Nevin Manimala

Clin Ther. 2026 Mar 19:S0149-2918(26)00047-0. doi: 10.1016/j.clinthera.2026.02.013. Online ahead of print.

ABSTRACT

PURPOSE: Medical cannabis (MC) patients frequently rely on budtenders, dispensary staff without formal medical training, for therapeutic guidance. This study examined whether budtender guidance aligns with that of MC clinicians and identified factors influencing alignment.

METHODS: A national sample of budtenders (n = 87) from multiple US states completed a survey in March to April 2025, which included 3 patient vignettes (chronic pain, pregnancy with insomnia, and posttraumatic stress disorder) and the Cannabis Knowledge Assessment Tool. Their responses were compared with consensus guidance from 7 MC clinicians. Alignment was rated on a 5-point scale, and statistical analyses included a 1-sample t test and multiple linear regression.

FINDINGS: Budtender guidance significantly diverged from clinician consensus (M = 2.75 vs 5.0; P < 0.001). Clinicians recommended MC for chronic pain, advised against use during pregnancy, and recommended cautious low-Δ-9-tetrahydrocannabinol regimens for posttraumatic stress disorder. In contrast, many budtenders suggested higher Δ-9-tetrahydrocannabinol dosages or endorsed MC use in pregnancy. Regression analysis revealed that higher Cannabis Knowledge Assessment Tool scores (P = 0.005) and absence of illicit market experience (P = 0.029) predicted closer alignment with clinician guidance, whereas dispensary type and cannabis-related degrees were not significant predictors.

IMPLICATIONS: These findings highlight variability in the quality of budtender guidance and the potential risks of relying on nonclinician sources for MC advice. Enhancing evidence-based cannabis education and establishing clearer policy frameworks may help ensure dispensary staff provide safer, clinically informed guidance to patients seeking cannabinoid therapy.

PMID:41862355 | DOI:10.1016/j.clinthera.2026.02.013

Neurosci Lett. 2026 Mar 19:138578. doi: 10.1016/j.neulet.2026.138578. Online ahead of print.

NO ABSTRACT

PMID:41862329 | DOI:10.1016/j.neulet.2026.138578

J Orthop Sci. 2026 Mar 19:S0949-2658(26)00082-5. doi: 10.1016/j.jos.2026.02.015. Online ahead of print.

ABSTRACT

BACKGROUND: Real-time ultrasound monitoring of muscle architecture changes during dynamic contractions is gaining traction as a practical tool for neuromuscular functional assessment.

PURPOSE: This study aimed to assess the muscle thickness (MT) and deformation velocity of rectus femoris (RF) for predicting muscle strength capacity, evaluating their predictive validity and clinical feasibility.

METHODS: Twenty-three elderly individuals with knee osteoarthritis (KOA) were examined. The thickness of the muscle at rest (MT_rest) and at maximal voluntary isometric contraction (MT_contraction), the velocity from rest state to maximum contraction (Velocity_activation) and the velocity from maximal contraction to rest state (Velocity_relaxation) were obtained by M-mode ultrasound. Maximum flexor and extensor strength were measured using an isokinetic dynamometer, the gold-standard assessment tool.

RESULTS: MT_rest and MT_contraction were significantly correlated with extension strength, also showed correlations with flexion strength. Velocity_activation correlated significantly with both strength (extension: r = 0.742; flexion: r = 0.707). Velocity_activation, but not MT, remained a statistically significant predictor of both extension and flexion strength in multivariate regression models (extension: adjusted R² = 0.381; flexion: adjusted R² = 0.314).

CONCLUSIONS: The deformation of RF, as measured by M-mode ultrasound, provides a visualization method for assessing extension and flexion strength. Velocity_activation showed a significant correlation with both extension and flexion strength. Furthermore, it improved the prediction of thigh muscle strength beyond muscle thickness (MT) alone. Assessing the deformation of RF by M-mode ultrasound may be valuable for detecting alterations in muscle strength and function throughout the disease process in individuals with knee osteoarthritis (KOA).

PMID:41862305 | DOI:10.1016/j.jos.2026.02.015

Nutr Metab Cardiovasc Dis. 2026 Feb 10:104624. doi: 10.1016/j.numecd.2026.104624. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: This study investigates genetic evidence for a causal association between alcohol intake and 1174 diseases, and various biomarkers.

METHODS AND RESULTS: A phenome-wide Mendelian randomization (MR) study was conducted using data from 337,463 UK Biobank participants. Five MR methods and sensitivity analyses tested linear associations, while non-linear MR assessed intake-dependent effects. Alcohol consumption was associated with 22 distinct diseases across ten categories. Beyond the strong association between genetically indexed alcohol intake with ‘alcohol-related disorders’ (OR per log-unit/week: 7.02, 95% CI: 5.26-9.37), MR analyses suggested robust evidence for increased risks of ‘cerebrovascular diseases’ (1.63, 1.20-2.21), ‘essential hypertension’ (1.34, 1.07-1.67), ‘electrolyte imbalance’ (1.82, 1.34-2.48), ‘magnesium metabolism disorder’ (4.39, 2.06-9.39), ‘open wounds of head, neck, and trunk’ (2.15, 1.39-3.33), and ‘symptoms involving nervous and musculoskeletal systems’ (2.16, 1.60-2.91). Suggestive evidence indicated higher risks for 12 diseases, mostly mental and digestive disorders, and lower risks for ‘benign neoplasms of connective and other soft tissue’, ‘urinary calculus’, and migraines. Seven diseases exhibited non-linear yet monotonic trends (all P_{non-linearity} ≤ 0.05). Alcohol intake was robustly associated with biomarkers including bilirubin, urine sodium, urea, and blood pressure.

CONCLUSION: This comprehensive analysis supports alcohol’s causal role in multiple diseases and biomarkers, highlighting significant risks with minimal benefits.

PMID:41862300 | DOI:10.1016/j.numecd.2026.104624

J Cyst Fibros. 2026 Mar 20:S1569-1993(26)00044-5. doi: 10.1016/j.jcf.2026.02.015. Online ahead of print.

ABSTRACT

Elexacaftor-Tezacaftor-Ivacaftor (ETI) has substantially improved lung function and life expectancy for people with cystic fibrosis (pwCF). Emerging evidence suggests that overweight, obesity and dyslipidaemia are now developing in pwCF prescribed ETI. This scoping review, conducted adhering to PRISMA guidelines, aimed to provide an overview of the research currently available that investigated body mass index (BMI), body composition and serum lipid profiles in adults with CF treated with ETI. Peer-reviewed articles and conference abstracts were identified through database searches and conference proceedings. Studies reporting BMI, body composition (fat mass, fat-free mass) and serum lipid profiles in adults with CF following ETI initiation were included. Data were extracted and synthesised descriptively. Of 126 studies (60 peer-reviewed, 66 conference abstracts), 90% reported increased BMI after ETI initiation, with 61% indicating this was statistically significant. Fat and fat-free mass rose significantly in 5 of 8 and 4 of 7 studies, respectively. In the 18 studies (11 peer-reviewed publications, 7 conference abstracts) reporting serum lipids, significant increases were observed; for total cholesterol (72% of studies), LDL-C (80%), and HDL-C (56%), with increased triglycerides (31%), non-HDL cholesterol and HDL: Total Cholesterol ratio (22% for both) less frequently seen. Current evidence suggests that BMI, weight, and serum lipids increase in adults with CF following ETI initiation, with some studies also reporting increased fat- and fat-free mass. The majority of measurements remain within the recommended range. These findings highlight the importance of ongoing monitoring of nutritional status and cardiometabolic health in this population. Prospective research to better characterise long-term cardiometabolic health in pwCF is required.

PMID:41862297 | DOI:10.1016/j.jcf.2026.02.015

J Voice. 2026 Mar 19:S0892-1997(26)00096-2. doi: 10.1016/j.jvoice.2026.02.031. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to analyze the voice quality of patients with vocal fold polyps and laryngopharyngeal reflux (LPR) and to explore the effect of LPR on voice quality in these patients.

METHODS: A total of 89 adult patients with vocal fold polyps were retrospectively selected between 1 August 2020 and 30 April 2025 using convenience sampling. The reflux finding score (RFS) and the reflux symptom index (RSI) were assessed after vocal fold polypectomy. Patients with an RFS > 7 and an RSI > 13 or with a previous diagnosis of LPR comprised the reflux group, whereas patients with vocal fold polyps but without evidence of LPR comprised the control group. Both groups underwent voice assessment using the Voice Handicap Index-10 (VHI-10) and fiber optic nasopharyngoscopy to evaluate vocal fold morphology. The Voice-Related Quality of Life (V-RQOL) questionnaire and the grade-roughness-breathiness-asthenia-strain (GRBAS grade) scale were also used. Differences in the above indicators between the two groups were compared.

RESULTS: The mean VHI-10 score (18.59 ± 8.956 vs 13.51 ± 7.354, P = 0.012) and the GRBAS grade (2.28 ± 0.615 vs 1.91 ± 0.626, P = 0.032) in the reflux group were higher than those in the control group, whereas the V-RQOL score (57.98 ± 20.13 vs 74.12 ± 18.69, P = 0.019) in the reflux group was lower than that in the control group; the differences were statistically significant. The incidence of broad-based vocal fold polyps (72.9% vs 20.8%, P = 0.032) and bilateral vocal fold polyps (78.4% vs 45.8%, P = 0.017) in the reflux group was higher than that in the control group, and these differences were statistically significant.

CONCLUSION: Laryngopharyngeal reflux may cause patients with vocal cord polyps to be more prone to sessile vocal cord polyps and bilateral vocal cord polyps, which in turn aggravates the hoarseness of the patient ‘s voice; laryngopharyngeal reflux may also affect the physiological, psychological and quality of life of patients with vocal cord polyps. Anti-reflux therapy is recommended for patients with vocal cord polyps with LPR after surgery.

PMID:41862294 | DOI:10.1016/j.jvoice.2026.02.031

Popul Health Manag. 2026 Mar 20:19427891261434673. doi: 10.1177/19427891261434673. Online ahead of print.

ABSTRACT

The COVID-19 pandemic highlighted pediatric health care disparities and disrupted routine care, including social needs assessments. The American Academy of Pediatrics recommends universal screening for Social Determinants of Health (SDOH), yet implementation remains inconsistent in primary care settings. This quality improvement (QI) project aimed to implement a standardized, sustainable SDOH screening and referral process in pediatric primary care, hypothesizing that structured interventions would improve screening rates. This QI initiative was conducted from January to September 2023 across six practices within a large pediatric health system. Eligible patients (ages 0-19) included those attending their first well visit of the calendar year. The SMART aim targeted a 50% increase in SDOH screening compliance, from 28% at baseline to 42% over 9 months. Using the Consolidated Framework for Implementation Research and two Plan-Do-Study-Act cycles, the team addressed key implementation barriers and refined interventions. The primary measure was screening completion rate; the balancing measure was the number of refusals to screen. SDOH screening rates increased from 28% to 55%, with eligible patient volumes ranging from 2400 to 5500. All six practices demonstrated statistically significant improvements (P < 0.001). Positive screens ranged from 3.3% to 8% of patients screened. Screening refusals increased significantly (P < 0.001). Standardized SDOH screening, implemented through structured QI methods and stakeholder engagement, significantly improved screening rates in pediatric primary care. Future studies should assess referral effectiveness, clinical outcomes, cost-effectiveness, and strategies to mitigate patient discomfort and systemic barriers.

PMID:41862289 | DOI:10.1177/19427891261434673

J Child Adolesc Psychopharmacol. 2026 Mar 20:10445463261436795. doi: 10.1177/10445463261436795. Online ahead of print.

ABSTRACT

OBJECTIVES: Pediatric mental health prevalence rates have increased in recent years, while gaps remain in the number of available providers. Ongoing evaluation and understanding of treatment progress and engagement are critical to psychiatric care, and these details are often documented in the electronic health record (EHR). Given the utility of retrospective chart review (RCR) as a tool for psychiatrists, we developed a coding system examining common comorbid conditions (anxiety and attention-deficit/hyperactivity disorder [ADHD]) and adherence and evaluated interrater reliability.

METHODS: We created a coding system with a comprehensive manual and coding instructions that explore both symptom severity domains (anxiety, ADHD, and global) and adherence to medication. Codes were rated using Likert scales, and two independent raters coded all data.

RESULTS: RCR was completed for 142 patients with a total of 1139 visits over 2 years. Weighted linear kappa statistics ranged between 0.77 and 0.95, and weighted quadratic kappa statistics ranged between 0.74 and 0.96, suggesting substantial to almost perfect agreement. Interrater agreement was highest for anxiety severity.

CONCLUSIONS: We created a novel coding system for RCR and found substantial to almost perfect interrater reliability for assessing ADHD severity, anxiety severity, global severity, and medication adherence using psychiatry encounter notes documented in an EHR. Our coding system explores conditions that are often heterogeneous and have waxing and waning presentations, using a continuum that captures the complexity of symptoms. Future directions include utilization of coding systems to explore emotion and behavior change over time to optimize treatment.

PMID:41862288 | DOI:10.1177/10445463261436795

Nefrologia (Engl Ed). 2026 Mar;46(3):501468. doi: 10.1016/j.nefroe.2026.501468.

ABSTRACT

BACKGROUND: Diabetes mellitus is the leading cause of end-stage renal disease, accounting for approximately 40% of cases. Data on glycaemic metrics in diabetic population on maintenance haemodialysis is sparse. The role of continuous glucose monitoring in this population remains underexplored.

METHODS: This prospective observational study aimed to comprehensively characterize glycaemic variability using continuous glucose monitoring in patients with type 2 diabetes mellitus undergoing maintenance haemodialysis. 25 patients aged between 18 and 70 years with more than 3 months of dialysis vintage were included in the study. After collecting socio-demographic and clinical data, an ambulatory glucose profile sensor was applied to the patient’s upper limb before starting their scheduled dialysis session. Sensors measured the interstitial fluid glucose every 15min, and a total of 96 readings were taken per day, continuously for 14 days (336h).

RESULTS: For statistical analysis, the study population was broadly divided into 2 major groups, one which required insulin for their glycaemic management and the other requiring an oral hypoglycaemic agent, linagliptin. Statistical analysis was performed using SPSS software version 26.0 (IBM Corp., Armonk, NY). In both the groups, glycaemic excursion was observed, with dialysis days having high mean glucose values than non-dialysis days, and the observation was more prominent in the insulin-treated group. The mean glucose levels were lower in the nocturnal period in both the groups. It was noticed that the overall glycaemic variability, glycaemic variability in both dialysis and non-dialysis days were lower in linagliptin-treated group.

CONCLUSION: This study demonstrated significant differences in glycaemic variability based on antidiabetic treatment modality in haemodialysis population. Continuous glucose monitoring is an invaluable tool to study glycaemic metrics and guide therapy in haemodialysis population.

PMID:41862265 | DOI:10.1016/j.nefroe.2026.501468

Lancet Psychiatry. 2026 Apr;13(4):316-326. doi: 10.1016/S2215-0366(26)00034-9.

ABSTRACT

BACKGROUND: To our knowledge, there are no evidence-based implementation strategies for care cascade optimisation of mental, neurological, and substance use (MNS) disorder treatment in low-income and middle-income countries. This trial evaluated the effectiveness of the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH) implementation strategy to improve MNS disorder care cascade outcomes in Mozambique.

METHODS: We conducted a 3-year, cluster-randomised trial comparing an 8-month baseline period with a 2-year implementation period. All patients diagnosed with MNS disorders across government facilities in Mozambique were eligible. Eligible facilities were required to be naive to the SAIA-MH implementation strategy; currently providing MNS disorder services including prescribing medication; within a 3-h one-way drive from Chimoio City, Manica or Beira City, Sofala; have at least one psychiatric technician and one psychologist currently practising; and have at least 100 annual outpatient MNS disorder visits during 2020-21. Facilities were allocated to the SAIA-MH intervention or attentional placebo control (1:1) using constrained randomisation. Statistical analysts were masked during initial primary outcome assessment. The SAIA-MH strategy combines external facilitation, clinical consultation, and provider team meetings with system-engineering tools in a continuous quality improvement framework. The primary outcome was a combination of low functional impairment or functional improvement measured using the WHODAS 2.0. Secondary outcomes were medication adherence and appointment attendance. We involved people with related lived experience in all elements of the research and writing process. The study was registered at Clinicaltrials.gov, NCT05103033, and is completed.

FINDINGS: Between Feb 4, 2022, and Oct 14, 2024, 3837 patients with MNS disorders (2153 in the intervention group and 1684 in the control group) attended 33 055 outpatient visits across 16 government facilities in Mozambique (eight intervention; eight attentional placebo control). The mean age was 26·0 years (SD 15·4; range 0-103), 2038 (53·1%) were male and 1800 (46·9%) were female, and 2581 (67·3%) were diagnosed with epilepsy. Ethnicity data were not collected. 966 patients in the intervention group (with 7697 visits) and 785 in the control group (with 3804 visits) who had their first visit during the study period, who completed the WHODAS 2.0 measurement at that visit, and who were aged 15 years or older, were included in the primary analysis of patient-visit-level functional improvement or low functional impairment to allow for examination of change from baseline. The SAIA-MH group showed 46·0 percentage points (95% CI 34·0 to 58·0; p<0·0001) higher functional improvement or low functional impairment, 18·1 percentage points (15·4 to 20·7; p<0·0001) higher medication adherence, and 18·4 percentage points (15·1 to 21·7; p<0·0001) higher appointment attendance than observed in the control group. Among non-adherent patient visits, the intervention group had 11·9 fewer non-adherent days than controls (95% CI -17·6 to -6·2; p<0·0001). WHODAS 2.0 scores decreased by 5·9 points more in the intervention group than the control group (95% CI -6·5 to -5·2; p<0·0001). One adverse event was reported during study implementation in the attentional placebo control group and was determined to be unrelated to study participation.

INTERPRETATION: The SAIA-MH implementation strategy shows evidence of effectiveness in increasing patient functioning, appointment attendance, and medication adherence for patients with MNS disorders treated in outpatient primary care. Our findings warrant further research across implementation contexts to determine how differences in diagnostic and comorbidity case mix might influence the ability of SAIA-MH to reduce gaps in task-shared MNS care.

FUNDING: National Institute of Mental Health TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.

PMID:41862257 | DOI:10.1016/S2215-0366(26)00034-9