Nevin Manimala

Inquiry. 2026 Jan-Dec;63:469580251410890. doi: 10.1177/00469580251410890. Epub 2026 Jan 3.

ABSTRACT

Long COVID increases healthcare utilization, yet differences in healthcare spending patterns between individuals with and without long COVID remain poorly characterized, especially at the national level. To evaluate differences in healthcare expenditures among U.S. adults with and without long COVID using nationally representative data. This cross-sectional study analyzed data from the 2022 Medical Expenditure Panel Survey (MEPS), including 16 762 unweighted adults (weighted population: 239 915 159). Healthcare spending outcomes included total expenditures and specific categories including office-based care, outpatient services, emergency room visits, hospital admissions, home healthcare, and prescription medications. A survey-weighted generalized linear model (GLM) with a log link and gamma distribution was used to estimate adjusted differences in expenditures between groups. Individuals with long COVID had significantly higher total healthcare expenditures (mean $11 567; SD $25 334) compared to those without long COVID ($7448; SD $21 734, P < .01). After adjusting for demographic characteristics, insurance status, chronic conditions, and other potential confounders, individuals with long COVID incurred 40% higher total expenditures (β = 1.40, P = .01). Expenditures were significantly elevated for office-based visits (35% higher; β = 1.35, P = .02) and outpatient services (118% higher; β = 2.18, P < .01). No significant differences were found in emergency room, hospital admissions, or dental care expenditures. Long COVID imposes a substantial financial burden on individuals and healthcare systems, primarily through increased outpatient and office-based service utilization. Understanding these spending patterns can help inform policy decisions, optimize healthcare resource allocation, and guide targeted interventions to manage long COVID more effectively.

PMID:41482843 | DOI:10.1177/00469580251410890

Echocardiography. 2026 Jan;43(1):e70385. doi: 10.1111/echo.70385.

ABSTRACT

OBJECTIVES: A novel index, termed the right ventricle (RV)-pulmonary artery (PA) index, was established by integrating the longitudinal strain of the right ventricular free wall (RVFWLS) and the right ventricular ejection fraction (RVEF), both evaluated using three-dimensional speckle-tracking echocardiography (3D-STE), with the stiffness of the pulmonary artery (PAS). This approach aims to enhance our understanding of the underlying mechanisms associated with heart failure with preserved ejection fraction (HFpEF).

METHODS: The study comprised 80 patients diagnosed with HFpEF, 60 high-risk patients without clinical heart failure (HF), and 50 healthy controls. Clinical data and pulmonary stiffness measurements were collected, and right ventricular function was evaluated using 3D-STE. Furthermore, the corresponding RV-PA coupling parameters were established. Statistical analyses were conducted using SPSS version 26.0 and R software, employing one-way ANOVA, the Kruskal-Wallis H test, Pearson and Spearman correlation coefficients, multivariable linear regression, and receiver operating characteristic (ROC) curve analysis.

RESULTS: Patients with HFpEF exhibited elevated levels of PAS, dilated right heart structures, and impaired right ventricular (RV) function when compared to both high-risk and control groups. PAS was identified as an independent risk factor for RV dysfunction. Stratified diagnostic analysis revealed that the novel coupling index, RVEF/PAS, demonstrated exceptional diagnostic performance during the initial screening phase (AUC = 0.813) and maintained robust discriminatory power during the differentiation stage of the high-risk population (AUC = 0.757). Both newly developed indices, RVEF/PAS and RVFWLS/PAS, exhibited significant positive correlations with tricuspid annular plane systolic excursion (TAPSE)/PASP (r = 0.536, p = 0.004; r = 0.449, p = 0.019). The proposed stratified diagnostic model, characterized by a “primary screening-refined discrimination” approach based on parameter characteristics, offers a novel strategy for the early detection of HFpEF.

CONCLUSIONS: The 3D-STE method reliably assesses right ventricular function in patients with HFpEF, while pulmonary arterial compliance is effectively evaluated through PAS. The novel RV-PA coupling indices, namely RVEF/PAS and RVFWLS/PAS, are developed by integrating these techniques, providing a stratified diagnostic strategy for the early detection of HFpEF. PAS is appropriate for initial screening in primary care settings, whereas RVEF/PAS offers precise diagnostic support in medical centers. Collectively, these methods establish a novel non-invasive tool system for evaluating interactions between the right heart and pulmonary vasculature.

PMID:41482835 | DOI:10.1111/echo.70385

JMIR Nurs. 2026 Jan 3. doi: 10.2196/90714. Online ahead of print.

ABSTRACT

BACKGROUND: Hospital-acquired pressure injuries (HAPIs) remain a largely preventable cause of patient injury and are often utilized as nursing-sensitive quality metrics. At a tertiary military hospital in XXXXXX, rising HAPI rates necessitated implementing a comprehensive quality improvement program in accordance with the National Database of Nursing Quality Indicators (NDNQI) guidelines. On the basis of Donabedian’s Structure-Process-Outcome model, we hypothesized that the implementation of a standardized, evidence-based pressure injury prevention bundle, accompanied by structured staff education (structure), will enhance adherence to prevention practices (process) and markedly decrease HAPI incidence and prevalence (outcomes) among hospitalized adult inpatients.

OBJECTIVE: To assess the effect of introducing a standardized, evidence-based pressure injury prevention bundle and corresponding staff education on HAPI incidence and prevalence.

METHODS: We implemented a comprehensive hospital-wide quality improvement project utilizing a pre-post methodology underpinned by Plan-Do-Study-Act (PDSA) cycles, statistical process control monitoring, and the FOCUS-PDSA framework. The strategy established a standardized preventive package for high-risk patients; it included routine risk and skin assessments, scheduled repositioning, pressure redistribution support surfaces, nutrition optimization with dietitian input, and moisture control. The primary outcomes were monthly HAPI incidence (per 1,000 patient-days), measured using wound care census and unit reporting, and quarterly HAPI prevalence, evaluated using NDNQI surveys by trained NDNQI link nurses, with >90% interrater reliability for staging.

RESULTS: In the initial deployment phase (July-December 2023), the HAPI incidence rate was 2.32 per 1,000 patient-days (267 cases/115,314 patient-days). The incidence declined to 1.44 per 1,000 patient-days (330 cases/229,647 patient-days) in 2024 (38% reduction from the baseline) and to 0.88 per 1,000 patient-days (98 cases/111,589 patient-days) by June 2025, (62% reduction from the baseline). The prevalence decreased from 5.12% in Q3 2023 to 1.38% in Q3 2024 and remained low at 1.43% in Q2 2025.

CONCLUSIONS: Implementation of a standardized prevention bundle, supported by systematic staff education, interdisciplinary collaboration, and periodic incidence and prevalence surveillance was associated with sustained reductions in HAPI incidence and prevalence over 2 years. These findings support a bundle-based approach to prevention, combined with real-time feedback and competency-driven teaching, as a scalable means of enhancing patient safety.

CLINICALTRIAL: none.

PMID:41482822 | DOI:10.2196/90714

Pak J Pharm Sci. 2026 Jan;39(1):292-298. doi: 10.36721/PJPS.2026.39.1.REG.15702.1.

ABSTRACT

BACKGROUND: Pediatric acute laryngitis and laryngeal obstruction can be severe enough to require tubes inserted into the airway and assist with breathing. Dexamethasone is commonly used to treat pediatric acute laryngitis and laryngeal obstruction, but the factors determining the need for intubation despite corticosteroid therapy remain unclear.

OBJECTIVES: We aimed to determine the rate of intubation and mechanical ventilation required, identify risk factors for these needs and examine the outcomes in pediatric patients who still require intubation despite dexamethasone treatment.

METHODS: A cross-sectional study at Jiangxi Children’s Hospital included 160 screened patients with 150 pediatric patients with acute laryngitis and laryngeal obstruction, conducted from January 2020 to December 2024. All patients were given conventional dexamethasone treatment either orally or via IV. Patients were stratified into two groups: Those who required intubation and those who did not. Demographic variables, comorbidity factors, lab values and satisfaction with dexamethasone treatment, with additional support from nebulized epinephrine, were extracted. The variables were then determined via multiple logistic regression analysis.

RESULTS: Among the 160 screened patients, 30 (18.75%) required intubation. Independent risk factors for intubation despite dexamethasone treatment included female gender (OR = 4.07), comorbid pulmonary and systemic disorders (OR = 7.30), increased neutrophil-to-lymphocyte (N/L) ratio (OR = 1.167 per unit increase), and elevated IgM levels (OR = 1.221), all with P < 0.05. These factors were identified as significant predictors for the need for intubation despite steroid therapy.

CONCLUSION: Despite the widespread use of dexamethasone, the intubation rate remains high in pediatric patients with acute laryngitis and laryngeal obstruction. Identifying females, comorbidities, neutrophil-to-lymphocyte ratio and high levels of IgM as risk factors can assist healthcare professionals in arriving at an early diagnosis.

PMID:41482799 | DOI:10.36721/PJPS.2026.39.1.REG.15702.1

Pak J Pharm Sci. 2026 Jan;39(1):261-270. doi: 10.36721/PJPS.2026.39.1.REG.13940.1.

ABSTRACT

BACKGROUND: Women with hypertensive postpartum syndrome (HDP) are more prone to negative emotions that affect their recovery, while magnesium sulfate has an anti-anxiety effect.

OBJECTIVES: This study aims to evaluate the efficacy of magnesium sulfate therapy, administered intravenously or intramuscularly, in preventing complications such as eclampsia and managing blood pressure (BP) in patients with hypertension.

METHODS: This research adopted a quantitative research paradigm and participants were assigned to the intervention and the control groups (70 participants each). The control group received their regular postpartum medical care that included antihypertensive medications and health education but did not receive magnesium sulfate treatment and designated physical rehabilitation. The data collected were then sorted and categorized genetically and were analyzed using the SPSS software program version 25.0 to enhance reliability of statistics.

RESULTS: The intervention group demonstrated significant improvements across physical, emotional and functional recovery, including BP compared with the control group. There was significant lowering of both systolic (-20.1 mmHg) and diastolic (-14.2 mmHg) BP, reduced fatigue, improvement in quality of life and decrease in pain (All P < 0.05). A regression analysis confirmed the treatment and health promotion as the positive indicators of the recovery rates while body mass index (BMI) and increased baseline diastolic BP as negative indicators. The convergence of pharmacological and non-pharmacological approaches made postpartum management more effective in terms of short-term as well as extended health problems.

CONCLUSION: These results are a robust starting off point for the application of a more comprehensive postpartum care framework in clinical care.

PMID:41482796 | DOI:10.36721/PJPS.2026.39.1.REG.13940.1

Pak J Pharm Sci. 2026 Jan;39(1):117-122. doi: 10.36721/PJPS.2026.39.1.REG.14416.1.

ABSTRACT

BACKGROUND: Severe brain injury patients often require effective analgesia and sedation to manage pain, agitation, and inflammatory responses, which can impact clinical outcomes.

OBJECTIVES: This study aimed to analyze the effects of ketamine combined with remifentanil on analgesic sedation and inflammatory factors in patients with severe brain injury.

METHODS: Sixty patients were randomly divided into a remifentanil-only control group and a ketamine combined with remifentanil group. VAS, SAS, BCS, Ramsay scores, inflammatory factors (TNF-α, IL-2), and adverse reactions were compared.

RESULTS: Compared with pre-operative levels, both groups showed significant reductions in VAS, SAS scores, TNF-α, and IL-2 (P < 0.05). Compared with the control group, the combined group exhibited significantly lower VAS and SAS scores, higher Ramsay sedation and BCS scores, and lower TNF-α and IL-2 levels (P < 0.05). There was no statistically significant difference in adverse reactions between groups (P > 0.05).

CONCLUSION: Ketamine combined with remifentanil provides better analgesic and sedative effects in severe brain injury patients, effectively reducing pain and agitation, improving comfort, and suppressing inflammatory responses, demonstrating good clinical application value.

PMID:41482781 | DOI:10.36721/PJPS.2026.39.1.REG.14416.1

Pak J Pharm Sci. 2026 Jan;39(1):61-73. doi: 10.36721/PJPS.2026.39.1.REG.14772.1.

ABSTRACT

BACKGROUND: Psoriasis represents a chronic autoimmune dermatosis that necessitates the implementation of both anti-inflammatory measures and UVA-UVB photoprotection.

OBJECTIVES: This study aimed to evaluate the phytochemical profile, antioxidant capacity , photoprotective efficacy, and anti-inflammatory potential of Tagetes erecta flower extracts (TEFE) prepared in different solvents.

METHODS: In this study phytochemical analysis and antioxidant properties were performed in various solvent extracts of Tagetes erecta flowers. Photoprotective efficacy was assessed using critical wavelength (λ_c) and SPF measurements under different exposure conditions. Anti-inflammatory activity was evaluated via heat-induced protein denaturation, heat-induced hemolysis, and hypotonicity- induced hemolysis assays.

RESULTS: The result indicated that TEFE contain all the secondary metabolites known for their skin-protective properties. The highest TPC was observed in the methanolic and ethyl acetate extracts, measuring (0.7733 ± 0.0024 and 0.7729 ± 0.0007 mg GAE/mg), respectively. The acetone and ethanolic extracts exhibited the highest flavonoid contents (17.553 ± 0.1064 and 14.904 ± 0.506 mg Rutin/mg) and flavanol contents (4.279 ± 0.268 and 3.829 ± 0.1002 mg Rutin/mg), respectively. At all concentrations, TEFE exhibited λ_c greater than 370 nm, indicating broad-spectrum photoprotective properties. At 800 ppm, TEFE demonstrated SPF values of 29 without exposure, while SPF of 40.2 under sunlight and 32.80 under UV exposure were measured. The Statistical analysis revealed significant differences in photoprotective activity across all tested concentrations (P<0.05).TEFE showed considerable inhibition of protein denaturation, with IC₅₀ = 527.845 µg/mL and exhibited concentration-dependent membrane stabilization, with a maximum inhibition of 69% in heat-induced RBC lysis and 22% in hypotonicity-induced RBC lysis.

CONCLUSION: These results advocate for a novel phototherapeutic strategy for addressing photoprotection in psoriatic skin and require further clinical research in dermatological preparations.

PMID:41482776 | DOI:10.36721/PJPS.2026.39.1.REG.14772.1

Pak J Pharm Sci. 2026 Jan;39(1):1-9. doi: 10.36721/PJPS.2026.39.1.REG.15013.1.

ABSTRACT

BACKGROUND: Galactorrhea, an abnormal milk secretion, is frequently triggered by medications that influence prolactin levels.

OBJECTIVES: This study aimed to identify high-risk drugs for drug-associated galactorrhea (DAG) and explore their characteristics using data from the FDA Adverse Event Reporting System (FAERS).

METHODS: We analyzed 6,195 DAG reports by applying four disproportionality analysis algorithms (ROR, PRR, MGPS, BCPNN) to detect positive signals.

RESULTS: The analysis of 6,195 reports showed that DAG was most prevalent in patients aged 20-40 years, with a slight male predominance (55.52%). Oral medications were the primary cause (68.99%). A total of 32 drugs were strongly associated with DAG, with antipsychotics being the most frequently implicated class (N = 12), followed by antidepressants (N = 7) and hormone-related drugs (N = 6). Risperidone had the highest risk (ROR = 346.71) and report count (N = 3,378).

CONCLUSION: This study provides a comprehensive list of high-risk drugs for DAG, offering critical data to guide safer prescribing and improve pharmacovigilance. Clinicians should be vigilant in monitoring for suggestive symptoms like galactorrhea, amenorrhea and sexual dysfunction, especially in high-risk individuals on long-term treatment with prolactin-elevating medications. These findings underscore the importance of patient safety and inform clinical practice.

PMID:41482770 | DOI:10.36721/PJPS.2026.39.1.REG.15013.1

Cancer Med. 2026 Jan;15(1):e71466. doi: 10.1002/cam4.71466.

ABSTRACT

INTRODUCTION: The relationship between insufficient sleep and prostate cancer incidence is unclear. Our goal was to investigate the association of sleep duration, restless sleep, and prostate cancer incidence and aggressiveness, and whether race influences any sleep-prostate cancer association.

METHODS: The Southern Community Cohort Study (SCCS) recruited study participants from 12 Southeastern states from 2002 to 2009. The cohort included nearly 35,000 males, predominantly African American (AA, 67%). Sleep exposures were measured via a baseline questionnaire at enrollment, which captured weekday and weekend sleep duration, weighted average sleep duration, and restless sleep. We used Cox proportional hazards models and multinomial logistic regression models to estimate associations between sleep and prostate cancer incidence and aggressiveness.

RESULTS: During follow-up (median 10.9 years), 1345 men developed prostate cancer. Shorter sleep duration (< 6 h), in comparison to optimal duration (7-8 h), was suggestively associated with a decreased risk of prostate cancer in the overall cohort (adjusted hazard ratio (HR) = 0.83, (95% confidence interval (CI): 0.68-1.01) for sleep average; HR = 0.79, 95% CI: 0.65-0.95 for sleep weekdays; and HR = 0.81, 95% CI: 0.66-0.99 for sleep weekends), and among Black men (HR = 0.77, 95% CI: 0.62-0.97 for sleep average; HR = 0.76, 95% CI: 0.61-0.94 for sleep weekdays; and HR = 0.74, 95% CI: 0.59-0.94 for sleep weekends) when stratified by racial groups. Sleep duration and restless sleep were not associated with prostate cancer aggressiveness overall.

CONCLUSION: Shorter sleep duration was suggestively associated with a decreased risk of prostate cancer, but sleep duration was not associated with aggressive prostate cancer. Stratified analysis suggests a reduction of prostate cancer risk among Non-Hispanic Black men with < 6 h of sleep, compared to those sleeping 7-8 h. This is an intriguing finding, and further research is needed to assess the impact of confounding factors on racial differences in prostate cancer development.

PMID:41482760 | DOI:10.1002/cam4.71466

Int J Cancer. 2026 Jan 2. doi: 10.1002/ijc.70325. Online ahead of print.

ABSTRACT

The effects of cofactors on the impact of body mass index (BMI) change on breast and endometrial cancer are rarely investigated. This cohort study included cancer-free women who underwent national health examinations in 2010-2014 (Cohort 1) and 2009-2013 (Cohort 2), with follow-up through 2021 and 2017, respectively. BMI at baseline and follow-up was combined and categorized into 25 BMI change patterns. Cohort 1 (2.24 million) had 30,323 breast and 5465 uterine corpus cancers, while Cohort 2 (1.46 million) had 8580 breast and 1170 uterine corpus cancers. In Cohort 1, persistent low BMI was associated with a reduced risk of both cancers, particularly in postmenopausal women and never-smokers. However, persistent overweight, obesity I/II, and BMI fluctuation (loss or gain) were linked to an increased risk of both cancers, particularly in postmenopausal women and ever-smokers. Among premenopausal women, substantial BMI loss was associated with increased breast cancer risk. In postmenopausal women, a transition from overweight to underweight (adjusted hazard ratio [aHR]: 4.63, 95% confidence interval [CI]: 1.15-18.59) and from overweight to obesity class II (aHR: 4.06, 95% CI: 1.01-16.30) significantly increased uterine cancer risk. Among smokers, most BMI changes did not show significant association, except for persistent obesity I (aHR: 1.57, 95% CI: 1.01-2.43) and progression from obesity class I to II (aHR: 4.03, 95% CI: 1.97-8.26). Cohort 2 findings were largely consistent with those from Cohort 1. In conclusion, persistent high BMI and further BMI gain were associated with increased risk of both cancers, particularly in postmenopausal women and never-smokers.

PMID:41482754 | DOI:10.1002/ijc.70325