Tag: nevin manimala

J Rehabil Med. 2026 Jul 23;58:jrm46093. doi: 10.2340/jrm.v58.46093.

ABSTRACT

OBJECTIVE: To identify a 5-year medical and psychosocial vulnerability profile among adults living at home 1 year after severe TBI and examine associated early characteristics.

DESIGN: Retrospective secondary analysis of a multicentre longitudinal cohort.

SUBJECTS/PATIENTS: Adults aged 16 years or older with operationally defined severe traumatic brain injury, private residence at 1 year, linked 5-year follow-up, and complete data for 4 profile indicators.

METHODS: Latent class analysis used 5-year rehospitalization, PHQ-9, GAD-7, and Satisfaction With Life Scale scores dichotomized with prespecified clinically interpretable thresholds. External rehabilitation outcomes and early associated factors were examined descriptively and with multivariable logistic regression.

RESULTS: Among 2,835 participants, a 2-class solution identified a lower-vulnerability profile (n = 2,361) and a multidomain vulnerability profile (n = 474). The latter showed more depressive symptoms, anxiety symptoms, low life satisfaction, and rehospitalization, with poorer 5-year functioning, participation, health, productive status, and higher frequency of non-private residence. Better 1-year global outcome was protective; female sex, preinjury illicit drug use, and living alone at 1 year were associated with assignment to this profile.

CONCLUSION: Home return after severe traumatic brain injury should be treated as a transition point for longitudinal rehabilitation surveillance.

PMID:42488972 | DOI:10.2340/jrm.v58.46093

Drug Metab Pers Ther. 2026 Jul 24. doi: 10.1515/dmpt-2025-0087. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the impact of the TNF-α promoter SNP -308G/A on therapeutic response, serum drug levels, and immunogenicity of TNF inhibitors in chronic inflammatory rheumatic diseases.

METHODS: This cross-sectional, multicentric study included 73 patients: 32 with rheumatoid arthritis (RA) and 41 with spondyloarthritis (SpA). Serum drug levels (SDL) and anti-drug antibodies (ADA) were quantified by ELISA (Promonitor^®). Genotyping for SNP -308 was performed via PCR-RFLP. Therapeutic response was assessed at 6 months using delta DAS28 and EULAR response in RA and delta BASDAI, BASDAI20 and BASDAI50 responses in SpA patients.

RESULTS: In RA, the heterozygous G/A genotype was significantly associated with a greater reduction in median DAS28 compared to G/G (p=0.039) and a higher proportion of good EULAR responders (p=0.154). In SpA, G/A carriers showed larger decreases in BASDAI scores though differences were not statistically significant. Across both diseases, the G/A genotype was associated with significantly higher median serum drug levels (p=0.032). No association was observed between SNP -308G/A and ADA positivity.

CONCLUSIONS: The TNF-α -308G/A polymorphism may be a predictive marker of TNF inhibitor efficacy in RA, potentially influencing serum drug levels while immunogenicity appears unaffected. Larger prospective studies are needed to confirm these findings and explore additional determinants of TNF inhibitor response.

PMID:42488961 | DOI:10.1515/dmpt-2025-0087

Stroke. 2026 Jul 23. doi: 10.1161/STROKEAHA.126.055939. Online ahead of print.

ABSTRACT

BACKGROUND: Health-related quality of life is a key secondary end point in stroke trials. Differential item functioning (DIF) occurs when individuals with the same underlying health-related quality of life interpret and respond differently to questionnaire items, potentially biasing treatment comparisons. This study evaluates DIF in the patient-reported 5-level EuroQOL questionnaire among patients with acute ischemic stroke across age, sex, and treatment groups.

METHODS: Data were from the AcT trial (Alteplase Compared to Tenecteplase), a registry-based randomized comparison of alteplase and tenecteplase conducted at 22 stroke centers across Canada (December 2019-January 2022). Patients with acute ischemic stroke presenting within 4.5 hours of symptom onset and eligible for thrombolysis completed the 5-level EuroQOL questionnaire at 90 days poststroke. DIF was assessed using multigroup graded response models with the Wald-based sweep procedure, which accounts for between-group differences in latent trait distributions. We quantified effect sizes using signed weighted area between curves (sWABC); |sWABC| <0.10=negligible.

RESULTS: Of 1577 patients enrolled in the trial, 1264 survived to 90 days with complete 5-level EuroQOL questionnaire data (51.2% tenecteplase; 46.5% female; 30.1% aged ≥80). Omnibus testing revealed significant DIF only for age (χ²=86.9, P<0.001); neither sex (χ²=31.7, P=0.063) nor treatment (χ²=22.4, P=0.379) showed evidence of DIF. Four items flagged for age-related DIF: self-care, usual activities, pain/discomfort, and anxiety/depression. However, only self-care (sWABC=-0.46) and usual activities (sWABC=-0.34) showed moderate effects, while pain/discomfort (sWABC=-0.002) and anxiety/depression (sWABC=0.09) were negligible. Importantly, factor scores from models with and without DIF adjustment correlated (correlation coefficient=0.98).

CONCLUSIONS: The 5-level EuroQOL questionnaire appears to function equivalently across sex and treatment groups in this stroke population. Age-related DIF, though statistically detectable in physical functioning items, had little practical consequence for individual scores, supporting the instrument’s use for health-related quality of life comparisons in stroke trials.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03889249.

PMID:42488952 | DOI:10.1161/STROKEAHA.126.055939

Western Pac Surveill Response J. 2026 Jun 30;17(2):1-6. doi: 10.5365/wpsar.2026.17.2.1223. eCollection 2026 Apr-Jun.

ABSTRACT

OBJECTIVE: On 18 October 2022, diarrhoeal cases among the Sama Badjao indigenous community in the Philippines were reported from a tertiary hospital in Lucena City, Quezon Province. An investigation was conducted to confirm the outbreak, profile cases, identify the source of infection, and recommend prevention and control measures.

METHODS: Suspected cases were identified through medical records review, active case finding and key informant interviews. Identified cases were interviewed using a structured questionnaire to collect demographic, clinical and exposure information. Rectal swabs and environmental water samples were collected for bacterial isolation and confirmation.

RESULTS: A total of 75 cases were identified, with 40 (53.3%) hospitalized and four fatalities (case fatality rate: 5.3%). Ages ranged from 2 months to 20 years (median: 4 years). Nine of the 15 rectal swabs were positive for Vibrio cholerae Ogawa biotype El Tor. The community practised open defecation, and only 24.7% of households had basic sanitation. Although V. cholerae was not found in water samples, faecal contamination was noted in a community well, and Aeromonas species were isolated, indicating the presence of multiple gastrointestinal pathogens.

DISCUSSION: A cholera outbreak was confirmed among the Sama Badjao community in Lucena City. Environmental assessment indicated that poor sanitation, open defecation and unsafe water sources likely contributed to the outbreak. The high case fatality rate (5.3%) was influenced by delayed care and limited health-care access. These findings emphasize the need for interventions to improve water, sanitation and hygiene practices and provide culturally appropriate public health programmes to reduce cholera risk among vulnerable communities.

PMID:42488931 | PMC:PMC13389470 | DOI:10.5365/wpsar.2026.17.2.1223

Res Rep Urol. 2026 Jul 15;18:597883. doi: 10.2147/RRU.S597883. eCollection 2026.

ABSTRACT

PURPOSE: Benign Prostatic Hyperplasia (BPH) is a common non-malignant prostate enlargement that contributes to bladder outlet obstruction and lower urinary tract symptoms in men as they age.

PATIENTS AND METHODS: In this 90-day study, ninety-five men aged 45-80 years with clinically and radiologically confirmed moderate BPH [International Prostate Symptom Score (IPSS) between 8-19] were randomly allocated (1:1) to receive either Undaria pinnatifida fucoidan (UPF) or placebo. Prostate health was evaluated using the validated IPSS (total and composite sub-scores) on days 30, 60 and 90. Potential clinically meaningful IPSS reductions were assessed as Minimum Clinically Important Difference (MCID). Urinary flow rate, post-void residual volume (PVR) and prostate-specific antigen were also assessed.

RESULTS: By day 60, the UPF group showed significant improvement in total IPSS score compared to placebo (p=0.0234), with further improvements by day 90 (p=0.0015). The mean reduction in total IPSS score from baseline to day 90 was -3.40 in the UPF group versus -0.93 in the placebo group. Voiding (p=0.0006) and storage (p=0.0150), sub-scores improved significantly by day 90 in the UPF group. Quality of life related to urinary symptoms improved continuously by day 60 and 90 (both p<0.05 vs placebo). A higher proportion of UPF-treated participants achieved MCID ≥2 (60.0%) and ≥3 points (51.1%) compared to placebo (42.2% and 28.9%), with statistical significance for ≥3 points (p=0.0314) at day 90. Urinary flow rate improved and PVR decreased in both groups; however, between-group differences, including PSA, were not statistically significant. Importantly, UPF was well tolerated.

CONCLUSION: UPF supplementation was associated with statistically and clinically significant IPSS improvement, including voiding and storage composite scores, and enhanced prostate-related quality of life when compared to placebo. Secondary outcomes did not differ significantly between groups, and the duration (90 days) limits long-term interpretation. UPF appears safe and potentially beneficial for managing moderate BPH symptoms.

PMID:42488927 | PMC:PMC13389963 | DOI:10.2147/RRU.S597883

Plast Reconstr Surg Glob Open. 2026 Jul 22;14(7):e7907. doi: 10.1097/GOX.0000000000007907. eCollection 2026 Jul.

ABSTRACT

SUMMARY: Dercum’s disease is a rare, incurable condition characterized by painful lipomas distributed throughout the body for which there is no standard care protocol. Current treatment focuses on pain control through medication and surgical intervention. However, available management options only provide temporary relief. This practical review aims to condense the available therapeutic approaches for Dercum’s disease.

METHODS: A literature review was conducted on multiple online databases to identify articles published between 1976 and 2025. Keywords included “Dercum’s disease,” “adiposis dolorosa,” and “treatment.” This search yielded 5 novel therapies to treat symptoms of Dercum’s disease.

RESULTS: Infliximab, which is traditionally used as an autoimmune medication targeting tumor necrosis factor alpha showed a visual reduction in lipoma size, as well as an improvement in subjective pain grading. Deoxycholic acid (DCA) is a bile acid found naturally in the body that helps to emulsify fat in the intestines. Subcutaneous injection of DCA resulted in both an objective lowering of pain and decreased size of lipomas. CBL-514 is a first-in-class small-molecule inhibitor that induces apoptosis in adipose tissue. It is currently in phase 2 clinical trials and has yielded statistically significant reduction in lipoma size resulting in it receiving Fast Track distinction from the Food & Drug Administration.

CONCLUSIONS: Current management of Dercum’s disease revolves around medications and surgical intervention, which provide transient results and can be limited in certain populations. Novel studies are looking into off-target therapy options with the goal of presenting long-term treatment choices for clinicians to enhance management of this debilitating disease.

PMID:42488923 | PMC:PMC13391129 | DOI:10.1097/GOX.0000000000007907

Plast Reconstr Surg Glob Open. 2026 Jul 22;14(7):e7809. doi: 10.1097/GOX.0000000000007809. eCollection 2026 Jul.

ABSTRACT

BACKGROUND: Surgical scars following breast cancer treatment can significantly impact survivors’ quality of life. Pulsed dye laser (PDL) therapy has demonstrated efficacy in improving erythematous scars, and epidermal cooling devices are commonly used to enhance treatment safety and comfort. However, no studies have directly compared contact cooling (CC) and dynamic cooling device (DCD) modalities with the fifth-generation PDL.

METHODS: In this randomized, controlled split-scar trial, 20 female patients with bilateral surgical breast scars underwent 3 PDL treatments (595 nm) at 4-6 week intervals. One side was treated with CC and the other with a DCD. Outcomes were assessed using the Vancouver Scar Scale, Manchester Scar Scale, Clinical Global Impression-Improvement scale, optical coherence tomography, and pain scores.

RESULTS: Both CC and DCD treatments resulted in statistically significant scar improvement, with no significant difference between modalities in Vancouver Scar Scale, Manchester Scar Scale, or Clinical Global Impression-Improvement scores. Mean pain scores were low (2.6 for CC and 2.3 for DCD; P = 0.1378). Optical coherence tomography imaging demonstrated reduced vascular density in both groups.

CONCLUSIONS: The fifth-generation PDL is effective for treating erythematous breast surgery scars. Both CC and DCD treatments demonstrated equivalent clinical improvement and minimal discomfort, supporting their use as effective and well-tolerated options for the treatment of erythematous surgical scars in breast cancer survivors.

PMID:42488918 | PMC:PMC13391131 | DOI:10.1097/GOX.0000000000007809

Front Vet Sci. 2026 Jul 8;13:1858865. doi: 10.3389/fvets.2026.1858865. eCollection 2026.

ABSTRACT

INTRODUCTION: African swine fever (ASF) was first detected in Vietnam in early February 2019 and spread rapidly nationwide. By December 2019, ASF had been reported in 8,509 of 11,055 communes (77%) across all 63 provinces and municipalities.

METHODS: Descriptive analyses were performed to summarize temporal and spatial patterns of ASF-affected communes (outbreaks). Outbreak data were aggregated weekly (week 1-48) based on onset date, and weekly counts, cumulative numbers, and proportions of affected communes were calculated. To quantify the early spread of ASF, we analyzed commune-level outbreak data from 2019. Temporal progression was assessed using linear and negative binomial regression models, whereas spatiotemporal clusters were identified using a space-time permutation model.

RESULTS: The linear regression analysis indicated an approximately 2.5 percentage-point weekly increase in the cumulative proportion of affected communes (R ² = 0.94) from 1 February to 14 July 2019. The negative binomial regression model estimated an approximately 7.6% weekly increase in affected commune counts (β = 0.073) from 1 February to 14 July 2019, corresponding to a doubling time of approximately 9.5 weeks. Consequently, more than half of the communes were affected within the first 24 weeks of the first detected case. A total of 18 statistically significant spatiotemporal clusters were identified. The earliest cluster was detected in the North, where the first outbreak was confirmed, and the most numerous clusters were in the Central region. Many cluster centers were located in areas of relatively high pig density, particularly in the Red River Delta and Mekong River Delta.

CONCLUSION: These findings highlight the extensive geographic scale of ASF transmission in Vietnam in the first year of the epidemic. The rapid and extensive spread observed suggests that a stamping-out strategy, as typically implemented, may face substantial challenges under such epidemic conditions. Instead, the results emphasize the importance of impact-mitigation strategies and long-term management approaches, including enhanced biosecurity, farmer support, and measures to maintain a stable pork supply. These findings also provide relevant insights for countries facing similar endemic conditions or at risk of ASF introduction.

PMID:42488908 | PMC:PMC13388069 | DOI:10.3389/fvets.2026.1858865

Front Vet Sci. 2026 Jul 8;13:1866378. doi: 10.3389/fvets.2026.1866378. eCollection 2026.

ABSTRACT

Porcine reproductive and respiratory syndrome (PRRS) remain one of the most economically significant diseases affecting the global swine industry. Caused by the PRRS virus (PRRSV), the disease leads to reproductive failure in sows and respiratory disorders in pigs of all ages. In Vietnam, PRRSV was officially reported in 2007, and the emergence of highly pathogenic PRRSV (HP-PRRSV) strains has since intensified outbreaks with high morbidity and mortality. This study evaluated the efficacy of the intradermal PRRSV-1 commercial vaccine (UNISTRAIN® PRRS, HIPRA) in piglets experimentally challenged with a Vietnamese HP-PRRSV-2 strain. Twenty-eight PRRS naïve, 21-day-old piglets were randomly assigned to a VC group, including vaccinated and challenged pigs (n = 12); UVC group, including unvaccinated and challenged pigs (n = 12); and a UVUC group, including unvaccinated and unchallenged pigs (n = 4). At 5 weeks post-vaccination, all animals in VC group and UVC group were challenged intramuscularly with 3 mL of HP-PRRSV (lineage L8E, 2025; at a dose of 10⁵ CCID₅₀/pig) and monitored for 28 days post-infection (dpi). Clinical signs, rectal temperature, viremia, antibody response, macro/micropathological lesions and growth performance were evaluated. Vaccinated pigs exhibited a lower incidence of fever and milder respiratory signs than unvaccinated pigs, corresponding to reduced clinical scores. Despite viremia in both groups post-infection, vaccinated pigs exhibited reduced viral loads, shorter viremia duration, and lower incidence than unvaccinated pigs at 7 dpi (p < 0.05). This constituted a significant reduction in viremia, evidenced by a 38.58% decrease in AUC. The antibody response developed earlier and persisted longer in vaccinated pigs, which displayed significantly higher S/P ratios at 7 dpi (p < 0.001). Lung lesions in vaccinated pigs were characterized by mild interstitial inflammation with preserved alveolar structure, whereas unvaccinated pigs exhibited severe, diffuse interstitial pneumonia with hemorrhage. Average daily gain was numerically higher in vaccinated animals, though not statistically significant (p > 0.05). Overall, intradermal PRRSV-1 vaccination partially protected against heterologous HP-PRRSV-2, lowering disease severity and promoting early antibody production.

PMID:42488905 | PMC:PMC13390625 | DOI:10.3389/fvets.2026.1866378

Front Vet Sci. 2026 Jul 8;13:1886000. doi: 10.3389/fvets.2026.1886000. eCollection 2026.

ABSTRACT

INTRODUCTION: Wildlife trafficking exposes parrots to stressful conditions that favor the transmission of infectious pathogens, including Salmonella pullorum and Mycoplasma gallisepticum. This study aimed to investigate seroreactivity against these pathogens and to evaluate the associated clinical, morphological, biochemical, metabolic, and hematological alterations in Amazona aestiva and Amazona amazonica parrots rescued from wildlife trafficking.

METHODS: Twenty-nine parrots rescued from wildlife trafficking were subjected to physical examination, morphological evaluation, hematological and biochemical analyses, and Rapid Serum Agglutination (RSA) testing for antibodies against M. gallisepticum and S. pullorum. Statistical comparisons were performed between reactive and non-reactive groups to identify laboratory alterations associated with seroreactivity.

RESULTS: Seroreactivity to M. gallisepticum was observed in 21.73% of A. aestiva and 14.3% of A. amazonica. For S. pullorum, 36.4% (8/22; 95% CI: 16.3-56.6%) of A. aestiva and 28.6% (2/7; 95% CI: 3.7-71.0%) of A. amazonica tested positive. Birds reactive to S. pullorum exhibited significantly lower total protein concentrations, whereas M. gallisepticum-reactive birds showed significantly lower leukocyte counts and higher glucose concentrations. Significant differences were also observed in calcium and sodium concentrations among groups. Reactive birds presented clinical alterations compatible with gastrointestinal and respiratory involvement, as well as changes in body condition and feather quality.

DISCUSSION: The findings indicate that parrots rescued from wildlife trafficking and reactive to S. pullorum or M. gallisepticum may exhibit important clinical and laboratory alterations suggestive of multisystemic impairment. As the RSA test detects circulating agglutinating antibodies without distinguishing immunoglobulin classes or confirming active infection, positive results should be interpreted as evidence of previous exposure and immune response rather than current infection. Nevertheless, the findings reinforce the importance of sanitary surveillance, screening programs, and appropriate clinical management in wildlife rehabilitation centers to support animal health, conservation efforts, and prevention of pathogen dissemination.

PMID:42488904 | PMC:PMC13390629 | DOI:10.3389/fvets.2026.1886000