Tag: nevin manimala

Clin Rheumatol. 2026 Jul 31. doi: 10.1007/s10067-026-08341-2. Online ahead of print.

ABSTRACT

BACKGROUND: Hashimoto’s thyroiditis (HT) and Sjögren’s syndrome (SS) frequently co-occur clinically, implying a potential association between the two diseases. However, their genetic association remains unclarified. To investigate whether there is a genetic link between HT and SS, we performed a two-sample bidirectional Mendelian randomization (MR) analysis.

METHODS: Data for HT were obtained from the IEU Open GWAS project, consisting of 15,654 cases and 379,986 controls. Data for SS were sourced from FinnGen Release 11, with 2981 cases and 439,424 controls included. We adopted the inverse variance-weighted (IVW) method plus four complementary robust MR methods to evaluate the genetic association between HT and SS. Comprehensive sensitivity analyses were implemented to verify the robustness of the MR estimates. Furthermore, a reverse MR analysis was performed to explore the potential for reverse association.

RESULTS: After rigorous screening, seven single nucleotide polymorphisms (SNPs) were selected as instrumental variables (IVs) for HT, while six SNPs served as IVs for SS. Positive MR analysis revealed a statistically significant causal effect of HT on SS, with an IVW odds ratio (OR) of 1.2188 (95% confidence interval (CI): 1.0755-1.3813; P = 0.0019). This finding was further validated by the weighted median and weighted mode methods (P < 0.05). Conversely, inverse MR analysis identified a statistically significant causal effect of SS on HT, with an IVW OR of 1.2154 (95% CI: 1.1387-1.2972; P < 0.001). This result was corroborated by the weighted median, MR-Egger, weighted mode, and simple mode methods (P < 0.05). Sensitivity analysis confirmed the robustness of these findings.

CONCLUSIONS: This study identifies a bidirectional genetic association between genetically predicted HT and SS in European populations. The observed relationship is likely attributable to shared autoimmune predisposition. These results may offer a useful reference for exploring their underlying pathogenesis. Key Points • HT and SS often coexist in clinical practice; nevertheless, the exact genetic relationship between 3 them remains to be elucidated. • A two-sample bidirectional MR approach was employed to evaluate the genetic relationship between HT and SS. • Our MR study identified a bidirectional genetic association between genetically predicted HT and SS in European populations.

PMID:42536326 | DOI:10.1007/s10067-026-08341-2

Endocrine. 2026 Jul 31;91(1):241. doi: 10.1007/s12020-026-04701-9.

ABSTRACT

PURPOSE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), used to treat type 2 diabetes and obesity, may improve metabolic health before conception. However, their association to hypertensive disorders of pregnancy (HDP) after periconceptional or early pregnancy exposure remains unknown.

METHODS: We performed a meta-analysis to investigating association between GLP-1 RAs preconception or first trimester of gestation exposure and HDP risk. Cochrane Central Register of Controlled Trials databases, ClinicalTrials.gov, PubMed, Scopus, and EMBASE databases were searched from inception through December 15, 2025. All eligible studies were observational cohorts. Case reports, reviews, editorials, and studies that lacked HDP data were excluded. We pooled odds ratios with 95% confidence intervals using a random-effects Mantel-Haenszel model. ROBINS-I tool was used to evaluate risk of bias.

RESULTS: Of 75 records identified, 3 retrospective cohort studies met inclusion criteria with 10,880 pregnancies (4942 exposed to GLP-1 RAs and 5938 unexposed). All the studies were conducted in the United States between 2014-2025 and evaluated the semaglutide, liraglutide, dulaglutide, tirzepatide, exenatide, lixisenatide, and albiglutide exposure. Two studies showed a lower HDP risks among exposed pregnant, whereas one study found a higher risk. In the pooled analysis, GLP-1 RA exposure showed a HDP risk with an OR 0.91 (OR 0.91, CI 0.57-1.47) with no statistical significance.

CONCLUSION: Periconceptional or first-trimester exposure to GLP-1 RAs are not significantly associated with HDP risk. This available evidence is limited and indicating the need for large prospective studies to establish a possible association between GLP-1 RAs are not significantly associated with HDP risk.

PMID:42536323 | DOI:10.1007/s12020-026-04701-9

Drug Saf. 2026 Jul 31. doi: 10.1007/s40264-026-01697-z. Online ahead of print.

ABSTRACT

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol have been associated with neutropenia and agranulocytosis with inconsistent results.

OBJECTIVE: To investigate the risk of neutropenia in association with frequently used NSAIDs compared to paracetamol.

METHODS: We conducted a cohort study using the UK-based Clinical Practice Research Datalink (CPRD) GOLD. In three pairwise comparisons, we compared the risk of neutropenia including agranulocytosis (defined by Read codes) between new NSAID users (diclofenac, ibuprofen, and naproxen) and new paracetamol users (active comparator) during a maximum follow up of 60 days. Secondary and tertiary outcomes additionally included (1) in-patient diagnosed agranulocytosis and (2) laboratory values indicating neutropenia. Both were additionally restricted to only agranulocytosis. We applied propensity score-fine stratification to control for measured confounding and quantified incidence rates (IRs) as well as hazard ratios (HRs) with 95% confidence intervals (CIs).

RESULTS: Our weighted cohorts included 1,003,314 (paracetamol) to 2,207,612 (diclofenac) patients. Weighted IRs of neutropenia (primary outcome) were between 2.1/10,000 person years (PYs) and 2.3/10,000 PYs. HRs for the primary outcome ranged between 1.00 (95% CI 0.51-1.94) and 1.12 (95% CI 0.57-2.23) for NSAIDs versus paracetamol. The secondary and tertiary outcome yielded reduced HRs between 0.53 and 1.03, and even lower HRs when restricted to agranulocytosis (HR between 0.19 and 0.51).

CONCLUSION: Our results indicate no risk of neutropenia for NSAIDs when compared to paracetamol. An increased risk of agranulocytosis in association with paracetamol is possible, but residual confounding by frailty may at least partially explain this association.

PMID:42536322 | DOI:10.1007/s40264-026-01697-z

J Urban Health. 2026 Jul 31. doi: 10.1007/s11524-026-01117-8. Online ahead of print.

ABSTRACT

Extreme heat events increasingly threaten public health, particularly in rapidly urbanizing areas like Maricopa County, Arizona. This study addresses gaps in identifying communities most vulnerable to extreme heat and heat waves by creating a Heat Vulnerability Index (HVI) that integrates often-overlooked populations. Utilizing US census data, satellite imagery, chronic illness prevalence rates, and unhoused population data, this HVI assesses vulnerability across census tracts in Maricopa County’s diverse urban-rural landscape. Principal components analysis identified nine factors influencing heat vulnerability: (1) socioeconomic disadvantage; (2) isolation; (3) elderly populations; (4) chronic illness; (5) environmental risks; (6) African American race and language barriers, (7) Native American and unemployment status; (8) lack of housing and male; and (9) mobile home residents. Model validation found that heat-related mortality rate increased with heat vulnerability. Despite statistical limitations from data resolution and timeframe, this study integrates unhoused data into vulnerability assessments, emphasizing the need for equitable approaches that include underserved communities to address extreme heat vulnerability.

PMID:42536312 | DOI:10.1007/s11524-026-01117-8

Updates Surg. 2026 Jul 31. doi: 10.1007/s13304-026-02781-w. Online ahead of print.

ABSTRACT

Bethesda IV thyroid nodules remain a major diagnostic challenge because cytology cannot reliably distinguish benign from malignant follicular-patterned lesions, often leading to diagnostic surgery for ultimately benign disease. This study evaluated whether ultrasound radiomics combined with machine learning could improve preoperative risk stratification in this setting. We conducted a retrospective monocentric study including 69 surgically treated patients with Bethesda IV thyroid nodules and definitive histopathology. Ultrasound images acquired between 2019 and 2020 were manually segmented, and radiomic features were extracted using LIFEx software. After preprocessing and removal of non-informative features, the dataset was split into training (n = 48) and a held-out test set (n = 21), isolated prior to any modelling procedure. Dimensionality reduction was performed with principal component analysis analysis (20 components, 99.5% explained variance). Three supervised machine-learning models were developed and compared: K-nearest neighbors (KNN), Random Forest (RF), and Extreme Gradient Boosting (XGBoost). Internal validation was performed by leave-one-out cross-validation on the training set, with StandardScaler and PCA fitted inside each fold. Final performance was assessed once on the held-out test set. All metrics are reported with 95% confidence intervals. Model performance was assessed using cross-validation and leave-one-out cross-validation, with evaluation of accuracy, F1-score, sensitivity, specificity, and ROC-AUC. Final histology showed malignancy in 39/69 nodules (56.5%). On the held-out test set, RF (n = 50 estimators, depth = 10) achieved the best overall performance: AUC 0.735 (95% CI 0.513-0.956), sensitivity 0.714 (95% CI 0.454-0.883), specificity 0.571 (95% CI 0.250-0.842), and accuracy 0.667 (95% CI 0.454-0.828). KNN (k = 3) achieved AUC 0.602 (95% CI 0.359-0.845). XGBoost did not generalise to the test set (AUC 0.378, 95% CI 0.094-0.661). Leave-one-out cross-validation estimates were modest across all models (AUC range 0.397-0.588), with confidence intervals overlapping 0.50, reflecting the limited statistical power of the training set at n = 48. Ultrasound radiomics combined with Random Forest shows preliminary discriminative ability for distinguishing benign from malignant Bethesda IV thyroid nodules. The wide confidence intervals observed highlight the need for a larger prospective validation cohort. These findings establish a methodological framework and provide sample size benchmarks for a powered confirmatory study.

PMID:42536308 | DOI:10.1007/s13304-026-02781-w

Updates Surg. 2026 Jul 31. doi: 10.1007/s13304-026-02785-6. Online ahead of print.

ABSTRACT

A catecholamine-induced hypertensive crisis in patients with pheochromocytoma has recently been defined as systolic/diastolic blood pressure ≥ 180/120 mmHg. However, the consequences of observing blood pressure values above these thresholds during laparoscopic adrenalectomy have never been evaluated. The aim of this study was to identify factors associated with intraoperative catecholamine-induced hypertensive crisis (main objective) and postoperative cardiovascular complications (secondary objective). A multi-institutional retrospective cohort study from 01/01/2000 to 12/31/2016 was performed in eight university hospitals to identify independent factors associated with catecholamine-induced hypertensive crisis while adjusting for the clustering of patients within hospitals (generalized linear mixed model for hierarchical analysis). Logistic regression analysis was used to analyze postoperative cardiovascular complications on day 30. A total of 1056 patients underwent adrenalectomy for pheochromocytoma, of whom 894 were included in the final analysis. During adrenalectomy, 122 patients (13.6%) presented with at least one episode of a catecholamine-induced hypertensive crisis. Cardiovascular complications were observed in 32 patients (3.6%) on the 30th postoperative day. Tumor diameter (OR 1.011, 95%CI 1.001-1.021; p = 0.035) and any biological profile with high adrenaline (OR 1.602, 95%CI 1.051-2.441; p = 0.028) were significantly associated with the occurrence of intraoperative catecholamine-induced hypertensive crisis. The occurrence of intraoperative catecholamine-induced hypertensive crisis (OR 2.4, 95%CI 1.603-3.707; p = 0.033) remained significantly associated with cardiovascular complications at 30 days postoperatively. Catecholamine-induced hypertensive crisis is a relevant criterion for evaluation during laparoscopic adrenalectomy for pheochromocytoma because it is associated with an increased incidence of postoperative cardiovascular complications.

PMID:42536306 | DOI:10.1007/s13304-026-02785-6

Front Oncol. 2026 Jul 16;16:1779553. doi: 10.3389/fonc.2026.1779553. eCollection 2026.

ABSTRACT

AIM: This study investigates the link between proliferation markers (PCNA, p16, Ki-67) and histopathological factors, exploring their prognostic value in breast cancer patients.

MATERIALS AND METHODS: We analyzed female breast cancer patients who underwent surgery. Data collected included demographics, clinical parameters (hemogram, Ca 15.3, menopause status, etc.), family cancer history, pathology, treatments (neoadjuvant, surgical, oncological), tumor staging, lymph node status, receptor status (ER, PR, cerb-b2), and survival. Paraffin blocks were retrospectively analyzed for PCNA, p16, and Ki-67 expression via immunohistochemical staining.

RESULTS: PCNA scores showed no association with demographic or clinical features, though a statistically significant inter-marker correlation with p16 was found (both markers increased together). P16 scores were not linked to other parameters aside from Ki-67 (also demonstrating positive correlation). Higher Ki-67 index was associated with decreased ER and PR expression and, importantly, decreased survival. Although a significant correlation was observed between PCNA and p16 expression levels, neither marker demonstrated independent prognostic significance with respect to overall survival.

CONCLUSIONS: Although PCNA and p16 expression levels were inter-correlated, neither marker showed an independent association with clinicopathological variables or overall survival in our cohort. In contrast, the Ki-67 index was significantly associated with hormone receptor status, pathological stage, and shorter overall survival, and remains the most informative proliferation marker for prognostic stratification in breast cancer. Further prospective studies with standardized scoring and multivariate analysis are warranted to clarify the prognostic value of PCNA and p16.

PMID:42534781 | PMC:PMC13422137 | DOI:10.3389/fonc.2026.1779553

Front Psychol. 2026 Jul 16;17:1901610. doi: 10.3389/fpsyg.2026.1901610. eCollection 2026.

ABSTRACT

Teacher caring is a crucial relational resource for student development in higher education, yet the process by which it connects to students’ perceived course-related learning gains remains underexplored. Drawing on caring theory, social cognitive theory, learning engagement theory, and a supportive relationship perspective, this study tested a sequential mediation model. This model posits that teacher caring is associated with perceived course-related learning gains through academic self-efficacy and learning engagement. A cross-sectional, anonymous online questionnaire survey was administered to Chinese undergraduate students. Out of 632 returned questionnaires, 562 valid responses remained after data cleaning, resulting in a valid response rate of 88.9%. The results showed that teacher caring was positively associated with academic self-efficacy, learning engagement, and perceived course-related learning gains. The CFA measurement model demonstrated a good fit, and composite score path analyses using standardized scores supported the proposed model. Bootstrap mediation tests indicated that both academic self-efficacy and learning engagement partially mediated the association between teacher caring and perceived course-related learning gains, and they also formed a significant sequential indirect path. These results remained stable even after controlling for gender, year of study, major category, region, and university identifier. The findings suggest that teacher caring should be understood not merely as emotional warmth or general support, but as a relational resource linked to students’ confidence in learning and active engagement in coursework. Because the study relied on cross-sectional self-report data, the results should be interpreted as statistical associations consistent with the proposed relational-motivational pathway rather than as evidence of causal ordering.

PMID:42534778 | PMC:PMC13422389 | DOI:10.3389/fpsyg.2026.1901610

Air Qual Atmos Health. 2026;19(8):168. doi: 10.1007/s11869-026-02060-y. Epub 2026 Jul 29.

ABSTRACT

Particulate Matter (PM_2.5) exposure contributes to the global disease burden, yet its monitoring remains sparse and uneven, with limited ground sensor infrastructure. Road-traffic proxy indicators can provide indirect estimates of PM_2.5 where measurements are limited but require context-specific validation. We evaluated three PM_2.5 road-traffic-related proxies: (i) population-Weighted Road Network Density (wRND), (ii) Euclidean (straight line) distance from highways (EH), and (iii) Euclidean distance from main roads (EM). We validated these proxies using high-resolution outdoor filtered PM_2.5 personal exposure measurements collected over 1 year from 343 postpartum participants in The Gambia, Kenya, and Mozambique. Proxy-PM_2.5 associations were assessed using Spearman correlation, and predictive utility was tested using country-specific and global Random Forest (RF) models (3-fold cross-validation), reporting R², RMSE, and feature importance. Spatial mapping showed heterogeneous proxy-PM_2.5 relationships across and within sites, with elevated PM_2.5 occurring in both low- and high-proxy contexts. wRND-PM_2.5 correlations were weak overall and statistically significant only in Mozambique (r = 0.351; p = 0.005), with non-significant associations in Kenya (r = – 0.041; p = 0.673) and The Gambia (r = – 0.020; p = 0.909). EH-PM_2.5 correlations were positive in The Gambia (r = 0.335; p = 0.053) and Mozambique (r = 0.292; p = 0.020) but negative and significant in Kenya (r = – 0.224; p = 0.018). Single-variable RF models performed poorly across all countries (R² < 0.45) and the Global model (R² = 0.42). Combining proxies improved performance in Kenya (R² = 0.52; RMSE = 31.7 µg/m³) and Mozambique (R² = 0.60; RMSE = 8.9 µg/m³), Global R² = 0.46; RMSE = 29.1 µg/m³), although in The Gambia, the combined model (R² = 0.53; RMSE = 37.6 µg/m³) did not exceed the best single-proxy model. Road-network proxies provided limited but context-dependent signals of personal PM₂.₅ exposure. Their performance varied substantially across countries, indicating that road-based indicators should not be used as stand-alone exposure measures in heterogeneous sub-Saharan African settings. Instead, they are most defensible as locally validated components of hybrid exposure models that also incorporate meteorology, land use, biomass burning, household energy, and other non-traffic sources.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11869-026-02060-y.

PMID:42534776 | PMC:PMC13421249 | DOI:10.1007/s11869-026-02060-y

Front Allergy. 2026 Jul 16;7:1911930. doi: 10.3389/falgy.2026.1911930. eCollection 2026.

ABSTRACT

INTRODUCTION: Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease of the upper airways, frequently characterized by recurrence and impaired quality of life. Persistent inflammation and bacterial biofilms contribute to disease chronicity. Topical plant-derived therapies may offer a preventive strategy in long-term CRS management. This study evaluated the effectiveness of a Pistacia lentiscus-based nasal medical device in reducing the impact of CRS recurrence on patients’ daily life.

METHODS: In this retrospective, observational, single- center case-control study, 100 adult patients with chronic rhinosinusitis (CRS) and recurrent disease were identified and included from clinical records. Patients were stratified according to prior exposure to nasal drops containing ultra-fractionated Pistacia lentiscus oil in addition to isotonic saline nasal irrigation, or to isotonic saline nasal irrigation alone, according to routine clinical practice. All patients had undergone a 12-month follow-up regimen with assessments available at baseline, 30 days, and 12 months. The primary outcome was symptom severity measured using the Sino-Nasal Outcome Test (SNOT-22). Secondary outcomes included nasal cytology parameters, biofilm presence, nasal discharge, bacterial elements, supranuclear stria, and ciliary motility.

RESULTS: Of the 100 identified subjects, 92 were included in the final analysis due to loss to follow-up. In the exposed group, SNOT-22 scores showed a 40.6% reduction after the first month, compared with a 7.8% reduction observed in the control group (p < 0.001). Only patients exposed to Pistacia lentiscus oil demonstrated statistically significant reductions over time in nasal discharge (p < 0.005), biofilm presence (p < 0.005), and bacterial elements (p < 0.05), while no significant changes were observed in the control group for these parameters. Ciliary motility remained unchanged in both groups across the study period.

DISCUSSION: Overall, within the limits of this retrospective case-control design, patients exposed to Pistacia lentiscus oil in addition to standard saline irrigation showed greater improvement in patient-reported symptoms and selected cytological markers compared with patients treated with saline irrigation alone.

PMID:42534765 | PMC:PMC13422398 | DOI:10.3389/falgy.2026.1911930