Nevin Manimala

Ann Pharmacother. 2026 Apr 26:10600280261437728. doi: 10.1177/10600280261437728. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the efficacy and safety of mepolizumab, a humanized monoclonal antibody that targets interleukin-5, a key mediator in eosinophilic inflammation, in reducing moderate-to-severe exacerbations among patients with eosinophilic chronic obstructive pulmonary disease (COPD).

DATA SOURCES: PubMed, Scopus, Web of Science, and Cochrane databases were systematically searched using the terms: “Mepolizumab,” “COPD,” “Chronic Obstructive Pulmonary Disease,” for randomized controlled trials comparing subcutaneous mepolizumab (100 mg every 4 weeks) with placebo in patients with eosinophilic COPD from inception till July 2025.

STUDY SELECTION AND DATA EXTRACTION: Randomized controlled trials comparing subcutaneous mepolizumab with placebo in adults with eosinophilic COPD were included. Two independent reviewers screened studies and extracted data. Finally, 4 studies with a total of 1953 patients were included. Of these, 978 (50.0%) received mepolizumab.

DATA SYNTHESIS: Statistical analysis was performed using R software (version 4.5.0). Mepolizumab significantly prolonged the time to first moderate or severe exacerbation (hazard ratio [HR] = 0.80; 95% confidence interval [CI] 0.69-0.92; P = 0.016) and reduced the rate of moderate-to-severe exacerbations (rate ratio 0.80; 95% CI 0.78-0.83; P < 0.001). The risk of adverse events (AEs) (risk ratio [RR] = 1.00; 95% CI 0.95-1.06; P = 0.962) was similar between groups, while the risk of serious adverse events or death (RR = 0.83; 95% CI 0.72-0.96; P = 0.031) was significantly lower in the mepolizumab group.Relevance to Patient Care and Clinical Practice in Comparison With Existing Drugs:Mepolizumab provides a targeted, biomarker-guided treatment option, potentially reducing exacerbations without the added safety concerns like infections and metabolic complications as seen with existing therapies.

CONCLUSION AND RELEVANCE: Mepolizumab reduces the time to first moderate or severe exacerbation and prolongs symptom-free periods in patients with eosinophilic COPD, without increasing the risk of AEs.

PMID:42035307 | DOI:10.1177/10600280261437728

West Afr J Med. 2025 Dec 30;42(9):701-707.

ABSTRACT

BACKGROUND: Exploring the relationship between refractive error and ocular biometry in young African school children is essential for early detection, prevention, and management of visual impairments.

OBJECTIVES: This study aimed to profile the distribution of ocular biometry parameters and to identify correlates of spherical equivalent refraction (SE) among school children in Nigeria.

METHODS: A cross-sectional study was conducted among 295 secondary school students aged 10-19 years in Ife Central Local Government Area. Ocular measurements, including axial length, corneal radius of curvature, keratometric readings, anterior chamber depth, and horizontal corneal diameter, were obtained using the IOL Master. Refractive error was assessed with an autorefractor, and subjective refraction was also performed on all participants.

RESULTS: Out of the total participants, 109 students (37.0%) had refractive errors, comprising 43.1% males and 56.9% females. Astigmatism was the most common type of refractive error, found in 75 students (68.8%), followed by myopia in 22 (20.2%) and hypermetropia in 12 (11.0%). The median (IQR) axial length was 23.4 (0.8) mm. The average keratometric reading and average corneal radius of curvature were 43.5 ± 1.4 diopters and 7.8 ± 0.2 mm, respectively. The median (IQR) anterior chamber depth, horizontal corneal diameter and spherical equivalent refraction were 3.3 (0.3) mm, 12.2 (0.8) mm and -0.8 (1.3) diopters, respectively. Myopic students had longer axial lengths, deeper anterior chambers, and lower average keratometric readings. Spherical equivalent refraction was significantly negatively correlated with axial length (r = -0.147, p < 0.011), anterior chamber depth (r = -0.130, p < 0.026), and horizontal corneal diameter (r = -0.119, p < 0.042). A positive but non-significant correlation was observed with average keratometric reading (r = 0.009, p = 0.872).

CONCLUSION: Axial length, anterior chamber depth, and horizontal corneal diameter showed significant inverse relationships with spherical equivalent refraction.

PMID:42035305

Global Spine J. 2026 Apr 26:21925682261447886. doi: 10.1177/21925682261447886. Online ahead of print.

ABSTRACT

Study designSystematic review and meta-analysis.ObjectiveTo compare the clinical, radiographic, fusion and complication outcomes between three-level anterior cervical discectomy and fusion (ACDF) and hybrid constructs combining ACDF and cervical disc arthroplasty (CDA).MethodsSystematic search of PubMed, Embase, Scopus, and Web of Science was performed in accordance with PRISMA guidelines. Comparative studies evaluating three-level ACDF and three-level hybrid surgery were included. Primary outcomes included neck disability index(NDI), visual analogue scale(VAS) scores, Japanese Orthopaedic Association (JOA) scores, C2-C7 Cobb angle, C2-7 range of motion (ROM), fusion rates, and complications. Random-effects meta-analyses were performed. Heterogeneity and publication bias were assessed using standard statistical methods.ResultsTwelve studies comprising 1008 patients (553 hybrid and 455 ACDF) met the inclusion criteria. Both surgical strategies demonstrated significant improvements in NDI (P = 0.62), VAS [neck (P = 0.40), arm(P = 0.70)], and JOA (P = 0.97) scores, with no significant between-group differences across clinical outcomes. Hybrid constructs maintained ROM (P = 0.06), and cervical lordosis (P = 0.93) comparable to ACDF. Fusion rates at intended arthrodesis levels were high and similar in both cohorts. There were no significant differences in total, early or late complication rates, although heterogeneity was moderate to high across several outcomes.ConclusionIn three-level cervical degenerative disease, hybrid surgery and ACDF provide equivalent improvements in pain, disability, neurological recovery, alignment, fusion success, and complication profiles. Hybrid constructs demonstrated a trend towards greater preservation cervical range of motion without compromising clinical efficacy or safety. These findings support hybrid surgery as a selective, motion-preserving alternative to three-level ACDF in appropriately chosen patients.Level of evidenceII.

PMID:42035304 | DOI:10.1177/21925682261447886

Eur Heart J Qual Care Clin Outcomes. 2026 Apr 24:qcag074. doi: 10.1093/ehjqcco/qcag074. Online ahead of print.

ABSTRACT

AIMS: The natural history and response to tafamidis treatment in women with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) remain insufficiently characterised. Current study aimed to explore sex-differences in clinical presentation, natural course and tafamidis treatment efficacy, focusing on women with ATTRwt-CM.

METHODS AND RESULTS: An international, multicentric cohort of ATTRwt-CM subjects was evaluated, including for all-cause mortality. In total 1454 patients were studied (mean age 81±7y), including 307 (21.1%) females. At presentation, females were ∼3 years older than males with slightly worse phenotype, including higher indexed left ventricular wall thickness and National Amyloidosis Centre (NAC) disease stage (p<0.050). Heart failure with preserved ejection fraction and hypertension coincided more often in women (p=0.001). Natural disease course was poor without sex-difference, even when age-corrected (p=0.210). Tafamidis was initiated in 1055 patients, 12% less in females (p<0.001), although reasons for non-initiation and discontinuation did not show heterogeneity by sex (p=0.116 and p=0.304, respectively), indicating structural undertreatment. After 1.9 (0.9-3.3) years of median follow-up, 409 (28.1%) patients died. Tafamidis related to lower mortality in the overall and propensity score-matched cohort (n=742, HR 0.44, 95%CI 0.32-0.61, p<0.001), without sex-difference (female HR 0.76, 95%CI 0.52-1.11, p=0.150) nor sex-based treatment efficacy interaction (p=0.381). NAC disease stages strongly related to mortality under tafamidis treatment (HR 2.13%, 95%, 1.81-2.50, p<0.001), but female sex did not (HR 0.82, 95%CI 0.53-1.27, p=0.365).

CONCLUSIONS: Women with ATTRwt-CM are prone to underdiagnosis and undertreatment, despite similar poor natural course and tafamidis treatment efficacy. Initiatives to increase diagnostic awareness and disease modifying treatment initiation in women are urgently needed.

PMID:42035239 | DOI:10.1093/ehjqcco/qcag074

Am J Hematol. 2026 Apr 25. doi: 10.1002/ajh.70328. Online ahead of print.

ABSTRACT

Venetoclax-based low-intensity regimens have improved the outcomes of older or unfit patients with acute myeloid leukemia (AML). This phase II study investigated the combination of cladribine plus low-dose cytarabine and venetoclax alternating with azacitidine plus venetoclax for older or unfit patients with newly diagnosed AML. A total of 190 patients were included; the median age was 68 years (range, 47-84 years; 13% ≥ 75 years). By the European LeukemiaNet 2022 classification, 16%, 20%, and 64% were stratified as favorable, intermediate, and adverse risk, respectively. The rates of complete remission (CR)/CR with incomplete blood count recovery (CRi) and minimal residual disease (MRD) negative CR/CRi were 84% and 75% overall and 91% and 77% among patients with TP53-wild type AML, respectively. The 4- and 8-week mortality rates were 1% and 3%, respectively. Among responders, 44% proceeded to allogeneic hematopoietic stem cell transplantation. The median overall survival (OS) and event free survival (EFS) were 52 and 50 months, respectively. The 2- and 5-year OS rates were 60% and 45%, respectively. The 2-and 5-year EFS rates were 56% and 43%, respectively. Patients achieving MRD-negative CR had a median OS not reached and a 2-year OS rate of 70%. The median time to absolute neutrophil count recovery (> 1 × 10⁹/L) and platelet count recovery (> 100 × 10⁹/L) after induction was 27 and 24 days, respectively. Overall, the treatment was safe and most grade 3 and 4 adverse events were infectious complications. The combination produced a high rate of remissions, translating into favorable outcomes for older patients with newly diagnosed AML. Trial Registration: ClinicalTrials.gov idetifier: NCT03586609.

PMID:42035228 | DOI:10.1002/ajh.70328

Stem Cell Res Ther. 2026 Apr 25. doi: 10.1186/s13287-026-05020-6. Online ahead of print.

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can induce immune dysregulation and multi-organ injury; mesenchymal stromal cell (MSC) therapy has shown promise in clinical trials for COVID-19 and may have broader applicability to pneumonia induced by respiratory viruses (e.g., the influenza virus). This meta-analysis synthesized the available comparative clinical evidence on the safety and efficacy of MSCs in patients with moderate to critical COVID-19 and examined the reported outcomes relevant to Long-COVID.

METHODS: We searched the PubMed, Embase, and CNKI databases for original, comparative studies in moderate, severe, or critical COVID-19 published up to September 2, 2024. Twenty-four eligible studies (13 RCTs and 11 non-randomized controlled trials; n = 1080) were included in the mortality meta-analysis. Patients were assigned to either the intervention group (MSC therapy plus standard care) or the control group (standard care with or without placebo). The primary efficacy outcome was all-cause mortality, while the primary safety outcomes were adverse events (AEs) and serious adverse events (SAEs). Secondary outcomes included clinical recovery, hospitalization metrics, chest imaging, and inflammatory biomarkers. We performed a pooled meta-analysis on mortality with subgroup analyses (by disease severity, administration route, dosing frequency, and study design), assessment of publication bias (using funnel plots and Egger’s test), and evaluation of the quality of evidence via the GRADE approach. AEs/SAEs were analyzed using meta-analysis and descriptive statistics, while other secondary outcomes were summarized descriptively.

RESULTS: MSC therapy significantly reduced all-cause mortality (MSC: 26.4% vs control: 31.9%; fixed-effect OR = 0.74, 95% CI 0.55-0.99), with low heterogeneity (I² = 2.8%, P =0.422[Q-test]) and no publication bias. The quality of evidence was moderate (according to the GRADE assessment). The subgroup analysis revealed a significant survival benefit in severe/critical patients (OR = 0.73, 95% CI 0.54-0.98) but not in studies that included moderate cases (OR = 0.91, 95% CI 0.23-3.65). No significant heterogeneity was found across study designs, administration routes, or dosing frequencies, which confirmed the robustness of the primary findings while indicating insufficient evidence to determine the optimal regimen. The secondary outcomes suggested improvements in clinical recovery, pulmonary function, and pro-/anti-inflammatory cytokine balance in patients that received MSC therapy. Limited studies with long-term follow-up indicated potential benefits for Long-COVID outcomes (e.g., fatigue, quality of life, residual CT abnormalities, and exercise tolerance). No significant differences were observed in AEs or SAEs post-MSC infusion, which suggested that MSC therapy was well tolerated.

CONCLUSION: This meta-analysis indicated that MSC therapy may reduce mortality in patients with severe or critical COVID-19, demonstrating a favorable safety profile and potential benefits for Long-COVID and other viral pneumonias. Further large-scale, rigorous RCTs and mechanistic studies are warranted to strengthen the evidence base and standardize MSC administration regimens (source, dosing, frequency, and intervals) for managing COVID-19, Long-COVID, and other viral pneumonias.

PMID:42035205 | DOI:10.1186/s13287-026-05020-6

BMC Psychol. 2026 Apr 25. doi: 10.1186/s40359-026-04532-3. Online ahead of print.

ABSTRACT

RESEARCH PURPOSE: Mental health care plans and services worldwide are increasingly transitioning toward community-based models (Cochrane Database Syst Rev 1:CD00790, 2017; Innovative care for chronic conditions in building blocks for action, 2002; J Nurs 62:5-11, 2015). In our country, there was a significant burden on and instability in the manpower of personnel in the community mental health care system, as compared to patients. However, there was a lack of research on the role of psychological capital as a mediator between role stress and job burnout among personnel in the community mental health care system. This study aims to explore the interrelationships among role stress, psychological capital, and job burnout among community mental health care personnel. Specifically, we investigate the predictive effect of role stress on job burnout and examine the mediating role of psychological capital within this relationship.

RESEARCH METHOD: The subjects of this study were personnel in the community mental health care system, and an online questionnaire was used. A total of 313 questionnaires were collected, with 262 valid responses. Data analysis and interpretation were conducted using SPSS and SPSS AMOS for descriptive statistics, structural equation modeling, and bootstrapping.

RESEARCH RESULTS: The research results were presented as follows: (1) The level of role stress among community mental health care system personnel was moderate to low (M = 2.78, SD = 0.78); (2) The level of job burnout among community mental health care system personnel was moderate to low (M = 2.91, SD = 0.842); (3) The level of psychological capital among community mental health care system personnel was moderate to high (M = 3.48, SD = 0.737); (4) Role stress significantly positively predicted job burnout (β = .379, t = 4.632, p < .001); (5) Psychological capital among community mental health care system personnel partially mediated the relationship between role stress and job burnout (β = .227, p = .001).

DISCUSSION AND CONCLUSION: Based on these findings, recommendations were proposed for the cultivation and management of community mental health care system personnel, such as organizing meetings to reduce role conflicts, planning and managing manpower to alleviate role overload, and establishing mechanisms for personnel training to enhance psychological capital.

PMID:42035199 | DOI:10.1186/s40359-026-04532-3

Arch Public Health. 2026 Apr 25. doi: 10.1186/s13690-026-01920-4. Online ahead of print.

ABSTRACT

BACKGROUND: The predicted skeletal muscle mass index (pSMI), derived from the serum creatinine-to-cystatin C ratio (CCR), has emerged as a novel biomarker for predicting the onset of type 2 diabetes mellitus. However, its application remains primarily limited to East Asian populations, and the relationship between pSMI and mortality in general populations remains unclear. Therefore, this study aimed to investigate the association between pSMI and all-cause mortality in a nationally representative US adult population.

METHODS: We analyzed data from three cycles (1999-2004) of the National Health and Nutrition Examination Survey (NHANES). pSMI levels were analyzed both as a continuous variable and categorized into tertiles. To assess the association between pSMI and all-cause mortality, we performed multivariable Cox regression, restricted cubic spline (RCS) analysis, and Kaplan-Meier survival analysis.

RESULTS: During a median follow-up of 193.2 months (2217 deaths), multivariable-adjusted analyses revealed that higher pSMI levels were significantly associated with reduced all-cause mortality (HR 0.76, 95% CI 0.72-0.80; p < 0.001). Compared to the lowest tertile (T1:4.98-7.83), T2 (7.84-9.18) and T3 (9.19-19.24) showed progressively lower mortality risks (T2: HR 0.79, 95% CI 0.67-0.94, p = 0.009; T3: HR 0.66, 95% CI 0.50-0.88, p = 0.004). Restricted cubic spline analysis demonstrated an L-shaped association (p for non-linear = 0.003) with an inflection point at 10.0 (HR 0.632, 95% CI 0.543-0.721; p < 0.001). Sex-stratified analyses revealed inflection points at 10.5 (males) and 7.6 (females). Kaplan-Meier analysis confirmed significantly improved survival with higher pSMI levels (all p < 0.001 for total population, males and females).

CONCLUSIONS: This study identifies pSMI as an independent predictor of lower all-cause mortality, revealing a nonlinear L-shaped association with a distinct threshold effect. The protective relationship remains consistent across both sexes, though with differing inflection points. These findings highlight the clinical importance of assessing skeletal muscle mass for mortality risk stratification.

PMID:42035178 | DOI:10.1186/s13690-026-01920-4

J Orthop Surg Res. 2026 Apr 25. doi: 10.1186/s13018-026-06855-8. Online ahead of print.

ABSTRACT

BACKGROUND: Some studies regarding patients complaining of residual pain after total knee arthroplasty (TKA) showed pain scores improvement using genicular nerve radiofrequency ablation (GNRFA). This prompted the hypothesis that combining GNRFA with TKA intraoperatively might improve early postoperative pain control and functional outcomes.

METHODS: Seventy patients were randomly assigned into two groups, one group underwent total knee arthroplasty combined with genicular nerve radiofrequency ablation (TKA-GNRFA), and the other group underwent total knee arthroplasty (TKA) alone. A parallel-group trial with 1:1 allocation using a superiority framework, Visual Analog Scale (VAS), and functional outcome using the Oxford Knee Score (OKS) were evaluated. Assessments were conducted during the first six months following surgery.

RESULTS: There were no significant differences in pain score or functional outcome between the two groups in the first six months postoperative follow-up period.

CONCLUSION: At Six months postoperatively, Combining Genicular Nerve radiofrequency ablation with total knee arthroplasty (TKA-GNRFA) showed no significant advantage regarding pain scores and functional outcome over performing TKA alone. Further randomized controlled trials with larger sample sizes are recommended to provide higher-level evidence and validate these findings. Trial Registration Retrospectively registered under Trial Registration Number NCT07381062 on 24-01-2026.

PMID:42035153 | DOI:10.1186/s13018-026-06855-8

Breast Cancer Res. 2026 Apr 25. doi: 10.1186/s13058-026-02232-9. Online ahead of print.

NO ABSTRACT

PMID:42035136 | DOI:10.1186/s13058-026-02232-9