Nevin Manimala

BMC Glob Public Health. 2026 Feb 2;4(1):12. doi: 10.1186/s44263-026-00243-4.

ABSTRACT

BACKGROUND: Group antenatal care (G-ANC) is an emerging service delivery model that integrates clinical assessments, health education, and peer support within group sessions. While evidence supports its effectiveness in pilot settings, less is known about its feasibility and impact when integrated into routine public health systems in low-resource settings.

METHODS: We conducted a registry-based observational cohort study (January 2023-November 2024) across six government facilities in Geita Region, Tanzania (two hospitals, two health centers, and two dispensaries). Pregnant women with gestational age ≥ 20 weeks were enrolled into G-ANC cohorts. Data was abstracted from routine antenatal care (ANC), labor and delivery, and cohort records. Descriptive statistics summarized ANC attendance and service uptake; associations with adverse birth outcomes were examined using a binomial-logit generalized linear mixed model (GLMM).

RESULTS: A total of 5936 women in 149 cohorts were enrolled. Overall, 93.9% completed ≥ 4 ANC visits (ANC4 +); 76.1% received ≥ 3 doses of malaria intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp3 +); 92.6% received iron-folate supplementation; and 96.2% delivered in health facilities. Only 8.5% initiated ANC in the first trimester, consistent with the ≥ 20-week threshold for G-ANC entry. In multivariable GLMM, completing ≥ 4 ANC visits was associated with lower odds of adverse birth outcomes (adjusted odds ratio [aOR] = 0.122, 95% CI 0.06-0.24; p < 0.001). Attendance at hospital-level facilities was associated with higher odds (aOR = 2.91, 95% CI 1.37-6.18; p = 0.005), likely reflecting referral of high-risk pregnancies. First-trimester initiation showed no significant association (aOR = 1.04, 95% CI 0.27-3.93).

CONCLUSIONS: In routine settings, G-ANC was associated with high ANC attendance, strong uptake of essential interventions, and positive birth outcomes. Integration appears feasible within public systems, though adaptations are needed to promote earlier initiation and alignment with the WHO eight-contact model. Further research should examine costs, feasibility, scalability, and long-term impact.

PMID:41622235 | DOI:10.1186/s44263-026-00243-4

Gen Hosp Psychiatry. 2026 Jan 27;99:151-158. doi: 10.1016/j.genhosppsych.2026.01.013. Online ahead of print.

ABSTRACT

OBJECTIVE: Anxiety and depression are common psychological symptoms following heart failure (HF) and are associated with adverse patient outcomes. However, pharmacological treatments often have suboptimal efficacy. Recently, non-pharmacological interventions have attracted increasing attention for improving psychological symptoms in HF patients, yet the most effective approach remains unclear. Therefore, this study performed a network meta-analysis (NMA) to compare the effectiveness of different non-pharmacological interventions in alleviating anxiety or depression among HF patients.

METHODS: We comprehensively searched PubMed, Embase, the Cochrane Library, and PsycINFO from inception to March 2025 to identify randomized controlled trials (RCTs) evaluating non-pharmacological interventions for anxiety or depression in HF patients. The RoB 2.0 tool was employed to assess methodological quality and risk of bias. An NMA was conducted under a frequentist framework using R and Stata software. Intervention efficacy was ranked using P-scores, and sensitivity analyses were performed to evaluate the stability of the results and explore potential sources of heterogeneity.

RESULTS: A total of 35 RCTs and one quasi-RCT involving 3829 participants were included. NMA results indicated that Tai Chi (P-score = 0.73; standardized mean difference (95% CI):-0.69(-1.59 to 0.21)) was the most efficacious intervention for improving anxiety symptoms in HF patients, while progressive muscle relaxation training (P-score = 0.78;-1.24(-2.74 to 0.26)) ranked highest for improving depressive symptoms. However, only aerobic exercise demonstrated statistically significant improvements in both anxiety (P-score = 0.63; -0.47(-0.86 to -0.07)) and depression (P-score = 0.74; -0.93(-1.44 to -0.41)).

CONCLUSION: Aerobic exercise appears effective for both anxiety and depression following HF. However, the evidence is of low to very low certainty.

PMID:41621139 | DOI:10.1016/j.genhosppsych.2026.01.013

Environ Int. 2026 Jan 21;208:110095. doi: 10.1016/j.envint.2026.110095. Online ahead of print.

ABSTRACT

Metals are associated with cardiovascular disease (CVD), but the underlying pathways remain largely unclear. We evaluated the potential intermediate role of coronary artery calcification (CAC) trajectory on the association between urinary metals and incident CVD, accounting for competing risks by death from other causes. We used data from 6,459 participants of the Multi-Ethnic Study of Atherosclerosis (MESA). CAC was measured longitudinally using the spatially weighted calcium score in five exams, starting in 2000. Participants were followed for CVD events through 2019. Cadmium, cobalt, copper, uranium, tungsten, and zinc were measured in urine at the baseline visit (2000-2002). We used a causal inference algorithm with a path-specific effects approach for longitudinal mediation analysis to evaluate the intermediate role of CAC on the association between metals and incident CVD. The association with incident CVD mediated through the CAC trajectory was statistically significant for cadmium, cobalt, copper, tungsten, and zinc. The number of CVD cases (95% CI) per 100,000 person-years attributable to an interquartile range (IQR) increase in metal levels through the longitudinal trajectory of CAC was 44 (20, 72) for cadmium, 21 (6, 39) for cobalt, 19 (2, 36) for copper, 18 (2, 38) for tungsten, and 43 (26, 62) for zinc. This study supports that part of the association between urinary metals and CVD is attributable to changes in CAC over time. In particular, half of the association between urinary cadmium and CVD might be mediated by longitudinal changes in CAC. This study could inform strategies for early detection and prevention of CVD based on urinary metal levels.

PMID:41621136 | DOI:10.1016/j.envint.2026.110095

Environ Int. 2026 Jan 24;208:110090. doi: 10.1016/j.envint.2026.110090. Online ahead of print.

ABSTRACT

Several studies have explored the short-term effects of environmental stressors on coronavirus disease 2019 (COVID-19) transmission and severity. However, evidence on the interactive effects of meteorological conditions and air pollution remains limited and geographically variable. We therefore aimed to quantify the independent and interactive effects of short-term exposure to humidex, a composite index of temperature and relative humidity, and fine particulate matter ≤ 2.5 μm (PM_2.5) on daily COVID-19 incidence across multiple cities and in multiple countries. Daily time-series data on confirmed COVID-19 cases, meteorological factors, and PM_2.5 concentrations were collected from 439 cities in 22 countries during January 2020-August 2022 as part of the Multi-Country Multi-City Collaborative Research Network. A two-stage design was applied: first, city-specific quasi-Poisson models with distributed lag non-linear models estimated exposure-response associations; second, multilevel random-effects meta-analyses pooled city-specific estimates. Effect modification by PM_2.5 was assessed using a product term between non-linear humidex function and linear PM_2.5 function. Approximately 95.1 million confirmed COVID-19 cases were analyzed. Lower humidex values (0.1 °C versus 15.1 °C) were associated with increased daily cases (relative risk [RR]: 1.1192, 95% confidence interval [CI]: 1.0214-1.2262). A 10 μg/m³increase in PM_2.5 over the current and preceding 2 days was associated with a modest increase in daily cases (RR: 1.0079, 95% CI: 1.0001-1.0161). No statistically significant interaction between humidex and PM_2.5 was observed. Short-term exposure to cold-dry conditions and elevated PM_2.5 independently increased COVID-19 incidence, highlighting the need to consider both thermal environment and air quality when designing climate-resilient public health responses. These findings enhance understanding of how climate-related environmental stressors influence COVID-19 transmission.

PMID:41621133 | DOI:10.1016/j.envint.2026.110090

Biomaterials. 2026 Jan 29;330:124031. doi: 10.1016/j.biomaterials.2026.124031. Online ahead of print.

ABSTRACT

Aging is a major risk factor for cardiovascular disease, the leading cause of death worldwide, and numerous other diseases, but the mechanisms of these aging-related effects remain elusive. Recent evidence suggests that chronic changes in the microenvironment and local paracrine signaling are major drivers of these effects, but the precise effect of aging on these factors remains understudied. Here, for the first time, we directly compare extracellular vesicles obtained from young and aged patients to identify therapeutic or disease-associated agents, and directly compare vesicles isolated from heart tissue matrix (TEVs) or plasma (PEVs). While young TEVs and PEVs showed notable overlap of miRNA cargo, aged EVs differed substantially, indicating differential aging-related changes between TEVs and PEVs. TEVs overall were uniquely enriched in miRNAs which directly or indirectly demonstrate cardioprotective effects, with 45 potential therapeutic agents identified in our analysis. Both populations also showed increased predisposition to disease with aging, though through different mechanisms. Changes in PEV cargo were largely correlated with chronic systemic inflammation, while those in TEVs were more related to cardiac homeostasis and local inflammation. From this, 17 protein targets were identified which were unique to TEVs and highly correlated with aging and the onset of cardiovascular disease. Further analysis via machine learning techniques implicated several new miRNA and protein targets, independently suggesting several of the targets identified by non-machine learning analysis, which correlated with aging-related changes in TEVs. With further study, this biomarker set may serve as a powerful, potential indicator of cardiac health and age which can be measured from PEVs. Additionally, several proposed “young-enriched” therapeutic agents were validated and, when tested, could successfully prevent cell death and cardiac fibrosis in disease-like conditions using a microfluidic heart-on-a-chip to model of acute and chronic fibrosis, making this study the first in literature to test the efficacy of a miRNA-based therapeutic encapsulated in lipid nanoparticles in an organ-on-a-chip device.

PMID:41621130 | DOI:10.1016/j.biomaterials.2026.124031

Vaccine. 2026 Jan 31;75:128298. doi: 10.1016/j.vaccine.2026.128298. Online ahead of print.

ABSTRACT

BACKGROUND: Measles remains a leading vaccine-preventable killer in low- and middle-income countries (LMICs). Using the WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) 2024 revisions, this article assesses measles-containing vaccine first-dose (MCV1) and second-dose (MCV2) coverage trends, inequities, and priority groups for targeted action.

METHODS: Data from 2019 to 2024 for 137 LMICs were analysed using descriptive statistics; Welch’s t-tests and Wilcoxon rank-sum tests to compare fragile versus non-fragile states; Gini coefficients for inequality; k-means clustering (k = 4) on coverage, MCV1-to-MCV2 dropout, change, unvaccinated counts, and fragility; and bounded linear models to project MCV1 to 2030.

RESULTS: In 2024, mean MCV1 coverage was 79.2% (95% CI: 76.8-81.6)-below the 95% threshold-with fragile LMICs at 68.5% versus 87.4% in non-fragile LMICs (difference – 18.1 percentage points; p < 0.001). MCV2 gaps were larger (-26.9 percentage points; p < 0.001). DTP1-based zero-dose prevalence was 20.8%, with 15.6 million children unvaccinated for MCV1 and 22.4 million for MCV2; West and Central Africa accounted for 7.2 million MCV1-unvaccinated (46.2%). Inequality rose (Gini 0.22 → 0.25, 2019-2024). Projections indicate MCV1 of 84.2% by 2030, with fragile LMICs off-track. Clustering identified four profiles: (1) very low coverage, high dropout, high fragility (22 countries); (2) high coverage, low dropout (44); (3) low coverage, severe dropout (31); and (4) low coverage, moderate dropout (40), each implying distinct priorities (conflict-adapted SIAs; sustaining gains; follow-up campaigns; expanding first-dose access).

CONCLUSIONS: Persistent and widening measles immunization gaps-especially in fragile settings-threaten IA2030’s 90% coverage targets. Pairing the 2024 WUENIC revision with fragility-sensitive clustering and bounded projections provides a practical framework to prioritize equity-focused funding and operational strategies where need is greatest.

PMID:41621116 | DOI:10.1016/j.vaccine.2026.128298

Differentiation. 2026 Jan 23;148:100936. doi: 10.1016/j.diff.2026.100936. Online ahead of print.

ABSTRACT

Micro-CT has become the standard for the assessment of malformations in mouse embryos because it allows the visualisation of internal structures in the context of the intact embryo. Statistical comparison of volume differences is possible via manual segmentation of organs of interest from micro-CT scans, but this process is slow and laborious. Automated registration-based methods now exist that make the volumetric analysis of all organs feasible. Here, we expand the available atlases for use with the LAMA registration and analysis pipeline to include high-resolution population averages derived from phosphotungstic acid-stained C57BL/6J embryos and corresponding manually segmented atlases at embryonic stage (E) 12.5, E15.5, and E17.5. We report application of these population averages and atlases with the LAMA phenotyping pipeline to Wbp11 heterozygous null embryos, identifying defects previously reported in the cervical vertebrae, brain, nasal cavity, palate, liver and kidneys as well as a right aortic arch defects missed by manual analysis, and volume differences in the eyes and spinal cord. Finally, we report a high-resolution isolated E18.5 mouse heart population average and corresponding atlas that when applied to the Wbp11 line identified significant differences. These findings highlight the advantages of unbiased, volumetric and quantitative approaches in the analysis of mouse models of human disease.

PMID:41621112 | DOI:10.1016/j.diff.2026.100936

Neurosurg Focus. 2026 Feb 1;60(2):E7. doi: 10.3171/2025.11.FOCUS25913.

ABSTRACT

OBJECTIVE: Stroke is a leading cause of long-term disability, with conventional rehabilitation often failing to achieve substantial motor recovery, particularly in patients with severe paresis or in chronic stages. Brain-computer interfaces (BCIs) offer a novel rehabilitation approach by translating neural signals into real-time external feedback. The authors performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of noninvasive BCIs for poststroke motor rehabilitation.

METHODS: A systematic literature review was performed based on the PRISMA guidelines using 3 databases. Eligible RCTs enrolled stroke patients receiving noninvasive BCI-assisted motor rehabilitation compared with conventional therapies. The primary outcome was the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) improvement. Secondary outcomes included the Action Research Arm Test (ARAT), Motor Activity Log (MAL), Modified Barthel Index (MBI), and Modified Ashworth Scale (MAS). Effect sizes were pooled using random-effects models and expressed as mean differences (MDs), standardized MDs (SMDs), or odds ratios, each with corresponding 95% confidence intervals (CIs).

RESULTS: Thirty-two RCTs comprising 1187 patients were included with no heterogeneity or significant imbalances in baseline characteristics across groups. A BCI was significantly superior in FMA-UE score improvement compared with controls (MD 3.85, 95% CI 2.84-4.86; p < 0.01), with benefits sustained at follow-up. Within-group analyses revealed greater improvement in the BCI arm from follow-up to baseline (MD 8.18, 95% CI 5.77-10.60; p < 0.01). A BCI was also associated with higher ARAT (MD 7.18, 95% CI 2.4-12.0; p < 0.01) and MAL (SMD 0.59, 95% CI 0.34-0.85; p < 0.01) scores, although between-group differences for these endpoints were not statistically significant. For the MBI, a subgroup analysis did not demonstrate significant differences, but a sensitivity analysis revealed a significant improvement in the BCI group (p = 0.042). There were no significant differences in the within- and between-group analyses of the MAS. A subgroup analysis suggested a synergistic benefit with the BCI combined with neuromuscular electrical stimulation. Adverse events were infrequent and generally mild; 2 withdrawals in the BCI group were reported due to seizure and electrode allergy. Notably, all heterogeneity was successfully resolved through sensitivity analyses, supporting the robustness of the findings.

CONCLUSIONS: Noninvasive BCI-assisted rehabilitation is a safe and effective adjunct to conventional therapy, enhancing motor recovery after stroke. While all included RCTs evaluated noninvasive systems, the potential value and efficacy of invasive and minimally invasive BCIs may require further consideration.

PMID:41621102 | DOI:10.3171/2025.11.FOCUS25913

Environ Toxicol. 2026 Feb 1. doi: 10.1002/tox.70046. Online ahead of print.

ABSTRACT

This study investigates how phthalate exposure contributes to uterine fibroid (UF) development by studying the effects of the Mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), a metabolite of Di(2-ethylhexyl) phthalate, on myometrial stem cells (MMSCs). MMSCs from normal (MYON) and at-risk (MYOF) uterine tissues were cultured in 3D organoids and treated with 1.6 μM MEHHP for 48 h. Functional assays investigated cell viability, apoptosis, and mitochondrial activity, whereas RT-PCR, immunohistochemistry (IHC), and RNA sequencing evaluated markers of proliferation, apoptosis, extracellular matrix (ECM), and oxidative stress (OS). Cytokines and growth factors secretion were analyzed using a multiplex ELISA. Results showed that MEHHP exposure significantly increased cell viability and inhibited apoptosis in MYOF compared to MYON organoids. Proliferation markers (PCNA, Ki67), anti-apoptotic markers (BCL2/BAX ratio), and ECM markers (fibronectin and COL1A1) were significantly upregulated, whereas pro-apoptotic markers (Caspase-3) were downregulated in MYOF organoids. MEHHP-treated MYOF organoids exhibited elevated secretion of pro-inflammatory cytokines (e.g., TNF-α, IL-6, IL-8) and growth factors (e.g., PDGF, VEGF, TGFβ1), indicative of impaired tissue repair and fibrosis. RNA sequencing identified increased OS in MYOF organoids, validated by differential expression of genes such as CA9 and GPX3. Mitochondrial analysis revealed enhanced oxidative phosphorylation (OXPHOS) and elevated oxygen consumption rates, implicating mitochondrial dysfunction as a driver of cytokine release and UF pathogenesis. In conclusion, MEHHP was shown to promote the transformation of MYOF organoids into a UF phenotype by driving proliferation, inhibiting apoptosis, and inducing cytokine-mediated inflammation via mitochondrial dysfunction. These findings related to MYOF-specific effects, as compared to MYON, emphasize that these differences are statistically significant and relevant to UF risk. It can shed insight on how phthalates exposures may impact UF pathogenesis and provide a basis for exploring targeted therapeutic strategies.

PMID:41621087 | DOI:10.1002/tox.70046

J Biomater Sci Polym Ed. 2026 Feb 1:1-18. doi: 10.1080/09205063.2026.2624425. Online ahead of print.

ABSTRACT

Resveratrol is a polyphenol with potent antioxidant activity; however, its application in topical formulations is limited by low aqueous solubility and poor stability. Polymeric nanoparticles represent an attractive strategy to overcome these limitations. Poly(D,L-lactic acid) (PLA) nanoparticles coated with poly(arginine) were prepared by nanoprecipitation and loaded with resveratrol at 5%, 10%, and 15% (w/w). The systems were characterized in terms of particle size, morphology, zeta potential, encapsulation efficiency, antioxidant activity, thermal stability, chemical structure, and cytocompatibility using L929 fibroblasts and HaCaT keratinocytes. The nanoparticles exhibited spherical morphology and mean diameters in the range of 100-150 nm, with high colloidal stability maintained for up to six months. Encapsulation efficiency decreased with increasing drug loading, from 84% at 5% to 62% at 15%. FTIR analysis indicated physical incorporation of poly(arginine) and resveratrol without detectable chemical interactions, while TGA confirmed adequate thermal stability of the systems. Antioxidant activity ranged within similar levels for free and encapsulated resveratrol, with no statistically significant differences among formulations in the DPPH assay. All formulations demonstrated excellent cytocompatibility, with cell viabilities exceeding 95%. Poly(arginine)-coated PLA nanoparticles constitute an effective platform to enhance the physicochemical stability of resveratrol while maintaining its antioxidant activity and biocompatibility. Among the evaluated systems, the 5% and 10% formulations exhibited the most balanced overall performance.

PMID:41621063 | DOI:10.1080/09205063.2026.2624425