QJM. 2026 Jun 15:hcag157. doi: 10.1093/qjmed/hcag157. Online ahead of print.
NO ABSTRACT
PMID:42295867 | DOI:10.1093/qjmed/hcag157
Tag: pubmed
Physiol Int. 2026 Jun 15:2060.2026.00920. doi: 10.1556/2060.2026.00920. Online ahead of print.
ABSTRACT
OBJECTIVE: The aim of this study was to evaluate circulating levels of heat shock protein 27 (HSPB1, Hsp27), heat shock protein 60 (HSPD1, Hsp60) and heat shock protein 90 (HSPC1, Hsp90) in a large cohort of healthy non-pregnant and pregnant women, as well as in patients with preeclampsia. In addition, we investigated whether serum levels of these heat shock proteins are associated with clinical characteristics and routine laboratory parameters of the study population.
METHODS: The study included 60 women with preeclampsia, 60 healthy pregnant women with uncomplicated pregnancies and 59 healthy non-pregnant controls. Serum concentrations of Hsp27, Hsp60 and Hsp90 were measured with ELISA. Standard clinical chemistry parameters were assessed on an automated analyzer. Statistical analyses were performed using nonparametric methods.
RESULTS: Serum levels of Hsp27, Hsp60 and Hsp90 were significantly higher in healthy pregnant women compared with healthy non-pregnant controls. Moreover, preeclamptic patients exhibited significantly elevated levels of all three heat shock proteins compared with both control groups. In the preeclamptic group, serum Hsp27 levels showed significant positive correlations with serum bilirubin and lactate dehydrogenase activity. Hsp60 levels were positively correlated with blood urea nitrogen, creatinine, aspartate aminotransferase activity and lactate dehydrogenase activity. Hsp90 levels showed a significant positive correlation with aspartate aminotransferase activity.
CONCLUSIONS: Moderately increased circulating levels of Hsp27, Hsp60 and Hsp90 in otherwise healthy pregnancies may reflect adaptive physiological responses. In contrast, markedly elevated levels observed in preeclampsia may be associated with placental ischemia and oxidative stress, as well as maternal systemic inflammation, endothelial dysfunction, and tissue injury in both placental and maternal organs.
PMID:42295854 | DOI:10.1556/2060.2026.00920
JAMA Intern Med. 2026 Jun 15. doi: 10.1001/jamainternmed.2026.1929. Online ahead of print.
ABSTRACT
IMPORTANCE: COVID-19 vaccines were previously shown to reduce risk of major adverse cardiovascular events (MACEs). Whether the 2024-2025 COVID-19 vaccine continues to reduce COVID-19-associated MACEs in the context of evolving variants and widespread population immunity is unknown.
OBJECTIVE: To determine whether the 2024-2025 COVID-19 vaccine is associated with reduced risk of COVID-19-associated MACE.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a target-trial emulation using US Department of Veterans Affairs (VA) electronic health records. Participants were veterans with vaccination encounters between September 3, 2024, and December 31, 2024.
EXPOSURES: Same-day coadministration of the 2024-2025 COVID-19 and influenza vaccines vs influenza vaccine alone.
MAIN OUTCOMES AND MEASURES: Composite end point of COVID-19-associated MACE, defined as COVID-19-associated cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure. Secondary outcomes included all-cause MACE, hospitalization, and death. Vaccine effectiveness (VE), calculated as 1 minus the risk ratio, and risk difference were estimated at 8 months using inverse probability weighting.
RESULTS: Among 1 039 659 participants who received influenza vaccine (mean [SD] age, 70.1 [12.4] years; 954 341 [91.8%] men), 349 085 received COVID-19 vaccine and 690 574 did not. At 8 months, the COVID-19 vaccine was associated with lower risk of COVID-19-associated MACE (VE, 37.7% [95% CI, 18.2%-54.9%]; risk difference per 10 000 persons, 2.0 [95% CI, 0.9-3.7]). VE for COVID-19-associated MACE was statistically significant only in individuals older than 75 years (VE, 50.7% [95% CI, 31.8%-65.6%]), a group that also experienced the largest absolute risk reduction (5.5 fewer events per 10 000 individuals). No statistically significant vaccine effectiveness was observed among those younger than 65 years or aged 65 to 75 years. While VE for COVID-19-associated MACE on the relative scale was statistically significant across subgroups of participants with and without comorbid health conditions, the absolute benefit was consistently and substantially greater for individuals with the comorbid health condition. Secondary analyses of all-cause MACE, all-cause hospitalization, and all-cause death suggested substantially larger absolute risk reductions (risk difference for all-cause MACE, 23.7 [95% CI, 14.1 to 34.7]).
CONCLUSIONS AND RELEVANCE: In this cohort study, receipt of the 2024-2025 COVID-19 vaccine was associated with reduced risk of COVID-19-associated MACE, with reductions most prominent in those 75 years or older and those with comorbidities. While the reduction in COVID-19-associated MACE was modest, the substantially larger reduction in all-cause MACE suggests that the vaccine’s protective association extends to the hidden burden of undetected SARS-CoV-2 and its sequelae.
PMID:42295793 | DOI:10.1001/jamainternmed.2026.1929
JAMA Neurol. 2026 Jun 15. doi: 10.1001/jamaneurol.2026.1542. Online ahead of print.
ABSTRACT
IMPORTANCE: Middle meningeal artery embolization (MMAE) is a minimally invasive adjunctive treatment for chronic subdural hematoma (cSDH). The TRUFILL n-butyl cyanoacrylate (n-BCA) liquid embolic system is indicated for embolization of cerebral arteriovenous malformations for presurgical devascularization and may be appropriate for MMAE in patients with cSDH.
OBJECTIVE: To evaluate safety and effectiveness of the study device for MMAE plus standard of care vs standard of care alone in patients with cSDH.
DESIGN, SETTING, AND PARTICIPANTS: The Middle Meningeal Artery Embolization for the Treatment of Subdural Hematomas With TRUFILL n-BCA (MEMBRANE) trial was a prospective, multicenter, open-label, randomized clinical trial conducted from May 27, 2021, to February 6, 2024, at 30 hospitals (28 in the United States and 2 in China). Participants aged 18 to 90 years with symptomatic cSDH and a modified Rankin Scale score of 3 or less were enrolled.
INTERVENTIONS: Site physicians determined whether each patient required surgical or nonsurgical management. Participants in the surgical and nonsurgical cohorts were then randomized 1:1 to receive MMAE plus standard of care or standard of care alone.
MAIN OUTCOMES AND MEASURES: The primary effectiveness end point was residual or re-accumulation of hematoma (>10 mm; assessed by an independent core laboratory) at 6 months or requiring a surgical procedure on the cSDH within 6 months (conducted as an intention-to-treat analysis). The primary safety end point was incidence of adverse events through 6 months (conducted as an as-treated analysis).
RESULTS: A total of 376 participants (188 in MMAE plus standard of care and 188 in standard of care alone) were included. In the MMAE plus standard of care and standard of care alone groups, the mean (SD) age was 70.9 (10.6) and 70.3 (12.1) years, and 45 (23.9%) and 49 (26.1%) were female, respectively. Primary effectiveness end point events occurred in 17 of 146 participants receiving MMAE plus standard of care (11.6%) and 29 of 131 receiving standard of care alone (22.1%) (final estimate of common odds ratio: 0.53 [90% CI, 0.31-0.91]; P = .04), indicating statistically significant benefit for MMAE plus standard of care vs standard of care alone. Adverse events occurred in 130 of 181 participants in the MMAE plus standard of care group (71.8%) and 124 of 190 in the standard of care alone group (65.3%) through 6 months. MMAE plus standard of care treatment was noninferior to standard of care alone based on analysis of good functional outcome at 3 months, as assessed by the modified Rankin Scale.
CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, MMAE plus standard of care significantly reduced rates of recurrence and reoperation vs standard of care alone, without a significant increase in adverse events.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier, NCT04816591.
PMID:42295790 | DOI:10.1001/jamaneurol.2026.1542
Ann Plast Surg. 2026 Jun 15. doi: 10.1097/SAP.0000000000004799. Online ahead of print.
ABSTRACT
OBJECTIVE: To examine the patterns, treatment practices, and outcomes of burn injuries over a 5-year period at a tertiary care center, focusing on mortality trends and factors influencing patient outcomes.
METHODS: A retrospective analysis was performed on 377 patients hospitalized for burns between 2020 and 2024 at a tertiary care center. Data were collected using a modified questionnaire and analyzed with IBM SPSS Statistics. We evaluated patient demographics, burn characteristics, treatment methods, and outcomes. We calculated the mean age and total body surface area (TBSA) and assessed mortality trends each year.
RESULTS: The study included 254 males (67.4%) and 123 females (32.6%) with a mean age of 33.4 years and a mean TBSA of 27.4%. Thermal burns were the main cause (282 patients, 74.8%), followed by electrical burns (86 patients, 22.8%) and chemical burns (9 patients, 2.4%). Most injuries were accidental (367 patients, 97.3%). We used allografts in 99 patients (26.3%), which helped with wound excision and lowered the risk of infection. The overall mortality rate was 21.8% (82 patients), with males more affected. Despite consistent burn severity, mortality showed a notable decrease from 23.9% in 2020 to 7.9% in 2024.
CONCLUSIONS: This study shows improvements in outcomes for major burn victims over the 5-year period, notably the drop in mortality rates. Introduction of measures such as barrier nursing and strict patient isolation, early aggressive tangential excision of wounds, along with the use of allografts postburn wound debridement. Ongoing investment in burn care infrastructure and access to better treatments may allow further reduction in complications and deaths related to burn injuries.
PMID:42295771 | DOI:10.1097/SAP.0000000000004799
JAMA Netw Open. 2026 Jun 1;9(6):e2616154. doi: 10.1001/jamanetworkopen.2026.16154.
ABSTRACT
IMPORTANCE: Despite advances in D2 gastrectomy (ie, gastrectomy with D2 lymphadenectomy) and adjuvant chemotherapy, the value of adding postoperative radiotherapy (RT) to adjuvant chemotherapy after D2 gastrectomy remains a topic of ongoing debate.
OBJECTIVE: To assess whether the addition of RT to the S-1 plus oxaliplatin (SOX) chemotherapy regimen increases disease-free survival (DFS) in patients with T4 or node-positive gastric cancer after D2 gastrectomy.
DESIGN, SETTING, AND PARTICIPANTS: This open-label, phase 3 randomized clinical trial was conducted between December 1, 2012, and August 30, 2022, at 5 large tertiary hospitals in China. Eligible patients were aged 18 to 70 years with gastric adenocarcinoma who underwent R0 resection with D2 lymphadenectomy, had pathologic stage T4 or node-positive disease, and had no evidence of metastasis (M0). Intention-to-treat statistical analyses were conducted from January 14 to March 31, 2025.
INTERVENTIONS: Participants were assigned 1:1 to receive concurrent chemoradiotherapy (SOX RT) or chemotherapy alone (SOX). The SOX RT group received 1 cycle of induction SOX, followed by RT (50.4 Gy in 28 fractions) with concurrent S-1 (50 mg twice daily), and then 3 cycles of SOX. The SOX group received 6 cycles of SOX (S-1 30-40 mg/m2 twice daily on days 1-14; oxaliplatin 130 mg/m2 on day 1, every 3 weeks).
MAIN OUTCOMES AND MEASURES: The primary end point was 3-year DFS. Secondary end points included overall survival (OS) and adverse events.
RESULTS: A total of 620 patients were randomly assigned to the SOX group (n = 311) or SOX RT group (n = 309). Patients had a median (IQR) age of 55 (47-62) years and included 401 males (64.7%). Overall, 274 patients (44.2%) had T4 disease, and 590 (95.2%) had node-positive disease. In the primary analysis for the prespecified 3-year DFS end point, there was no evidence of a between-group difference in DFS (SOX RT vs SOX: HR, 0.98; 95% CI, 0.73-1.33). Similarly, there was no evidence of a between-group difference in OS (HR, 0.86; 95% CI, 0.60-1.23). The Kaplan-Meier-estimated 3-year DFS rates were 70.5% in the SOX RT group and 69.3% in the SOX group (log-rank P = .93), and the corresponding 3-year OS rates were 80.8% and 78.4%, respectively (log-rank P = .41). At 5 years, the DFS rates were 60.0% and 57.3% (log-rank P = .76) and the corresponding OS rates were 73.7% and 71.4% (log-rank P = .55) in the SOX RT and SOX groups, respectively. Treatment-related adverse events were similar between groups.
CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of patients with T4 or node-positive gastric cancer who underwent D2 gastrectomy, SOX RT did not significantly improve DFS or OS. Accordingly, among patients with D2-resected gastric cancer, the findings do not support routine addition of adjuvant chemoradiotherapy to chemotherapy.
TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR-TRC-12002919.
PMID:42295761 | DOI:10.1001/jamanetworkopen.2026.16154
Indian J Med Res. 2026 Jun;163(6):829-837. doi: 10.25259/IJMR_256_2026.
ABSTRACT
Background and objectives In India, national nutrition programmes emphasise age-appropriate, nutrient-dense complementary foods for young children. This study aimed to optimise nutrient-dense complementary foods for children aged 12-35 months using locally sourced ingredients and a mixture design approach, in alignment with the Nutrition Norms of the Poshan 2.0 Programme under Schedule II of the National Food Security Act, 2013 (NFSA 2013), revised in 2023. Methods D-optimal mixture design is an advanced statistical design of experiments method used to determine the ideal proportions of ingredients in a mixture, where components sum to 100%. We used this design to optimise the proportions of cereals, pulses, milk powder, nuts, seeds, and oil to maximise iron, calcium, and zinc content while minimising phytate-to-mineral molar ratios. The optimised complementary base mix was standardised into three variants: one with reduced refined sugar and two without added refined sugar (one savoury-based mix and one dates powder-based mix). Mineral and phytic acid contents were analysed using standard analytical methods. Sensory evaluation was conducted using a nine- point hedonic scale with a semi-trained institutional panel. Results All optimised formulations met revised NFSA, 2013 nutrient standards for energy, protein, fat, carbohydrates, and key essential micronutrients, while reducing phytate-to-mineral molar ratios within practical formulation limits. Sensory evaluation showed good overall acceptability for all variants, with a mean score above 7.0. The savoury-based mix achieved the highest overall acceptability, followed by the reduced refined sugar-based mix and the dates powder-based mix. Interpretation and conclusions The findings demonstrate that a systematic formulation approach can be used to develop nutrient-dense, complementary food mixes with reduced or no added refined sugar using locally available ingredients without compromising micronutrient adequacy and sensory acceptability, supporting their potential relevance for public nutrition programmes.
PMID:42295725 | DOI:10.25259/IJMR_256_2026
Indian J Med Res. 2026 Jun;163(6):745-762. doi: 10.25259/IJMR_2554_2025.
ABSTRACT
Background and objectives Hypothyroidism is the most common thyroid disorder during pregnancy and, if not managed adequately, increases the risk of adverse foeto-maternal outcomes. The present systematic review and meta-analysis was conducted to assess the prevalence of hypothyroidism among Indian pregnant women and related foeto-maternal outcomes. Methods A systematic search was conducted across PubMed, Google Scholar, and preprint servers to identify observational studies reporting the prevalence of hypothyroidism and associated foeto-maternal outcomes among Indian pregnant women. A random-effects model was utilised to pool effect sizes, and heterogeneity was assessed using I2 statistic. Funnel plots, along with Begg’s and Egger’s tests, were used to assess publication bias. Data were analysed using STATA version 17. Results A total of 60 studies were included. The pooled prevalence of hypothyroidism among pregnant women was 17% [95% confidence interval (CI): 14%, 19%] with subclinical hypothyroidism at 15% (95% CI: 12%, 18%) and overt hypothyroidism at 3% (95% CI: 3%, 4%). In women with subclinical hypothyroidism, the pooled prevalence of adverse maternal outcomes was 9% (95% CI: 6%, 11%), while the prevalence of adverse foetal outcomes was 11% (95% CI: 9%, 14%). The pooled prevalence was 18% for preterm birth (95% CI: 11%, 25%), 17% for low birth weight (95% CI: 10%, 25%), 7% for intrauterine death (95% CI: 2, 14%), and 2% for stillbirth (95% CI: 0, 4%). Among women with overt hypothyroidism, the prevalence of adverse maternal and foetal outcomes was 12% (95% CI: 10%, 15%) and 14% (95% CI: 11%, 17%), respectively. The pooled prevalence was 22% for low birth weight (95% CI: 13%, 31%), 16% for preterm birth (95% CI: 9%, 24%), 16% for intrauterine death (95% CI: 7%, 27%), and 6% for stillbirth (95% CI: 1%, 13%). Most studies used trimester-specific TSH cut-offs based on the American Thyroid Association guidelines. One fourth (n=15) of the 60 studies applied alternative thresholds, with upper limits for normal TSH varying from 4.0-10.0 mIU/L. Interpretation and conclusions The rising burden and adverse consequences of hypothyroidism in pregnancy demand urgent attention. Uniform, evidence-based screening and management practices must be implemented at all levels of care. There is a pressing need for India-specific diagnostic cut-offs and large-scale prospective studies to inform treatment thresholds and long-term outcomes.
PMID:42295724 | DOI:10.25259/IJMR_2554_2025
Indian J Med Res. 2026 Jun;163(6):770-777. doi: 10.25259/IJMR_3570_2025.
ABSTRACT
Background and objectives Tuberculosis (TB) and viral hepatitis (hepatitis B and C) co-infection is a significant threat in low-and middle-income countries like India. To optimise treatment protocols and prevent liver-related complications, it is essential to estimate the burden of these co-infections. This systematic review and meta-analysis were conducted to determine the prevalence of hepatitis B and C co-infection with tuberculosis in India. Methods In line with PRISMA guidelines, a systematic search of PubMed, Scopus, Embase, CINAHL, and Web of Science was conducted for English-language observational studies published up to January 6, 2026, that reported hepatitis B or C co-infection among TB patients in India. Pooled prevalence estimates were calculated using a random-effects model, heterogeneity was assessed using the I2 statistic, and risk of bias was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool. Results A total of 11 studies with 4502 participants reporting hepatitis B or C co-infections in among TB patients in India were included. The pooled prevalence of hepatitis B was 10% [95% Confidence Interval (CI):5%-16%], while the pooled prevalence of hepatitis C was 6% (95% CI:5%-7%). Among TB patients co-infected with HIV, the pooled prevalence of hepatitis B was 17% and pooled prevalence of hepatitis B among drug-resistant TB patients was 11%. Higher rates were reported in Southern and Western India. Interpretation and conclusions High prevalence of hepatitis B and C co-infections among TB patients in India suggests the need for integrated screening and management of these co-infections within the national programme strategies.
PMID:42295712 | DOI:10.25259/IJMR_3570_2025
Indian J Med Res. 2026 Jun;163(6):838-846. doi: 10.25259/IJMR_2123_2025.
ABSTRACT
Background and objectives Household food security is defined as physical and economic access to sufficient, safe, and nutritious food for an active and healthy life. Evidence suggests that urban poor are more food insecure (51%-Delhi and 74.6%-Vellore) than rural poor. Food insecurity adversely affects under-five children’s nutritional status. This study aimed to assess prevalence, determinants, and its association with child-nutrition in urban slums of Salem district, Tamil Nadu. Methods A community-based cross-sectional study was conducted among 363 randomly selected households between January to September 2023 using multi-stage random sampling. Data were collected from primary-care-givers using a validated-semi-structured-questionnaire (USAID-HFIAS) followed by measurement of daily raw food consumption and anthropometry of under-five children. Statistical analysis was performed in SPSSv16.0 using Chi-square/Fisher’s test, ANOVA and regression with P<0.05 taken as significant. Results Household food insecurity prevalence was 82.1%, with 20.1% severe. Mean food consumption was significantly lower among insecure households. Determinants included age/gender of household head, single earning member, dependents, and irregular use of public distribution system. Children with normal nutrition had 2.75 [P<0.05;95% confidence interval (C.I):1.31-5.75] times odds of belonging to secure households. Interpretation and conclusions Food insecurity was closely linked to under-five malnutrition, underscoring the need for interventions addressing affordability and structural factors such as housing, healthcare access, and resource distribution.
PMID:42295709 | DOI:10.25259/IJMR_2123_2025