Tag: nevin manimala

JAMA Neurol. 2026 May 11. doi: 10.1001/jamaneurol.2026.1206. Online ahead of print.

ABSTRACT

IMPORTANCE: Reliable global estimates of the incidence and prevalence of dementia with Lewy bodies (DLB) are lacking, limiting understanding of its epidemiology and burden.

OBJECTIVE: To estimate pooled incidence and prevalence of DLB from population-based studies worldwide, overall and by age and sex.

DATA SOURCES AND STUDY SELECTION: PubMed, Embase, and Scopus were systematically searched from inception to October 22, 2024, for population-based studies reporting DLB incidence and/or prevalence based on validated diagnostic criteria.

DATA EXTRACTION AND SYNTHESIS: Three reviewers independently screened studies, extracted data, and assessed risk of bias according to PRISMA guidelines. Incidence and prevalence estimates were pooled using random-effects meta-analysis. Subgroup and sensitivity analyses explored variation by age, sex, and study design.

MAIN OUTCOMES AND MEASURES: Incident and prevalent DLB cases defined by consensus, Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases diagnostic criteria, with denominators based on census or author-defined population at risk.

RESULTS: From 2520 records screened, 16 population-based studies were included and 12 contributed to meta-analyses. In individuals 65 years or older, pooled incidence was 46.85 per 100 000 person-years (95% CI, 23.78-92.30) and pooled prevalence 352.26 per 100 000 population (95% CI, 112.25-1099.79). In individuals younger than 65 years, pooled incidence was 0.34 per 100 000 person-years (95% CI, 0.14-0.83) and prevalence 2.52 per 100 000 population (95% CI, 1.43-4.44). Incidence was higher in males (5.45; 95% CI, 4.13-7.19) than females (4.32; 95% CI, 2.48-7.52). Across all ages, pooled crude incidence was 4.79 (95% CI, 3.90-5.88). Only 1 study reported all-age prevalence (19.13; 95% CI, 15.38-23.51). Between-study heterogeneity was high (I2 ≥ 85%).

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of population-based studies, clinically diagnosed DLB was uncommon, likely reflecting underdiagnosis and diagnostic insensitivity. Reported incidence and prevalence rose steeply with age, were higher in men, and varied widely across settings. These findings provide a robust reference for future epidemiologic research and public health planning, underscoring the need for standardized diagnostic approaches and inclusion of underrepresented populations to refine global burden estimates.

PMID:42113545 | DOI:10.1001/jamaneurol.2026.1206

Vet Med Sci. 2026 May;12(3):e70991. doi: 10.1002/vms3.70991.

ABSTRACT

Eimeria spp. are major protozoan parasites of cattle, causing coccidiosis with substantial economic and animal health impacts worldwide. This study systematically reviewed and meta-analysed the global prevalence, species distribution and associated risk factors of Eimeria spp. in cattle. Various international databases were searched from inception to 16 April 2025. Eligible studies reported extractable prevalence data for naturally infected cattle. Pooled prevalence was estimated using a random-effects model, with heterogeneity assessed by I² statistic. Subgroup analyses were conducted by publication year, continent, country and sample size. Age- and sex-specific data were analysed descriptively due to missing denominators. Genetic diversity and seasonal patterns were summarized descriptively. Meta-regression evaluated sample size, annual precipitation, publication year and national cattle population. Sensitivity analysis and funnel plot (Egger’s test) assessed robustness and publication bias. A total of 203 studies including 133,740 cattle from 55 countries were analysed. The global pooled prevalence of Eimeria spp. in cattle was 33.6% (95% confidence interval [CI]: 29.6%-37.8%), with substantial heterogeneity (I² = 99.4%). Prevalence ranged from 27.1% (2012-2018) to 40.8% (≤2011), 29.5% in Asia to 67.4% in Central America and 1% (Macedonia) to 94.2% (Costa Rica), though some national estimates were based on single studies. Calves <1 year accounted for the highest proportion of positives (56.3%, 95% CI: 46.2-65.8), and females showed higher infection rates (66.7%, 95% CI: 61.7-71.4). Infections peaked during warm and humid periods. Sixteen Eimeria species were identified in cattle; E. bovis and E. zuernii predominated, followed by E. auburnensis, E. ellipsoidalis, E. cylindrica and E. alabamensis. Sensitivity analyses confirmed estimate stability. Meta-regression identified sample size as the only significant predictor, explaining 4% of heterogeneity. Publication bias was detected (p < 0.05). Eimeria infection imposes a substantial global burden in cattle, particularly among calves and females. Although sample size influenced reported prevalence, marked heterogeneity persists. Standardized reporting and geographically balanced studies are needed to better inform global coccidiosis control strategies.

PMID:42113544 | DOI:10.1002/vms3.70991

JAMA Netw Open. 2026 May 1;9(5):e2611774. doi: 10.1001/jamanetworkopen.2026.11774.

ABSTRACT

IMPORTANCE: Robotic-assisted surgery is increasingly used in acute care surgery, but the impact of individual surgeon robotic case volume on outcomes for both elective and emergency general surgery procedures remains uncertain.

OBJECTIVE: To evaluate the association between annual surgeon robotic case volume and patient outcomes following robotic-assisted elective and emergency general surgery.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the Premier Healthcare Database (PHD), a large US all-payer hospital database, from January 2021 to December 2023. The PHD aggregates data from nonprofit, community, and teaching hospitals across rural and urban areas, representing 25% of all US inpatient admissions. Adult patients (aged ≥18 years) undergoing robotic-assisted cholecystectomy, colectomy, appendectomy, small bowel resection, or ventral hernia repair were included.

EXPOSURE: Annual surgeon-level robotic case volume, categorized as low (≤25), intermediate (26-75), high (76-150), or very high (≥151).

MAIN OUTCOMES AND MEASURES: The primary outcome was conversion to open surgery; secondary outcomes included postoperative complications, intensive care unit (ICU) admission, 30-day readmission, operative time, hospital length of stay, total hospital cost, and in-hospital mortality. Multivariable logistic and linear regression models, respectively, were used to estimate adjusted odds ratios (AORs) and mean ratios with 95% CIs. Models adjusted for patient demographics, hospital characteristics, and surgeon specialty.

RESULTS: Among 185 924 patients undergoing robotic procedures (137 879 elective and 48 045 emergency), most (58.2%) were female (57.1% of elective and 61.5% of emergency cases). Mean (SD) patient age was 54.9 (16.6) years overall (55.6 [15.8] years for elective and 53.0 [18.5] years for emergency procedures). In elective procedures, increasing annual surgeon volume was associated with stepwise improvements across most outcomes; compared with low volume surgeons, very high volume surgeons had lower odds of conversion to open surgery (AOR, 0.45; 95% CI, 0.36-0.56), complications (AOR, 0.87; 95% CI, 0.79-0.96), readmission (AOR, 0.79; 95% CI, 0.68-0.91), and ICU admission (AOR, 0.61; 95% CI, 0.46-0.82). Operative time (mean ratio, 0.77; 95% CI, 0.75-0.79), hospital length of stay (mean ratio, 0.89; 95% CI, 0.88-0.91), and costs (mean ratio, 0.83; 95% CI, 0.82-0.84) were also significantly lower. In emergency procedures, very high vs low surgeon volume was associated with lower odds of conversion to open surgery (AOR, 0.73; 95% CI, 0.54-1.00) and modest reductions in operative time (mean ratio, 0.88; 95% CI, 0.85-0.91) and cost (mean ratio, 0.92; 95% CI, 0.89-0.94). No association was observed between surgeon volume and in-hospital mortality in either cohort.

CONCLUSIONS AND RELEVANCE: In this cohort study, greater annual surgeon robotic case volume was associated with better patient outcomes in elective general surgery and, to a lesser degree, in emergency procedures. These findings highlight the importance of surgeon-specific experience in robotic surgery and may inform training, credentialing, and strategies for safe expansion of robotic capabilities in acute care surgery.

PMID:42113516 | DOI:10.1001/jamanetworkopen.2026.11774

JAMA Netw Open. 2026 May 1;9(5):e2611835. doi: 10.1001/jamanetworkopen.2026.11835.

ABSTRACT

IMPORTANCE: Telemedicine is now widely used, stimulated by pandemic-era expansion rules and payment parity to in-person visits. Lawmakers continue to consider how to revise existing policies because of uncertainty about the potential for telemedicine to increase utilization and spending.

OBJECTIVE: To quantify the association between telemedicine adoption and visits and spending.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used multipayer medical claims data from MedInsight’s research database for a national sample of adults continuously enrolled in Medicare fee-for-service, Medicare Advantage, dual-eligible, Medicaid, or commercial insurance, from January 1, 2019, to October 31, 2023. Data were analyzed from April 30, 2024, to February 10, 2026.

EXPOSURE: Regional telemedicine adoption (measured at the hospital referral region [HRR] level).

MAIN OUTCOMES AND MEASURES: The primary outcomes were (1) total combined telemedicine and in-person ambulatory visits (primary care, specialist, and preventive screening visits), and (2) total combined per-member-per-month spending on professional, inpatient, facility outpatient, prescription drug, and ancillary payments. By use of difference-in-differences analyses on visit-level and spending-level changes before (January 1, 2019, to December 31, 2019) vs after (January 1, 2021, to October 31, 2023) telemedicine expansion in high-telemedicine vs low-telemedicine adoption quintiles (measured at the HRR level), age-adjusted, sex-adjusted, and diagnosis-adjusted Poisson regressions were estimated, accounting for repeated measurements over time. Analysis was also stratified by urbanicity, payer, and Centers for Disease Control and Prevention Social Vulnerability Index quintiles to explore heterogeneous associations.

RESULTS: The sample included 3.04 million US individuals (mean [SD] age, 54.2 [17.2] years; 55.7% female) who utilized 120 million visits and incurred $178.4 billion in spending during 2019 to 2023. In 2019, the mean (SD) visit rate was 0.66 (0.035), and the mean (SD) spending rate was $774.59 ($36.78) per-member-per-month. Overall, point estimates suggested high-adopting areas had 2.4% (95% CI, -8.1% to 3.6%) fewer visits and 0.5% (95% CI, -13.1% to 13.9%) lower spending; however, 95% CIs crossed the null. Similarly, point estimates varied across subgroups but none achieved statistical significance: there were 4.4% (95% CI, -11.2% to 3.0%) fewer visits and 2.3% (95% CI, -18.9% to 17.8%) lower spending among urban populations, 2.5% (95% CI, -12.9% to 8.0%) lower spending for Medicaid-insured individuals, 5.3% (95% CI, -47.1% to 66.2%) lower spending for dual-eligible individuals, 3.0% (95% CI, -9.2% to 3.5%) lower spending for Medicare Advantage-insured individuals, and 1.5% (95% CI, -19.1% to 19.8%) lower spending among the most socially vulnerable populations. Conversely, point estimates suggested 3.4% (95% CI, -4.9% to 12.5%) greater visits and 3.8% (95% CI, -12.2% to 21.4%) higher spending in rural areas, 1.1% (95% CI, -12.8% to 17.3%) higher spending for commercially insured individuals, 1.0% (95% CI, -7.1% to 11.5%) higher spending for Medicare fee-for-service-insured individuals, and 4.5% (95% CI, -12.7% to 23.1%) higher spending among the least socially vulnerable groups. All 95% CIs crossed the null.

CONCLUSIONS AND RELEVANCE: Nationwide telemedicine adoption was not significantly associated with changes in visits or spending, either overall or when stratified by urbanicity, payer type, or area-level social vulnerability, thus easing concerns about large utilization and spending increases from telemedicine expansion.

PMID:42113515 | DOI:10.1001/jamanetworkopen.2026.11835

JAMA Netw Open. 2026 May 1;9(5):e2611913. doi: 10.1001/jamanetworkopen.2026.11913.

ABSTRACT

IMPORTANCE: Upstream social determinants, including structural disadvantages, are critical drivers of health and aging. While structural disadvantages shape biological aging and inflammatory processes among older adults, it is less clear how this association emerges and endures over the life course.

OBJECTIVE: To assess whether adolescent exposure to structural disadvantage is associated with epigenetic aging and inflammation-related DNA methylation (DNAm) in early midlife and to evaluate whether associations differ by race.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used data from non-Hispanic Black and White respondents in the National Longitudinal Study of Adolescent to Adult Health (Add Health). Add Health comprises a nationally representative cohort of US adolescents in grades 7 to 12 in 1994 (wave I) followed for over 20 years across 6 waves of data. Venous blood samples were collected (2016-2018) and analyzed for DNAm (2021-2024) among Add Health respondents in early midlife (ages 33-43 years at blood collections). Data were analyzed from September 2024 to February 2026.

EXPOSURE: The main exposure was structural disadvantage in adolescence, assessed as 5 county-level economic, education, and segregation indicators from the 1990 decennial US Census.

MAIN OUTCOMES AND MEASURES: The main outcomes included 3 epigenetic clocks (PhenoAge, GrimAge2, and DunedinPACE) and 2 measures of inflammation-related DNAm (C-reactive protein [CRP] and tumor necrosis factor-α). Confirmatory factor analysis was used to derive a latent factor of structural disadvantage in adolescence, and multivariate regression models assessed the association between the structural disadvantage latent measure and each outcome.

RESULTS: Data from 3788 participants (mean [SD] age at wave V, 38.4 [0.01] years; 50.9% [SE, 1.1%] female and 49.1% [SE, 1.1%] male; and 19.7% [SE, 0.9%] Black and 80.3% [SE, 0.9%] White) were analyzed. Considering average associations across the sample, exposure to higher vs lower levels of structural disadvantage in adolescence was associated with accelerated epigenetic aging (GrimAge2: β, 0.35 [95% CI, 0.09-0.61]; DunedinPACE: β, 0.08 [95% CI, 0.03-0.13]) and greater CRP-related DNAm (β, 0.07 [95% CI, 0.02-0.12]), even after adjusting for self-reported race and family socioeconomic status. Findings from an interaction model suggested that while Black respondents experienced faster epigenetic aging and greater CRP-related DNAm overall, the association between adolescent structural disadvantage and these outcomes was slightly negative for Black respondents, yet positive for White respondents.

CONCLUSIONS AND RELEVANCE: In this prospective cohort study of adults in early midlife, the results suggest that early-life contexts were important factors for accelerated epigenetic aging and CRP-related DNAm. These findings enhance understanding of when and how disparities in aging-related diseases may emerge, informing effective solutions for addressing the rising burden of aging-related diseases.

PMID:42113514 | DOI:10.1001/jamanetworkopen.2026.11913

Iran J Allergy Asthma Immunol. 2026 Feb 1;25(2):212-221. doi: 10.18502/ijaai.v25i2.20800.

ABSTRACT

Anti-recombinant human acid α-glucosidase (anti-rhGAA) antibody formation is a major challenge in patients with Pompe disease receiving enzyme replacement therapy (ERT). The clinical significance of these antibodies and their detection methods remain uncertain. This study aimed to evaluate the diagnostic and functional relevance of anti-rhGAA antibodies in late-onset Pompe disease (LOPD) and to compare the performance of ELISA and Western blot assays. Fourteen patients with LOPD undergoing ERT and 14 age- and sex-matched healthy controls were studied. Serum anti-rhGAA antibodies and their IgG, IgM, and IgA isotypes were quantified using ELISA and verified by Western blot. Motor function was assessed using the Pompe Motor Function Levels Questionnaire, an adapted version of the GMFCS validated for Pompe disease. Total and isotype-specific anti-rhGAA antibody levels were significantly higher in patients than in controls. ROC analysis showed excellent discrimination between groups. Strong agreement was observed between ELISA and Western blot results. However, antibody levels were not significantly correlated with motor function grade. Given the small sample size (n = 14), this non-significant result may reflect limited statistical power rather than a true lack of association. Anti-rhGAA antibody detection effectively distinguishes LOPD patients from healthy individuals. Western blot provides a reliable, low-cost alternative to ELISA, particularly useful in resource-limited settings. Nevertheless, the prognostic utility of antibody titers for functional outcomes remains uncertain and warrants larger, multicenter validation studies.

PMID:42113496 | DOI:10.18502/ijaai.v25i2.20800

Iran J Allergy Asthma Immunol. 2026 Feb 1;25(2):161-169. doi: 10.18502/ijaai.v25i2.20795.

ABSTRACT

Asthma is a common chronic respiratory disease in children, often leading to acute exacerbations marked by dyspnea, cough, and wheezing, which frequently necessitate emergency medical care. While standard therapies are effective, the exploration of novel drug delivery routes continues. Oral montelukast is a recognized treatment, but the efficacy of its intranasal formulation for acute attacks remains underexplored. This study aimed to evaluate the clinical effectiveness of intranasal montelukast as an adjunct therapy for pediatric asthma exacerbations. A single-blinded, placebo-controlled, single-center trial was conducted involving children aged 2-12 years hospitalized with moderate to severe acute asthma. Participants were randomized to receive either intranasal montelukast or a placebo alongside standard care. Key outcomes, including the Pulmonary Index Score (PIS), respiratory rate, oxygen saturation, and length of hospital stay, were systematically assessed. The analysis of 25 patients in each group revealed no significant baseline differences. The intranasal montelukast group demonstrated a statistically significant and sustained reduction in PIS scores at critical intervals (8, 12, and 24 hours) compared to the placebo group. Improvements in respiratory rate and oxygen saturation were also more pronounced with the active treatment. Notably, the mean hospital stay was significantly shorter for the montelukast group (2.16 days) than the placebo group (3.12 days). In conclusion, intranasal montelukast shows significant promise as an effective adjunct therapy for acute pediatric asthma, correlating with accelerated clinical improvement and a reduced duration of hospitalization. These encouraging results justify further investigation through larger, multicenter trials to definitively establish its efficacy and safety profile.

PMID:42113491 | DOI:10.18502/ijaai.v25i2.20795

Int J Pharm Pract. 2026 May 11:riag061. doi: 10.1093/ijpp/riag061. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the acceptability of the ‘I manage my meds’ toolkit in supporting adults aged 65 years and above to manage multiple medications at home. A secondary objective was to assess the extent to which ‘I manage my meds’ acceptability differs between different demographic groups, in this study, those from a South Asian background.

METHODS: A community researcher facilitated study was conducted in Bradford, UK. Sixty participants aged 65-94 years, each managing at least five medications, were recruited. As a focus of this study was to explore whether the culturally adapted toolkit was acceptable, half of the sample recruited were from a South Asian background. Participants engaged with the toolkit, available in English and Urdu, before completing a structured questionnaire based on the theoretical framework of acceptability. Quantitative data were analysed using factor analysis, descriptive statistics, and comparative tests between ethnic groups.

KEY FINDINGS: The toolkit demonstrated high overall acceptability, with a mean score of 2.93 out of 4. Acceptability did not significantly differ by age but varied across domains of the framework. Intervention Coherence received the highest ratings, indicating that participants found the toolkit easy to understand, while self-efficacy scored lowest, suggesting some limitations in confidence for medicine self-management. South Asian participants reported significantly higher overall acceptability (mean 3.33) compared with non-South Asian participants (mean 2.61). Significant differences were found across multiple domains, with South Asian participants reporting greater perceived usefulness and fewer barriers to use.

CONCLUSIONS: The findings indicate that the ‘I manage my meds’ toolkit is a clear, practical, and well-received resource for older adults managing polypharmacy at home. The culturally adapted version demonstrated high acceptability among South Asian participants, highlighting the importance of tailoring health interventions to diverse populations.

PMID:42113487 | DOI:10.1093/ijpp/riag061

J Biopharm Stat. 2026 May 11:1-28. doi: 10.1080/10543406.2026.2667334. Online ahead of print.

ABSTRACT

The win ratio (WR) is a widely used metric to compare treatments in randomized clinical trials with hierarchically ordered endpoints. Counting-based approaches, such as Pocock’s algorithm, are the standard for WR estimation. However, this algorithm treats participants with censored or missing data inadequately, which may lead to biased and inefficient estimates, particularly in the presence of heterogeneous censoring or missing data between treatment groups. Although recent extensions have addressed some of these limitations for hierarchical time-to-event endpoints, no existing methods – aside from the computationally intensive multiple-imputation approach – can accommodate settings that include nonsurvival endpoints that are subject to missing data. In this paper, we propose a simple nonparametric maximum likelihood estimator (NPMLE) of WR for two hierarchical endpoints that are subject to censoring and missing data. Our method uses all observed data, avoid strong parametric assumptions and come with a closed-form asymptotic variance estimator. We demonstrate its performance using simulation studies and two data examples, based on the HEART-FID and ISCHEMIA trials. The proposed method provides a consistent estimator, improves estimation efficiency, and is robust under noninformative censoring and missing at random (MAR) assumptions, offering a flexible alternative to existing WR estimation methods. A user-friendly R package, WinRS, is available to facilitate implementation.

PMID:42113484 | DOI:10.1080/10543406.2026.2667334

Phys Eng Sci Med. 2026 May 11. doi: 10.1007/s13246-026-01742-2. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer is the most frequently diagnosed cancer among women. Accurate diagnosis and effective management rely heavily on high-quality positron emission tomography (PET) imaging. A novel time-of-flight (TOF)-enhanced deep learning reconstruction (DLR) technique has recently been introduced for the Omni Legend (GE Healthcare) PET/CT system. However, its clinical utility in breast cancer imaging has not yet been fully established. This study aims to assess the impact of the DLR method on ¹⁸F-FDG PET/CT imaging in patients with breast cancer.

METHODS: This retrospective study included 30 female breast cancer patients who underwent ¹⁸F-FDG PET/CT using the Omni Legend system. PET images were reconstructed using the Bayesian penalized likelihood (BPL) method and a DLR method with three TOF enhancement levels: low (L-DLR), medium (M-DLR), and high (H-DLR). Image quality was evaluated using liver noise level (Noise) and lesion signal-to-background ratios (SBR). Percentage changes in these metrics between BPL and each DLR setting were calculated. The four reconstruction methods were compared using the Friedman test with Bonferroni correction. P-values < 0.05 were used to denote statistical significance.

RESULTS: Noise values for BPL, L-DLR, M-DLR, and H-DLR were 0.08, 0.06, 0.06, and 0.08, respectively (P < 0.001), whereas SBR values were 3.75, 3.85, 4.09, and 4.39, respectively (P < 0.001). Compared with BPL, L-DLR and M-DLR significantly reduced Noise by 33.20% (P < 0.001) and 22.21% (P < 0.001), respectively, whereas M-DLR and H-DLR significantly improved SBR by 8.96% (P < 0.001) and 16.79% (P < 0.001), respectively.

CONCLUSIONS: The TOF-enhanced DLR method improves PET image quality metrics compared with the BPL method and has the potential to enhance image quality in ¹⁸F-FDG PET/CT for patients with breast cancer.

PMID:42113440 | DOI:10.1007/s13246-026-01742-2