Nevin Manimala

J Food Drug Anal. 2026 Jun 1;34(1):20-30. doi: 10.38212/2224-6614.3584.

ABSTRACT

Metabolomics is the most recent and final discipline among the post-genomic, multiomics fields. It encompasses key technologies in systems biology, providing an overview of low-molecular-weight metabolites while examining disturbances to offer pathophysiological explanations. The two key analytical tools in metabolomics are nuclear magnetic resonance spectroscopy and mass spectrometry, which includes gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry. Metabolomic research relies on a three-stage data generation process: the first stage involves precise analytical chemistry to produce data; the second stage employs multivariate statistical analysis; and the last stage uses big data as a reference for comparison to establish biochemical, metabolic, and pathophysiological correlations, thereby providing possible interpretations. The initiative of precision medicine starts with cancer as the first disease target. This review discusses and illustrates the application of metabolomics in precision medicine, choosing two types of cancer as example. Warburg effect and metabolic reprogramming are particularly discussed. By providing global, top-down, and less biased information, metabolomics enables precision medicine.

PMID:42485531 | DOI:10.38212/2224-6614.3584

J Food Drug Anal. 2026 Jun 1;34(1):68-77. doi: 10.38212/2224-6614.3574.

ABSTRACT

Metabolomics studies small-molecule metabolites to provide insights into health and disease, supporting early diagnosis and personalized medicine. Advances in mass spectrometry and nuclear magnetic resonance (NMR) have expanded its use in metabolic, cancer, and cardiovascular diseases. In pediatrics, high-resolution NMR metabolomics has been instrumental in identifying age-related metabolic changes during early childhood and their associations with growth, nutrition, and disease risk. However, a comprehensive review of its clinical applications and future potential remains limited. This review highlights how utilizing specific NMR pulse sequences, such as CPMG and NOESY, allows for precise and non-destructive metabolic profiling of diverse biofluids, supported by minimal sample preparation and high-throughput automated analysis. Data processing tools like NMRProcFlow and MetaboAnalyst facilitate spectral preprocessing, statistical analysis, and biological interpretation, streamlining metabolomics workflows. Clinically, NMR-based metabolomics has elucidated metabolic alterations in pediatric growth, prematurity, nutrition-related sensitizations, allergic diseases, lipid metabolism, infectious conditions, and neurobehavioral disorders. In particular, metabolomics has been applied to identify specific metabolic signatures underlying the molecular mechanisms of childhood allergic asthma. Despite limitations in detecting low-abundance metabolites, NMR’s ability to preserve sample integrity and integrate multi-omics data, especially gut microbiota-derived metabolites, shows great promise in advancing precision pediatric medicine, early disease screening, and personalized therapeutic strategies.

PMID:42485526 | DOI:10.38212/2224-6614.3574

Rev Esc Enferm USP. 2026 Jul 20;60:e20250553. doi: 10.1590/1980-220X-REEUSP-2025-0553en. eCollection 2026.

ABSTRACT

OBJECTIVE: To compare the care trajectories of women with advanced breast cancer in the last 30 days of life, analyzing clinical differences and healthcare service utilization between patients undergoing intravenous palliative chemotherapy (IPC) and those followed by specialized palliative care (SPC) teams.

METHOD: A retrospective study based on the analysis of electronicmedical records of 370 women who died between 2019 and 2023, distributed into IPC (n = 176) and SPC (n = 194). Comparisons were performed using the chi-square, Fisher’s exact, or Mann-Whitney tests (p < 0.05).

RESULTS: Patients in SPC presented greater metastatic burden (4; IQR 3-5; p < 0.001), greater central nervous system involvement (39.69% vs. 16.48%; p < 0.001), and more multidisciplinary consultations (p < 0.001). They presented lower emergency care utilization (1; IQR 1-2; p < 0.001) and lower hospitalization in the last 24 hours of life (p < 0.001).

CONCLUSION: Follow-up by SPC teams was associated with less aggressive care trajectories at the end of life, even among patients with greater clinical complexity.

PMID:42485510 | DOI:10.1590/1980-220X-REEUSP-2025-0553en

Rev Esc Enferm USP. 2026 Jul 20;60:e20250451. doi: 10.1590/1980-220X-REEUSP-2025-0451en. eCollection 2026.

ABSTRACT

OBJECTIVE: To evaluate the effect of Bach Flower Remedies Therapy on the hope and quality of life of people with advanced cancer.

METHOD: Randomized, triple-blind (1:1) clinical trial in a high-complexity public hospital in the Southern region of Brazil. Ninety-nine participants were allocated to either the intervention group (solution with nine flower essences) or the placebo group (Hydro-brandy solution). Both groups used four drops orally, four times a day, for 120 days, with monthly follow-up. Hope measured by the Herth Hope Index, quality of life through Functional Assessment of Chronic Illness Therapy – Palliative Care.

RESULTS: In the flower remedies group (n = 50), hope varied from 43.44/48 to 44.53/48 and in the placebo group (n = 49) from 41.67/48 to 44.29/48, a significant increase over time (p = 0.024), with no difference between groups (p = 0.977). Quality of life ranged from 141.39/184 to 150.60/184 in the flower remedies group, and from 133.76/184 to 148.96/184 in the placebo group, with no significant difference between groups (p = 0.230) or time (p = 0.240).

CONCLUSION: Although not statistically significant, there was a slight increase in life expectancy and quality of life, highlighting the importance of non-pharmacological therapies in evidence-based palliative care practice.

BRAZILIAN REGISTRY OF CLINICAL TRIALS: RBR-8q6z6kq.

PMID:42485509 | DOI:10.1590/1980-220X-REEUSP-2025-0451en

Lang Speech Hear Serv Sch. 2026 Jul 22:1-12. doi: 10.1044/2026_LSHSS-25-00186. Online ahead of print.

ABSTRACT

PURPOSE: Developmental language disorder (DLD) is a hidden disorder in understanding and producing language, which has lifelong impacts. There is a significant amount of research-based evidence to support speech-language pathologists (SLPs) who support younger children with DLD, yet there is a dearth of professional development (PD) specific to intervention for older students and implementation of research in practice.

METHOD: We distributed a 26-question survey to SLPs working with adolescents (i.e., children in Grades 5 and above) who have DLD via American Speech-Language-Hearing Association groups, social media, and researcher connections. Survey questions asked about their perceptions of (a) available PD opportunities, (b) confidence in learning and applying new strategies, and (c) PD delivery.

RESULTS: We analyzed data from 117 complete surveys using descriptive statistics. SLPs who responded to this survey sought PD most often through online platforms and live conferences. Respondents reported difficulty finding PD specific to serving older students with DLD. Despite the lack of available PD specifically tailored to adolescents with DLD, SLPs felt confident in their ability to serve these students on their caseloads.

CONCLUSIONS: SLPs who serve adolescents with DLD largely rely on their clinical judgment to provide evidence-based services. We propose that emphasizing clinical judgment as practice-based evidence would allow researchers and clinicians to further develop, study, and provide appropriate PD to meet the needs of secondary SLPs and older students.

PMID:42485492 | DOI:10.1044/2026_LSHSS-25-00186

Curr Opin Crit Care. 2026 Jul 23. doi: 10.1097/MCC.0000000000001415. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: Clinical models are commonly applied in critical care for both descriptive and predictive purposes. However, methodological rigour is often lacking in their development and validation. This review examines the principles underlying the multiple domains of model validity. We argue that a clear model purpose and theoretical framework are essential preconditions for validity.

RECENT FINDINGS: Recently developed descriptive and predictive models illustrate different approaches to promoting validity. In developing SOFA-2, eCARTv5, Sepsis-3 and the PHOENIX paediatric sepsis criteria, authors used combinations of expert-driven consensus, data-driven derivation and iterative refinement. These examples demonstrate that validity requires a process of repeated evaluation across distinct populations, settings and time periods.

SUMMARY: The best approach to establishing validity combines a clear theoretical framework, structured expert consensus (including Delphi methodology), rigorous statistical evaluation (discrimination, calibration, net benefit) and prospective external validation. The distinction between models designed to predict outcomes and those designed to describe or quantify organ dysfunction is fundamental and should guide development and validation strategy from the outset.

PMID:42485487 | DOI:10.1097/MCC.0000000000001415

Disabil Rehabil Assist Technol. 2026 Jul 22:1-12. doi: 10.1080/17483107.2026.2704991. Online ahead of print.

ABSTRACT

AIM: Globally, access to menstrual cycle and hygiene information is limited, especially for women who are largely hearing impaired. Interactive games offer a promising approach as they increase knowledge about menstrual health. This study was conducted to determine the effect of an interactive game played with women of reproductive age with hearing disabilities on their perception of the menstrual cycle and hygiene.

METHOD: This quasi-experimental pre-test-post-test study was conducted between May 30 and August 31, 2025, with 82 women with hearing disabilities (40 control, 42 intervention). In the intervention group, the interactive game was played once, and the post-test was administered four weeks later. No intervention was applied to the control group. Data were collected using a questionnaire including demographic information and sections on menstrual cycle and hygiene perception. Analyses were performed using the Independent Sample T-Test, ANOVA, Paired T-Test, and Mixed ANOVA.

FINDINGS: The mean post-test scores of menstrual cycle and hygiene perceptions were statistically significantly higher in the intervention group compared to the control group (F: 126.197, p < 0.001, ηp²: 0.612). It was also determined that all women in the intervention group (100%) were satisfied with the interactive game.

CONCLUSION: This study found that the interactive game had a significant effect on the menstrual cycle and hygiene perception of women with hearing disabilities. Therefore, it is recommended that health professionals use the interactive game-based training model when providing menstrual cycle education and counselling, to support the knowledge levels of women with hearing disabilities.

PMID:42485092 | DOI:10.1080/17483107.2026.2704991

JAMA Netw Open. 2026 Jul 1;9(7):e2622227. doi: 10.1001/jamanetworkopen.2026.22227.

ABSTRACT

IMPORTANCE: Extant diagnostic and screening tools struggle to accommodate the diverse features of autism spectrum disorder (ASD) while balancing psychometric properties with respondent burden. Bifactor multidimensional item response theory (MIRT)-based computerized adaptive testing (CAT) can increase accuracy and accessibility of diagnostic assessments.

OBJECTIVE: To develop, calibrate, and validate the CAT-Autism tool for children and adolescents.

DESIGN, SETTING, AND PARTICIPANTS: This diagnostic study used National Institute of Mental Health Data Archive data available February 2024 from neurodevelopmental studies including children and adolescents with item-level responses for measures relevant to domains related to autism phenotype features. Based on reported scores from clinical assessments or measures, individuals were grouped by diagnosis as neurotypical and ASD (all levels of severity). Data were analyzed from February 2024 to February 2026.

MAIN OUTCOMES AND MEASURES: Valid CAT-based estimates in 10 subdomains (restricted to those in sample completing 200 items or more) compared with full item-bank scores; predictive performance was evaluated in discrimination, calibration, and clinical utility analyses against clinician-assigned diagnostic status.

RESULTS: A total of 490 questions to parents and caregivers were considered for potential item bank inclusion. The final sample included 10 309 children and adolescents for calibration (mean [SD] age, 9.3 [6.4] years; 7716 male [74.9%]); 2055 children and adolescents diagnosed as neurotypical (19.9%) and 8254 with ASD (80.1%). Of 490 items, 424 fit the bifactor structure with loadings higher than 0.3 on the primary dimension (ASD). Correlation between observed and estimated item-category proportions was r = 0.98, indicating exceptional fit of the model to the data. With age and sex included as external predictors, the CAT-Autism model yielded outstanding diagnostic predictive accuracy for differentiating neurotypical from ASD results with an AUC of 0.95 (95% CI, 0.92-0.98) for 1-to-5-year-olds and 0.94 (95% CI, 0.92-0.97) for 6-to-18-year-olds. Correlation between full item-bank scores and CAT scores (mean, 13 items; range, 6-45 items) was r = 0.95 for 1-to-5-year-olds and r = 0.94 for 6-to-18-year-olds.

CONCLUSIONS AND RELEVANCE: In this development and validation of our prediction model, CAT-Autism surpassed full item-bank scores with an average of 13 questions; these findings demonstrated that adaptively administering a small, statistically optimal subset of items can yield comparable (or better) results while reducing respondent burden. Next steps will be to test implementation parameters and confirm efficacy of CAT-Autism in clinical and community settings.

PMID:42485044 | DOI:10.1001/jamanetworkopen.2026.22227

JAMA Netw Open. 2026 Jul 1;9(7):e2624382. doi: 10.1001/jamanetworkopen.2026.24382.

ABSTRACT

IMPORTANCE: Concerns regarding weight changes during hormonal contraceptive use may influence health care-seeking behavior and contraceptive use patterns. While semaglutide use for weight management has increased substantially among women of reproductive age, the association of hormonal contraception use with semaglutide initiation remains unexplored.

OBJECTIVE: To investigate the association between hormonal contraception use and subsequent initiation of semaglutide therapy among females of reproductive age.

DESIGN, SETTING, AND PARTICIPANTS: This nested case-control study used Danish health registers to identify all females aged 12 to 49 years from January 1, 1996, to December 31, 2023. Eligible participants included females who filled their first prescription for semaglutide with no prior fill of prescriptions for drugs to lower glucose levels (semaglutide users). The date of first semaglutide prescription fill was the index date. Semaglutide users were each matched by birth year to 10 nonusers (nonuser controls) with no prior use of drugs to lower glucose levels. Data were analyzed from November 25, 2025, to May 18, 2026.

EXPOSURE: Hormonal contraception use was summarized based on the chronological order of all hormonal contraceptives for which individuals had filled prescriptions from 12 years of age (or study entry) until the index date.

MAIN OUTCOME AND MEASURE: First filled prescription of semaglutide of any dose.

RESULTS: A total of 22 694 cases and 229 640 matched controls (249 634 participants; median age, 37 [IQR, 30-44] years) were included in the analysis. All hormonal contraception utilization patterns were associated with semaglutide initiation compared with nonuser controls. Among utilization patterns involving a single contraceptive type, adjusted hazard ratios ranged from 1.42 (95% CI, 1.34-1.51) for combined oral tablets to 1.63 (95% CI, 1.46-1.82) for progestin-only intrauterine devices. For utilization patterns involving 2 or more contraceptive types, adjusted hazard ratios ranged from 1.64 (95% CI, 1.47-1.82) for combined oral tablets followed by progestin-only oral tablets to 2.11 (95% CI, 1.97-2.25) for other utilization patterns. Adjustment for body mass index attenuated but did not eliminate associations. Subgroup analyses by age, educational attainment, income, parity, immigrant status, and semaglutide type showed consistent associations across most utilization patterns.

CONCLUSIONS AND RELEVANCE: In this nationwide case-control study, use of hormonal contraception was associated with subsequent semaglutide initiation across all utilization patterns compared with controls, highlighting a need to examine factors associated with weight management in females.

PMID:42485041 | DOI:10.1001/jamanetworkopen.2026.24382

JAMA Netw Open. 2026 Jul 1;9(7):e2624391. doi: 10.1001/jamanetworkopen.2026.24391.

ABSTRACT

IMPORTANCE: Some drinking water contaminants, including disinfection byproducts, are known or suspected carcinogens with endocrine-disrupting properties. Few epidemiologic studies have evaluated associations with uterine cancer.

OBJECTIVE: To investigate prospective associations between multiple regulated contaminants in drinking water and the risk of uterine cancer.

DESIGN, SETTING, AND PARTICIPANTS: The California Teachers Study is a prospective cohort of female California educators. Participants who were cancer-free and had not undergone hysterectomy at enrollment (1995-1996) were followed up through December 31, 2020. Data were analyzed from November 2024 to October 2025.

EXPOSURES: The 15-year mean concentrations (1990-2005) of individual and total trihalomethanes (THMs) and haloacetic acids (HAAs), nitrate, arsenic, and uranium were calculated. The mixture effects of individual THMs, arsenic, uranium, and nitrate were also evaluated using quantile-based g-computation.

MAIN OUTCOMES AND MEASURES: Associations with incident uterine cancer overall, endometrioid tumors, and nonendometrioid tumors were analyzed categorically by tertile and continuously per log2 increase in water contaminant exposures, using Cox models adjusted for age, body mass index, and smoking status.

RESULTS: This study included 53 100 women (median [IQR] age, 50 [43-60] years) with enrollment addresses linked to a community water supply among women with residential duration at enrollment of 10 years or more. Higher levels of total THMs were associated with a higher risk of uterine cancer (hazard ratio [HR], 1.18 [95% CI, 1.02-1.38]; P for trend = .06) and endometrioid tumors specifically (HR, 1.23 [95% CI, 1.05-1.46]; P for trend = .01). Positive associations were found for the individual THM chloroform. Higher levels of the sum of 5 HAAs were associated with nonendometrioid tumors (HR, 1.86 [95% CI, 1.06-3.25]; P for trend = .01), with similar associations for the HAA monochloroacetic acid. No associations were observed with nitrate, arsenic, or uranium levels. Associations per IQR increase in the drinking water contaminant mixture composed of individual THMs, nitrate, arsenic, and uranium were 1.21 (95% CI, 0.96-1.53) and 1.34 (95% CI, 1.04-1.74) for uterine and endometrioid histotypes, respectively. The THMs chloroform and dibromochloromethane were the major contributors.

CONCLUSIONS AND RELEVANCE: In this cohort study of female California educators, associations between drinking water THMs and uterine cancer overall and with endometrioid tumors specifically were consistent with findings from the only prior study, conducted in the midwestern US. Further investigation of drinking water contaminants as modifiable risk factors for this common gynecologic cancer is warranted.

PMID:42485040 | DOI:10.1001/jamanetworkopen.2026.24391