Nevin Manimala

Saudi Dent J. 2026 May 8;38(5):64. doi: 10.1007/s44445-026-00158-8.

ABSTRACT

When it comes to root canal therapy, the right working length (WL) must be established in order to minimize material extrusion and the resulting post- procedure pain. Although electronic apex locators (EALs) are a radiation-free, time-saving substitute for conventional or digital radiography techniques, but their impact on postoperative pain has been controversial. This systematic review was registered in PROSPERO (CRD420251247626) and adhered to PRISMA 2020 guidelines. Randomized controlled trials (RCTs) comparing EAL versus radiographic WL determination, with postoperative pain as an outcome, were searched in PubMed, Cochrane CENTRAL, and ScienceDirect from January 2000 to November 17, 2025. Only peer-reviewed RCTs involving permanent teeth were considered. Bias risk was evaluated using Cochrane RoB 2.0. Four RCTs (total n = 414 patients) met the inclusion criteria. Four RCTs (2014-2024) showed no statistically significant difference in postoperative pain incidence, intensity (measured by VAS or 4-point verbal rating scale), analgesic consumption, or time to pain resolution between EAL and radiographic groups at any time point (4 h to 7 days). Pain levels were generally low to moderate and resolved within 72 h in both groups. One three-arm trial demonstrated significantly lower early pain (6-48 h) with a simultaneous/hybrid EAL plus radiographic technique compared with either method alone. No flare-ups or serious adverse events were reported. Based on limited evidence from four RCTs with methodological concerns (including risks in randomization, blinding, and subjective pain assessment) and very low certainty, electronic apex locators and radiographic methods may yield similar postoperative pain outcomes in single-visit root canal treatment of vital teeth. A combined method of both techniques showed preliminary indications of early pain alleviation in one small trial on symptomatic conditions, but this requires confirmation. EALs may represent a radiation free alternative or supplement to radiography that does not appear to increase pain, though the evidence is insufficient to draw firm conclusions.

PMID:42101759 | DOI:10.1007/s44445-026-00158-8

Acta Neuropsychiatr. 2026 May 8:1-55. doi: 10.1017/neu.2026.10085. Online ahead of print.

ABSTRACT

OBJECTIVE: Dementia is a group of symptoms, characterized by a loss of cognition that interferes with everyday tasks, difficulty focusing, planning, problem solving, and behavioral changes, such as apathy, anxiety, or depression. The leading cause of dementia is Alzheimer’s disease, but vascular dementia or mild cognitive impairment are also frequently occurring. There are six drugs legislated in Europe for use in the treatment of dementia. There are unmet clinical needs to find more effective, better tolerated or complementary therapeutic options. The aim of this study is to comprehensively analyze the results of clinical trials and other human studies regarding the efficacy and safety of herbal interventions used in patients with dementia.

METHODS: We enrolled a total of 48 studies for this systematic review, of which 27 were included into the statistical analysis of effect size (Cohen’s d).

RESULTS: We found significant improvements mainly after administration of Ginkgo biloba, Crocus sativus, Salvia officinalis, and Melissa officinalis.It should be emphasized that some herbs and herbal formulations demonstrated efficacy comparable to that of donepezil, a widely used and approved medication, suggesting potential for phytopharmaceutical therapies as complementary approaches. In some studies, the observed effects were similar to those reported for conventional treatments, indicating promising directions for further research in Alzheimer’s disease and dementia.

CONCLUSION: In light of the evidence, phytopharmaceuticals have a promising role as a co-therapeutic option or alternative for patients with dementia who do not tolerate or have contraindications to standard medications. However, further research is necessary to translate these initial promising results into clinical practice.

SUMMATIONS: Phytopharmaceuticals have a promising role as a complementary or alternative option for dementia patients who cannot tolerate or respond to standard medications. Certain phytopharmaceuticals demonstrated comparable short-term symptomatic effects to standard treatments in small trials; however, evidence is insufficient to support equivalence or superiority.

CONSIDERATIONS: Many of the studies reviewed are limited by very small sample sizes, which is associated with a high risk of bias when interpreting large effect sizes (Cohen’s d). The short duration of interventions (often only 3 to 6 months) is insufficient to assess whether phytotherapeutics can constitute disease-modifying treatments (DMTs).

PMID:42100836 | DOI:10.1017/neu.2026.10085

Psychol Med. 2026 May 8;56:e123. doi: 10.1017/S0033291726103833.

ABSTRACT

BACKGROUND: Systemic inflammation is hypothesized to contribute to post-traumatic stress disorder (PTSD) vulnerability. Few studies have examined inflammation shortly after trauma as a predictor of later PTSD symptoms. We examined whether inflammation from the emergency department (ED) post-trauma is associated with PTSD symptom severity over the following 6 months.

METHODS: Our sample included 742 AURORA participants, a longitudinal cohort of patients in 29 EDs across the United States after a traumatic stressor, followed up to 6 months. Plasma cytokines were assessed from a study blood draw in the ED: an inflammatory index (standardized sum of generally pro-inflammatory markers interleukin [IL]-6, IL-8, tumor necrosis factor alpha [TNF-α], interferon gamma [IFN-γ]), and generally anti-inflammatory IL-10. PTSD symptoms were self-reported at 2 weeks, 8 weeks, 3 months, and 6 months post-ED. Covariate-adjusted repeated-measures regressions estimated associations between inflammation and PTSD symptoms, overall and sex-stratified.

RESULTS: Among 742 participants (age m = 40.0 [13.7]; 479 [64.6%] female), PTSD symptoms were elevated then modestly decreased over follow-up. Higher ED inflammation was associated with higher PTSD symptoms across follow-up (standardized symptoms β = 0.05, 95% CI: 0.01-0.09), adjusted for potential confounders. Higher pro-inflammatory index levels and IL-6, IL-8, and TNF-α were associated with higher PTSD symptoms in males only, while higher IL-10 was associated with higher PTSD symptoms in females only.

CONCLUSIONS: Pro-inflammatory levels shortly after traumatic stress are associated with heightened PTSD symptoms, particularly among males. Inflammatory markers may prove useful additions to prediction models for PTSD following trauma, with attention to sex differences.

PMID:42100824 | DOI:10.1017/S0033291726103833

Stroke. 2026 May 8. doi: 10.1161/STROKEAHA.126.055315. Online ahead of print.

ABSTRACT

BACKGROUND: Preservation of treatment allocation randomness, achievement of treatment group size balance, and balance on prognostic baseline covariates are desirable properties of optimal randomization schemes. Previous studies have demonstrated the accuracy of covariate-adaptive randomizations, such as minimal sufficient balance (MSB) randomization, for achieving covariate balance in acute stroke trials at the end of the trial. This study evaluates the performance of covariate-adaptive randomization techniques against simple and block randomization in minimizing site-specific treatment group imbalance in multicenter acute stroke trials.

METHODS: Monte Carlo simulations were used to evaluate the performance of stratified and unstratified versions of MSB, common scale MSB, and common scale group-size MSB (CSSize-MSB), against permuted block and simple randomization designs, for achieving balance across baseline covariates and sites. Simulation conditions investigated include the number of sites (3, 6, or 20 sites), enrollment per site (equal or unequal enrollment across sites), number and distribution of baseline covariates (sex, age, National Institutes of Health Stroke Scale score, large vessel occlusion status), and sample size (n=250, 600, 1000, 3000). The probability of observing statistically significant imbalance on any baseline covariate, proportion of biased allocations, and overall and site-specific group allocation ratio at interims and end of enrollment were used to evaluate the performance of the randomization schemes.

RESULTS: The average probability of observing imbalance on any of the baseline covariates for the simple randomization, permuted block, common scale MSB, common scale group-size MSB, and MSB were 21%, 21%, 0%, 2%, and 2%, respectively, at n=600 with 20 study sites. Although site-specific treatment allocation imbalance was improved under MSB algorithms, imbalance at low-enrolling sites persisted, regardless of the randomization scheme. Treatment allocation randomness and treatment-control group balance were preserved in high-volume sites under MSB.

CONCLUSIONS: Although site-specific treatment group imbalance persisted in low-enrolling sites, regardless of the randomization technique adopted, the overall randomness of treatment allocation and balance of covariates were preserved with MSB algorithms. Logistical considerations and oversight to minimize low enrollment across sites are recommended before onboarding sites in multicenter acute stroke trials.

PMID:42100801 | DOI:10.1161/STROKEAHA.126.055315

Hum Reprod. 2026 May 8:deag029. doi: 10.1093/humrep/deag029. Online ahead of print.

ABSTRACT

STUDY QUESTION: What updates of the International Glossary on Infertility and Fertility Care are required, to reflect contemporary scientific knowledge, social needs, and inclusive definitions, while harmonizing international communication across clinical, research, policy, and public domains?

SUMMARY ANSWER: This 4th edition presents 348 consensus-based terms and definitions, including numerous revisions from the previous edition and 79 newly introduced definitions reflecting advances in reproductive science, technology, and evolving social contexts.

WHAT IS KNOWN ALREADY: Previous glossary editions (2006, 2009, 2017) established internationally recognized definitions related to clinical practice, research, and policy. The 2017 edition comprised 283 terms and, among many others, expanded the concept of infertility to include not only its recognition as a disease, but also as an impairment of function generating disability. The glossary has been extensively used worldwide and has contributed to international standardization of data collection, appropriate comparison of outcome measures, and provided a reference for all stakeholders including policy makers.

STUDY DESIGN, SIZE, DURATION: Under guidance of the organizing committee, 21 professionals from across the world, and representing expertise in different sub-specialties, formed five working groups: clinical definitions; outcome measures; embryology laboratory; clinical and laboratory andrology; and epidemiology, public health and gender related definitions. The definitions from the previous glossary were evaluated and new terms identified. All definitions were then reviewed by an international advisory panel of nine experts that evaluated the glossary from scientific, ethical, cultural, and policy perspectives.

PARTICIPANTS/MATERIALS, SETTING, METHODS: Between November 2024 and October 2025, periodical virtual meetings were held within and between working groups and the organizing committee. Following circulation of the first consensually agreed draft, a one-day in-person meeting with representatives of all working groups and members of the international advisory panel was held at ESHRE, June 2025. Most terms and definitions were discussed and agreed. In the absence of agreement, further discussions were held between the organizing committee, working group chairs and members of the advisory panel. It had been determined at the outset that final disagreement would be resolved via a two-third majority vote. All terms and definitions were, however, reached by consensus and adopted following a final round of review and approval by all authors.

MAIN RESULTS AND THE ROLE OF CHANCE: The glossary now includes 348 terms. Compared to the previous edition, 14 terms were deleted, numerous terms modified and 79 new terms were added. Modifications reflect current scientific knowledge, technological advancements, and inclusivity related to gender and family structures. Chance does not play a role, as all definitions are consensus-based.

LIMITATIONS, REASONS FOR CAUTION: Some terms may require future refinement as scientific knowledge evolves and societal contexts change. The glossary reflects consensus rather than empirical testing of all definitions.

WIDER IMPLICATIONS OF THE FINDINGS: This glossary provides a global reference for standardized terminology, supporting clinical care, research, international comparisons, policy making, patient communication, and reproductive health literacy.

STUDY FUNDING/COMPETING INTEREST(S): Neither ICMART, responsible for conducting this project, nor any of the participants received specific financial support for their activities in this project. Ferring provided ICMART with a fixed amount to cover venue costs and a one-day hotel accommodation for participants attending the in-person meeting held prior to the ESHRE Congress in June 2025. Disclosures were provided by all authors, and none reported any conflict of interest related to this manuscript.

TRIAL REGISTRATION NUMBER: N/A.

PMID:42100799 | DOI:10.1093/humrep/deag029

Front Psychiatry. 2026 Apr 22;17:1799213. doi: 10.3389/fpsyt.2026.1799213. eCollection 2026.

ABSTRACT

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected the physical and mental health of older adults worldwide. This study aimed to identify the factors associated with depression among older adults during the pandemic and to develop strategies to enhance their psychological well-being.

METHODS: Data from The Irish Longitudinal Study on Ageing (TILDA) collected during the COVID-19 pandemic were compared with pre-pandemic data (Wave 5). We examined the impact of the pandemic on depressive symptoms in older adults and investigated potential influencing factors related to depression, including lifestyle changes, COVID-19 concern and protective behaviors, and psychological assessments.

RESULTS: The prevalence of clinically significant depressive symptoms in older adults was significantly higher after the onset of the COVID-19 pandemic than in the pre-pandemic Wave 5 (p < 0.001). The rates of difficulty falling asleep and early awakening increased significantly, whereas the time spent on anaerobic exercise, aerobic exercise, and slow walking decreased markedly (all p < 0.001). Hierarchical multiple linear regression analysis revealed that the model including predictors such as age, gender, Perceived Stress Scale score, UCLA Loneliness Scale score, difficulty falling asleep, early awakening, sleep duration, days of anaerobic exercise, days of aerobic exercise, and days of slow walking was statistically significant (F = 165.241, p < 0.001, R = 0.734, R² = 0.539, adjusted R² = 0.536), explaining 53.9% of the variance in depressive symptoms.

CONCLUSION: The COVID-19 pandemic might be associated with an increase in depressive symptoms among older adults. This exacerbation is closely linked to lifestyle changes (sleep disturbances and reduced physical activity), psychological factors (heightened stress and loneliness), and certain information-seeking behaviors. These findings underscore the need for integrated interventions that target these modifiable risk factors.

PMID:42100780 | PMC:PMC13143985 | DOI:10.3389/fpsyt.2026.1799213

Front Psychiatry. 2026 Apr 22;17:1811824. doi: 10.3389/fpsyt.2026.1811824. eCollection 2026.

ABSTRACT

INTRODUCTION: The neurobiological mechanisms underlying Attention-Deficit/Hyperactivity Disorder (ADHD) remain incompletely understood. Existing research has identified abnormalities in alpha rhythm among individuals with ADHD; however, its association with core symptoms lacks consistency, suggesting that enhanced alpha activity may represent a state-dependent compensatory manifestation. The family environment, particularly caregiver stress, is recognized as an important external factor influencing the development of children with ADHD, yet its potential role as a mediator between clinical symptoms and neural brain activity has yet to be systematically explored.

METHODS: The study included 59 children with ADHD. Correlations among attention deficit scores (ADS), hyperactivity/impulsivity scores (HIS), various dimensions of caregiver strain, and posterior alpha power were analyzed, with Bonferroni correction applied to control for multiple comparisons. Subsequently, hierarchical regression and mediation modeling were employed to examine the mediating effect of caregiver strain.

RESULTS: No direct correlation was found between ADS and alpha power. A triangular pattern among symptoms, stress, and brain activity emerged: ADS showed strong positive correlations with all dimensions of caregiver strain, and subjective internalized strain (SIS) remained significantly positively correlated with alpha power even after correction. The mediation model indicated a suppression pattern, wherein the statistical association between ADS and alpha power was consistent with a positive indirect pathway via SIS, alongside a masked direct association, resulting in a non-significant total effect.

DISCUSSION: The findings suggest a model in which SIS is a key statistical mediator in the relationship between ADHD symptoms and specific neural oscillatory patterns, and highlight the plasticity of brain function in response to the family emotional environment.

PMID:42100769 | PMC:PMC13143875 | DOI:10.3389/fpsyt.2026.1811824

Dialogues Health. 2026 Apr 21;8:100305. doi: 10.1016/j.dialog.2026.100305. eCollection 2026 Jun.

ABSTRACT

PURPOSE: This study aimed to evaluate oral and dental health status, hygiene practices, and access to dental care among adults living in Gaza, Khan Younis, and the central governorates of Palestine.

METHODS: A descriptive cross-sectional survey was conducted in 2025 among 39 adults aged ≥18 years residing in the study regions. Data were collected using a structured questionnaire (14 closed-ended and 4 open-ended questions) addressing oral hygiene habits, healthcare access, living conditions, and perceptions of dental services. The survey was administered via Google Forms. Descriptive statistics were used, and categorical variables were presented as frequencies and percentages.

RESULTS: The study included 39 participants (48.7% women, 51.3% men). None reported adequate access to nutritious food. A high proportion (89.7%) experienced toothache within the last two years. The most common response was self-management with analgesics (71.6%), while other strategies included visiting a health facility (28.6%), tooth extraction (28.6%), and use of traditional remedies (28.6%). A small proportion (5.7%) reported taking no action. Only 46.2% had visited a dentist in the last two years. Open-ended responses highlighted key challenges, including lack of hygiene supplies (25.6%), limited access to dental services (20.5%), financial constraints (5.1%), poor nutrition (5.1%), and ongoing oral health problems (5.1%).

CONCLUSION: Findings indicate a substantial burden of untreated oral conditions and limited access to dental care in a conflict-affected population. Oral health needs should be integrated into humanitarian health responses to ensure access to preventive and essential dental services.

PMID:42100760 | PMC:PMC13146592 | DOI:10.1016/j.dialog.2026.100305

Health Sci Rep. 2026 May 5;9:e72487. doi: 10.1002/hsr2.72487. eCollection 2026 May.

ABSTRACT

BACKGROUND AND AIMS: The first 28 days of life, the neonatal period, represent a phase of heightened vulnerability for infant survival globally. Despite advancements in medical interventions and increased healthcare access, a substantial number of newborns continue to succumb to preventable causes annually. This study aimed to ascertain the time to death and its associated factors among neonates admitted to the Neonatal Intensive Care Unit (NICU) at Tibebe Ghion Specialized Hospital, Ethiopia.

METHODS: A retrospective follow-up design was employed, encompassing 385 neonates admitted to the NICU of Tibebe Ghion Specialized Hospital between September 11, 2022 and September 5, 2023. Data were extracted from patient records using a standardized checklist. The outcome was time to death, with surviving neonates considered censored. Data were analyzed using STATA version 17. Kaplan-Meier survival curves analyses were used to estimate the probability of death over time. A Cox proportional hazards model was utilized to identify independent predictors of neonatal mortality. Variables with a p value < 0.05 in the multivariable Cox regression were deemed statistically significant at a 95% confidence interval.

RESULTS: Among the 385 neonates, 12.73% experienced mortality, yielding an incidence rate of 43.80 deaths per 1000 neonatal days (95% CI: 0.03-0.06). The median time to death for neonates was 7 days (95% CI: 6.00, 8.00). After multivariable adjustment, respiratory distress syndrome (Adjusted Hazard Ratio [AHR]: 3.00; 95% CI: 1.27-7.75), congenital anomalies (AHR: 2.90; 95% CI: 1.42-5.91), very low birth weight (AHR: 2.50; 95% CI: 1.18-5.28), and gestational diabetes mellitus (AHR: 4.00; 95% CI: 1.76-9.67) were identified as significant independent predictors of neonatal death.

CONCLUSION: The incidence of neonatal mortality observed in this setting was notable. Respiratory distress syndrome, congenital anomalies, very low birth weight, and gestational diabetes mellitus were found to be independently associated with an increased risk of neonatal death.

PMID:42100758 | PMC:PMC13144749 | DOI:10.1002/hsr2.72487

Health Sci Rep. 2026 May 5;9:e72493. doi: 10.1002/hsr2.72493. eCollection 2026 May.

ABSTRACT

INTRODUCTION: Traditional fish smoking in Abuesi, Ghana, exposes workers, primarily women, to significant health risks due to prolonged smoke inhalation. This study evaluates the knowledge, attitudes, and practices (KAP) concerning safe smoking methods. It examines the prevalence of eye conditions among these fish smokers to assess their awareness of health risks and document the impact of extended exposure to smoke.

METHODS: A cross-sectional design was employed involving 320 fish smokers from Abuesi. Data collection was conducted through structured interviews and detailed eye examinations. Statistical analysis included chi-square tests and logistic regression models, were used to explore relationships between exposure duration and health outcomes.

RESULTS: Most participants were women, mostly between the ages of 30 and 65. While nearly 90% were aware of the health risks linked to smoke exposure, fewer than 30% followed recommended safety practices, which shows a significant gap between what they knew and what they did. Many self-reported health concerns, including mild vision problems (about 22%), moderate impairments (just under 2%), and even cases of blindness (around 3%) were reported. Other frequently mentioned symptoms included breathing difficulties (66%), persistent headaches (58%), and eye irritation (49%). Importantly, the analysis showed that participants with greater awareness were 21% more likely to take safety precautions and 13% less likely to suffer from eye conditions, suggesting that knowledge does have a protective effect when it is acted upon.

CONCLUSION: The study highlights a critical disparity between knowledge and the implementation of safety measures among fish smokers in Abuesi. The results underscore the need for targeted educational programs and intervention strategies to reduce health risks among traditional fish smokers.

PMID:42100753 | PMC:PMC13144757 | DOI:10.1002/hsr2.72493