Nevin Manimala

J Forensic Sci. 2026 Aug 16. doi: 10.1111/1556-4029.70438. Online ahead of print.

ABSTRACT

Skeletal age estimation is crucial to medicolegal work, aiding subadult identification, and living age assessments in legal contexts. This study aims to document the ontogeny of knee skeletal indicators on post-mortem computed tomography (PMCT), and quantify interpopulation variation between modern American and Australian children. PMCT data from 402 Australian subadults from Victoria, Australia (228 males, 174 females), and 445 North American subadults from New Mexico (233 males, 202 females) were retrospectively accessed. Thin-slice data were visualized as multiplanar reconstructions, and an ordinal scoring system applied to 11 indicators on the femur, tibia, and fibula. High repeatability was exhibited by excellent intra-rater (ICC = 0.99) and good inter-rater (ICC = 0.89) agreement. Transition analysis produced maximum likelihood maturation estimates, with age parameters derived from a multivariable Bayesian model using 68-95% credible intervals. Active knee fusion occurred in Australian females aged 10-16 and males 12-18, with complete fusion of all sites no earlier than 14 and 16 years. North American females showed slightly later fusion (11-15 years), consistent with males (11-16 years). Sexual dimorphism was consistent in both subpopulations, and interpopulation differences were especially prominent in later adolescence to early adulthood for the epiphyses for males, but were not identified for most morphological indicators. Recalibrated, normative PMCT knee development standards are presented for Australian and North American subadults, identifying four indicators especially informative for age estimation across developmental profiles derived from a Bayesian cluster model. Our findings support use of population-specific standards, particularly in later fusion stages after 15-16 years, to improve accuracy in forensic and clinical applications.

PMID:42604584 | DOI:10.1111/1556-4029.70438

Matern Child Nutr. 2026 Jul;22(3):e70221. doi: 10.1111/mcn.70221.

ABSTRACT

Adequate nutrition during pregnancy is critical for mothers and newborns, but few studies have characterized maternal diets. The Global Diet Quality Score (GDQS) is a new metric to evaluate population diets. This study examined GDQS during pregnancy and its influencing factors in rural Uttar Pradesh, India. Data were from the Alive & Thrive (A&T) impact evaluation study, a cluster-randomized trial testing behavior change communication delivered through the antenatal care (ANC) platform. We analyzed multi-pass 24-h dietary recalls combined from two cross-sectional surveys, at baseline (2017, n = 660) prior to intervention and endline (2019, n = 674). The GDQS was constructed based on grams/day of 25 food groups consumed (range 0-49); for 16 healthy food groups (GDQS+), higher scores indicated higher consumption, whereas for 9 unhealthy food groups (GDQS-), scoring was reversed with higher scores reflecting lower consumption. Maternal and household factors influencing GDQS examined in a multivariable linear regression model included age, education, parity, nutrition knowledge, ANC visits, household size, religion, caste, socio-economic status (SES), and food insecurity, adjusted for pregnancy duration, survey time, and A&T intervention. The mean (SD) at 18.5 (3.4) for overall GDQS, 7.3 (3.2) for GDQS+, and 11.2 (1.6) for GDQS- was low. Factors positively associated with overall GDQS and GDQS+ were 4+ ANC visits (β = 0.83 and 0.78), nutrition knowledge (β = 0.12 and 0.13), and SES (β = 0.82 and 0.96). Maternal education (β = 0.66) and caste (β = -0.66) were significantly associated with GDQS+ while no factors were associated with GDQS-. This study highlights poor diet quality during pregnancy in this context.

PMID:42604575 | DOI:10.1111/mcn.70221

Helicobacter. 2026 Jul-Aug;31(4):e70156. doi: 10.1111/hel.70156.

ABSTRACT

BACKGROUND: Helicobacter pylori infection is a primary cause of gastric cancer. Although eradication therapy in adulthood suppresses carcinogenesis, its efficacy is limited due to the progression of advanced gastric mucosal atrophy before eradication. Implementing a “screen-and-treat” strategy during adolescence represents a promising approach to prevent advanced atrophy and subsequent gastric cancer.

METHODS: This prospective cohort study included first-year high school students in Kyoto Prefecture, Japan, from 2015 to 2023. Screening was performed using a primary urine H. pylori antibody test, followed by a secondary stool antigen test for confirmation. Confirmed positive individuals were referred to designated medical institutions for 7-day eradication therapy. The primary therapeutic regimen was shifted from rabeprazole, amoxicillin, and clarithromycin (PAC) in 2015 to rabeprazole, amoxicillin, and metronidazole (PAM) from 2016 onward. Clostridium butyricum MIYAIRI 588 strain (CBM588) was co-administered starting in 2017. Eradication success was verified via a stool antigen test at least 8 weeks post-treatment.

RESULTS: A total of 50,031 students were targeted over the 9-year period, with an overall consent rate ranging from 59.9% to 83.9%. The confirmed H. pylori infection rate declined from 4.7% in 2015 to 1.5% in 2023. The medical consultation rate among positive screenees exhibited a declining trend, peaking at 84.6% (2015) and dropping to 15.8% (2023), despite a temporary increase in 2019 (65.9%). The eradication success rate significantly improved from 76.5% with the PAC regimen (2015) to over 93.8% with the PAM regimen (2016 onward), exceeding 96.0% after the addition of CBM588. No serious adverse events were reported throughout the study period.

CONCLUSIONS: The prospective adolescent screen-and-treat program demonstrated a significant decrease in H. pylori infection rates among first-year high school students over the decade. While the safety and efficacy of the PAM-based eradication regimen were verified, declining medical consultation rates present a continuous challenge for public health implementation.

PMID:42604572 | DOI:10.1111/hel.70156

Orv Hetil. 2026 Aug 16;167(33):1318-1323. doi: 10.1556/650.2026.33628. Print 2026 Aug 16.

ABSTRACT

INTRODUCTION: Hepatitis C virus (HCV) shows great structural variability. Currently, it has 8 genotypes and 93 subtypes with differing distributions according to geographical regions, ethnicities, and risk groups. In Hungary, HCV infections have been screened since 1992. In our Molecular Diagnostic Laboratory, we have been conducting HCV serotyping since 1996 and genotype and subtype analyses since 2000, both with national coverage.

OBJECTIVE: To analyse the genotype and subtype distributions of our national sample (n = 9067) according to age, sex, geographical region, and their evolution over three decades (1996-2026).

METHODS: Serotyping was carried out between 1996-1999 (n = 175) followed by genotyping with hybridization between 2000-2016 (n = 4844) and with real-time PCR since 2016 (n = 4223).

RESULTS: Over the three decades, GT1b remained the dominant subtype in Hungary, but its relative frequency diminished in comparison to GT1a and GT3. Overall prevalence was the highest among younger males (<40 years) and older females (>60 years). Age under 40 years showed statistically significant association with increased prevalence of GT3 and non-GT1b genotypes. GT3 was the most common in the Southwest region, while non-GT1b was the most frequent in the Northeast region.

DISCUSSION: Similarly to international findings, our results confirm a continuous change in the genotype/subtype distribution of HCV in Hungary, too. The observed increase in genetical diversity is linked to migration, travelling and the increasing frequency of intravenous drug use. Genotype monitoring of HCV, therefore, remains important for the early detection of rare subtypes, interpretation of unexpected therapeutic outcomes, and directed epidemiological investigations. It also supports the indirect monitoring of changes in population lifestyle factors and infection routes. Relevant information is necessary for the differentiation of relapse from reinfection. Orv Hetil. 2026; 167(33): 1318-1323.

PMID:42604548 | DOI:10.1556/650.2026.33628

Medicina (B Aires). 2026;86(4):955-962.

ABSTRACT

INTRODUCTION: We evaluated the prevalence and clinical impact of ST-segment depression and/or T-wave inversion (ST-T changes) assessed on a standard electrocardiogram (ECG) among patients with an acute ischemic stroke (AIS).

MATERIALS AND METHODS: We included adult patients admitted with AIS between October 2020 and June 2022. Clinical data, admission ECG, and in-hospital outcomes were recorded. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). The primary endpoint was a composite of severe stroke (NIHSS>5 at discharge) or in-hospital mortality, as well as length of hospital stay.

RESULTS: A total of 221 patients with AIS were analyzed (71.8±12.8 years, 56% male). Baseline ECG abnormalities were present in 170 (77%) patients. The most frequents findings were ST-T changes (n=80, 36%), intraventricular conduction disturbances (n=71, 32%), and atrial fibrillation (AF) (n=65, 29%). During hospitalization, 20 (9%) patients died and 64 (32%) had NIHSS>5 at discharge. Hospital stay was longer in patients with AF [9.0 (6.5; 20.5) days] vs. those without AF [5.0 (3.0; 11.0) days, p<0.0001], and in those with ST-T changes [9.0 (4.0; 21.0) days] vs. those without ST-T changes [5.0 (3.0; 10.0) days, p<0.0001]. The presence of abnormal ECG (p<0.0001), AF (p=0.027), and ST-T changes (p<0.0001) were associated with the composite endpoint. In the logistic regression analysis, ST-T changes were the only predictor (OR 3.7; 95% CI 2.0-6.8; p<0.0001).

CONCLUSION: Baseline ST-T abnormalities on admission ECG are predictors of worsening stroke severity and in-hospital outcomes in AIS.

PMID:42604505

Medicina (B Aires). 2026;86(4):944-954.

ABSTRACT

INTRODUCTION: Late diagnosis (LD) of HIV infection, defined as a CD4+ cell count below 350 cells/uL or the presence of an AIDS-defining illness, remains a major public health problem due to its association with increased morbidity, mortality, and ongoing transmission. We aimed to identify factors associated with LD among individuals with a new HIV diagnosis.

MATERIALS AND METHODS: We conducted an observational mixed-methods study including adults with a recent HIV diagnosis consecutively enrolled at a referral hospital in Buenos Aires between October 2023 and January 2025. Quantitative analyses evaluated factors associated with LD, while qualitative interviews explored barriers to HIV testing and healthcare access.

RESULTS: A total of 102 patients were included (median age 32 years; median CD4+ count 294 cells/uL). Late diagnosis was observed in 59.8% of cases. Seven patients died from AIDS-related causes, all in the LD group. Older age and heterosexual orientation were independently associated with LD. Notably, 36.1% of participants had at least one healthcare visit in the year prior to diagnosis, representing missed opportunities for testing. During follow-up, 92.2% achieved viral suppression at six months, with no new AIDS-defining events. Qualitative findings identified self-perceived good health, low awareness of HIV testing, and perceived exclusion from healthcare services as barriers to timely diagnosis.

CONCLUSION: More than half of patients were diagnosed late, with frequent missed opportunities for earlier detection. These findings support the need for expanded and targeted HIV testing strategies to reduce preventable morbidity and mortality.

PMID:42604504

Medicina (B Aires). 2026;86(4):915-922.

ABSTRACT

INTRODUCTION: The impact of mild hyperprolactinemia (serum prolactin <50 ng/mL) on assisted reproductive outcomes remains controversial. For that reason, we aimed to compare pregnancy and live birth rates in a cohort of women with untreated mild hyperprolactinemia versus women with normal prolactin levels (<26.5 ng/mL) undergoing high complexity assisted reproductive techniques.

MATERIALS AND METHODS: This was a retrospective study conducted between 2011 and 2021, including women under 40 years of age with infertility due to tubal factor, male factor, or unexplained infertility (UI) who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Pregnancy and live birth rates were compared between two groups: women with normal prolactin levels and those with untreated mild hyperprolactinemia (not receiving dopamine agonist therapy).

RESULTS: A total of 242 patients were included; 82% (n=199) had normal prolactin levels and 18% (n=43) had mild hyperprolactinemia. Of these, 31.1% (n=76) underwent IVF and 68.9% (n=166) underwent ICSI. The pregnancy rate was 37.8% (n=74) in the normal prolactin group and 67.5% (n=27) in the mild hyperprolactinemia group (p=0.001). After adjusting for overweight status, age, and infertility etiology, women with mild hyperprolactinemia had threefold higher odds of achieving pregnancy compared with those with normal prolactin levels (p=0.004). No significant differences were observed in live birth rates between groups (p=0.4).

CONCLUSION: In women undergoing IVF or ICSI, mild hyperprolactinemia did not adversely affect assisted fertilization outcomes. On the contrary, it was associated with a significantly higher pregnancy rate.

PMID:42604501

J Anesth. 2026 Aug 16. doi: 10.1007/s00540-026-03869-8. Online ahead of print.

ABSTRACT

PURPOSE: This study characterized nationwide trends, demographic distributions, and regional disparities in cardiac anesthesia and intraoperative transesophageal echocardiography (ITEE) in Japan.

METHODS: We conducted a retrospective observational study using the National Database of Health Insurance Claims (NDB) Open Data Japan (2019-2023). Cardiac anesthesia was defined using reimbursement codes for cardiac or thoracic great-vessel surgery requiring cardiopulmonary bypass. ITEE was evaluated using add-on claims classified into two categories: ITEE for cardiac/non-cardiac surgeries, and ITEE for percutaneous interventions. Trends were assessed using linear and Poisson regression models. Age- and sex-specific distributions and regional disparities (Gini coefficients) were assessed.

RESULTS: A total of 179,920 cardiac anesthesia events were identified (28.7 per 100,000 person-years), with a male predominance (male-to-female ratio, 1.6:1). Age distribution was bimodal, peaking at 0-4 and 75-79 years. Both cardiac anesthesia and ITEE use declined transiently during Japan’s first coronavirus disease 2019 state of emergency in May 2020, followed by recovery in the latter half of fiscal year 2020. Age-adjusted rates of cardiac anesthesia demonstrated no significant annual change. In contrast, ITEE use increased significantly in both cardiac/non-cardiac surgeries (relative risk [RR], 1.011/year; P < 0.0001) and percutaneous interventions (RR, 1.117/year; P < 0.0001). Regional disparities in cardiac anesthesia decreased over time, with Gini coefficients declining from 0.20 to 0.15.

CONCLUSION: Cardiac anesthesia remained generally stable in Japan from 2019 to 2023. Increasing ITEE, especially for percutaneous interventions, suggests evolving cardiovascular perioperative practice, although claims-based categories require cautious interpretation.

PMID:42604463 | DOI:10.1007/s00540-026-03869-8

Biodemography Soc Biol. 2026 Aug 16:1-15. doi: 10.1080/19485565.2026.2716716. Online ahead of print.

ABSTRACT

In 2020, the total fertility rate in Puerto Rico was estimated at 0.93 children per woman, one of the lowest in the world. While fertility decline preceded the new millennium, little is known about whether the onset of the 2006 economic crisis influenced its pace. Using birth counts from the Puerto Rico Vital Statistics System and population estimates, we calculate fertility measures for 1990-2020. Regression models estimated by ordinary least squares, with Newey-West standard errors, were fit to estimate the overall annual percent change (APC), and to compare the periods before and after the onset of the economic crisis (1990-2005 and 2006-2020). The pace of decline changed for eight of the nine indicators: accelerating for seven, while the ASFR for women aged 40-44 years declined at a slower pace. Stratified models show that all fertility measures and the share of women aged 15-44 declined significantly in both periods, with a faster decline observed in the post-crisis period for six of the nine. A significant acceleration in fertility decline was observed in the age-specific fertility rates for women under 35 years. In Puerto Rico, findings suggest that fertility decline accelerated after the onset of the economic crisis.

PMID:42604459 | DOI:10.1080/19485565.2026.2716716

Med J Aust. 2026 Aug;224(8):e70253. doi: 10.5694/mja2.70253.

ABSTRACT

OBJECTIVE: To estimate population-level eligibility for glucagon-like peptide-1 receptor agonist (GLP-1RA) medications among adults in Australia, according to Therapeutic Goods Administration-approved indications for chronic weight management and secondary prevention of cardiovascular disease in individuals with overweight or obesity.

STUDY TYPE: Cross-sectional analysis of data from the Australian Bureau of Statistics 2022 National Health Survey.

SETTING, PARTICIPANTS: Non-pregnant adults aged ≥ 18 years who were residents of Australia living in a private dwelling.

MAIN OUTCOME MEASURES: Total number of adults eligible for GLP-1RA medications according to approved indications for chronic weight management and secondary prevention of cardiovascular disease in individuals with overweight or obesity, across subgroups defined by body mass index, weight-related comorbidities and/or sociodemographic factors.

RESULTS: Overall, 39.7% (95% confidence interval [CI], 38.4%-41.0%) of adults were eligible for GLP-1RA use for chronic weight management, accounting for 7.8 million (95% CI, 7.6-8.1 million) individuals. Among those eligible, 2.9 million (95% CI, 2.7-3.1 million) adults had no weight-related comorbidities, 3.3 million (95% CI, 3.1-3.4 million) adults had one weight-related comorbidity and 1.7 million (95% CI, 1.6-1.8 million) adults had at least two weight-related comorbidities. The proportion of adults eligible under this indication varied across clinical and sociodemographic factors. Among those eligible under the chronic weight management indication, up to 338.9 thousand (95% CI, 271.3-406.5 thousand) adults also met the indication criteria for secondary prevention of cardiovascular disease.

CONCLUSION: About 7.8 million Australian adults are eligible to access GLP-1RAs for chronic weight management, with up to 338.9 thousand adults also qualifying according to the indication for established cardiovascular disease. This study provides a valuable reference for policymakers to understand the number of adults in Australia who may access GLP-1RA medications based on approved indication criteria and under various coverage scenarios.

PMID:42604458 | DOI:10.5694/mja2.70253