Nevin Manimala

Chin Med J (Engl). 2026 May 29. doi: 10.1097/CM9.0000000000004140. Online ahead of print.

ABSTRACT

BACKGROUND: The association of Life’s Essential 8 (LE8) with the development of first chronic lung disease (FCLD), progression to chronic lung multimorbidity (CLM), and subsequent mortality remains inconclusive. In addition, the relative importance of individual LE8 components is unclear.

METHODS: We used data from the UK Biobank, including 391,384 participants free of chronic lung diseases (CLDs) at baseline. CLM was defined as the coexistence of two or more CLDs, including asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and lung cancer. A multistate model was used to estimate the impact of LE8 score on the dynamic progression of CLDs. Component-specific contributions were assessed using Heller’s explained risk.

RESULTS: During a median follow-up of 13.6 years, 27,934 participants developed FCLD, 4174 subsequently developed CLM, and 31,881 died. Higher LE8 scores were consistently associated with lower risks across all transition stages, with hazard ratios (95% confidence intervals) per 10-point increase of 0.75 (0.74-0.76) for transition from baseline to FCLD, 0.85 (0.83-0.87) from FCLD to CLM, 0.85 (0.84-0.86) from baseline to death, 0.92 (0.90-0.94) from FCLD to death, and 0.89 (0.85-0.92) from CLM to death. For CLD subtypes, LE8 scores showed heterogeneous associations with disease-specific transitions, even within the same transition stage. LE8 showed the strongest protective association with COPD incidence (a 36% risk reduction per 10-point increase), whereas its strongest protective association with disease progression was observed for asthma to CLM (a 27% risk reduction per 10-point increase). Among the component of LE8, smoking ranked highest in relative importance across nearly all transitions, while diet emerged as a comparably influential factor for the transition from CLM to death.

CONCLUSIONS: Higher LE8 scores are associated with significant risk reductions for CLDs at all progression stages. Early LE8 optimization, particularly smoking avoidance, offers the greatest potential for CLDs prevention, while post-diagnosis benefits support lifelong adherence.

PMID:42218565 | DOI:10.1097/CM9.0000000000004140

Gut Pathog. 2026 May 30. doi: 10.1186/s13099-026-00838-0. Online ahead of print.

ABSTRACT

BACKGROUND: Gut microbial dysbiosis has been implicated in sepsis-related organ dysfunction. However, the longitudinal dynamics of the gut microbiota and mycobiota-and particularly their cross-kingdom ecological organization-in pneumonia-derived sepsis remain incompletely understood.

METHODS: Patients with pneumonia-derived sepsis were prospectively enrolled. Fecal samples and clinical data (SOFA scores and inflammatory markers) were collected on Day 1 and Day 7. Gut bacterial and fungal communities were profiled using 16 S rRNA and ITS1 sequencing. Longitudinal and outcome-stratified analyses were performed. Trans-kingdom co-occurrence networks and module-based topological analyses were constructed, and associations with clinical parameters were explored.

RESULTS: Global analyses indicated relative compositional stability in the gut microbiota and mycobiota between Day 1 and Day 7, with no significant differences in alpha or beta diversity. The dominant bacteria were Bacillota, Bacteroidota, and Pseudomonadota at the phylum level, and Enterococcus, Bacteroides, and Escherichia-Shigella at the genus level; Escherichia-Shigella showed a decreasing trend and Bacteroides an increasing trend, though neither reached statistical significance (Padj > 0.05). Ascomycota dominated the fungal community, with Candida, Fusarium, and Oligophagozyma as the core genera, with no obvious temporal shifts. However, outcome-based stratification revealed that fungal Chao1 richness increased significantly post-treatment, specifically in the bad-outcome group (P < 0.05). The most notable findings emerged from the trans-kingdom interactome. In the favorable-outcome group, a specific modular configuration (ModM1) was identified post-treatment, containing four microbiota hubs (Parabacteroides, Mediterraneibacter, Serratia, and Enterococcus). While the aggregate abundance of ModM1 lacked clinical correlation, its hub genus, Mediterraneibacter-a prevalent anaerobe-showed a negative association with PCT and TNF-α. Additionally, the fungal-integrated ModM8 showed a potential positive association with IL-8. Conversely, the bad-outcome group showed a lack of such hub-anchored coordination.

CONCLUSIONS: In this small exploratory cohort, early pneumonia-derived sepsis appeared to exhibit relative taxonomic stability but subtle reorganization of cross-kingdom ecological connectivity. Microbial shifts appeared to manifest primarily as changes in network embedding rather than abundance. These observations provide exploratory insights that require further validation regarding topological integration, especially fungal involvement in inflammatory modules, for understanding host-microbiome interactions in critical illness. Larger longitudinal studies are warranted.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT04525677, registered on 14 July 2020.

PMID:42218556 | DOI:10.1186/s13099-026-00838-0

J Orthop Surg Res. 2026 May 30. doi: 10.1186/s13018-026-07002-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Ingrown toenail surgery is a standard procedure that can significantly affect a patient’s quality of life. While preoperative photo demonstration has been proven to enhance patient satisfaction in other surgical fields, its potential in ingrown toenail surgery remains unexplored. The primary objective of this study is to investigate whether exposure to preoperative photographs influences the perception of postoperative outcomes in patients undergoing ingrown toenail surgery using the Winograd technique.

METHODS: This retrospective study included 126 patients who underwent ingrown toenail surgery using the Winograd technique between January 2022 and August 2024. Patients were divided into two groups based on whether standardized preoperative clinical photographs were shown: Group 1 (photographs shown) and Group 2 (photographs not shown). All patients were followed up for 12 months. Clinical and functional outcomes were assessed using the Visual Analog Scale (VAS), Dermatology Life Quality Index (DLQI), Manchester-Oxford Foot Questionnaire (MOXFQ), and the Patient Satisfaction Scale (PSS). Both groups were compared using these scores and recurrence rates.

RESULTS: Significant postoperative improvements were observed in both Group 1 (n = 57) and Group 2 (n = 69) in VAS, DLQI, MOXFQ, and PSS scores (p < 0.001). The postoperative VAS score was significantly lower in Group 1 (2.15 ± 2.07) compared to Group 2 (3.01 ± 2.20) (p = 0.015). The postoperative PSS score was significantly higher in Group 1 (7.95 ± 2.64) than in Group 2 (6.19 ± 2.95) (p < 0.001). No statistically significant difference was found between the groups regarding recurrence rates (p > 0.05).

CONCLUSIONS: Preoperative photograph presentation may modify patients’ perception of postoperative outcomes, rather than directly improving clinical results. This approach may be considered a potential adjunct to the patient education process, offering a promising avenue for improving patient outcomes.

PMID:42218540 | DOI:10.1186/s13018-026-07002-z

Infect Agent Cancer. 2026 May 30. doi: 10.1186/s13027-026-00769-0. Online ahead of print.

ABSTRACT

BACKGROUND: Worldwide, it is believed that high-risk human papillomavirus (hr-HPV) strains are the root cause of many types of cancers, including cervical cancer, anorectal cancers, vaginal cancers, and penile cancers, with an estimated 922, 728 females diagnosed with HPV-related cancer in 2022. Particularly, in sub-Saharan Africa, the majority of women (55.13%) were affected by hr-HPV, and human immunodeficiency virus (HIV)-positive women have had double-fold higher risk of hr-HPV infection. Evidence is scarce in the study area; therefore, the current study aimed to assess the prevalence of hr-HPV and associated factors among HIV-positive women in public health facilities of Mekelle, Tigray, northern Ethiopia.

METHODS: A health facility-based cross-sectional study was conducted in five conveniently selected public health facilities of Mekelle, northern Ethiopia, from December 10, 2024, to July 10, 2025. The study included 390 consecutively recruited HIV-positive women, from whom questionnaire-based interviews were made, and provider-collected cervical brush specimens were processed using the Abbot cervi-collect kit in accordance with standard procedures. Following automated deoxyribonucleic acid (DNA) extraction using the Abbot m2000sp, the presence of 14 hr-HPV genotypes was detected using the m2000rt real-time polymerase chain reaction (RT-PCR) assay. Bivariate and multivariate logistic regression analyses were performed to assess the statistical association between the potential factors and hr-HPV status. Finally, statistical significance was declared at p < 0.05, along with the corresponding 95% confidence interval.

RESULT: The mean ± SD age of the respondents was 42 years (42.82 ± 9.55). The majority, 231/390 (59.2%) of the respondents, were of a normal weight, and with an overall mean Body Mass Index (BMI) of 21.77 ± 3.86 kg/m². According to the RT-PCR, the overall prevalence of hr-HPV DNA positivity was 39.7% (155/390); [95% CI: 34.9-44.9%]. Specifically, the prevalence of HPV-16, HPV-18, and collectively the other hr-HPV types was 10.8% [95% CI: 7.7-13.8%], 3.6% [95% CI: 1.8-5.6%], and 32.7% [95% CI: 27.9-37.2%], respectively. In multivariable logistic regression analysis, condom use was assocatied with lower odds of hr-HPV infection [AOR = 0.23; 95%CI: 0.06-0.89; p = 0.034], whereas oral contraceptive use [AOR = 4.47; 95%CI: 1.39-14.28; p = 0.012], history of vaginal discharge [AOR = 2.61; 95%CI: 1.01-6.70; p = 0.046], genital ulcer disease [AOR = 4.09; 95%CI: 1.12-14.59; p = 0.030], history of unprotected sex before marriage [AOR = 2.20; 95%CI: 1.14-4.24; p = 0.017], lack of awareness about HPV-linked cervical cancer [AOR = 2.23; 95%CI: 1.18-4.24; p = 0.013], duration ( less than or equal to11 years) since ART initiation [AOR = 2.05; 95%CI: 1.13-3.74; p = 0.018], a history of 3 or more documented ART interruption events [AOR = 4.37; 95CI: 1.06-17.99; p = 0.041], and having detectable recent HIV viral load (40 copies/mL or greater) [AOR = 6.89; 95%CI: 2.75-17.28; p < 0.001] were independently associated with higher odds of hr-HPV infection.

CONCLUSION: The findings of the current study indicate a high burden (39.7%) of oncogenic HPV strains among HIV-positive women, though lower than the pooled estimates in sub-Saharan Africa. Notably, HPV-16 and the non-HPV-16/18 high-risk genotypes collectively accounted for the majority of infections. Factors that influenced the presence of high-risk HPV included a history of unprotected sex before marriage, oral contraceptive use, vaginal discharge, genital ulcer disease, lack of awareness regarding HPV and cervical cancer, a shorter duration since ART initiation, frequent ART interruptions, and detectable recent HIV viral loads.

PMID:42218531 | DOI:10.1186/s13027-026-00769-0

BMC Res Notes. 2026 May 30. doi: 10.1186/s13104-026-07877-5. Online ahead of print.

ABSTRACT

OBJECTIVE: Anopheles gambiae s.l. is the major malaria vector in sub-Saharan Africa, and increasing pyrethroid resistance threatens vector control. This study investigated the prevalence of knockdown resistance (kdr) mutations and pyrethroid susceptibility in An. gambiae s.l. populations from Kwara State, North-Central Nigeria.

RESULTS: A total of 250 An. gambiae s.l. mosquitoes were collected from three Local Government Areas. Molecular analysis identified An. coluzzii (31.2%, 95% CI: 25.7-37.3%), An. gambiae s.s. (16.8%, 95% CI: 12.6-22.0%), and An. arabiensis (13.6%, 95% CI: 9.9-18.4%), while 38.4% failed amplification. All populations were resistant to permethrin, deltamethrin, and alphacypermethrin (mortality < 90%), with mortality ranging from 23% to 64% across locations. Knockdown times were fastest with deltamethrin (KDT₅₀: 32.75-52.80 min) and slowest with permethrin (KDT₅₀: 39.41-93.34 min). Kdr genotyping showed 41.6% homozygous resistant (RR) and 58.4% homozygous susceptible (rr) mosquitoes; no heterozygotes were detected. These findings indicate widespread pyrethroid resistance partially mediated by kdr mutations, with significant variation among locations and sibling species. The absence of heterozygotes suggests strong selection pressure, emphasizing the need for resistance monitoring and strategic vector control interventions.

PMID:42218529 | DOI:10.1186/s13104-026-07877-5

BMC Sports Sci Med Rehabil. 2026 May 30. doi: 10.1186/s13102-026-01770-1. Online ahead of print.

ABSTRACT

BACKGROUND: Injury is an inevitable component of competitive football and has a significant influence on the psychological and physical well-being of the athletes. Psychological readiness to return to sport following injury is a multidimensional construct encompassing emotional, cognitive and contextual factors that influence an athlete’s transition back to training and competition.

OBJECTIVE: This study aims to evaluate the level and multidimensional structure of psychological readiness to return to sport in elite female football players using the Psychological Readiness of Injured Athletes to Return to Sport (PRIA-RS) questionnaire.

METHODS: A cross-sectional questionnaire-based study was conducted, which included 84 elite and semi-professional female football players who were undergoing the final stages of rehabilitation or preparing to return to full training post a sports-related injury. The psychological readiness of these athletes was assessed using the PRIA-RS instrument. Descriptive statistics and exploratory factor analysis (EFA) were performed to identify the underlying psychological dimensions associated with the return-to-sport readiness.

RESULTS: Most athletes reported positive perceptions of rehabilitation progress, mood, functional recovery, and overall readiness to return to training. Approximately 64.3% of the respondents rated rehabilitation progression as “very good,” while 70.2% reported having a very positive attitude at the end of rehabilitation. However, a substantial proportion reported anxiety (29.8%) and uncertainty risk towards a reinjury (23.8%) related to returning to sport. Exploratory factor analysis identified four components explaining 61.2% of total variance, representing emotional confidence, fear and anxiety, perceived functional safety, and external pressure.

CONCLUSION: Elite female football players generally report a high level of psychological readiness to return to sport following an injury, although anxiety and fear of reinjury remain prevalent in a meaningful portion of the athletes. Inclusion of psychological tools such as PRIA-RS into return-to-sport decision-making alongside physical rehabilitation provides the necessary psychological support to the athletes before them to return to full training and competition. The findings support the importance of evaluating psychological readiness as a multidimensional construct alongside physical recovery when making return to sport decisions.

PMID:42218527 | DOI:10.1186/s13102-026-01770-1

Confl Health. 2026 May 30. doi: 10.1186/s13031-026-00807-z. Online ahead of print.

ABSTRACT

BACKGROUND: The 2020-2022 Tigray conflict affected health infrastructure, antiretroviral therapy (ART) supply chains, and continuity of HIV care. Assessing patient satisfaction during the recovery period is important to monitor service quality and inform service improvement. This study aimed to (i) measure the level of patient satisfaction among people living with HIV (PLHIV) receiving ART in post-conflict Mekelle City, (ii) model the relationships between four service-quality dimensions and overall satisfaction, and (iii) identify determinants of overall satisfaction with HIV care clinic services.

METHODS: The study was conducted from October to November 2024 in Mekelle City, Tigray (eight public facilities and three operated by non-governmental organizations (NGOs)). Eligible participants were adults (≥ 18 years) on ART for at least 12 months. Patient satisfaction was measured using a 21-item, 5-point Likert-scale questionnaire covering four domains: provider-client relationship (PCR), availability and accessibility of care (AAC), quality of care services (QCS), and facility and service environment (FSE). Confirmatory factor analysis (CFA) was used to validate the four-factor measurement model, a second-order structural equation model (SEM) examined associations between the four domains and overall satisfaction, and binomial logistic regression identified determinants of dichotomised overall satisfaction (mean composite score > 3.69 = satisfied).

RESULTS: Of 631 eligible patients, 569 consented (90.17%); 521 were retained after exclusions. Mean age was 42.4 years and 60.7% female. Overall, 62.4% reported satisfaction with HIV care clinic services. Domain-level satisfaction was: 64.5% for PCR, 31.5% for AAC, 57.2% for QCS, and 57.4% for FSE. The second-order SEM showed strong, statistically significant standardised associations between overall satisfaction and each domain (PCR β = 0.920; AAC β = 0.963; QCS β = 0.925; FSE β = 0.985; all p < 0.001). In multivariable logistic regression, clients at tertiary-level facilities (OR = 0.50, 95% CI 0.37-0.67) and at public facilities (OR = 0.64, 00195% CI 0.54-0.76) had significantly lower odds of satisfaction; sociodemographic and clinical variables were not independently associated with satisfaction.

CONCLUSIONS: Overall satisfaction with HIV care clinic services in post-conflict Mekelle City was 62.4%, below Ethiopia’s Health Sector Transformation Plan-II (HSTP-II) target of 80% and at the lower end of the Ethiopian pooled estimate of 69.7% (95% CI 63.8-75.5%). All four service-quality domains were strongly associated with overall satisfaction, and tertiary-level and public facilities had lower odds of satisfaction. Targeted quality improvement is warranted across access, environment and quality-of-care dimensions, particularly at tertiary and public facilities. Whether changes in satisfaction translate into ART interruption, virologic failure, or drug resistance was outside the scope of this cross-sectional analysis and should be examined in longitudinal research.

PMID:42218526 | DOI:10.1186/s13031-026-00807-z

Scand J Trauma Resusc Emerg Med. 2026 May 30;34(1):99. doi: 10.1186/s13049-026-01640-2.

ABSTRACT

BACKGROUND: Major trauma in patients with direct oral anticoagulants (DOACs) is increasing as treatment with DOACs is becoming more prevalent. DOACs add complexity to trauma due to increased risk of bleeding. The primary aim of this study was to compare the likelihood of packed red blood cell (PRBC) transfusion and PRBC volumes in patients with DOACs to non-anticoagulated controls after major trauma. Secondary aims were to compare mortality rates between these groups.

METHODS: This was a multicentre retrospective cohort study with four participating hospitals. Inclusion criteria were age ≥ 18 years and admission for trauma with New Injury Severity Score (NISS) > 15 from Jan 1, 2019, to Dec 31, 2023. The Swedish Trauma Registry and medical records were used to identify patients and to retrieve data. For primary weighted analyses, propensity scores for DOACs were estimated using sex, age, injury mechanism, ASA class, antiplatelet treatment, and NISS. Non-weighted adjusted regression models were used for complementary analyses.

RESULTS: A total of 1817 patients were admitted for major trauma during the study period, of which 756 patients were included in the analytic cohort. PRBC was administered to 30.8% of patients with DOACs and to 20.7% of controls. PRBC likelihood was higher among patients with DOACs (OR 1.73, 95% CI 1.03-2.91). The number of PRBC units among patients who received transfusions was not significantly higher for DOACs (GMR 1.11, 95% CI 0.79-1.56). Mortality rates within 24 h and 30 days did not differ significantly in primary analyses (OR 1.82, 95% CI 0.78-4.23 and OR 1.34, 95% CI 0.80-2.24, respectively).

CONCLUSIONS: Patients with DOACs were more likely to receive PRBC transfusion, but PRBC volumes were not significantly different among transfused patients. Mortality did not differ significantly in the primary weighted analyses.

PMID:42218522 | DOI:10.1186/s13049-026-01640-2

BMC Vet Res. 2026 May 30. doi: 10.1186/s12917-026-05595-5. Online ahead of print.

ABSTRACT

BACKGROUND: Liver biopsy is a valuable diagnostic tool for diagnosing hepatobiliary diseases in ruminants. Although laparoscopic biopsy is established in cattle and small animals, there is no standardised comparison of the biopsy instruments for buffaloes (Bubalus bubalis).

OBJECTIVES: This study aimed to compare the quality of liver samples obtained by laparoscopy using three instruments: Babcock forceps (B1), laparoscopic biopsy forceps (B2) and a 14G truss cut needle (B3). We hypothesised that the tru-cut needle would provide superior samples with fewer artefacts.

STUDY DESIGN: Prospective experimental study.

METHODS: To understand sedation and epidural anaesthesia, laparoscopic liver biopsies were performed on five healthy female buffaloes. Using a right intercostal approach, three sequential samples were collected from each animal with B1, B2, and B3. The samples were histologically evaluated for quality (presence of portal /central veins), sufficiency, and artefacts (edge squeeze and detachment). The area was measured digitally. Statistical analysis used Cochran’s Q and post-hoc McNemar tests (α = 0.05).

RESULTS: The truss truss cut needle (B3) produced adequate quality samples in 100% of cases, compared to 80% for B2 and 60% for B1. Sample sufficiency was higher for B2 and B3 (80% each) than for B1 (0%; P = 0.0408). Edge detachment was significantly lower for B3 (20%) than for B2 (40%) and B1 (100%; P = 0.0388). Crush artifact was absent in B3 samples but present in 60% of B1 and B2 samples.

MAIN LIMITATIONS: The small sample size (n = 5) of healthy animals limits statistical power and generalisability to clinical cases. The fixed order of the instrument may have introduced a sequence bias.

CONCLUSIONS: Laparoscopic liver biopsy with a truss cut needle yields diagnostically superior samples with significantly fewer artefacts compared to forceps-based techniques in buffaloes, recommending it as the instrument of choice for this species.

PMID:42218513 | DOI:10.1186/s12917-026-05595-5

Am J Sports Med. 2026 May 30:3635465261443986. doi: 10.1177/03635465261443986. Online ahead of print.

ABSTRACT

BACKGROUND: Because of the difficulty of baseball players with capitellar osteochondritis dissecans (OCD) lesions to return to sport (RTS), multiple operative strategies have been used for these lesions. However, there has yet to be a systematic review of RTS outcomes in specifically baseball players.

PURPOSE/HYPOTHESIS: The purpose of this study was to compare the RTS rates between surgical procedures for capitellar OCD lesions in youth baseball players, with a secondary purpose of comparing improvements in elbow range of motion (ROM) and improvements in Timmerman-Andrews scores between surgical procedures. The authors hypothesized that RTS rates would not differ based on the surgical procedure for capitellar OCD lesions in youth baseball players.

STUDY DESIGN: Systematic review; Level of evidence, 4.

METHODS: The authors performed a literature search in February 2025 to identify studies evaluating postoperative outcomes for the treatment of capitellar OCD lesions in youth baseball players. Surgical procedures were grouped into debridement/loose-body removal ± microfracture, fixation procedures, bone peg grafting, and autologous osteochondral transplantation. Preoperative and postoperative elbow flexion and extension ROM, Timmerman-Andrews scores, and RTS rate and time were collected. Meta-analysis included pooled effect estimates for improvements in flexion ROM, extension ROM, and Timmerman-Andrews scores, as well as the proportion of RTS, applying a common effect model.

RESULTS: Overall, 462 studies were screened and 16 studies were included. There were 389 total youth baseball players and 89% of lesions were unstable. RTS after autologous osteochondral transplantation (175/182; 96%) was more likely than after fixation (68/76; 89%), bone peg grafting (27/31; 87%), or debridement/loose-body removal ± microfracture (59/70; 84%) (P = .022). Overall, 31 of 60 (52%) pitchers were able to return to pitching. Fixation procedures were associated with greater improvements in elbow extension ROM (8° vs 3°; P = .013) than autologous osteochondral transplantation. Fixation procedures (score, 71) and autologous osteochondral transplantation (score, 58) also had greater improvements in Timmerman-Andrews scores than bone peg grafting (score, 26; P < .001); however, there was significant heterogeneity across studies and large differences in preoperative Timmerman-Andrews scores across groups.

CONCLUSION: Overall, 92% of youth baseball players RTS after operative management of capitellar OCD lesions, with the highest RTS rates after autologous osteochondral transplantation; however, almost half of pitchers are unable to return to pitching. Clinicians can counsel injured youth baseball players that capitellar OCD lesions indicated for autologous osteochondral transplantation can have similar or better RTS outcomes than OCD lesions indicated for fixation or debridement ± microfracture.

PMID:42216683 | DOI:10.1177/03635465261443986