Nevin Manimala

Clin Ter. 2026 May-Jun;177(3):642-651. doi: 10.7417/CT.2026.2052.

ABSTRACT

OBJECTIVE: To identify the continuous dose-response relationship between the duration of premature rupture of membranes (PROM) and the probability of neonatal and maternal infectious morbidity.

METHODS: This meta-analysis and systematic review synthesise data from 15 studies worldwide involving more than 70,000 mother-neonate pairs. A two-step random-effects model of PROM duration as a continuous dose, using restricted cubic splines, was used to estimate specific risk thresholds.

RESULTS: The analysis established a progressive, non-linear escalation of risk. The onset of statistical risks at 16 hours is the early-onset pneumonia (Adjusted OR 1.86, 95% CI: 1.152.99). At the age of 18 hours, the incidence of culture-proven sepsis in neonates was 4.0%, and the odds ratio for maternal fever was significantly higher (AOR 36.6). The analysis of the ROC curves revealed a critical mathematical pivot point at 37 hours, after which complications escalate exponentially. Latency greater than 48 hours was the most significant independent predictor of culture-proven sepsis, with an increased risk of 8.2 (p < 0.001). Histologic chorioamnionitis was detected in 39% of mothers, and in many cases, they are clinically silent. Considerable heterogeneity (I2 > 60%) was mainly caused by gestational age disparities in cohorts of extremely preterm and term babies.

CONCLUSION: PROM latency risk is not a threat but accelerates with time. Although 18 hours will be an acceptable early warning level, the range of 37 to 48 hours is a high-risk period that needs aggressive treatment. International guidelines need to be reviewed to reflect this non-linear trend, especially regarding pregnancy, where the risks of delivery are low compared to the rising risk of latency.

PMID:42047155 | DOI:10.7417/CT.2026.2052

Clin Ter. 2026 May-Jun;177(3):606-617. doi: 10.7417/CT.2026.2047.

ABSTRACT

BACKGROUND: This study aimed to identify psychosocial determinants of medication adherence among hypertensive patients and examine urban-rural disparities.

METHODS: In this cross-sectional study, 385 hypertensive patients from urban and rural areas completed a comprehensive questionnaire assessing demographic characteristics, psychosocial factors, and medication adherence measured by the Morisky Medication Adherence Scale (MMAS-8). Multiple statistical approaches, including logistic regression, path analysis, and structural equation modeling, were employed to examine direct and indirect relationships between predictors and medication adherence.

RESULTS: 52.7% of participants demonstrated high medication adherence, with significantly higher rates in urban (62%) than rural (43%) populations. Multivariate analysis identified family support (AOR=2.34, 95% CI: 1.76-3.12), self-efficacy (AOR=1.87, 95% CI: 1.38-2.54), and health literacy (AOR=1.93, 95% CI: 1.42-2.61) as significant positive predictors of adherence, while perceived stigma (AOR=0.63, 95% CI: 0.48-0.83) and cultural beliefs about traditional remedies (AOR=0.58, 95% CI: 0.43-0.78) were significant barriers. Path analysis revealed that psychosocial factors mediated the relationship between education level and medication adherence, with health literacy accounting for 42% of this relationship. Significant urban-rural differences were observed in the strength of associations between psychosocial factors and adherence.

CONCLUSIONS: This study provides novel insights into the complex interplay between demographic characteristics, psychosocial determinants, and medication adherence among hypertensive patients in Saudi Arabia. The identified urban-rural disparities and cultural influences highlight the need for tailored interventions that address specific psychosocial barriers in different contexts. Our findings suggest that comprehensive approaches enhancing health literacy, self-efficacy, and family support while addressing cultural beliefs could significantly improve medication adherence.

PMID:42047149 | DOI:10.7417/CT.2026.2047

Clin Ter. 2026 May-Jun;177(3):591-596. doi: 10.7417/CT.2026.2045.

ABSTRACT

BACKGROUND: Vitiligo is a chronic depigmentary disorder with autoimmune and neurogenic mechanisms. Neurotensin, a neuropeptide with immunomodulatory properties, has been implicated in inflammatory skin conditions, but its role in vitiligo remains unclear.

OBJECTIVES: To compare serum neurotensin levels in active and stable vitiligo patients versus healthy controls, and to evaluate their correlation with disease activity (VIDA score) and extent (VASI score).

METHODS: A case-control study was conducted including 40 vitiligo patients (20 active, 20 stable) and 20 age- and sex-matched healthy controls. Serum neurotensin was measured using ELISA. Disease activity and extent were assessed with VIDA and VASI scores, respectively. Statistical analysis included Kruskal-Wallis, Mann-Whitney U, and Spearman rank correlation tests.

RESULTS: The median serum neurotensin levels were 20.40 ng/ml (range 7.35-74.00) in active patients, 14.55 ng/ml (range 6.10-30.00) with stable patients and 11.20 ng/ml (range 6.40-18.30) with controls. Kruskal-Wallis test indicated that there was a statistically significant overall difference between the three groups (H=16.506, p<0.001). Serum neurotensin showed a modest but statistically significant positive correlation with VIDA score (rs = 0.333, p = 0.036), but no significant correlation with VASI score (p = 0.190).

CONCLUSIONS: Serum neurotensin is elevated in vitiligo, particularly in active disease, supporting a potential role for neurogenic mechanisms in melanocyte destruction. Its association with disease activity suggests its potential utility as a biomarker of vitiligo activity.

PMID:42047147 | DOI:10.7417/CT.2026.2045

Clin Ter. 2026 May-Jun;177(3):549-553. doi: 10.7417/CT.2026.2040.

ABSTRACT

BACKGROUND: The optimal management of patients with concurrent gallbladder and common bile duct (CBD) stones remains a topic of debate, especially in resource-limited settings. Single-stage laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) under the same anesthesia has the potential to lower operative risks, reduce hospital stay, and cut healthcare costs.

METHODS: A retrospective review was conducted of 374 consecutive patients who underwent single-stage LC + ERCP between January 2018 and December 2024 at 115 People’s Hospital in Ho Chi Minh City, Vietnam. Demographic data, perioperative outcomes, operative time, complication rates, and postoperative recovery were analyzed.

RESULTS: The mean age was 60 ± 15 years; 59% were female. The mean total operative time was 123 ± 33 minutes, and the average postoperative hospital stay was 2 ± 1 days. Successful CBD stone clearance was achieved in 100% of patients, with 16% requiring temporary biliary stent placement. Postoperative complications occurred in 4% of patients, all mild pancreatitis, with no bile leakage, bleeding, or mortality. ERCP time >45 minutes, CBD diameter <10 mm, and previous ERCP were significantly associated with post-ERCP pancreatitis.

CONCLUSION: Single-stage LC + ERCP for concurrent gallbladder and CBD stones is safe, effective, and feasible in a tertiary Vietnamese hospital setting. The procedure achieved high success and low complication rates, with shortened hospital stay and minimal morbidity.

PMID:42047142 | DOI:10.7417/CT.2026.2040

Clin Ter. 2026 May-Jun;177(3):496-501. doi: 10.7417/CT.2026.2034.

ABSTRACT

BACKGROUND: Orthostatic hypotension (OH) represents a link between haemodynamic instability and psychosocial adversity in low-resource settings.

OBJECTIVES: To estimate the prevalence of OH among postpartum women in Ndola, Zambia, and examine associations with family scapegoating abuse (FSA) and symptoms of depression, anxiety, and stress.

METHODS: In a community-based cross-sectional study, postpartum women aged 20-30 years within one year of delivery (N = 666) underwent active-stand blood pressure testing. OH was defined as a ≥20 mmHg fall in systolic and/or ≥10 mmHg fall in diastolic pressure within 3 minutes of standing. FSA was measured using the FSA-25 and mental health symptoms using the DASS-21. Descriptive statistics, chi-square tests, logistic regression (including a stepwise sensitivity model), and structural equation modelling (SEM) evaluated direct, indirect, and moderated associations with OH.

RESULTS: OH was identified in 93 (13.9%) women. Any FSA was reported by 164 (24.6%) women, and moderate-to-severe scapegoating was present in 136 (20.4%). In SEM, depressive symptoms showed a positive direct association with OH, with indirect pathways involving anxiety and FSA, while stress related to OH primarily through FSA. In logistic regression, Stress_G(1) was associated with lower odds of OH (OR = 0.109, 95% CI: 0.042-0.280), whereas employment status was not independently associated with OH; interaction estimates with employment were unstable. In the stepwise model, Stress_G(1) was the only retained significant predictor of OH.

CONCLUSIONS: OH is a clinically relevant postpartum finding in this Zambian cohort and co-occurs with substantial family scapegoating and internalising symptoms. Integrating orthostatic blood pressure assessment with structured psychosocial screening may help identify women at heightened risk for dizziness, falls, and persistent mood and anxiety problems, supporting more holistic postpartum care in similar low-resource settings.

PMID:42047136 | DOI:10.7417/CT.2026.2034

Clin Ter. 2026 May-Jun;177(3):460-465. doi: 10.7417/CT.2026.2029.

ABSTRACT

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with significant morbidity, mortality, and impaired quality of life (QOL). Insulin therapy is central to glycaemic control in advanced disease but poses psychosocial and practical challenges. This study evaluated QOL among insulin-treated T2DM patients in tertiary care hospitals.

METHODS: A cross-sectional study was conducted in the outpatient and inpatient departments of hospitals affiliated with Medical College in south Asian city. Total 272 patients aged >30 years with T2DM on insulin therapy for ≥3 months were included. Patients with type 1 diabetes or on oral therapy alone were excluded. Data on demographics, comorbidities, HbA1c, and complications were collected. QOL was assessed using the Quality-of-Life Instrument in Indian Diabetic Patients (QOLID), and barriers to insulin therapy were measured with the BITQ questionnaire. Statistical analysis was performed using SPSS v25, with p<0.05 considered significant.

RESULTS: Of the 272 participants, 74% were aged >50 years and 61% were female. Neuropathy (18%) was the most common complication. Overall QOL score averaged 126.36 ± 21.69, with lowest scores in role limitation (19.40), physical endurance (19.25), and emotional health (15.58). Patients on combination therapy (insulin plus oral agents) reported better physical endurance and overall QOL compared to insulin-only users, though financial burden was greater. Complications and poor glycemic control (HbA1c) significantly worsened QOL across domains.

CONCLUSION: Insulin-treated T2DM patients experience moderate impairment in QOL, influenced by complications, poor glycaemic control, and financial and psychological burdens. A holistic, patient-centred approach incorporating medical, psychosocial, and economic support is essential to improve outcomes.

PMID:42047131 | DOI:10.7417/CT.2026.2029

Clin Ter. 2026 May-Jun;177(3):432-438. doi: 10.7417/CT.2026.2025.

ABSTRACT

BACKGROUND: Laparoscopic Nissen Fundoplication (NF) remains the gold standard anti-reflux procedure due to its well-established long-term efficacy and safety. However, the modified Nissen fundoplication (MNF) which incorporates additional sutures to fixate the esophagus to the right and left crus aims to enhance hiatal stabilization and potentially reduce GERD symptom recurrence.

AIM: This study aims to compare between conventional Laparoscopic Nissen Fundoplicalion and Modified Nissen Fundoplication regarding post-operative complications specially “Dysphagia, recurrence of GERD symptoms”.

PATIENTS AND METHODS: This study is a prospective randomized controlled trial. The study took place at Ain Shams University Hospitals. The study was conducted from January 2023 to January 2025, including one year for patient recruitment and one year for follow-up.

RESULTS: This study compared NF and MNF in terms of postoperative complications, revealing a statistically significant difference in the incidence of postoperative hiccups and left shoulder pain. While some prior studies found no significant differences between the two techniques, our results suggest that MNF can be performed safely by experienced surgeons without increased morbidity or complication rates.

CONCLUSION: The current study was constrained by its limited sample size and follow-up duration, which may affect the generalizability of findings. To further validate these results, future research should involve larger cohorts and extended follow-up periods to assess long-term recurrence rates and complications. Such data will help determine whether MNF offers superior outcomes over conventional NF, guiding clinical decision-making for optimal surgical management of GERD.

PMID:42047127 | DOI:10.7417/CT.2026.2025

Clin Ter. 2026 May-Jun;177(3):405-413. doi: 10.7417/CT.2026.2022.

ABSTRACT

OBJECTIVE: In chronic kidney disease, gut dysbiosis increases intestinal permeability, allowing toxins to enter the bloodstream and causing inflammation. This study aimed to assess the impact of probiotic supplementation on serum Zonulin levels, P-cresyl sulfate and highly sensitive C-reactive protein (hs-CRP) in hemodialysis patients.

MATERIALS AND METHODS: Forty hemodialysis patients were enrolled and divided into either a probiotic group or a control group (20 patients per group). The probiotic group received supplements for 3 months. Serum Zonulin, hs-CRP and P-cresyl sulfate were measured at baseline and after the 3-month intervention.

RESULTS: After 3 months of probiotic administration, the probiotic group showed a statistically significant decrease in serum Zonulin (p < 0.001), P-cresyl sulfate (p < 0.001) and hs-CRP (p = 0.037). Furthermore, a significant difference was observed between the two groups regarding post-intervention levels of Zonulin (p < 0.001), P-cresyl sulfate (p < 0.001), and hs-CRP (p < 0.001).

CONCLUSIONS: Probiotic administration in hemodialysis patients improved intestinal barrier integrity, reduced gut-derived toxin levels, and lowered systemic inflammation.

PMID:42047124 | DOI:10.7417/CT.2026.2022

Clin Ter. 2026 May-Jun;177(3):388-394. doi: 10.7417/CT.2026.2020.

ABSTRACT

BACKGROUND: Adrenaline is commonly added to local anesthetic solutions to reduce bleeding and prolong analgesia. However, its clinical impact during ultrasound-guided interfascial plane blocks in superficial soft tissue surgery remains insufficiently evaluated. This randomized controlled trial assessed the effect of adding adrenaline (1:200,000) to bupivacaine during ultrasound-guided lipoma plane block.

METHODS: In this prospective randomized controlled study, 40 adult patients undergoing elective superficial lipoma excision were randomly assigned to two groups (20 patients each). Group A received 0.25% bupivacaine with adrenaline (1:200,000), and Group B received 0.25% bupivacaine alone. Primary outcomes were intraoperative blood loss, operative time, and postoperative pain scores at 2, 6, and 24 hours. Secondary outcomes included need for rescue analgesia, supplemental anesthesia, ease of dissection, capsule integrity, and postoperative complications. Statistical significance was defined as p < 0.05.

RESULTS: Baseline characteristics were comparable between groups. Intraoperative blood loss was significantly lower in Group A (6.2 ± 1.5 mL) compared with Group B (12.7 ± 2.8 mL; p < 0.001). Operative time was shorter in the adrenaline group (12.4 ± 3.1 min vs. 17.8 ± 3.9 min; p = 0.002). Postoperative pain scores were significantly lower in Group A at 2 hours (p = 0.004), 6 hours (p = 0.006), and 24 hours (p = 0.009). Rescue analgesia was required less frequently in Group A (15% vs. 40%; p = 0.038). Ease of dissection and capsule integrity preservation were significantly improved with adrenaline. Minor hematoma occurred less frequently in Group A (5% vs. 20%; p = 0.041). No serious adverse events were observed.

CONCLUSIONS: The addition of adrenaline (1:200,000) to bupivacaine in ultrasound-guided lipoma plane block significantly reduces intraoperative blood loss, shortens operative time, and improves postoperative analgesia. Adrenaline appears to be a safe and effective adjunct in superficial lipoma excision.

PMID:42047122 | DOI:10.7417/CT.2026.2020

Afr J Reprod Health. 2026 Apr 28;30(8):53-65. doi: 10.29063/ajrh2026/v30i8.6.

ABSTRACT

Using a qualitative interpretive descriptive-analytical approach, this study analysed harmonised secondary data from the World Bank World Development Indicators covering six countries between 2000 and 2024. Longitudinal trend assessment and crosscountry comparisons were employed to examine urban population, modern contraceptive prevalence, and total fertility rates. The findings indicate sustained urban expansion across all countries, accompanied by gradual increases in contraceptive uptake and fertility decline. However, these patterns remain uneven across national contexts. Ghana and Sierra Leone combine relatively high urbanisation with stronger improvements in contraceptive prevalence and faster fertility decline. In contrast, Nigeria and Guinea maintain comparatively high fertility levels despite substantial urban growth and weaker contraceptive uptake. The Gambia and Liberia display intermediate trajectories characterised by moderate urbanisation, rising contraceptive use, and gradual fertility reduction. The results indicate that urbanisation alone does not generate uniform reproductive outcomes; rather, fertility transitions are mediated by contraceptive access and the effectiveness of urban health service. The study recommends integrating family planning into urban development strategies and strengthening reproductive health service delivery in rapidly expanding urban and peri-urban settlements to reduce persistent reproductive health inequalities.

PMID:42047119 | DOI:10.29063/ajrh2026/v30i8.6