Nevin Manimala

Minim Invasive Ther Allied Technol. 2026 Jun 22:1-9. doi: 10.1080/13645706.2026.2686989. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to investigate and compare the postoperative effects of vaginal natural orifice transluminal endoscopic surgery (vNOTES) and conventional laparoscopy on patients’ sexual function, quality of life, and self-esteem for benign indications.

METHODS: Data from patients who underwent hysterectomies and tubal surgeries using either vNOTES or conventional laparoscopy between January 2022 and August 2023 were analyzed and compared. The primary outcomes were sexual function, quality of life, and self-esteem, assessed both preoperatively and at 3 months post-surgery. Other outcomes of interest, such as surgical success, duration of surgery, complication rates, and postoperative pain, were also included.

RESULTS: Among the women included in the study, 105 (34.8%) underwent total laparoscopic hysterectomy (TLH), 63 (20.9%) underwent vNOTES hysterectomy (VH), 53 (17.5%) underwent laparoscopic tubal surgery (LTS), and 81 (26.8%) underwent vNOTES tubal surgery (VTS). Postoperative Short Form-12 (SF-12) Physical Component Summary (PCS) scores improved significantly in the hysterectomy groups (TLH: 41.16 ± 4.85; VH: 39.68 ± 4.73; p = 0.001). Similarly, Mental Component Summary (MCS) scores also improved postoperatively (TLH: 42.54 ± 5.05; VH: 39.68 ± 4.26; p = 0.001). In the tubal surgery groups, postoperative PCS scores were 42.87 ± 3.38 for LTS and 41.6 ± 3.25 for VTS, with significant improvements observed in both LTS (p = 0.033) and VTS (p = 0.002). However, postoperative MCS changes were not statistically significant for either LTS (p = 0.808) or VTS (p = 0.072). Postoperative Female Sexual Function Index (FSFI) scores increased significantly in both hysterectomy groups (TLH: 20.73 ± 6.26; VH: 21.52 ± 5.23; p = 0.001). Preoperative FSFI scores were similar between the LTS (23.67 ± 6.88) and VTS (23.75 ± 3.26) groups (p = 0.741). Postoperatively, mean FSFI scores increased to 26.98 ± 5.35 in the LTS group and 29.95 ± 4.31 in the VTS group, demonstrating significant improvement (p = 0.001). On the Rosenberg Self-Esteem Scale, only the VH group showed a significant postoperative improvement (p = 0.001).

CONCLUSIONS: The vNOTES procedures yielded results comparable to those of the control group while demonstrating notable improvements in patient-centered outcomes, including sexual function, quality of life, and self-esteem, alongside favorable perioperative surgical outcomes.

PMID:42325077 | DOI:10.1080/13645706.2026.2686989

Natl Med J India. 2026 Jul-Aug;39(4):257-260. doi: 10.25259/NMJI_383_2024.

ABSTRACT

Background Workplace violence is a critical occupational hazard faced by healthcare professionals worldwide, adversely affecting their mental well-being and the quality of healthcare. Assessing the situation and how junior doctors deal with it is critical. We assessed the prevalence of workplace violence against junior doctors in a tertiary care hospital in Manipur and explored coping strategies amongst those who experienced it. Methods A mixed-method study was conducted from October to November 2023 amongst junior doctors. Data were collected using a self-administered questionnaire and in-depth interviews were conducted amongst those who had experienced workplace violence. Descriptive statistics and Chi-square test were used. p<0.05 was considered statistically significant. Thematic analysis was done to identify codes, categories and themes. Results Of the 124 participants, 55 (44.4%) had experienced workplace violence. Verbal violence was the most common. It was significantly higher among non-academic junior residents (p=0.005) than among interns and those working shifts (p=0.017). Thematic analysis also showed that perpetrators of violence were mainly patients or their relatives and were caused by miscommunication or lack of supplies. During such incidents, they attempted to avoid the situation or sought help from colleagues, and seeking support and disengagement were crucial in coping with the crisis. Conclusion Nearly half the junior doctors experienced workplace violence. A positive work environment for junior doctors with measures to prevent workplace violence is needed. Effective coping mechanisms are crucial during and after a crisis to navigate the incident and its aftermath.

PMID:42325045 | DOI:10.25259/NMJI_383_2024

Natl Med J India. 2026 Jul-Aug;39(4):235-238. doi: 10.25259/NMJI_536_2024.

ABSTRACT

Background Diabetic foot ulcers are an important problem for people with diabetes mellitus. We aimed to determine the mortality rate in patients with diabetic foot ulcers and assess the relationship between mortality, the Wagner classification of diabetic foot, and biochemical parameters, such as glucose, haemoglobin A1c (HbA1c), and lipid profile. Methods We included patients with diabetic foot ulcers treated at a training and research hospital from April 2019 to June 2022. We compared patients who died during this period and those who were alive to determine the mortality rate and assess predictive factors for mortality. Results We included 170 patients in the study; their mortality rate was 29.4%. The Wagner classification did not reveal a statistically significant difference in mortality (p=0.334). However, a statistically significant association was found between mortality and the duration of diabetes (p=0.036), uric acid levels and creatinine values (p<0.05). Although the median HbA1c levels were higher in those who were alive compared with the deceased, this did not affect mortality. Conclusion The Wagner classification for diabetic foot ulcers did not show any correlation with mortality. Instead, blood glucose, creatinine, and aspartate aminotransferase values predicted mortality in people with diabetic foot.

PMID:42325033 | DOI:10.25259/NMJI_536_2024

Natl Med J India. 2026 Jul-Aug;39(4):218-223. doi: 10.25259/NMJI_617_2023.

ABSTRACT

Background Hypertension is a major global threat associated with adverse cardiovascular events, especially in the Asian population. Ambulatory blood pressure monitoring (ABPM) is a valuable tool in diagnosis and management of hypertension and is predictive of future cardiovascular events. We assessed the feasibility of ABPM and generated preliminary normative data specific to the Indian population. Methods The circadian profile of 24-hour blood pressure (BP) in 53 healthy subjects was studied in their natural settings. Various circadian parameters like midline estimating statistic of rhythms (MESOR), 24-hour average BP, awake hours average BP, sleep hours average BP, % dip in systolic BP, and morning surge in BP were studied. Results BP and heart rate followed a sinusoidal pattern, with almost all the subjects having significant Cosinor rhythm. ABPM was generally well-tolerated, with no major discomfort, limited restrictions on daily activities, and the values of ABPM parameters in this population matched those of other populations. Conclusion ABPM is feasible and acceptable in India and follows a sinusoidal pattern in healthy young adults, similar to other populations.

PMID:42325022 | DOI:10.25259/NMJI_617_2023

Gut Liver. 2026 Jun 22. doi: 10.5009/gnl250626. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: The metabolic dysfunction-associated fibrosis 5 (MAF-5) tool has been proposed for identifying individuals at high risk of liver fibrosis, but its ability to predict liver-related events (LREs) remains unknown. We aimed to evaluate the ability of MAF-5 to predict LREs and assess whether modifications could enhance its predictive capacity.

METHODS: A retrospective cohort of 62,625 adults without cancer, organ transplantation, chronic viral hepatitis, or heavy alcohol intake was followed for LREs (hepatocellular carcinoma and/or liver cirrhosis complications). The MAF-5 score was calculated and compared with other non-invasive liver fibrosis biomarkers. We also assessed whether modifying the MAF-5 score could improve LRE prediction.

RESULTS: During a median follow-up of 11.2 years, 147 patients developed LREs. The MAF-5 scores were used to stratify participants by LRE risk into low-, intermediate-, and high-risk categories, with incidence rates of 0.108, 0.576, and 1.520 cases per 1,000 person-years, respectively. Age was identified as an independent risk factor for LREs, and therefore, we developed an age-modified MAF-5 (aMAF-5) score, which showed improved performance (C-index: 0.870 vs 0.818; integrated area under the curve: 0.858 vs 0.784). Within the same MAF-5 category, LRE risk varied according to the aMAF-5 score. The use of “either positive” criteria improved sensitivity (from 0.412 to 0.765) and decreased specificity (from 0.944 to 0.830), while “both positive” criteria improved specificity and reduced sensitivity. Both scores performed well regardless of age, sex, or metabolic syndrome status.

CONCLUSIONS: The MAF-5 score allows effective stratification of LRE risk. The aMAF-5 score further improves risk stratification. These scores identify individuals at risk of LREs who may benefit from enhanced surveillance.

PMID:42325012 | DOI:10.5009/gnl250626

Int J Lang Commun Disord. 2026 Jul-Aug;61(4):e70278. doi: 10.1111/1460-6984.70278.

ABSTRACT

BACKGROUND: Flexible endoscopic evaluation of swallowing (FEES) is internationally recognised as an important instrumental assessment for paediatric dysphagia. Evidence supports its feasibility and safety in infants and children, but UK specific data remain limited. No published UK report describes a jointly delivered speech and language therapist (SLT) and paediatric otolaryngologist (ENT) FEES model applied across both neonatal and paediatric cohorts.

OBJECTIVE: To describe the implementation of a neonatal and paediatric FEES service delivered jointly by SLTs and ENT surgeons, and to evaluate clinical characteristics, FEES findings and subsequent changes to management.

METHODS: A retrospective audit included all children undergoing FEES between January 2024 and January 2025. Extracted data included demographics, comorbidities, referral indications, secretion management, penetration and aspiration events, swallow physiology, procedural tolerance and pre and post FEES feeding plans. Descriptive statistics were used to describe results. Governance approval was obtained through the hospital’s information governance office. (IG 2024-890).

RESULTS: Thirty-three children aged 4 days to 8 years underwent FEES. Comorbidities associated with dysphagia were present in 31/33 participants. Penetration or aspiration occurred in 21/33 participants, and secretion management difficulties occurred in 14/33 participants. Following FEES, 30/33 participants had a change to their feeding management plan compared with the plan developed based on a clinical feeding evaluation. No major adverse events occurred. One brief episode of mild epistaxis resolved spontaneously. The joint SLT and ENT model supported efficient scope passage and likely contributed to high procedural tolerance.

CONCLUSION: A neonatal and paediatric FEES service can be safely implemented in a UK tertiary hospital using a joint SLT and ENT model. Simultaneous upper airway examination alongside FEES provided clinically meaningful information that frequently changed management. Findings support further multicentre work to establish national paediatric FEES pathways.

WHAT THIS PAPER ADDS: What is already known on this subject FEES is a well-established instrumental assessment for paediatric dysphagia, providing objective insights into swallow function and airway protection. While widely used in countries like the U.S., Australia, and Canada, there is limited research describing paediatric or neonatal FEES in the United Kingdom or broader European context. Existing literature focuses primarily on feasibility and diagnostic accuracy, but does not address its implementation in UK public health systems or its integration with ENT services. What this study adds to the existing knowledge This is the first known study to describe the implementation of a joint ENT-SLT led paediatric FEES service within an NHS hospital. It identifies a high incidence of laryngomalacia during FEES, suggesting a potential association with oropharyngeal dysphagia even in the absence of classic airway symptoms. The study also demonstrates substantial variation in oral feeding plans post-FEES compared to bedside assessment, raising concerns about the standalone reliability of non-instrumental evaluations in neonates and infants. What are the potential or actual clinical implications of this work? The study supports routine inclusion of ENT in paediatric FEES, particularly for neonates, due to the frequency of structural airway anomalies such as mild laryngomalacia. It highlights critical limitations of bedside swallow evaluations as sole diagnostic tools and underscores the need for expanded access to FEES within the NHS. These findings reinforce the urgency for standardized UK-specific protocols and training pathways for neonatal and paediatric FEES to ensure accurate diagnosis and safe feeding management.

PMID:42324950 | DOI:10.1111/1460-6984.70278

Chem Res Toxicol. 2026 Jun 22. doi: 10.1021/acs.chemrestox.6c00065. Online ahead of print.

ABSTRACT

Reliable quantification of uncertainty is critical for the interpretation and regulatory use of the QSAR models. Applicability domain (AD) assessment was introduced precisely for this purpose─the original OECD guidance defines AD in terms of prediction reliability─yet in practice AD metrics output heuristic similarity scores without statistically guaranteed confidence estimates. We present conformal prediction as a calibration layer that retrofits any QSAR models into a confidence predictor, producing prediction intervals for regression and prediction sets for classification at a user-specified nominal confidence level (e.g., 90%), with statistically guaranteed coverage, without retraining, using only model predictions and a calibration set. The guarantee holds under the exchangeability assumption─that calibration and test compounds are drawn from the same input space─and follows as a mathematical consequence of the rank-based calibration procedure. When the assumption is violated, coverage may fall below the nominal level─signaled by widening intervals and shrinking singleton rates. The framework uses auxiliary models trained on molecular fingerprints as nonconformity scores, a role that most existing AD indices can equally fulfill; a novel ordinal distance strategy extends the approach to hard-label classifiers by generating pseudoproabilities compatible with standard conformal methods. Applied to over 100 VEGA QSAR models spanning physicochemical properties, toxicity, and environmental endpoints (https://www.epa.gov/pesticide-science-and-assessing-pesticide-risks/technical-overview-ecological-risk-assessment-risk), the framework consistently achieves nominal coverage across all models and endpoint types. Conformal efficiency metrics─prediction interval width for regression and singleton rate for classification─correlate strongly with AD indices, demonstrating that CP formalizes and quantifies what AD heuristics approximate: the relationship between structural novelty and prediction reliability, successfully transforming heuristic chemical similarity into statistically valid prediction intervals or label sets. Large-scale application to the EPA CompTox chemical inventory demonstrates practical deployment at a regulatory scale. An open-source pipeline facilitates application to any QSAR/QSPR platform, enabling an improved transparency and reliability assessment.

PMID:42324899 | DOI:10.1021/acs.chemrestox.6c00065

J Med Virol. 2026 Jun;98(6):e71010. doi: 10.1002/jmv.71010.

ABSTRACT

Cervical cancer remains a major public health concern in Sarawak, East Malaysia, which reports the highest incidence in the country. Prophylactic human papillomavirus (HPV) vaccination programme currently uses bivalent (2 v) and quadrivalent (4 v) vaccines targeting HPV16 and 18 (and additional low-risk HPV6 and 11 for 4 v). However, the alignment of these vaccines with locally circulating high-risk HPV (hrHPV) genotypes is poorly understood. We conducted a serial cross-sectional study involving 1,108 women in Sarawak, Malaysia from 2018 to 2024. Self-collected high vaginal swabs were analyzed using the Anyplex™ II HPV HR Detection Kit for 14 hrHPV genotypes. Demographic data and vaccination status were collected. Descriptive statistics and Chi-square tests were used to evaluate associations between hrHPV positivity and demographic variables. The overall hrHPV prevalence was 10.2% (95% CI: 8.6-12.1%). Among positive cases, 87.6% had single, 10.6% dual, and 1.8% triple genotype infections. The most frequent genotypes were HPV18 (19.2%), HPV52 (16.9%), HPV39 (14.6%), and HPV51 (10.0%). Genotypes covered by the 2 v/4 v vaccines (HPV16/18) accounted for 25.4% of infections, and those included in the nonavalent (9 v) vaccine extended coverage to 56.2%. Notably, 43.8% of infections were due to non-2v/4 v/9 v vaccine genotypes. No significant associations were found between HPV positivity and age group, ethnicity, geographic division, or vaccination status. Our findings indicate a mismatch between current HPV vaccines and the prevalent hrHPV genotypes in Sarawak. While the 9 v vaccine offers improved coverage, a substantial proportion of infections are due to non-vaccine types. Strengthening molecular surveillance, improving access to screening, and addressing vaccine-derived complacency are critical to achieving cervical cancer elimination in this region.

PMID:42324898 | DOI:10.1002/jmv.71010

Ethn Health. 2026 Jun 21:1-20. doi: 10.1080/13557858.2026.2688761. Online ahead of print.

ABSTRACT

BACKGROUND: The Latine population is at least two times more likely to be food insecure compared to the non-Hispanic white population. Challenges in accessing sufficient, culturally preferred, and healthy foods, particularly for those in rural areas, include limited financial resources and transportation difficulties. Additionally, this population commonly has low enrollment in food assistance programs, an effective method in reducing food insecurity (FI). Obesity, diabetes, cardiovascular diseases (CVD), and depression are frequently associated with FI; the Latine population carries a disproportionately high burden or risk of these diseases.

OBJECTIVES: We aimed to understand the prevalence of FI, FI as a predictor and outcome variable, and health conditions associated with FI among the Latine population in rural, western North Carolina.

METHODS: We conducted a cross-sectional survey in community settings using purposive sampling. Data were analyzed using descriptive statistics, bivariate analysis, and multivariable binary logistic regressions.

RESULTS: Among 193 participants, 47% reported FI. Those identifying as food insecure were more likely to report a household income under $35,000 (OR 5.49, 95% CI: 1.37, 22.06), low educational attainment (OR 3.85, 95% CI: 1.23, 12.04), and being unmarried (OR 3.53, 95% CI: 1.01, 12.20). When modeled as a predictor, FI was associated with higher odds of reporting symptoms of CVD (OR 3.95, 95% CI: 1.43, 12.14) and depression (OR 5.01, 95% CI: 1.45, 21.52).

CONCLUSION: Our study demonstrates a high prevalence of FI and significant relationships between FI and a myriad of variables in a region of rural, western NC and contributes to a dearth of literature about the experience of FI among the Latine population. Understanding the predictors of FI in this context can better support efforts to increase food security among this population.

PMID:42324865 | DOI:10.1080/13557858.2026.2688761

J Bioinform Comput Biol. 2026 Jun;24(3):2650006. doi: 10.1142/S021972002650006X. Epub 2026 Jun 11.

ABSTRACT

Copy number variation (CNV) is one of the most imperative forms of structural variations that can span over the coding and non-coding regulatory regions of an individual’s genome. Copy number variations (CNV) can significantly impact the genotype and phenotype traits by altering the gene dosage, consequently affecting the gene expression landscape concerning various cellular functions and are the cause behind complex diseases in an individual. Exceptionally fast advancement in Next Generation Sequencing (NGS) technology has led to massive growth of DNA-seq data, which contains both Whole Genome Sequence (WGS) and targeted Exome Sequence data of various species including H.sapiens, and precise detection of the DNA region affected by CNV enables the copy number profiling of a genome, thereby understanding our genome. This work has proposed a methodology named ReinVar, which can accurately determine and analyze the underlying copy number profile of the whole genome by adopting a model-free reinforcement learning paradigm. The methodology involves a novel approach to model the problem of identifying CNV as a Markov decision process (MDP), followed by determination of CNV under Reinforcement Learning framework. ReinVar also adopted a Map-Reduce programming paradigm to provide a big data solution to address the issue of exponential growth of NGS read sequence data. ReinVar has shown strong performance in detecting CNV gains and losses across diverse ethnic groups, with a high number of shared variant calls. ReinVar’s ability to accurately identify both CNV gains and losses, coupled with consistent detection across ethnic groups and strong ROC characteristics, underscores ReinVar’s effectiveness as a robust and sensitive CNV detection method.

PMID:42324820 | DOI:10.1142/S021972002650006X