Nevin Manimala

Int Wound J. 2026 Apr;23(4):e70910. doi: 10.1111/iwj.70910.

ABSTRACT

Burn injuries pose a significant challenge in resource-limited settings, particularly during humanitarian crises. This study examines the epidemiology, management, and outcomes of burn patients at a tertiary hospital in Damascus, Syria, from 2021 to 2024. A single-centre retrospective cohort study was conducted on 500 admitted burn patients. Data on demographics, injury characteristics, management, complications and mortality were analysed using descriptive statistics, chi-square tests, Mann-Whitney U tests and binary logistic regression. The lethal area 50% (LA50) was estimated using the logistic regression equation: $\mathrm{LA}50=–\frac{\text{constant}+\sum \left(b_i{x}_i\right)}{b_{\text{TBSA}}}$ . The mean patient age was 20.5 ± 17.9 years, with a male predominance (55%). Flame burns (72.4%) at home (87.6%) were most common. The mean total body surface area burned was 30.99% ± 21.31%, with 68.6% being full-thickness injuries. The complication rate was 91%, with infection being most prevalent. The overall mortality rate was 39%, with sepsis (56.4%) as the leading cause. Logistic regression identified larger burn area (OR = 1.152, p < 0.001), full-thickness depth (ref. partial thickness, OR = 0.281, p < 0.001), older age and female gender as independent predictors of increased mortality. Deceased patients had significantly shorter hospital stays. LA50 was 42.63% for a 40-year-old male with a partial-thickness flame burn and a 10-day hospital stay; for a female with a full-thickness flame burn under the same conditions, it was 27.43%. This study reveals an alarmingly high burden of burn injuries in a crisis-affected setting, with extreme complication and mortality rates. The findings highlight the critical impact of extensive burns and sepsis, underscoring severe systemic constraints on care. Urgent context-specific interventions to strengthen acute burn management, infection control, and prevention strategies are imperative.

PMID:41991187 | DOI:10.1111/iwj.70910

Mol Cell Endocrinol. 2026 Apr 14:112807. doi: 10.1016/j.mce.2026.112807. Online ahead of print.

ABSTRACT

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. As a clinically heterogeneous condition, distinct subtypes of PCOS may exist with varying clinical and biochemical features which impact clinical handling of PCOS. Identifying sub-clusters of PCOS women is a critical and challenging issue toward individualized treatment. Using data on the DNA methylome of PCOS cases and healthy controls, we performed an epigenome-wide association study (EWAS) on DNA methylation variability to investigate epigenetic heterogeneity of PCOS to explore the molecular basis in its clinical heterogeneity. We identified 136 CpG sites that are significantly highly variable in DNA methylation in PCOS cases (p<1×10^-7). The EWAS results were significantly enriched for biological pathways including non-alcoholic fatty liver disease, polycomb repressive complex, and Hippo signaling pathway, all have been reportedly to involve in PCOS physiopathology. Based on the identified 136 significant sites, we were able to cluster PCOS cases into two major clusters. Correlation of the clusters with observed clinical variables found four reproductive hormones i.e. estradiol, progesterone, thyroid stimulating hormone and testosterone, that optimally characterize the clustering with high statistical significance (p=1.50×10^-3). Our results showed that variability analysis of the PCOS DNA methylome can be a valuable approach for exploring the biological basis in PCOS clinical heterogeneity to promote individualized treatment and management.

PMID:41990965 | DOI:10.1016/j.mce.2026.112807

J Hazard Mater. 2026 Apr 11;509:142041. doi: 10.1016/j.jhazmat.2026.142041. Online ahead of print.

ABSTRACT

This study provides the first global statistical assessment of how water quality parameters (WQPs) influence the formation and regulatory exceedances of major disinfection by‑products (DBPs) in drinking water (disinfected tap water), including trihalomethanes (THMs), haloacetic acids (HAAs), and haloacetonitriles (HANs). A dataset of over 800 drinking water samples from 30 countries was analysed using multivariate techniques (PCA, CCA, MRA, FAMD) to disentangle the contributions of seven WQPs to DBP formation. Bromide emerged as the dominant driver of DBP speciation, with the Br⁻:Cl⁻ ratio strongly favouring brominated DBPs, while temperature showed consistent positive associations with multiple DBPs. TOC, pH, and inorganic nitrogen species exhibited compound‑specific associations, reflecting the diverse precursor and formation pathways across DBP classes. Globally, HAAs were the most prevalent DBP group and exceeded safety thresholds more frequently than THMs and HANs. Elevated THMs and HANs levels occur in several European countries (France and Croatia, respectively) dependent on source waters chemistry, such as high Br⁻ levels. Iran from Middle East and India report the highest HAAs occurrence, driven by regional reliance on unregulated or saline sources. Overall, DBP occurrence was more strongly governed by water‑matrix chemistry than by geographic location or treatment type, underscoring the need for locally tailored water‑treatment strategies that account for parameters such as bromide levels, NOM characteristics, and temperature‑driven variability to effectively control DBP formation and ensure safe drinking water. This work offers practical guidance for water utilities and regulatory agencies by clarifying how fluctuations in WQPs shape DBP formation under typical operational conditions.

PMID:41990661 | DOI:10.1016/j.jhazmat.2026.142041

Arkh Patol. 2026;88(2):52-58. doi: 10.17116/patol20268802152.

ABSTRACT

OBJECTIVE: To establish the mechanisms of pathomorphism of grafted C6 glioma (glioblastoma, GB) under the influence of 1267 nm laser therapy using in vivo experiments.

MATERIAL AND METHODS: The experiment was performed on 40 Wistar rats with transplanted GB. In the experimental groups, 1 week after tumor transplantation, rats underwent daily laser therapy for 3 weeks. One therapy session lasted 51 minutes (3 laser irradiations for 17 minutes with 5-minute breaks between irradiations), at a dose of 12.6 kJ/cm² laser with a wavelength of 1267 nm. The comparison groups consisted of animals without a tumor and with a tumor, but without LT. Immunohistochemical markers of apoptosis (p53, Bax, Fas receptor), proliferation (Ki67), and autophagolysosome formation (LC3B, clathrin, and caveolin) were used. In statistical analysis, the Shapiro-Wilk test for the normality of the distribution was performed. The averages were compared using the Welch t-test.

RESULTS: The survival rate in the group with transplanted GB after laser therapy compared with the experimental group of animals without LT was 1.8 times higher after a course of LT with a dose of 12.6 kJ/cm² (64% and 34%, respectively). It was found that LT reduces the proliferation of GB cells (Ki67), activates the mitochondrial pathway of apoptosis (Bax and p53) in GB cells, and blocks the formation of autophagolysosomes (LC3B, clathrin, caveolin). Conclusion. Under the action of a laser (1267 nm), pronounced pathomorphosis of transplanted C6 glioma develops, its growth rate decreases, and animal survival increases from 34% to 64%. Thus, GB therapy with a laser with a wavelength of 1267 nm may become a promising therapeutic approach in the development of additional non-invasive GB treatment method.

PMID:41989546 | DOI:10.17116/patol20268802152

Inform Health Soc Care. 2026 Apr 16:1-11. doi: 10.1080/17538157.2026.2654150. Online ahead of print.

ABSTRACT

OBJECTIVES: This study conducted an informatics system evaluation of two LLMs (GPT-4o and DeepSeek-V3) for patient education, combining clinician-rated quality with patient-perceived usability across thematically stratified queries.

MATERIALS AND METHODS: In a blinded, within-subject design, 16 frequently asked questions about biologic therapies were categorized into three domains: treatment/drug selection, safety/adverse effects, and special conditions/daily life. Responses were standardized, generated without external retrieval, anonymized as A/B pairs. Thirty physicians assessed clinical appropriateness, scientific accuracy, comprehensiveness, while 60 patients rated readability, understandability, actionability, perceived adequacy, decision support, and trust on 5-point Likert scales. Analyses included paired t-tests, Holm/FDR corrections and two one-sided tests (TOST) to distinguish statistical non-difference from practical equivalence.

RESULTS: Physicians rated GPT higher across all domains (p < .002), with largest gaps in safety/side effects and treatment/drug selection. Patients favored GPT for understandability, actionability, and decision support (p < .001), while readability, adequacy, trust, and reading time were statistically and clinically equivalent.

CONCLUSION: Findings highlight the need for topic-aware governance: guideline-dense queries suited to retrieval-augmented generation and checklist compliance, and context-sensitive queries requiring uncertainty signaling and human oversight. This layered approach advances health informatics by defining where LLMs may substitute versus where they require verification, supporting safe and auditable integration into patient education.

PMID:41989204 | DOI:10.1080/17538157.2026.2654150

J Med Food. 2026 Apr 16:1096620X261421081. doi: 10.1177/1096620X261421081. Online ahead of print.

ABSTRACT

This study was conducted to determine the effects of fructo-oligosaccharide (FOS) inulin on anxiety symptoms in college students. Forty million adults in the United States suffer from anxiety. Previous studies have viewed gut microbiota and its potential link to anxiety in both humans and mice. However, no previous studies focused on the effect of FOS inulin on college students. Fourteen subjects received 4.9 g per day of FOS inulin as the treatment (TX) or no supplement as the control (CON) for 28 days. Both the TX and CON groups were given the Generalized Anxiety Disorder 7-Item Scale (GAD-7) on days 1 and 28. Both groups were also given a 3-day food log at the beginning of the experiment and otherwise maintained their regular diet. Results showed a statistically significant decrease in median GAD-7 scores in both groups (P = .017, r = .637 and P = .042, r = .587 for the TX and CON groups, respectively). However, when comparing the GAD-7 scores between groups, no statistically significant results were found. FOS inulin supplementation did not alleviate anxiety symptoms in college students participating in this study.

PMID:41989194 | DOI:10.1177/1096620X261421081

mSystems. 2026 Apr 16:e0178125. doi: 10.1128/msystems.01781-25. Online ahead of print.

ABSTRACT

The Enterobacter genus contains 23 species that include common nosocomial pathogens capable of causing a wide variety of infections. We obtained all available Enterobacter genomes and retained 4,805 high-quality genomes after quality control. Genome sequencing analysis of Enterobacter species revealed the presence of type VI secretion systems (T6SS) in these bacteria, but systematic analysis and comparison of these systems among different species are limited. We found that these bacteria code for three distinct types of T6SS, each with a unique set of diverse predicted effectors. Whereas at least 14 effectors are found in each strain, the number of immunity proteins is considerably fewer. By demonstrating a correlation between the abundance of known T6SS-associated proteins and the presence of T6SS, we proposed a comparative genomics model to evaluate the correlation between unknown T6SS-associated ortholog proteins and T6SSs. Among the homologous groups most strongly associated with T6SS, we potentially identified several effectors. It is conceivable that our methodology could be scaled to survey additional bacterial genera for novel T6SS effectors, thereby providing fresh perspectives and directions for subsequent biological experiments.IMPORTANCEEnterobacter species are important human pathogens that can cause severe conditions like pneumonia, urinary tract infections, and bacteremia. As Gram-negative bacteria, they frequently carry diverse T6SS loci, which are often associated with bacterial virulence and are also one of the important causes of bacterial infection. T6SS effectors play a critical role in interbacterial competition and virulence during infection. VgrG proteins are essential T6SS components that form the spike structure and mediate effector delivery, making them critical for bacterial competition and virulence. However, systematic studies on their distribution and function remain limited. Here, we analyzed all available high-quality Enterobacter genomes and revealed that T6SS diversity is shaped by both species’ evolution and horizontal gene transfer (HGT). We proved that it is feasible to measure the biological relevance of unknown functional proteins to the T6SS through statistical analyses. This high-throughput approach provides a new perspective for future research on T6SS functionality, especially in Enterobacter.

PMID:41989184 | DOI:10.1128/msystems.01781-25

J Holist Nurs. 2026 Apr 16:8980101261439580. doi: 10.1177/08980101261439580. Online ahead of print.

ABSTRACT

Purpose of StudyThis study aimed to determine the effect of a holistic intervention, integrating painting, and music activities, on the perceived stress and burnout levels of nurses working in frontline conditions during extraordinary crises.Design of StudyA quasi-experimental pretest/post-test control group design was utilized, grounded in holistic nursing principles.Methods UsedThe intervention consisted of three online art-based sessions designed to facilitate emotional expression and cognitive relief. Data were collected from nursing staff via an introductory form, the Perceived Stress Scale (PSS), and the Burnout Scale (BS). Statistical analyses were performed using SPSS, including nonparametric tests and effect size calculations.FindingsFor the intervention group, the BS median values showed a significant improvement following the sessions (p < .05), moving from a pretest median of 3.00 to 4.00 (indicating lower burnout). While PSS scores decreased from 33.00 to 31.50, this change did not reach statistical significance (p > .05). Participants in both groups reported a high baseline interest in music.ConclusionsNurses experience dangerously high levels of burnout during prolonged extraordinary circumstances. Short-term, holistic art-based interventions can significantly reduce perceived burnout. Integrating creative arts into the workplace serves as a vital holistic strategy to enhance psychological resilience and work-life quality.

PMID:41989161 | DOI:10.1177/08980101261439580

Dent Med Probl. 2026 Mar-Apr;63(2):311-322. doi: 10.17219/dmp/202962.

ABSTRACT

BACKGROUND: The current treatment for patients with myalgia comprises splint therapy (ST), cognitivebehavioral therapy (CBT), psychological treatment, and education.

OBJECTIVES: The aim of the present study was to compare the effectiveness of relax-psycho-breathing therapy (RPB) and ST in women with myalgia, and to evaluate the efficacy of occlusal splint and/or behavioral therapy in the management of muscle pain.

MATERIAL AND METHODS: The study, designed as a randomized controlled trial (RCT), involved 105 women aged 25-55 years with pain in the masticatory muscles during the 30 days prior to examination. Myalgia was diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I. The clinical examination assessed muscle and temporomandibular joint (TMJ) pain intensity, TMJ sounds, maximum mouth opening (MMO), and deviation in mouth opening and mandibular movement. After an initial assessment, at the 2nd visit (V2), the 25 patients from the 1st group were introduced to RPB: relaxation techniques; breathing patterns; psychological-behavioral instruction; muscle exercise therapy; puffing therapy; and self-massage. The 2nd group of patients received a custom-made, thermoplastic, flatplane relaxation splint placed on the mandible. The efficacy of treatment in all subjects was evaluated at 2 follow-up visits (V3 and V4).

RESULTS: In cases of muscle pain, pain during function, TMJ and muscle tenderness, and headache attributed to TMD, a statistically significant difference between the RPB and ST groups was observed only at the final follow-up visit. No significant differences between the 2 groups were found for MMO.

CONCLUSIONS: The reduction in myalgia following treatment suggests that both RPB exercises and ST are equally effective. However, considering the cost and duration of myalgia therapy, comprehensive care incorporating relaxation techniques may be a preferable first-line approach rather than ST alone.

PMID:41989134 | DOI:10.17219/dmp/202962

Eur J Ophthalmol. 2026 Apr 16:11206721261440985. doi: 10.1177/11206721261440985. Online ahead of print.

ABSTRACT

BackgroundPediatric Thyroid Eye Disease (TED) is a rare autoimmune condition primarily associated with Graves’ disease. Although usually milder than adult TED, it can still cause functional and psychological morbidity. Pediatric management remains unclear due to the absence of specific guidelines and concerns about treatment-related risks such as growth suppression.MethodsWe conducted a systematic review and meta-analysis following PRISMA guidelines, searching MEDLINE, Embase, and Emcare from inception to March 2024. Studies included interventional and observational reports involving patients ≤18 years with TED. Data were synthesized narratively and quantitatively. Meta-analyses were conducted using random-effects models, with heterogeneity assessed via I² statistics and meta-regression. Primary outcomes included visual acuity (VA), proptosis, Clinical Activity Score (CAS), and adverse events.ResultsThirty-two studies comprising 810 pediatric patients (mean age 11.7 years, 64.8% female) were included. The most common symptoms were exophthalmos (99.5%), eyelid retraction (73.1%), and dry eye (66.3%). Treatments ranged from antithyroid drugs and corticosteroids, to orbital decompression and biologics. Meta-analysis showed mean exophthalmos reductions of 4.69 mm for decompression, 4.25 mm for steroids, and 1.75 mm for biologics. Substantial heterogeneity and low certainty of evidence limited interpretability. Interventions were performed earlier than recommended, with no significant adverse effects reported.ConclusionsDespite most pediatric TED cases being mild, a subset of patients requires more intensive management. This review, comprising predominantly of case reports and case series with very low certainty evidence, reveals gaps between practice and recommendations, highlighting the need for pediatric-specific guidelines informed by systematic evidence.

PMID:41989129 | DOI:10.1177/11206721261440985