat were associated with survival. Steroid responders survived significantly longer than non-responders. The multivariate Cox model suggested that survival mainly depends on Karnofsky performance status (< 70 vs. ≥ 70), extracranial metastases (present/absent), and primary tumour type (better in renal cell cancer/malignant melanoma vs. all others combined), p ≤ 0.01 for all three predictors of survival.

CONCLUSIONS: All prognostic strata in our study had median survival times < 2.5 months, indicating an inevitable poor outcome, despite presence of statistically significant differences, e.g. for the primary tumour type. The clinical impact of prognostic scores would thus be very limited. Median survival was similar in historical studies of BSC. Best supportive care is a reasonable choice in patients with brain metastases and very short life expectancy, as also evident from prospective research.

PMID:42089035 | PMC:PMC13137425 | DOI:10.5114/wo.2026.159586

Contemp Oncol (Pozn). 2026;30(1):68-76. doi: 10.5114/wo.2026.159587. Epub 2026 Feb 27.

ABSTRACT

INTRODUCTION: The aim of this study was to assess the inflammatory status of patients with pancreatic cancer (PC) prior to the initiation of the first course of chemotherapy and to ascertain the most precise systemic inflammation index for predicting overall survival (OS).

MATERIAL AND METHODS: A single-centre retrospective analysis involving 310 pa- tients with PC was conducted. Blood samples were collected from patients during chemotherapy qualification, either on the first day of chemotherapy or the day before the first chemotherapy dose. The following inflammatory indices were calculated: systemic immune-inflammation index, systemic inflammation response index, and inflammatory benchmark index (IBI). Statistical analyses were performed utilizing appropriate tests (e.g., the log-rank test).

RESULTS: All parameters were significant predictors of mortality; however, their area under the curve indicated only a moderate ability to differentiate mortality risk. Among the indices analysed, IBI was the sole metric that predicted OS in adjuvant (p < 0.05) and palliative (p < 0.001) cohorts, alongside disease-free survival (p < 0.04) and progression-free survival (p < 0.009). In the multivariate analysis, only IBI was proven to be statistically associated with OS (p < 0.043). Furthermore, IBI well stratified the tumour stage.

CONCLUSIONS: All analysed indices related to inflammation and immune response may function as prognostic markers; however, additional studies are required to determine their precise cut-off value. In our investigation, IBI exhibited a distinctive protective effect, culminating in a 65% reduction in mortality, thereby underscoring the importance of C-reactive protein in patient stratification.

PMID:42089034 | PMC:PMC13137428 | DOI:10.5114/wo.2026.159587

Contemp Oncol (Pozn). 2026;30(1):47-55. doi: 10.5114/wo.2026.159311. Epub 2026 Feb 13.

ABSTRACT

INTRODUCTION: Radiodensity of subcutaneous adipose tissue (SAT), measurable on routine computed tomography (CT), may reflect metabolic status and cachexia, both of which influence cancer outcomes. However, its prognostic role in metastatic non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICI) remains unclear. This study aimed to evaluate the prognostic value of SAT radiodensity in this patient population.

MATERIAL AND METHODS: The retrospective analysis included 92 patients with stage IV NSCLC receiving ICI. Subcutaneous adipose tissue radiodensity (Hounsfield units) was measured from pre-treatment CT at the L3 level and categorized into quartiles. Kaplan- Meier analysis, log-rank test, and Cox proportional hazards models were used. Nonlinear associations were assessed using restricted cubic splines. Cox models were? adjusted for demographic, clinical, and treatment factors. A p-value < 0.05 was considered statistically significant.

RESULTS: Median overall survival for Q1, Q2, Q3, and Q4 was 13.4, 26.3, 18.4, and 14.2 months, respectively (log-rank p = 0.0226). Compared with Q1, Q2 showed a significantly reduced mortality risk across all models (fully adjusted hazard ratios = 0.32, 95% CI: 0.15-0.64, p = 0.002). Q3 and Q4 were not significantly different from Q1. Restricted cubic spline analysis revealed a mild U-shaped relationship (p for nonlinearity = 0.0094), with intermediate SAT density linked to best outcomes. Programmed death ligand 1 expression significantly modified the SAT-survival association (p for interaction < 0.0001).

CONCLUSIONS: Moderate SAT radiodensity was associated with improved survival in metastatic NSCLC patients on ICI, potentially reflecting an optimal metabolic-immune balance. Subcutaneous adipose tissue density, easily obtained from routine imaging, warrants further prospective validation as a scalable prognostic biomarker.

PMID:42089030 | PMC:PMC13137427 | DOI:10.5114/wo.2026.159311

Front Digit Health. 2026 Apr 20;8:1764371. doi: 10.3389/fdgth.2026.1764371. eCollection 2026.

ABSTRACT

Panic attacks (PAs) are acute anxiety episodes that are pervasive, with one in 10 individuals having experienced a PA in the past year. PAs impair daily functioning and are associated with an increase in emergency room visits and suicide attempts. Despite their impact, the unpredictable nature of PAs makes them challenging to manage. PAs are transdiagnostic, occurring in individuals across and without a mental health diagnosis. However, prior work has largely focused on PA indications within individuals with panic disorder. This study identifies PA risk factors from over 6 months of passive sensing data recorded by Oura Rings in 182 young adults with and without adverse childhood experiences and psychiatric diagnoses, beyond just panic disorder. Our findings reveal that changes in Oura Ring-derived measures are associated with next-day PAs, with distinct associations observed across different mental health diagnoses. For individuals with panic disorder, the likelihood of PA increases with time spent inactive. For those with depression, the likelihood of PA increases with decreased variation in nightly respiratory rate, decreased rapid eye movement sleep, and increased time spent in high-intensity activity. For those without a mental health diagnosis, the likelihood of PA increases with decreased heart rate variability. Data aggregation window sizes that capture the associations with PA risk vary by diagnosis and the type of feature, suggesting that cumulative physiological patterns from windows up to 7 days before a PA contribute to onset. These findings point to the possibility that continuous monitoring of panic attack risk could one day support preventive mental health intervention.

PMID:42089029 | PMC:PMC13136185 | DOI:10.3389/fdgth.2026.1764371

Br J Nutr. 2026 May 6:1-29. doi: 10.1017/S0007114526107375. Online ahead of print.

ABSTRACT

Elevated LDL-cholesterol concentration is a major risk factor for CVD. Regular consumption of marine fish and seafood is associated with a reduced risk of CVD, although the n-3 PUFAs EPA and DHA have no cholesterol-lowering effect when given in physiologically relevant doses. Recent studies have demonstrated a lower LDL-cholesterol concentration in rodents after intake of cetoleic acid (CA, C22:1n-11), found in pelagic fish species such as herring. The primary aim was to investigate the effect of consuming capsules containing CA on LDL-cholesterol concentration in adults with overweight or obesity. The study was designed as a randomised clinical trial with two arms. Eighty participants were enrolled, and data from 75 participants were included in the statistical analyses. Participants consumed capsules containing either a CA concentrate (CECO group; 1480 mg CA and 232 mg EPA per day) or soyabean oil mixed with a n-3 PUFA concentrate without CA as comparator arm (SOYO3 group; 258 mg EPA/day) for eight weeks. The within-group changes in LDL-cholesterol were compared using ANCOVA with changes in body fat percentage as covariate. The LDL-cholesterol concentration was decreased from baseline to 8 weeks in the CECO group (n 37, median -0.1 (quartiles -0.1, 0.0) mmol/L) in comparison to the SOYO3 group (n 38, median 0.2 (quartiles 0.1, 0.2) mmol/L), with F=19.35, P=0.033 and η_p² = 0.212, corresponding to approximately 7% reduction in the CECO group relative to the SOYO3 group. To conclude, 8 weeks of dietary supplementation with CECO decreased the LDL-cholesterol concentration in adults with overweight or obesity.

PMID:42087284 | DOI:10.1017/S0007114526107375

Eur J Heart Fail. 2026 May 5:xuag150. doi: 10.1093/ejhf/xuag150. Online ahead of print.

ABSTRACT

AIMS: Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, has been shown to reduce cardiovascular (CV) and kidney events in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). We aimed to quantify the robustness of its CV benefits in phase 3 randomized controlled trials (RCTs) using fragility metrics coupled with conventional clinical effect measures.

METHODS AND RESULTS: We systematically searched MEDLINE and Scopus (from inception to June 2025) for phase 3 or 4 placebo-controlled RCTs of finerenone in T2DM and CKD reporting dichotomous CV outcomes. Three trials were included: FIDELIO-DKD, FIGARO-DKD, and the pooled FIDELITY analysis. We extracted hazard ratios (HRs), absolute risk reduction (ARR), relative risk reduction (RRR), number needed to treat (NNT), fragility index (FI), reverse fragility index (RFI), fragility quotient (FQ), and reverse fragility quotient (RFQ) for the primary composite CV outcome (CV death, non-fatal myocardial infarction [MI], non-fatal stroke, heart failure hospitalization [HFH]) and individual components. The primary composite outcome was significantly reduced in FIDELIO-DKD (HR 0.86, NNT 56; FI 4, FQ 0.0007) and FIDELITY (HR 0.86, NNT 59; FI 38, FQ 0.002), but not FIGARO-DKD (HR 0.87; RFI 7, RFQ 0.0009). Among individual outcomes, HFH showed the most consistent and robust benefit (FIDELITY HR 0.78, NNT 91; FI 23, FQ 0.001). Effects on CV death, MI, and stroke were numerically favorable but statistically non-significant, with low RFIs (mostly 1-3, and up to 9).

CONCLUSIONS: Finerenone significantly reduces HF hospitalization and modestly improves composite CV outcomes in T2DM with CKD, but effects on CV death, MI, and stroke are fragile. Combining fragility metrics with standard efficacy measures offers a clearer view of the reliability of trial results.

PMID:42087276 | DOI:10.1093/ejhf/xuag150