Tag: nevin manimala

Transpl Infect Dis. 2026 May 26:e70245. doi: 10.1111/tid.70245. Online ahead of print.

ABSTRACT

BACKGROUND: Despite increasing interest in sex and gender in transplant medicine, the impact of recipient-donor sex combinations (RDSCs) on posttransplant infections, graft survival, and rejection remains unclear. To assess if RDSC is independently associated with infectious events in solid organ transplantion (SOT) recipients.

METHODS: This retrospective cohort study assessed a national prospectively maintained registry including six transplant centers. All adult patients, undergoing primary transplant of either heart, kidney, liver, or lung, between May 1, 2008, and December 31, 2021, were included. Endpoints were clinically significant infectious events (primary endpoint), graft survival, rejection, and overall survival within the first year. Patients were grouped as per RDSC. The primary statistical outcome of the organ-specific, a priori known risk factor-adjusted analyses are reported as incidence rate ratios (IRRs).

RESULTS: The cohort included 5033 recipients: 2886 (57.3%) kidney, 1224 (24.3%) liver, 515 (10.2%) lung, and 408 (8.1%) heart transplants, documenting 6067 infections. Recipient-donor sex mismatch was not associated with weighted posttransplant infection risk in heart (IRR: 1.06; 95% CI: 0.75, 1.48; p = 0.75), kidney (IRR: 1.03; 95% CI: 0.90, 1.17; p = 0.69), liver (IRR: 1.10; 95% CI: 0.81, 1.50; p = 0.52), or lung (IRR: 1.02; 95% CI: 0.82, 1.26; p = 0.89) recipients. Female kidney recipients had significantly higher infection rates than males (IRR: 1.50; 95% CI: 1.32, 1.71; p < 0.001), largely explained by urinary tract infections. One-year graft survival, rejection, and overall survival were unaffected by RDSC across all organs.

CONCLUSION: RDSC does not influence 1-year SOT infectious outcome, as well as rejection or graft survival as exploratory outcomes.

PMID:42189585 | DOI:10.1111/tid.70245

Arch Argent Pediatr. 2026 May 28:e202510997. doi: 10.5546/aap.2025-10997.eng. Online ahead of print.

ABSTRACT

Introduction. Multiple pregnancies are more frequently associated with adverse maternal and neonatal outcomes. The incidence of multiple pregnancies has increased with the use of assisted reproductive technologies (ART): they account for between 15% and 25% of twin births. ART has also been associated with adverse outcomes in both singleton and multiple pregnancies, although the available evidence is limited and heterogeneous. Objective. To evaluate maternal and perinatal outcomes in spontaneously conceived twin pregnancies and compare them with those conceived through ART. Population and methods. Patients aged 18 years or older with twin pregnancies who reached a gestational age of 24.0 weeks and who underwent first-trimester screening, follow-up, and delivery at the Hospital Italiano de Buenos Aires between January 2014 and December 2022. A composite outcome of maternal and neonatal adverse events was analyzed. Neurological development was monitored until age 2. Results. A total of 243 twin pregnancies were included (148 ART; 95 spontaneous). The ART group had a higher prevalence of advanced maternal age, nulliparity, obesity, and chronic diseases, with statistically significant differences (p <0.001). There were no significant differences in primary maternal outcomes (29% vs. 23%; p = 0.347) or neonatal outcomes (16% vs. 19%; p = 0.371). We found an increased frequency of autism spectrum disorders in pregnancies conceived through ART. Conclusion. Twin pregnancies resulting from ART showed similar maternal and neonatal outcomes to those resulting from spontaneous conception, despite significant differences in baseline maternal characteristics. Long-term follow-up studies are needed.

PMID:42189568 | DOI:10.5546/aap.2025-10997.eng

JAMA Neurol. 2026 May 26. doi: 10.1001/jamaneurol.2026.1443. Online ahead of print.

ABSTRACT

IMPORTANCE: Postherpetic neuralgia (PHN) is a refractory neuropathic pain condition with limited therapeutic options. Although electroacupuncture has demonstrated potential analgesic effects, high-quality evidence from rigorous randomized clinical trials remains limited.

OBJECTIVE: To determine whether electroacupuncture reduces pain severity compared with sham electroacupuncture and evaluate its safety in patients with PHN.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, randomized, sham-controlled clinical trial took place at 7 tertiary hospitals in China and enrolled participants from October 2020 to July 2022, with the last follow-up in September 2022. Data analyses were performed from August to December 2025. Participants with PHN aged 45 to 75 years and moderate to severe pain (11-point Numeric Rating Scale [NRS-11] score ≥4) were recruited. Of 1072 patients screened, 624 were excluded. The remaining 448 participants were randomized to electroacupuncture (n = 225) or sham electroacupuncture (n = 223); 383 participants (85.49%) completed the trial.

INTERVENTION: Twenty sessions of electroacupuncture or sham electroacupuncture over 4 weeks, followed by a 4-week posttreatment follow-up.

MAIN OUTCOMES AND MEASURES: The primary outcome was the change in the NRS-11 scores from baseline to week 4, with responders defined as participants achieving a 30% or more reduction in NRS-11 scores.

RESULTS: Of 448 participants, the mean (SD) age was 63.19 (9.26) years, 233 (52.01%) were male, and 215 were female (47.99%). At week 4, the electroacupuncture group had a greater decrease in the NRS-11 scores (-1.52) than the sham electroacupuncture group (-0.99) with an adjusted mean difference of -0.53 (95% CI, -0.61 to -0.43; P < .001), and the responder rate was significantly higher in the electroacupuncture group (46.68%) than in the sham electroacupuncture group (24.28%) (adjusted risk difference, 22.40%; 95% CI, 13.02%-31.79%; P < .001). These treatment benefits persisted through a 1-month follow-up; no clinically significant adverse events were observed.

CONCLUSIONS AND RELEVANCE: Among patients with PHN in this study, electroacupuncture provided a statistically significant reduction in pain severity, increased responder rates, and improved pain-related functional outcomes. These benefits suggest that electroacupuncture may be a useful nonpharmacological option for integrated management of PHN.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04560361.

PMID:42189557 | DOI:10.1001/jamaneurol.2026.1443

JAMA Netw Open. 2026 May 1;9(5):e2615000. doi: 10.1001/jamanetworkopen.2026.15000.

ABSTRACT

IMPORTANCE: The abrupt withdrawal of humanitarian aid in early 2025 has destabilized health systems across sub-Saharan Africa, yet little is known about the frontline realities of these cuts in refugee-hosting settings.

OBJECTIVE: To explore health care practitioners’ perspectives and experiences of how reductions in global health funding have affected services and refugee health and to identify practitioner recommendations for sustaining care.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used semistructured, in-depth interviews conducted in July 2025 at 6 health facilities within Nakivale Refugee Settlement, Uganda. Participants were health care practitioners representing diverse cadres and facility sizes.

EXPOSURE: Reduction of humanitarian aid.

MAIN OUTCOMES AND MEASURES: The primary outcomes were health care practitioners’ perspectives on the impacts of funding reductions, including changes in service delivery, supply availability, staff conditions, and anticipated future health trends, as well as their recommendations to mitigate harms. Rapid qualitative techniques and thematic analysis were used to analyze responses to obtain actionable implications systematically and efficiently.

RESULTS: The 26 participants (mean [SD] age, 30.92 [3.52] years; 16 men [61.5%]) had a mean (SD) duration in practice of 6.80 (2.65) years, with a mean (SD) of 3.09 (1.92) years in Nakivale. Interviews yielded 4 overarching themes and 18 subthemes: (1) reductions in health care services (HIV and tuberculosis services, nutritional support, maternal health, immunization adherence, inpatient and outpatient care, and perceptions of service availability), (2) supply shortages (medical supplies, transportation fuel, and household support), (3) deteriorating staff conditions (staff reduction, workload and burnout, and resilience), and (4) future predictions and recommendations (disease patterns, migration patterns, bridging the funding gap, and general settlement conditions).

CONCLUSIONS AND RELEVANCE: This qualitative study examined the cascading outcomes of humanitarian aid withdrawal on refugee health care through the voices of frontline practitioners. Their testimonies underscored urgent priorities for restoring and retargeting aid-investing in high-impact levers, strengthening local leadership, and advancing policy reforms-to safeguard refugee health and system resilience, while reminding us of the shared human stakes of humanitarian policy and the global responsibility to act.

PMID:42189537 | DOI:10.1001/jamanetworkopen.2026.15000

JAMA Pediatr. 2026 May 26. doi: 10.1001/jamapediatrics.2026.1815. Online ahead of print.

ABSTRACT

IMPORTANCE: The prevalence of invasive bacterial infections (IBIs), specifically bacteremia and bacterial meningitis, is not well established among febrile infants in the third month of life. International guidelines exclude or vary in management recommendations for this age group.

OBJECTIVE: To assess the prevalence of IBIs among febrile infants aged 60 to 90 days.

DATA SOURCES: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Scopus were searched with deliberate limitation to studies between January 1, 2000, to October 2, 2025, and analyzed in December 2025.

STUDY SELECTION: Studies were included that reported on previously healthy, well-appearing febrile infants 60 to 90 days old evaluated in emergency department or outpatient settings and for whom patient-level IBI status could be ascertained.

DATA EXTRACTION AND SYNTHESIS: Data were extracted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, and risk of bias was assessed using the Joanna Briggs Institute critical appraisal Checklist for Prevalence Studies. Pooled prevalences were calculated using random-effects generalized linear mixed models of logit-transformed single proportions of cases.

MAIN OUTCOMES AND MEASURES: The primary outcome was the prevalence of IBI. Secondary outcomes included the prevalence of bacteremia and bacterial meningitis separately.

RESULTS: The search yielded 13 130 records; 59 studies were included (20 distinct datasets of 34 835 infants). The pooled prevalence of IBI was 1.11% (95% CI, 0.84%-1.47%), bacteremia was 1.01% (95% CI, 0.76%-1.34%), and bacterial meningitis was 0.11% (95% CI, 0.08%-0.16%). Results were consistent across multiple sensitivity analyses excluding (1) retrospective cohorts; (2) cohorts of only infants with fever without source; (3) cohorts with shorter clinical follow-up of less than 7 days; and (4) the largest study (66% of all included patients).

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, the pooled prevalence of IBI among well-appearing febrile infants in the third month of life was 1.11%; bacteremia accounted for most cases, whereas bacterial meningitis was rare. These contemporary prevalence estimates should inform guideline development and shared parent and clinician decision-making for the management of these infants.

PMID:42189531 | DOI:10.1001/jamapediatrics.2026.1815

Hum Vaccin Immunother. 2026 Dec;22(1):2670827. doi: 10.1080/21645515.2026.2670827. Epub 2026 May 26.

ABSTRACT

We aimed to evaluate 12-y (2012-2024) burden, clinical and microbiological characteristics of Invasive Pneumococcal Disease (IPD) at one large research hospital – IRCCS Fondazione Policlinico San Matteo – in northern Italy, with focus on serotypes’ distribution, resistance trends, and vaccination impact on outcomes and costs. The study included 234 IPD cases. Data were obtained from medical records, microbiological reports, and vaccination registries. Statistical analyses included descriptive measures, multivariate regression models for risk factors (adjusted for sex, age group, comorbidities), and comparison of length of stay and costs between vaccinated and unvaccinated patients. Most cases occurred in males aged ≥65. Bacteremia with pneumonia was the most frequent presentation (55.6%). Obesity and splenectomy were associated with higher risk of severe outcome. The most common serotypes overall were 3 and 8. Among vaccinated patients serotypes 15A, 14, 19A, and 15C were more frequent. Macrolide resistance was detected in 26.9% of isolates and beta-lactam resistance in 14.9%. Collectively, 34.5% of cases were caused by serotypes preventable with Pneumococcal Conjugate Vaccine 13 (PCV13), an additional 5.1% by PCV15, 21% by PCV20 and 14.4% by V116 preventable serotypes. Vaccine-preventable serotypes accounted for 64% of cases, mostly (56%) in patients aged ≥65. Vaccinated patients reported shorter hospital stay (median 8 vs 16 d) and lower associated costs (€3313 vs €5101). IPD surveillance is critical to inform prevention strategies. Our findings quantify how much vaccination reduces disease severity and healthcare costs but highlight gaps in vaccine coverage against emerging serotypes due to replacement mechanisms.

PMID:42189530 | DOI:10.1080/21645515.2026.2670827

Pathog Glob Health. 2026 May 26:1-7. doi: 10.1080/20477724.2026.2679956. Online ahead of print.

ABSTRACT

SARS-CoV-2 XFG (nicknamed Stratus), a recombinant lineage arising from LP.8.1.2 and LF.7, is currently the most prevalent circulating lineage. Although most recombinant lineages do not pose a significant public health concern, some have shown the capacity to emerge and spread, highlighting the importance of their investigation. In this context, we performed a genome-based analysis to assess the genetic variability of XFG and to identify its recombination breakpoint. The breakpoint was mapped to approximately position 1507 within the spike (S) gene, in the distal region of the receptor-binding domain. This configuration suggests that LP.8.1.2 contributed the genomic backbone as the acceptor, whereas LF.7 acted as the donor. Phylodynamic survey suggests that XFG originated in early 2024, approximately 10 months before its first genomic detection. Bayesian Skyline Plot revealed a transient expansion phase beginning in August 2024, followed by a plateau, indicating limited and non-sustained growth. The estimated evolutionary rate of XFG (2.90 × 10^-4 subs/site/year) was comparable to those of its parental lineages, supporting a relatively low level of genetic variability. Overall, these findings suggest that the widespread prevalence of XFG is more likely driven by lineage turnover rather than increased transmissibility, highlighting the importance of continuous genomic surveillance for monitoring emerging SARS-CoV-2 lineages.

PMID:42189509 | DOI:10.1080/20477724.2026.2679956

Clin Pharmacokinet. 2026 May 26. doi: 10.1007/s40262-026-01637-1. Online ahead of print.

ABSTRACT

BACKGROUND: Mavyret, a combination medication of glecaprevir (GLE) and pibrentasvir (PIB), is approved to treat chronic and acute hepatitis C virus (HCV) (genotypes 1-6) infection in adults and pediatric patients ≥ 3 years old. To support approval, a two-part clinical trial was conducted in adolescents (≥ 12 to < 18 years) and children (≥ 3 to < 12 years) to identify the appropriate dosage and determine the efficacy and safety in pediatric patients.

OBJECTIVES: Population pharmacokinetic (popPK) analyses reported herein aimed to (1) characterize the pharmacokinetic (PK) parameters of orally administered GLE and PIB and the sources of PK variability in pediatric patients and (2) support the use of a body weight-based pediatric GLE/PIB dose ratio of 50/20 mg in HCV-infected children.

METHODS: PopPK models were built for GLE and PIB independently using nonlinear mixed-effects modeling and utilized data collected from 126 pediatric patients. Demographic, pathophysiological, and treatment factors were investigated for their impact on GLE and PIB PK.

RESULTS: PopPK analyses of pediatric exposures confirmed comparable exposures to those of adults who achieved over 95% sustained virologic response (SVR12). The pediatric popPK model incorporated allometric body weight-based scaling and subsequently identified no covariate that significantly impacted GLE exposures. Similarly, no covariate beyond the specified allometric body weight scaling was identified to impact PIB exposures. The developed pediatric popPK models were able to describe the central tendency and variability of the data.

CONCLUSION: These results supported the approval of body weight-based dosing regimens of GLE and PIB in children (< 45 kg) infected with any HCV genotype.

CLINICAL TRIALS: NCT03067129.

PMID:42189498 | DOI:10.1007/s40262-026-01637-1

Sports Med. 2026 May 26. doi: 10.1007/s40279-026-02448-x. Online ahead of print.

ABSTRACT

BACKGROUND: Sport-related concussion (SRC) is a common and complex injury in athletic populations. Linear head acceleration (LHA) and rotational head acceleration (RHA) are key biomechanical factors believed to contribute to SRC, each through distinct mechanisms. Evaluating head impact magnitudes across different sports, athlete populations, and measurement methods is essential for advancing SRC injury prevention and risk assessment.

OBJECTIVE: We aimed to examine linear and rotational head acceleration magnitudes associated with SRC impacts in athletes participating in team sports across all ages and both sexes.

METHODS: We conducted a systematic review and meta-analysis adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We searched three databases (MEDLINE, Scopus, SPORTDiscus) until 4 September, 2024, and the literature search was updated on the 10 November, 2025. Observational and experimental studies reporting peak LHA and/or RHA during SRC impacts in team sport athletes were included. Data were extracted on study characteristics, instrumentation, and head impact magnitudes. The risk of bias was assessed using the National Institutes of Health Quality Assessment Tool, and the certainty of the evidence was evaluated using GRADE. Random-effects meta-analyses were conducted to compare SRC and non-concussive impacts, and subgroup analyses were performed by sport type, age group, sex, session type, and instrumentation type, reporting standardized mean difference and mean difference. Between-group differences were assessed using Q_b statistics, and heterogeneity was evaluated using the I² statistics. Sensitivity and publication bias analyses were also performed.

RESULTS: Data from 30 articles representing 3262 athletes (12% female) were included. Sport-related concussion impacts produced significantly greater head acceleration magnitudes than non-concussive impacts, with large differences for both LHA (69.6 g vs 25.3 g; standardized mean difference = 2.42; 95% confidence interval 1.73-3.12) and RHA (4931 rad/s² vs. 1966 rad/s²; standardized mean difference = 1.99; 95% confidence interval 1.17-2.81). For SRC impacts, subgroup analyses revealed significant differences across sports (p < 0.001), age groups (LHA only, p = 0.01), sexes (LHA only, p < 0.001), and instrumentation types (LHA p < 0.001; RHA p = 0.02). The highest LHA values were observed in American Football (83.2 g), while the highest RHA values were recorded in rugby (7627 rad/s²). Higher LHA values were recorded for male athletes (78.2 g) compared with female athletes (44.2 g), and for high school athletes (88.3 g) compared with youth (61.4 g) and adult athletes (72.2 g). Helmet-mounted sensors recorded the highest LHA (79.0 g), and skin patches recorded the highest RHA (6938 rad/s²). No significant differences were found between games and practices.

CONCLUSIONS: In team sports, SRC impacts are associated with significantly higher LHA and RHA than non-concussive impacts. The observed overlap and contextual variability in head acceleration magnitudes highlight the importance of considering individual-specific and context-specific interpretation in SRC risk assessment and provide a foundation for improving head impact monitoring, injury prevention strategies, and athlete safety.

CLINICAL TRIAL REGISTRATION: PROSPERO CRD42024584070.

PMID:42189496 | DOI:10.1007/s40279-026-02448-x

Drugs Aging. 2026 May 26. doi: 10.1007/s40266-026-01303-y. Online ahead of print.

ABSTRACT

BACKGROUND: Orthostatic hypotension is recognized as a potential contributor to cognitive impairment in older adults. It is still unknown whether pharmacological treatment of orthostatic hypotension can affect cognition.

OBJECTIVE: The aim of this scoping review was to identify whether treatment of orthostatic hypotension with midodrine, droxidopa, and fludrocortisone had any effect on cognitive performance.

METHODS: We searched the databases of Embase and MEDLINE. Key eligibility criteria included observational studies or clinical trials using midodrine, droxidopa, or fludrocortisone to treat adult patients with orthostatic hypotension with cognition assessed. Key search terms used were “orthostatic hypotension,” “cognition,” “midodrine,” “fludrocortisone,” and “droxidopa.” Quality assessment was performed using the LEGEND (Let Evidence Guide Every New Decision) Evidence Evaluation System. A descriptive synthesis was undertaken because of heterogeneous study designs and assessments, categorizing studies by patient population, with no statistical pooling.

RESULTS: Five studies met the criteria for the scoping review. These studies investigated midodrine, droxidopa, and fludrocortisone used individually, or in combination, to treat orthostatic hypotension. Three studies found cognitive improvements with orthostatic hypotension treatment, one found negative cognitive side effects with orthostatic hypotension medications and one study found no significant change. Three patient populations were examined in these studies: patients with dementia, patients with parkinsonism, and patients with spinal cord injury. Included studies were small, observational, and interventional and cognitive outcomes ranged from symptom-based assessments to formal neuropsychological testing.

CONCLUSIONS: Limited conclusions can be drawn from these five studies because of non-standardized cognitive assessments, small sample sizes, and methodological variability. However, overall, this scoping review provides evidence that treatment of orthostatic hypotension might have a cognitive benefit in certain populations. Further observational studies and clinical trials are warranted to better elucidate whether combinations of midodrine, droxidopa, and fludrocortisone will work in specific patient populations to improve clinical outcomes.

PMID:42189477 | DOI:10.1007/s40266-026-01303-y