Tag: nevin manimala

Int J Soc Psychiatry. 2026 Feb 28:207640261419135. doi: 10.1177/00207640261419135. Online ahead of print.

ABSTRACT

BACKGROUND: Substance use disorders (SUDs) represent a growing public health concern in Canada, contributing to emergency department (ED) overcrowding and high system costs. Despite rising rates of SUD-related ED visits, the role of equity-related determinants, such as socioeconomic status, households and dwellings marginalization, and access to coordinated care, remains insufficiently understood.

AIM: This study examined how equity-related and sociodemographic factors, along with clinical and service utilization characteristics, are associated with frequent ED visits for SUD in Ontario, Canada.

METHODS: Using provincial health administrative data from ICES, we conducted a retrospective cohort analysis of individuals aged 12 and older with an SUD-related ED visit between April 2022 and March 2023. Frequent ED visits were defined as three or more substance use-related emergency department visits in the 12 months preceding an individual’s index visit, excluding the index visit itself, which represented approximately the 90th percentile of visit frequency in the cohort. Logistic regression identified factors associated with frequent ED utilization (⩾3 annually).

RESULTS: Frequent SUD-related ED visitors were disproportionately young adults (25-44 years) and male. Individuals in the most housing-unstable areas had significantly higher odds of frequent ED visits. Racialized and newcomer indices were not statistically associated with frequent visits. Comorbid mental illness, chronic diseases, and alcohol use were strong clinical correlates. High service utilization patterns, including prior mental health and acute care hospitalizations, were also associated with frequent ED use.

CONCLUSION: High-frequency ED users with SUD reflect a convergence of clinical complexity, socioeconomic vulnerability, and systemic gaps. While households and dwellings marginalization emerged as a key factor, the absence of associations with racialized or newcomer indices should not be misread as a lack of need, as these indices were measured at the area level. These findings highlight the urgent need for equity-informed, integrated care to reduce preventable ED use.

PMID:41763904 | DOI:10.1177/00207640261419135

Hand (N Y). 2026 Feb 28:15589447261416977. doi: 10.1177/15589447261416977. Online ahead of print.

ABSTRACT

BACKGROUND: Finger amputation is one of the most common surgical procedures conducted by hand surgeons. The purpose of the current study was to compare the incidence of painful neuromas requiring surgical interventions after finger amputation secondary to acute trauma versus chronic digital ischemia.

METHODS: A retrospective chart review was conducted at a single tertiary academic medical center. Patients who underwent finger amputation due to acute trauma or chronic ischemia were identified using Current Procedural Terminology codes. The primary outcome was the incidence of neuroma formation. Patient demographics, treatment types, and postoperative complications, such as infection, residual pain, and phantom limb, were also collected.

RESULTS: Between January 2013 and December 2023, there were 1150 patients who underwent finger or thumb amputations, 917 due to acute trauma and 233 associated with chronic ischemia. Men were more likely involved in traumatic amputations. Raynaud’s disease, scleroderma, and end-stage renal disease were the common causes for ischemic finger amputation. No significant difference was found between the 2 groups in postamputation complications. Thirty-eight in the traumatic group (4.1%) and 4 in the chronic ischemia group (1.7%) developed painful neuroma requiring surgical intervention. However, the difference was not statistically significant (P = .09).

CONCLUSIONS: The overall incidence of painful stump neuroma after digital amputation was low. While there was a stronger tendency in developing painful neuromas after finger amputation due to trauma compared with chronic ischemia, the difference was not statistically significant.

PMID:41763898 | DOI:10.1177/15589447261416977

Hand (N Y). 2026 Feb 28:15589447261416114. doi: 10.1177/15589447261416114. Online ahead of print.

ABSTRACT

Randomized controlled trials (RCTs) comparing surgical fixation versus conservative management of distal radius fractures (DRFs) among the elderly often rely on P values for outcomes despite small sample sizes, attrition, and nonsignificant findings. This study uses the reverse fragility index (rFI) and reverse fragility quotient (rFQ) to assess the statistical stability of re-intervention and complication outcomes in RCTs. PubMed and Embase were searched for RCTs between January 1, 2000, and May 2024 for RCTs that evaluated surgical management versus conservative management of DRFs in the elderly population were included. RCTs were included if they contained 2 treatment arms reporting categorical dichotomous outcomes and had an equal or longer than 1-year follow-up. Non-RCT studies, RCTs with more than 2 treatment arms, RCTs without 1 year or longer follow-up, and RCTs without DRFs in elderly cohorts were excluded. rFI were calculated as the number of outcome even reversals needed to change statistical significance for nonsignificant (P ≥ .05) outcomes. rFQ was calculated by dividing the rFI by the sample size of the study. One thousand three hundred sixty-one articles were screened, with 12 studies with 1495 patients included for final analysis. The median rFI for re-intervention was 4 (range: 1-18), with a median rFQ of 0.035 (3.5%) within all RCTs evaluated. In every trial, the number of patients lost to follow-up was higher than the rFI, suggesting fragile statistical conclusions. For fracture healing complications, the median rFI was 4, with an rFQ of 0.02 (2%). Minor and major complications had rFI of 3, with rFQ of 0.02 (2%) and 0.04 (4%), respectively. Randomized controlled trials (RCTs) comparing surgical and conservative management of DRFs among elderly patients are statistically fragile, with a median of only 4 event reversals needed to alter significance. Caution is warranted when interpreting RCT results to determine fracture management among this patient population. Authors recommend larger, well-powered trials with standardized rFI analyses to better interpret outcomes in DRF RCTs among elderly patients.Level of Evidence: Therapeutic Level III.

PMID:41763897 | DOI:10.1177/15589447261416114

Food Res Int. 2026 Apr 1;229:118496. doi: 10.1016/j.foodres.2026.118496. Epub 2026 Jan 21.

ABSTRACT

Dairy white wastewater (WW), a by-product of industrial cleaning processes, contains residual milk proteins that can be enzymatically converted into bioactive peptides. In this study, WW proteins were hydrolyzed using four enzymes, pepsin, trypsin, thermolysin, and pronase E, for up to 240 min, and the resulting hydrolysates were evaluated for ACE inhibition, DPP-IV inhibition, and antioxidant capacity. Thermolysin hydrolysates exhibited the strongest ACE inhibition, with IC₅₀ values as low as 21.0 μg protein/mL, whereas pepsin and pronase E hydrolysates showed DPP-IV inhibitory activities with IC₅₀ values of 2.4-3.1 mg protein/mL. Pepsin hydrolysates presented the highest antioxidant capacity, reaching 3.5 μM Trolox equivalents/mg protein. LC-MS/MS analysis combined with multivariate statistics identified 60 discriminant peptides, including 17 peptides previously reported to possess antihypertensive, antidiabetic, and/or antioxidant bioactivities. Based on a combination of PLS-DA loadings, QSAR scores, novelty relative to known bioactive peptides and physicochemical diversity, 20 peptides were synthesized and validated experimentally. Several peptides such as LRF, QW, GAWY, PPF, GPIVL, and SFNPTQL exhibited potent inhibitory effects, with micromolar IC₅₀ values for ACE and/or DPP-IV. In comparison to chemically synthesized ACE inhibitors like captopril, the most potent peptide, LRF, is five times more active on a molar basis (11.34 μM vs 63.06 μM). These findings demonstrate that WW is a promising source of multifunctional peptides and that integrating peptidomics with machine learning accelerates peptide discovery and validation.

PMID:41763818 | DOI:10.1016/j.foodres.2026.118496

Food Res Int. 2026 Apr 1;229:118387. doi: 10.1016/j.foodres.2026.118387. Epub 2026 Jan 13.

ABSTRACT

Gastrodia elata, a recognized medicine food homology plant, has traditionally been consumed as a functional herbal tea owing to its rich bioactive composition and associated health benefits. Herein, we systematically investigated the effects of crushing degree (lamellated, granular, and powdered forms), brewing temperature (70-100 °C), and time (3-10 min) on the physicochemical properties, total phenolics, total flavonoids, individual bioactives (adenosine; gastrodin; p-hydroxybenzyl alcohol; p-hydroxy benzaldehyde; and parishin compounds A, B, C, and E), flavor, and sensory characteristics of Gastrodia elata tea by using advanced analytical equipment combined with chemometrics methods. Among the different crushing degrees, granular Gastrodia elata tea exhibited the most favorable properties. Upon increasing brewing temperature and time, the bioactive levels, scavenging capacities against DPPH and ABTS free radicals, and sensory attributes of Gastrodia elata tea generally followed parabolic and incremental trends. Notably, granular Gastrodia elata tea treated at 90 °C for 10 min showed the highest total phenolics, flavonoids, and sugar contents. Non-targeted metabolomics analysis further revealed the differences in metabolites of Gastrodia elata tea under different brewing conditions. Through multivariate statistical analysis, the internal relationships among different brewing conditions, volatile and non-volatile components and quality characteristics were established, and 11 potential characteristic markers closely related to the quality of Gastrodia elata tea were obtained. Results underscored the role of brewing conditions in enhancing the dissolution of quality-related volatile and nonvolatile bioactives. Collectively, the findings provided a scientific guidance for the consumption of Gastrodia elata tea to support daily nutritional and health needs.

PMID:41763758 | DOI:10.1016/j.foodres.2026.118387

Lancet. 2026 Feb 28;407(10531):876-891. doi: 10.1016/S0140-6736(25)02365-7.

ABSTRACT

BACKGROUND: Antipsychotic drugs are the established treatment for acute schizophrenia but differ in receptor-binding profiles. In 2024, a new-in-class muscarinic receptor agonist (xanomeline-trospium) was licenced, acting upstream of antidopaminergic agents, and providing hope to decrease the adverse effects burden of antipsychotics. We aimed to compare the efficacy and tolerability of antipsychotics by performing network meta-analysis of randomised controlled trials (RCTs).

METHODS: This systematic review (PROSPERO, CRD42022380708) included blinded and open RCTs investigating antipsychotic drugs in participants of any age with acute psychotic symptoms of schizophrenia over 3 weeks to 3 months. Included antipsychotics comprised 23 primarily dopamine-receptor blocking medications and the muscarinic receptor agonist xanomeline-trospium in different applications. We searched Cochrane Schizophrenia group’s register, previous reviews, and five Chinese databases for trials published from database inception until July 26, 2024 and contacted authors to assess trials’ methodological quality; only trials with appropriate randomisation indicated were included. The primary outcome was rating scale-measured overall symptoms of schizophrenia (efficacy) analysed with random-effects frequentist network meta-analysis. Secondary outcomes comprised 32 further efficacy and tolerability outcomes. The confidence in the estimates was assessed using the Confidence in Network Meta-Analysis approach.

FINDINGS: After screening 18 859 references and contacting authors of 5428 trials, we included 438 RCTs. Of those, 388 RCTs with 78 193 participants (28 448 women and 49 745 men) provided usable data for at least one outcome. 5117 Chinese trials were identified but most were excluded because authors did not reply or reported serious methodological concerns. 256 double-blind studies with 58 948 participants provided usable data for the primary outcome. All antipsychotics reduced symptoms more than placebo with standardised mean differences ranging from -0·90 (95% CI -1·03 to -0·77) to -0·23 (-0·39 to -0·06). Particularly clozapine, as well as amisulpride, olanzapine, and risperidone were more efficacious than at least three other antipsychotics (confidence in estimates were low-to-moderate). Adverse effects varied across medications.

INTERPRETATION: This network meta-analysis provides evidence for small-to-medium clinically relevant differences between antipsychotics in efficacy; this finding warrants stronger and more specific emphasis in clinical guidelines. Nonetheless, important differences in tolerability need to be considered for individualised drug choice, with partial dopamine agonists having overall better tolerability and xanomeline-trospium lacking adverse effects of dopamine-blocking agents but resulting in cholinergic and anticholinergic adverse events. Future research should directly compare xanomeline-trospium with other antipsychotics to confirm its efficacy; modern trials using clozapine early in schizophrenia are needed to establish whether it improves outcomes and prevents chronification.

FUNDING: German Research Foundation, German Ministry of Research, Technology and Space, and National Natural Science Foundation of China.

PMID:41763745 | DOI:10.1016/S0140-6736(25)02365-7

Lancet. 2026 Feb 28;407(10531):855-866. doi: 10.1016/S0140-6736(25)02305-0.

ABSTRACT

BACKGROUND: Total hip replacement is a successful operation that aims to restore function and quality of life to millions of people globally. Knowing how long a total hip replacement might last is important for patients, surgeons, and health-care institutions for planning and resource allocation. Over the past 20 years, the use of contemporary bearing surfaces for total hip replacement has substantially altered implant wear and, possibly, longevity. To date, there has been no large-scale study that examines survivorship of these modern implants. We aimed to determine the survivorship of contemporary total hip replacements and bearing materials.

METHODS: We focused solely on the assessment of modern bearing surfaces: highly cross-linked polyethylene versus metal or third-generation and fourth-generation ceramic heads and ceramic-on-ceramic primary total hip replacement in adult patients. We conducted a search of MEDLINE and Embase from database inception to June 13, 2024, including articles that reported a minimum of 10 years of survivorship, irrespective of fixation method or surgical approach. We then conducted a meta-analysis combining data from eight national joint registries assessing all-cause revision within the various bearing combinations. We extrapolated the extracted data to estimate survivorship to 30 years, using the multivariable random-effects model from the registry data. The primary outcome was survivorship of the hip replacement, defined as time from primary total hip replacement to first all-cause revision, expressed as a percentage of unrevised implants at specific timepoints. This study is registered with PROSPERO (CRD42024572518).

FINDINGS: We identified 1 904 237 total hip arthroplasties across 29 clinical studies (n=5203) and eight national joint registries (n=1 899 034). Pooled analysis of the included studies showed an all-cause implant survivorship of 0·97 (0·96-0·98) under the random-effects model. Survivorship estimate based on joint registry data was at 93·6% (95% CI 92·3-94·7) at 20 years. Extrapolating these data indicates a predicted survivorship of 92·8% (91·2-94·2) at 25 years and 92·1% (90·1- 93·7) at 30 years.

INTERPRETATION: The estimated 92% 30-year survivorship of contemporary total hip replacement suggests that advances in bearing surface technology have greatly improved the long-term durability of total hip replacements and might influence patient counselling, health-care planning, and device regulation.

FUNDING: None.

PMID:41763743 | DOI:10.1016/S0140-6736(25)02305-0

Lancet. 2026 Feb 28;407(10531):826-827. doi: 10.1016/S0140-6736(25)02517-6.

NO ABSTRACT

PMID:41763728 | DOI:10.1016/S0140-6736(25)02517-6

Ann Otol Rhinol Laryngol. 2026 Feb 28:34894261423285. doi: 10.1177/00034894261423285. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the effects of using Exparel^® bupivacaine liposome suspension 1.3% (13.3 mg/mL) as an adjunct to standard of care medication in adult tonsillectomy patients.

STUDY DESIGN: Randomized controlled trial.

SETTING: Community Hospital.

METHODS: The study arm (n = 22) received Exparel^® bupivacaine liposome suspension 1.3% (13.3 mg/mL) as an adjunct to the standard of care (SOC) medication bupivacaine HCl 0.25% (2.5 mg/mL) with epinephrine (5 μg/mL). The control group (n = 20) received SOC bupivacaine HCl 0.25% with epinephrine (5 μg/mL). All injections were administered after the excision of the tonsil, prior to conclusion of the operative procedure. Pre- and post-operative clinicopathologic variables of interest were collated from electronic medical records and daily pain diaries. Results were analyzed via standard univariate statistics, linear mixed models, and Poisson regression.

RESULTS: The Exparel^® + SOC group experienced significantly less pain at post operative day (POD) 3 compared to the control group (P < .05). Mean pain score decreased on average by 1.23 points in the Exparel^® + SOC group and increased on average by 0.39 points in the control group (adj. P-value < .001). Similarly, analysis showed that maximum pain score decreased on average by 0.64 points in the Exparel^® + SOC and increased on average by 0.61 points the control group (adj. P-value < .001). There was a statistically significant decrease in dose of oxycodone use between POD 3 and POD 5 within the Exparel^® + SOC group (16.39 vs 7.22 mg, P-value = .035). The relative proportion of patients who took oxycodone was less in the Exparel^® + SOC group compared to the control group across all PODs.

CONCLUSION: Use of Exparel^® in adult tonsillectomy may decrease post-operative opioid use compared to standard of care treatment. These findings may serve as guidance for best practices in adult tonsillectomy.

PMID:41763725 | DOI:10.1177/00034894261423285

PDA J Pharm Sci Technol. 2026 Feb 28;80(1):137-138. doi: 10.5731/pdajpst.2026.26109.

ABSTRACT

For more than 40 years, the Limulus Amebocyte Lysate (LAL) test has served as the standard method for bacterial endotoxin Testing (BET). The critical proteins required for endotoxin detection in LAL assays are sourced from amoebocytes-blood cells extracted from horseshoe crabs.Animal-free reagents have been developed to support conservation efforts and the 3Rs (Replacement, Reduction, and Refinement). One such alternative is the recombinant cascade reagent (rCR), which contains three recombinant proteins that replicate the natural enzymatic cascade found in horseshoe crab amoebocytes to detect bacterial endotoxins.This study assessed the equivalency of rCR to FDA-licensed LAL reagents using 563 pharmaceutically relevant samples. Of these, 134 samples were contaminated with natural environmental endotoxin (NEE), allowing for a direct statistical comparison.Results showed that the rCR assays were equivalent in performance to FDA-licensed LAL assays, detecting endotoxin at similar levels under real-world conditions. Equivalency was demonstrated using methods consistent with those outlined in compendial guidance for bacterial endotoxin testing.

PMID:41763684 | DOI:10.5731/pdajpst.2026.26109