Tag: nevin manimala

Proc Natl Acad Sci U S A. 2026 Sep;123(35):e2619192123. doi: 10.1073/pnas.2619192123. Epub 2026 Aug 24.

ABSTRACT

The role of escape from the cytotoxic T cell (CTL) response in Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) evolution remains controversial. Here, we study the origin and spread of SARS-CoV-2 variants whose mutations reduce presentation by the human leukocyte antigen (HLA) class I alleles common in human populations. We find that 35% of mutations that are characteristic of the variants of concern, and 39% of all subsequent viral mutations, facilitate escape of viral epitopes from presentation. Mutations allowing escape from more common HLA alleles reach higher frequencies, particularly in those countries where these HLA alleles are more frequent, indicating that escape is selected by the local genetic composition of the human host population. We also show that viral mutations that accumulated in general-population transmission chains matched population HLA class I allele frequencies as well as, or better than, mutations acquired during persistent infections, suggesting that selection in favor of escape mutations is not limited to immunocompromised individuals. Together, these data reveal CTL escape as a facet of selection, a driver of evolution, and an epidemiological concern for SARS-CoV-2.

PMID:42636373 | DOI:10.1073/pnas.2619192123

Age Ageing. 2026 Aug 3;55(8):afag241. doi: 10.1093/ageing/afag241.

ABSTRACT

OBJECTIVE: While pre-existing dementia is a known negative predictor for good endovascular thrombectomy (EVT) outcomes, comparative efficacy and safety data of EVT versus best medical management (BMM) for large vessel occlusion (LVO) patients with dementia are limited. This study compares hospitalisation outcomes of EVT versus BMM for LVO patients with underlying dementia.

METHODS: Using the US Nationwide Readmissions Database from 2016 to 2022, we retrospectively identified adult patients with dementia who presented with LVO stroke. The primary outcome was discharge to home. Secondary outcomes included in-hospital mortality, length-of-stay and complications. Patients who underwent EVT were compared to those who received BMM after propensity score matching. Interaction and subgroup analyses assessed treatment effect heterogeneity associated with age and dementia type.

RESULTS: Among 37 298 patients included, 6618 EVT and 13 092 BMM patients remained after propensity score matching. Home discharge rates were similar between groups (27.1% vs 26.4%, P = .51). EVT was associated with longer length-of-stay (median 7 vs 6 days, P < .001) and increased intracranial haemorrhage (23.9% vs 11.1%, P < .001), with no significant difference in mortality (15.0% vs 14.9%, P = .87). Patient age significantly moderated EVT effectiveness (interaction P < .001), and EVT among patients <75 years old was significantly associated with higher rates of home discharge (36.7% vs 26.8%, P < .001). Additionally, EVT appeared more effective for patients with vascular dementia (vs Alzheimer’s disease, interaction, P = .014), among whom EVT was associated with significantly higher rates of home discharge (32.7% vs 25.2%, P = .007).

INTERPRETATION: Treatment response to EVT among LVO stroke patients with dementia was heterogeneous, and EVT was beneficial for patients <75 years old and those with vascular dementia.

PMID:42636356 | DOI:10.1093/ageing/afag241

Rev Esc Enferm USP. 2026 Aug 24;60:e20250577. doi: 10.1590/1980-220X-REEUSP-2025-0577en. eCollection 2026.

ABSTRACT

OBJECTIVE: To identify the factors associated with successful aging among community-dwelling older adults in rural Indonesia.

METHOD: This analytical cross-sectional study involved 104 older adults aged ≥60 years living in Lamongan Regency, Indonesia. Data were collected through structured face-to-face interviews assessing sociodemographic characteristics, health status, and five indicators of successful aging: physical function, cognitive function, psychological well-being, social engagement, and active engagement with life. Multiple linear regression analysis was performed to determine significant predictors.

RESULTS: Half of the respondents demonstrated moderate levels of successful aging. Working status (β = 0.383; 95% CI: 0.201-0.565; p < 0.001) and distance to health facilities (β = 0.588; 95% CI: 0.242-0.935; p = 0.001) were significant determinants. Older adults who were still working and those living 1-5 km from health facilities had higher successful aging scores.

CONCLUSION: Successful aging among rural older adults is influenced by working status and proximity to healthcare facilities. Promoting productive activity and maintaining accessible, independent, and supportive health services are essential for aging well in rural communities.

PMID:42636337 | DOI:10.1590/1980-220X-REEUSP-2025-0577en

Hum Vaccin Immunother. 2026 Dec 31;22(1):2712139. doi: 10.1080/21645515.2026.2712139. Epub 2026 Aug 24.

ABSTRACT

Public transportation drivers (PTDs) are vulnerable to influenza and could potentially act as super-spreaders. Therefore, understanding the factors associated with influenza vaccine uptake is crucial for public health. This cross-sectional study evaluated the prevalence of and factors associated with influenza vaccination uptake and intention among PTDs in Lebanon. A face-to-face questionnaire was administered to 509 PTDs in 2023. Socio-demographics, health-related variables, environmental factors, social norms, and knowledge were collected. Vaccine Hesitancy and Vaccination Attitudes Examination scales were used. Chi-square test and hierarchical logistic regression analyses were performed. Influenza vaccine uptake rate was 28.9%, with 56.2% expressing an intention to receive the vaccine if it was affordable or available through a mobile clinic. Factors that were positively associated with vaccine uptake included: knowing someone who took the vaccine aOR = 3.6[2.2-6.1]; being advised to take the vaccine aOR = 2.1[1.2-3.8]; and previous influenza infection aOR = 1.9[1.4-2.7]. Factors negatively associated with vaccine uptake included: lack of confidence in vaccines aOR = 0.7[0.6-0.9] and risk calculation aOR = 0.8[0.6-0.9]. Factors positively associated with influenza vaccine intention were knowing someone who took the vaccine aOR = 2.2[1.4-3.4] and previously taking the influenza vaccine aOR = 1.8[1.1-3.0]. Factors negatively associated with vaccine intention were having an average socioeconomic status aOR = 0.6[0.4-0.9], lack of confidence aOR = 0.7[0.6-0.8], concerns about commercial profiteering aOR = 0.7[0.6-0.9], and a preference for natural immunity 0.8[0.6-0.9]. Enhancing vaccine accessibility and affordability along with targeted educational campaigns that address specific concerns and misinformation, could increase uptake rates among PTDs.

PMID:42636327 | DOI:10.1080/21645515.2026.2712139

JBJS Rev. 2026 Aug 24;14(8). doi: 10.2106/JBJS.RVW.26.00057. eCollection 2026 Aug 1.

ABSTRACT

BACKGROUND: Normal saline is commonly used as a presumed inert placebo control in lumbar injection trials. However, prior studies suggest that saline injections may be associated with improvements in patient-reported outcomes, potentially confounding interpretation of comparative treatment effects. The magnitude, durability, and clinical relevance of these changes have not been systematically characterized. The primary aim of this study was to evaluate changes in patient-reported outcomes following saline injection in patients with lumbar radiculopathy and, separately, in patients with diskogenic low back pain.

METHODS: A systematic review of PubMed, Embase, and Google Scholar was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify randomized controlled trials (RCTs) published between 2000 and 2025 that included a saline injection arm for lumbar radiculopathy or diskogenic pain. Within-arm pre-post changes in Visual Analog Scale (VAS) pain scores and Oswestry Disability Index (ODI) were pooled. Outcomes were evaluated at multiple time points up to 1 year. Subgroup analyses were performed based on injection route. Changes were contextualized relative to established minimal clinically important difference (MCID) thresholds.

RESULTS: Eighteen RCTs comprising 759 patients were included. In lumbar radiculopathy, saline arms demonstrated statistically significant reductions in leg pain and disability across all evaluated time points. Pooled mean differences for leg pain VAS ranged from -1.79 at 1 month to -3.85 at 1 year, while ODI improvements increased from -7.30 to -17.83 points over the same interval, exceeding MCID thresholds. Improvements were more consistent following epidural injection. By contrast, patients with diskogenic pain exhibited smaller changes in back pain and disability, with most pooled estimates failing to reach MCID thresholds.

CONCLUSIONS: Saline injection arms of lumbar injection RCTs demonstrate meaningful improvements in pain and disability over time, particularly in patients with lumbar radiculopathy. These findings suggest that saline injections are not inert comparators and may elevate baseline response in interventional trials, potentially obscuring the incremental benefit of active injectates. Future RCTs should consider incorporating nonsaline control arms to better isolate treatment-specific effects and improve interpretability of comparative outcomes.

LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

PMID:42636319 | DOI:10.2106/JBJS.RVW.26.00057

Arthroscopy. 2026 Aug 24. doi: 10.1002/arj.70430. Online ahead of print.

ABSTRACT

PURPOSE: To determine the difference in reported outcomes and failures in retrospective versus prospective studies investigating the matrix-induced autologous chondrocyte implantation (MACI) procedure.

METHODS: PubMed, Embase, and Scopus were queried for studies investigating outcomes following the MACI procedure for knee cartilage defects. Studies selected included second- and third-generation MACI procedures. Inclusion criteria were as follows: (1) described study design, (2) was in English, and (3) had full-text available. Exclusion criteria were systematic review, meta-analysis, case reports, abstracts, and presentations. Year, study design, Modified Coleman Methodology Score, level of evidence, follow-up, intraoperative complications, postoperative complications, rate of graft failure, rate of graft hypertrophy, return to play rate, revision rate, and patient-reported outcome measures were collected. A 2-sample t-test was used to compare prospective and retrospective studies. Statistical significance was defined as a P value < .05.

RESULTS: A total of 28 studies were included for analysis. There were 19 prospective studies, consisting of 979 patients and 1021 knees, and 9 retrospective studies, consisting of 460 patients and 463 knees. There were significantly higher rates of graft failure in prospective studies compared with retrospective studies (4.30% vs 0.06%, P = .0043). There were no significant differences in graft hypertrophy, subsequent procedures, or other postoperative complications. Only 6 of 19 prospective studies and 0 of 9 retrospective studies reported return to sport. There were 8 different patient-reported outcome measures reported across the studies, with the most common being the Knee Injury and Osteoarthritis Outcome Score.

CONCLUSIONS: Prospective studies investigating MACI were more likely to report graft failure than retrospective studies but had similar findings in other outcome measures. Understanding differences in outcomes between retrospective and prospective studies is critical in evaluating the efficacy of the MACI procedure, as study design significantly influences reported findings.

LEVEL OF EVIDENCE: Level IV, systematic review of Level I, III, and IV studies.

PMID:42636292 | DOI:10.1002/arj.70430

Arthroscopy. 2026 Aug 24. doi: 10.1002/arj.70451. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the mid-term (≥5 years) to long-term (≥10 years) clinical outcomes of isolated hip arthroscopy in borderline hip dysplasia (BDH) patients compared to those with normal acetabular coverage.

METHODS: A comprehensive literature search was performed in PubMed, Ovid Medline, and Scopus. Studies were included if they directly compared BDH patients to controls with normal acetabular coverage after isolated hip arthroscopy, with a minimum follow-up of 5 years. Outcomes analyzed included patient-reported outcomes, revision surgery rates, and conversion to hip replacement.

RESULTS: Four studies (478 patients: 157 BDH, 321 control) with follow-up ranging from 5 to 10 years were included. The pooled analysis demonstrated no statistically significant differences in postoperative patient-reported outcomes, revision rates (14.0% vs 20.9%; odds ratio, 0.61; P = .07), or conversion to hip replacement (1.9% vs 4.7%; odds ratio, 0.45; P = .22) between BDH and control groups.

CONCLUSIONS: Patients with BDH undergoing isolated hip arthroscopy demonstrate comparable clinical outcomes, revision rates, and hip survivorship to those with normal acetabular coverage at mid- to long-term follow-up (ranging from 5 to 10 years).

LEVEL OF EVIDENCE: Level III, systematic review of Level II and III studies.

PMID:42636291 | DOI:10.1002/arj.70451

JNCI Cancer Spectr. 2026 Aug 24:pkag086. doi: 10.1093/jncics/pkag086. Online ahead of print.

ABSTRACT

PURPOSE: Cancer-related cognitive impairment is common in patients receiving cancer treatment but may be under detected by clinician-graded adverse events (AEs) alone. Patient-reported outcomes and cognitive screening may improve identification of cognitive symptoms.

METHODS: We conducted a secondary analysis of the nationwide, multicenter GAP70+ trial of adults aged ≥70 years with advanced cancer starting systemic therapy. Cognitive symptoms were assessed longitudinally using patient-reported and clinician-graded cognitive AEs, and Mini-Cog screening at baseline, 4-6 weeks, 3 months, and 6 months. We examined prevalence, longitudinal trajectories, and associations with Mini-Cog impairment. Statistical significance was set at two-sided p< 0.05.

RESULTS: Among 704 participants (mean age, 77.2 years; range, 70 to 96 years), patient-reported cognitive AEs were more prevalent than clinician-graded cognitive AEs at all timepoints: 19% vs 0.48% at 4 to 6 weeks, 18% vs 2.5% at 3 months, and 22% vs 0.44% at 6 months at 6 months (all p < 0.001). Patient-reported cognitive AEs also fluctuated within patients over time. Impaired Mini-Cog was associated with higher patient-reported cognitive AEs at all post-baseline timepoints: 31% vs 15% at 4 to 6 weeks, 34% vs 14% at 3 months, and 49% vs 15%at 6 months (all p < 0.001). In contrast, associations with clinician-graded cognitive AEs were observed only at 3 months (p = 0.004) and 6 months (p = 0.04).

CONCLUSIONS: Cognitive symptomatic AEs are common and often under detected by clinician grading alone in older adults with advanced cancer. Combining patient-reported AEs with brief cognitive screening may improve detection during treatment.

PMID:42636266 | DOI:10.1093/jncics/pkag086

Expert Rev Anti Infect Ther. 2026 Aug 24. doi: 10.1080/14787210.2026.2723576. Online ahead of print.

ABSTRACT

INTRODUCTION: Marburg virus disease (MVD) is a highly lethal filovirus infection with case fatality rates of up to 88%. Although no virus-specific interventions have yet been approved, recent laboratory breakthroughs have markedly accelerated translational progress in vaccine and therapeutic development.

AREAS COVERED: A hybrid methodological design was employed, combining macro-level bibliometric analysis with a targeted qualitative narrative review. As per the findings, the human monoclonal antibody MR191N provides complete post-exposure protection in non-human primates. Advanced RNA-targeted siRNAs, antisense oligonucleotides, and small-molecule nucleoside analogues (e.g. galidesivir) demonstrate robust preclinical efficacy in suppressing viral replication. Prophylactic platforms – including adenovirus-vectored (ChAd3-MARV), rVSV-MARV, and mRNA-based vaccines – are progressing through early-phase clinical and preclinical evaluation. Bibliometric analysis, however, reveals pronounced geographic disparities: high-income nations dominate scientific output (United States: 31.7%), while endemic African countries remain severely underrepresented in global collaboration networks.

EXPERT OPINION: Addressing MVD requires a coordinated transition from experimental research to licensed, field-ready interventions. This necessitates adaptive trial designs, expanded diagnostic models, and synergistic combination therapies. Ultimately, correcting global research inequities and embedding robust, cross-border One Health surveillance infrastructure are essential to transforming scientific advances into equitable, rapid-response solutions for endemic regions.

PMID:42636264 | DOI:10.1080/14787210.2026.2723576

PLoS One. 2026 Aug 24;21(8):e0353483. doi: 10.1371/journal.pone.0353483. eCollection 2026.

ABSTRACT

BACKGROUND AND AIMS: Malaria remains a public health concern in Bangladesh, despite a notable decline in reported cases since 2012 and a brief resurgence in 2014. Aligned with the United Nations Sustainable Development Goal (SDG) 3.3, which targets the elimination of malaria by 2030, Bangladesh has implemented multiple control and prevention strategies. This study assesses the significance of the decline in malaria cases and applies Bayesian hierarchical models to capture spatial dynamics of malaria-related vulnerability, map district-level risk, and inform targeted interventions.

METHODS: A nationwide spatial analysis was conducted using district-level malaria data from the Bangladesh Disaster-related Statistics (BDRS) 2021, which report cumulative counts of “population suffering from malaria due to disaster” for 2015-2020. These data were used as a proxy indicator of relative malaria vulnerability. National malaria time-series data were obtained from Bangladesh’s National Strategic Plan for Malaria Elimination (2021-2025) published by the Asia Pacific Malaria Elimination Network (APMEN), together with malaria surveillance summaries from the World Malaria Reports (2024,2025) published by the World Health Organization (WHO). District-level rainfall data were obtained from the Bangladesh Water Development Board. Bayesian hierarchical disease mapping models were used to assess spatial dependence and district-level malaria risk. Spatial visualization and autocorrelation analyses (Global Moran’s I, Geary’s C, and Local Moran’s I) were performed using R (version 4.4.0), and Bayesian model estimation was carried out using WinBUGS via Markov Chain Monte Carlo methods.

RESULTS: The analysis showed evidence of a trend in decreasing malaria cases by a value of -0.691 in the Mann-Kendall trend test. However, spatial analysis revealed significant clustering and geographic heterogeneity. Persistent high-risk clusters were identified in the southeastern hilly regions. Additionally the presence of excess zeros in the data justified the use of zero-inflated models.

CONCLUSION: The findings show significant national decline and offer valuable insights into the geographical variability in malaria-related vulnerability in Bangladesh. Rather than being direct indicators of malaria transmission, the results should be understood as representing relative risk patterns based on data related to disasters. Under current data limitations, these results provide evidence to boost spatially informed malaria control methods and assist geographically focused interventions.

PMID:42636262 | DOI:10.1371/journal.pone.0353483