Nevin Manimala

Eur J Public Health. 2026 Jun 10;36(4):ckag086. doi: 10.1093/eurpub/ckag086.

ABSTRACT

Incidence and mortality of oral cancer slightly decreased in recent years in Hungary; however, age-standardized estimated incidence and mortality for both sexes are still among the highest in Europe. The objective of the large observational study was to conduct oral cancer screening in Hungary using mobile screening units to examine 5000 individuals living in converging municipalities with low population density and under challenging socio-economic conditions. The study also aimed to develop related patient pathways, and to educate the population on the prevention of oral malignancies. The population screened for oral cancers using Visual Oral Examination (VOE) between 21 June 2021 and 31 March 2023 included individuals of 18 years of age or older, living in converging municipalities and in other geographical locations across Hungary. In 2024, a retrospective cross-sectional study was carried out to analyze the results. During the studied time period, a total of 8266 people attended the oral cancer screening study from converging municipalities (n = 4275; 51.7%), and from other geographical locations (n = 3991; 48.3%). Oral mucosal lesions were detected in 1725 individuals, of whom only 66 people (3.8%)-13 men and 53 women-visited a specialist, and 6 were diagnosed with malignant neoplasms. Mobile screening units can be an effective tool of secondary prevention for screening high-risk groups in rural, socio-economically challenging settings. However, low compliance of screen positive individuals to attend follow-up visits poses a threat to the effectiveness of the screening programs and it needs to be addressed by optimizing patient pathways.

PMID:42437427 | DOI:10.1093/eurpub/ckag086

Pediatr Surg Int. 2026 Jul 12;42(1):297. doi: 10.1007/s00383-026-06533-0.

ABSTRACT

PURPOSE: Antegrade continence enema (ACE) appendicostomy is widely used in children with complex colorectal and neurogenic bowel conditions, yet data from resource-constrained settings remain limited. We aimed to describe the experience of a single-center pediatric cohort in a low-middle-income country (LMIC).

METHODS: A retrospective review of all ACE procedures performed between 2012 and 2026 was conducted. Demographics, diagnoses, indications, complications, surgeries, and functional outcomes (assessed with Milan Bowel Function Questionnaire) were collected from clinical and operative records. Descriptive statistics were applied.

RESULTS: Forty-five children (80% male) underwent ACE procedures, with a median age of 8.3 years. Most had appendicostomy; two required cecostomy intraoperatively. The most common diagnosis was anorectal malformation (n = 33, 73.3%), followed by neurogenic bowel (n = 7, 15.5%). Eight patients (17.7%) underwent a concomitant Mitrofanoff procedure. The main complication was skin-level stricture (n = 17, 37.8%), representing the only indication for surgical revision (n = 15, 33.3%), with a median time to revision of 5.5 months. Nearly all patients achieved clinical success, with high satisfaction reported on the questionnaire.

CONCLUSION: ACE appendicostomy is an effective and satisfactory option in LMICs, with outcomes comparable to high-income settings, supported by careful patient selection and ongoing quality improvement efforts.

PMID:42437421 | DOI:10.1007/s00383-026-06533-0

Naunyn Schmiedebergs Arch Pharmacol. 2026 Jul 12. doi: 10.1007/s00210-026-05706-x. Online ahead of print.

ABSTRACT

Pseudomonas aeruginosa is a clinically significant opportunistic pathogen characterized by intrinsic and acquired resistance mechanisms coupled with a diverse array of virulence determinants. This study investigated the distribution of P. aeruginosa in various clinical specimens (n = 382), its virulence genes, antimicrobial resistance patterns, and associations with total resistant P. aeruginosa (TRPA) phenotypes. The majority of isolates were recovered from sputum (24.3%) and endotracheal tube samples (22.5%). Virulence gene screening revealed moderate-to-high prevalence of lasB (55.0%), toxA (49.7%), pilA (53.7%), aprA (56.5%), phzS (45.0%), exoS (41.9%), and exoU (38.0%), indicating their widespread involvement in pathogenicity. Antimicrobial susceptibility profiling demonstrated the highest susceptibility to amikacin (56.3%) and gentamicin (52.4%), while resistance to carbapenems (imipenem 52.4%, meropenem 52.9%) and cephalosporins was alarmingly high. Based on resistance classification, 33.5% of isolates were MDR, and 9.7% XDR. Among ceftazidime-resistant isolates (n = 200), 83% harboured ESBL genes, with bla_CTX-M (38.0%) being most prevalent. Notably, 30.7% and 22.8% of isolates carried bla_NDM-1 and bla_OXA-48, respectively. Comparative analysis demonstrated statistically significant associations between TRPA phenotype and virulence genes: lasB (OR = 90.3), toxA (OR = 260.9), and pilA (OR = 32.6) (p < 0.0001). Resistance determinants such as bla_CTX-M (OR = 3.5), aac(6′)-Ib (OR = 2.9), qnrA (OR = 3.9), and co-carriage of NDM-1 + OXA-48 (OR = 4.9) were significantly enriched in TRPA isolates. These findings demonstrate a significant association between virulence and antimicrobial resistance traits, emphasizing the potential expansion of high-risk P. aeruginosa clones in clinical settings and highlighting the need for genomic surveillance and antimicrobial stewardship interventions.

PMID:42437416 | DOI:10.1007/s00210-026-05706-x

Environ Geochem Health. 2026 Jul 12;48(10):447. doi: 10.1007/s10653-026-03353-y.

ABSTRACT

While exposure to individual non-essential metals (NEMs) links to abdominal obesity (AOB), the NEM mixture effects and mechanisms remain unclear, particularly in vulnerable aging populations. We included 3795 community-dwelling Chinese older adults (age ≥ 60 years), measured 6 urine NEMs [gallium (Ga), arsenic (As), cesium (Cs), barium (Ba), thallium (Tl), and uranium (U)] via ICP-MS, defined AOB by sex-specific waist circumference, assessed insulin resistance (IR) via triglyceride-glucose (TyG) index, and determined vitamin D status by serum 25-hydroxyvitamin D [25(OH)D]. Multivariable logistic regression, mixture models [weighted quantile sum (WQS), quantile g-computation (QGC), and Bayesian kernel machine regression (BKMR)], mediation and moderation analyses, and network toxicology analyses were performed. Multivariable logistic regression showed a positive association between urinary Tl and AOB (OR = 1.18, 95% CI: 1.05-1.32). Mixture analyses consistently revealed a significant overall effect of NEMs on AOB, with Tl identified as the primary contributor (WQS weight = 0.481; QGC weight = 0.428; conditional PIP = 0.918). The TyG index was identified as a potential mediator, accounting for 10.18-7.84% of the associations between Tl and AOB and the NEM mixture and AOB, respectively. Vitamin D sufficiency [serum 25(OH)D ≥ 75 nmol/L] significantly attenuated TyG index-AOB association. Network toxicology identified the AGE-RAGE signaling pathway and several hub genes as candidate biological pathways for future investigation of the association between NEM exposure and AOB. These findings highlight the metabolic implications of NEMs, particularly Tl, and suggest that Vitamin D sufficiency may influence metabolic responses associated with AOB, offering novel insights into AOB prevention in the context of NEMs exposure.

PMID:42437414 | DOI:10.1007/s10653-026-03353-y

Exp Brain Res. 2026 Jul 12;244(8):156. doi: 10.1007/s00221-026-07354-2.

ABSTRACT

Working memory issues are an often life-impairing deficit seen in several neurological disorders. Transcutaneous vagus nerve stimulation (tVNS) is a promising neuromodulatory adjunct to cognitive training and may improve working memory. High-density functional near-infrared spectroscopy (HD-fNIRS) is a modern neuroimaging modality that can assess cerebral blood flow in cortical areas. In the current study, we used HD-fNIRS to determine the effects of tVNS during a working memory task. Twenty-two healthy adult participants (12 female, 10 male) performed a 3-back task in a block design whilst high-density fNIRS was recorded across the bilateral prefrontal cortex using 36 sources and 48 detectors (1728 channels). Sham (earlobe) tVNS was delivered during the first task trial and active (tragus) tVNS was delivered during the second task trial. Statistical analysis was performed at a group level within trial (task – baseline) and between trials (active tVNS vs. sham tVNS) using node-level and regional approaches. Task-related increases in HbO were seen in the right dorsolateral middle frontal gyri, left inferior frontal gyrus and right lateral orbitofrontal cortex under both active and sham tVNS. Decreases were observed in the bilateral superior medial frontal gyri and medial orbital frontal cortices. No significant differences were seen between sham and active tVNS. Simultaneous recording of HD-fNIRS during a 3-back task and concurrent tVNS was feasible and well-tolerated. Robust task-related activation was seen in lateral frontal areas. No significant active-versus-sham differences in cortical activity or behavioural performance were observed under the stimulation parameters used here; however, this finding should be interpreted cautiously because the fixed-order design may have introduced fatigue or habituation effects. HD-fNIRS could be used in future studies of working memory and neuromodulation in clinical cohorts.

PMID:42437406 | DOI:10.1007/s00221-026-07354-2

J Interprof Care. 2026 Jul 12:1-8. doi: 10.1080/13561820.2026.2698726. Online ahead of print.

ABSTRACT

Interprofessional primary care providers play a central role in delivering palliative care, although it remains challenging to implement. We evaluated a virtual interprofessional education program called CAPACITI, aiming to increase early identification of palliative care needs in the context of interprofessional primary care teams. A three-module two-arm version of CAPACITI was delivered in a randomized controlled trial, with teams assigned to either a self-directed or facilitated learning arm. Participants completed surveys before and after each module, including the Assessment of Interprofessional Team Collaboration Scale-II (AITCS-II). The pre-intervention survey also included the Organizational Readiness to Change Assessment (ORCA) measure. Descriptive statistics, paired t-tests, and generalized linear models were conducted. Of the 566 enrolled, 380 (67.1%) completed Module 1, 274 (48.4%) completed Module 2, 202 (35.7%) completed Module 3, and 192 (33.9%) completed all three modules. AITCS-II scores improved significantly (p < .001) following CAPACTI, with no difference between self-directed and facilitated groups for any module. Participants with lower ORCA scores at baseline experienced greatest improvement in team collaboration. CAPACITI demonstrates promise as an effective and scalable intervention to enhance interprofessional collaboration in palliative primary care. These findings support the integration of virtual team-based training as a strategy to strengthen collaborative care across primary care settings.

PMID:42437374 | DOI:10.1080/13561820.2026.2698726

Environ Sci Technol. 2026 Jul 12. doi: 10.1021/acs.est.6c04963. Online ahead of print.

ABSTRACT

Data-driven modeling in wastewater treatment is increasingly constrained by the reality of small, high-dimensional data, where the abundant monitoring parameters in small-sized data sets obscure fundamental mechanistic understandings. This study proposes a knowledge-driven feature selection framework that integrates mechanistic insights with statistical correlations to identify the most informative predictive features. Using nitrous oxide (N₂O) emission prediction at a full-scale plant as a case study, we compared classic deep-learning feature selection algorithms using attention mechanisms against two new knowledge-based approaches: (i) expert-guided feature selection and (ii) large language model (LLM)-augmented feature selection. Expert-knowledge-guided feature selection substantially enhances predictive accuracy, achieving a mean R² of 0.723 and an MAE of 0.033, compared to R² = 0.712 and MAE = 0.033 for the best-performing attention-based architecture. More importantly, the proposed framework markedly improves model generalizability: under out-of-distribution high-flow conditions where the attention-based model fails to capture N₂O emission patterns, the expert-selected model continues to reproduce the dominant temporal dynamics of N₂O emissions. The LLM-assisted approach also delivers competitive accuracy (mean R² = 0.596, MAE = 0.041) and similarly preserves generalizability under an input distributional shift. By introducing mechanistic understanding into the feature selection process, this framework offers a generalizable pathway for addressing complex wastewater treatment challenges while maintaining a computational efficiency.

PMID:42437349 | DOI:10.1021/acs.est.6c04963

Iran J Allergy Asthma Immunol. 2026 Jun 3;25(4):554-564.

ABSTRACT

To investigate the feasibility and effectiveness of targeted lung recruitment and the titration of optimal positive end-expiratory pressure (PEEP) in neonates under the guidance of lung ultrasound. The atelectasis neonates from June 2022 to June 2024 in the Neonatology Department of People’s Hospital of Pidu were collected and randomly divided into a lung ultrasound scoring (LUS) group and an oxygen (OXY) group, both of which were given mechanical ventilation treatment. The lung recruitment and optimal PEEP were performed by the LUS and OXY methods, respectively. The optimal PEEP and the respiratory and hemodynamic indexes of the two groups were compared before and after lung recruitment and after the optimal PEEP was titrated. After the intervention, the dynamic lung compliance (Cdyn) in the LUS group increased by 38.2% compared with the baseline (from 30.6 ± 4.3 to 42.3 ± 5.1 mL/cmH2O), which was significantly higher than the 21.4% increase in the OXY group (from 29.8 ± 4.1 to 35.6 ± 4.8 mL/cmH2O). The improvement in PaO2/FiO2 in the LUS group was 22.5% higher than in the OXY group. There was no statistically significant difference in the incidence of complications between the two groups. Lung ultrasound can guide neonatal lung recruitment and optimal PEEP titration, improving lung compliance and oxygenation without affecting the safety of treatment.

PMID:42437315

Iran J Allergy Asthma Immunol. 2026 Jun 3;25(4):517-528.

ABSTRACT

Postoperative infections (POIs) significantly contribute to morbidity and mortality following partial hepatectomy for hepatocellular carcinoma (HCC). While the Systemic Immune-Inflammation Index (SII) and Prognostic Nutritional Index (PNI) are recognized biomarkers for immune-inflammatory and nutritional status, their combined predictive value for POIs in liver surgery requires further investigation. This study evaluates SII and PNI as preoperative predictors for infections in this patient population. A retrospective observational study was conducted on 300 patients undergoing partial hepatectomy between 2022 and 2024. Preoperative laboratory data were used to calculate SII and PNI, with POIs identified within 30 days based on CDC guidelines. Statistical analyses, including multivariate logistic regression, were performed to compare infected and non-infected cohorts and identify independent predictors of infection. Of the 300 patients, 96 (32%) developed POIs. The infected group exhibited significantly higher SII (1142 ± 618 vs 792 ± 450) and lower PNI (40.1 ± 5.8 vs 46.4 ± 5.9) than the non-infected group. Multivariate analysis confirmed high SII (OR 2.85) and low PNI (OR 3.26; 95% CI, 2.01-5.12) as independent predictors. Furthermore, infections were associated with prolonged hospitalization, increased ICU admissions, and higher 30-day mortality. Preoperative SII and PNI are effective, independent predictors of POIs in patients undergoing hepatectomy for liver cancer. Integrating these biomarkers into routine evaluation enhances risk stratification and guides perioperative optimization. Early identification through these indices allows for targeted interventions, such as nursing-led nutritional support and intensified surveillance, to reduce complications and improve surgical outcomes.

PMID:42437312

Malays Fam Physician. 2026 Jun 4;21:32. doi: 10.51866/oa.1006. eCollection 2026.

ABSTRACT

INTRODUCTION: Menopause is a substantial life transition for women, signifying the end of reproductive capability, with implications for symptoms, long-term health and well-being. Women’s experiences during menopause can differ widely, affecting their attitudes towards this transition. This study aimed to investigate knowledge and attitudes towards menopause among midlife women in Malaysia.

METHODS: A community-based cross-sectional online survey using non-probability sampling was conducted among Malaysian women aged 40-60 years residing in an urban setting. A validated online questionnaire was used to assess the study parameters. Knowledge and attitudes were quantified, and associations with sociodemographic factors were examined using the Kruskal-Wallis test. Descriptive statistics and Spearman’s correlation analysis were performed using the IBM Statistical Package for the Social Sciences Statistics version 26.0.

RESULTS: Of the 300 respondents, the majority were Malay (94.7%), married (85.3%) and aged 55-60 years (27.3%). Over half (52.0%; mean score=12.98±6.77 [22 max score]) demonstrated poor knowledge, while 45.3% held negative attitudes towards menopause. The average attitude score was 33.48±6.58 [56 max score], indicating a generally negative orientation towards menopause. A weak but significant positive correlation was observed between knowledge and attitudes (r=0.249, P<0.01).

CONCLUSION: Targeted educational initiatives may be beneficial in enhancing menopause-related knowledge and fostering more positive attitudes among midlife Malaysian women. Future research should rigorously assess changes in knowledge, attitudes and related clinical behaviours after such interventions to inform policy and practice.

PMID:42437304 | PMC:PMC13355863 | DOI:10.51866/oa.1006