Nevin Manimala

Rev Med Inst Mex Seguro Soc. 2026 Mar 3;64(2):e6893. doi: 10.5281/zenodo.17543983.

ABSTRACT

This letter to the editor presents key concepts on research designs, prevalence and incidence, as well as statistics for comparing dichotomous variables, highlighting the difference with likelihood ratio. A Chi2 exercise with the study data is included to illustrate the methodology. Finally, a brief description of the pathophysiological mechanism linking COVID-19 infection with pulmonary thromboembolism is provided.

PMID:41774473 | DOI:10.5281/zenodo.17543983

Cardiovasc J Afr. 2025 Sep 3;36(3):374-379. doi: 10.5830/CVJA-2025-056. Epub 2025 Sep 2.

ABSTRACT

INTRODUCTION: During cardiopulmonary bypass (CPB), adequate prime solution allows pre-treatment of the tubing line, oxygenator and blood pump, evacuation of air from the arterial conduit, and appropriate blood dilution. However, the volume of prime solution may also affect the blood transfusion rate.

OBJECTIVE: This study evaluated the effect of different volumes of CPB prime solution used in two different cardiac surgery centres on blood transfusion rate, as well as the relationship between the volume of CPB prime solution and early clinical outcomes.

METHODS: A total of 323 patients who underwent CPB-guided cardiac surgery were included in this retrospective study. Patients with different prime solution volumes in two different cardiac surgery centres were included in the study. Each centre was considered as a separate study group. The data of the groups were compared statistically.

RESULTS: There were 195 patients in group 1 and 128 patients in group 2. The preoperative characteristics and laboratory variables of the two groups were similar (p > 0.05). The amount of additional fluid given during CPB, the amount of urine and haemofiltrate removed by the patients, intraoperative bleeding drainage rate, postoperative platelet and erythrocyte values, need for intracardiac defibrillation, need for inotropic support and intra-aortic balloon pump (IABP) requirement during CPB weaning, duration of postoperative mechanical ventilation support, and duration of intensive care unit (ICU) stay were similar in both groups (p > 0.05). However, intraoperative erythrocyte transfusion rates, postoperative bleeding drainage rates, postoperative erythrocyte transfusion rates, postoperative leukocyte value and length of hospital stay were significantly higher in group 2 (p = 0.000; p = 0.006; p = 0.000; p = 0.009; p = 0.037, respectively). Additionally, postoperative haemoglobin and haematocrit values were significantly lower in group 2 (p = 0.034; p = 0.047, respectively).

CONCLUSION: As a result of this study, we observed that low prime solution volume vs. high prime solution volume impacts the negative variables of CPB patients. We believe that perfusionists avoiding high prime solution volumes in fluid management during CPB will positively reduce the blood transfusion rate/amount, and also reduce other negative variables.

PMID:41774456 | DOI:10.5830/CVJA-2025-056

JAMA Netw Open. 2026 Mar 2;9(3):e260409. doi: 10.1001/jamanetworkopen.2026.0409.

ABSTRACT

IMPORTANCE: Respiratory syncytial virus (RSV) is a leading cause of pediatric viral lower respiratory tract infections (VLRTIs), often leading to inappropriate antibiotic use. Although rapid antigen diagnostic tests (Ag-RDTs) support clinical diagnosis, their effect on antibiotic prescribing in community settings remains uncertain.

OBJECTIVE: To evaluate the association of RSV Ag-RDT implementation with antibiotic prescribing practices for infants and children assessed for LRTIs.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from a community-based primary care setting involving family pediatricians in Italy participating in the Pedianet network. Data were collected between December 2023 and May 2024 from children aged 9 to 36 months with symptoms of VLRTI who underwent RSV Ag-RDT during the 2023-2024 respiratory epidemiologic season and historical matched cohorts.

EXPOSURE: Children with RSV-positive and RSV-negative Ag-RDT results were compared with each other and with matched historical (2022-2023) and contemporaneous (2023-2024) cohorts of children with clinically diagnosed VLRTIs or bronchiolitis who did not undergo laboratory testing.

MAIN OUTCOMES AND MEASURES: The primary outcome was antibiotic prescribing within 14 days of diagnosis. Prescriptions associated with suspected or confirmed bacterial infections (such as elevated C-reactive protein levels or documented coinfections) were excluded. Relative risks (RRs) and 95% CIs were estimated using log-binomial regression models.

RESULTS: Among 256 cases (median age, 15.06 [IQR, 11.61-22.72] months; 133 males [51.95%]), 79 (30.86%) were RSV positive and 177 (69.14%) were RSV negative. These 2 groups were comparable in age, with RSV-negative children slightly younger (median age, 14.95 [IQR, 11.66-22.67] vs 15.34 [IQR, 11.40-23.10] months), and in sex distribution, with a higher proportion of females among RSV-positive cases (41 [51.90%] vs 82 [46.33%]). Antibiotic prescribing was lower in RSV-positive than RSV-negative children (0.18 [95% CI, 0.10-0.25] vs 0.29 [95% CI, 0.22-0.35] prescriptions per 10 person-days) and was associated with a reduction in risk of receiving an antibiotic prescription (RR, 0.52; 95% CI, 0.33-0.83). Implementation of RSV Ag-RDT was associated with lower antibiotic use for VLRTIs compared with a matched untested cohort (RR, 0.54 [95% CI, 0.44-0.66] in 2022-2023 and 0.61 [95% CI, 0.50-0.75] in 2023-2024) and for bronchiolitis in 2022-2023 (RR, 0.56 [95% CI, 0.33-0.95]) but not in 2023-2024 (RR, 0.75 [95% CI, 0.42-1.33]). Reductions were greater among RSV-positive cases: for VLRTIs, the RR was 0.33 (95% CI, 0.20-0.52) in 2022-2023 and 0.41 (95% CI, 0.25-0.67) in 2023-2024; for bronchiolitis, the RR was 0.33 (95% CI, 0.15-0.76) in 2022-2023, but the reduction was not significant in 2023-2024 (RR, 0.43 [95% CI, 0.18-1.00]).

CONCLUSIONS AND RELEVANCE: In this cohort of 256 VLRTI cases, the findings suggest that RSV contributed to a broad range of VLRTIs across ages and that RSV Ag-RDT was a useful outpatient antimicrobial stewardship tool, particularly in bronchiolitis. Combined with universal immunoprophylaxis, widespread Ag-RDT use may improve diagnostic accuracy, resource allocation, and clinical outcomes.

PMID:41774441 | DOI:10.1001/jamanetworkopen.2026.0409

JAMA Netw Open. 2026 Mar 2;9(3):e260434. doi: 10.1001/jamanetworkopen.2026.0434.

ABSTRACT

IMPORTANCE: Ultraprocessed foods (UPF) contribute to nearly half of energy intake among preschool-aged children in Canada, yet their impact on behavioral and emotional functioning remains underexplored.

OBJECTIVE: To examine the associations between UPF intake at age 3 years and behavioral outcomes at age 5 years.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included children with dietary and behavioral data from September 2011 to April 2018 in the CHILD Cohort Study, a prospective Canadian pregnancy cohort. Data analysis was done between February to July 2025.

EXPOSURE: UPF intake at age 3 years was assessed by a 112-item food frequency questionnaire and categorized using the NOVA system.

MAIN OUTCOMES AND MEASURES: Behavior was measured using the validated Child Behavior Checklist (CBCL; range 0-100; higher scores indicating more adverse symptoms). UPF intake measured as a continuous percentage of energy was examined using multivariable-adjusted linear regression models accounting for maternal diet, birth factors, infant feeding, and sociodemographic and early-childhood characteristics. A multivariable-adjusted substitution model estimated the association of statistically replacing 10% energy from UPF with minimally processed foods (MPF) among all children.

RESULTS: Among 2077 participants, 1092 (52.6%) were male; 1376 children (66.2%) were White, 480 children (23.1%) were multiracial, and 221 children (10.7%) were identified as another ethnic group. At age 3 years, UPF contributed a mean (SD) of 45.5% (11.6%) of total energy intake. At age 5 years, the mean (SD) CBCL scores were 44.6 (9.1) for internalizing, 39.6 (9.4) for externalizing, and 41.2 (9.0) for total behavior. Each 10% increase in energy from UPF was associated with higher CBCL internalizing (β = 0.81 [95% CI, 0.43 to 1.19]), externalizing (β = 0.47 [95% CI, 0.08 to 0.87]), and total (β = 0.64 [95% CI, 0.27 to 1.01]) scores. Substitution of 10% energy from UPF with MPF was associated with lower internalizing (β = -0.91 [95% CI, -1.33 to -0.49]), externalizing (β = -0.49 [95% CI, -0.93 to -0.06]), and total (β = -0.70 [95% CI, -1.12 to -0.29]) scores.

CONCLUSIONS AND RELEVANCE: In this cohort study of preschoolers in Canada, higher UPF intake was associated with adverse behavioral and emotional symptoms by age 5 years. These findings suggest that replacing UPF with MPF during the preschool years may support healthier behavioral development, with potential benefits for long-term mental health. These findings also support ongoing policy actions that promote MPF and underscore the need for early-life dietary interventions.

PMID:41774440 | DOI:10.1001/jamanetworkopen.2026.0434

Int J Clin Oncol. 2026 Mar 3. doi: 10.1007/s10147-025-02885-0. Online ahead of print.

ABSTRACT

BACKGROUND: The prognostic value of the creatinine-cystatin C ratio (CCR) in individuals with cancer has been investigated in numerous studies, but the findings vary. To accurately identify the prognostic value of CCR in individuals with cancer, we conducted this meta-analysis.

METHODS: Pertinent studies were retrieved across PubMed, Web of Science, Embase and Cochrane from their establishment to June 8, 2024. Additional searches were conducted until November 16, 2024. In this study, the calculation of the hazard ratio (HR) and its 95% confidence interval (CI) allowed us to determine the prognostic value of CCR in individuals with cancer. Additionally, Newcastle-Ottawa scale (NOS) was employed for quality evaluation, Cochrane I² statistic for heterogeneity assessment, funnel plots for publication bias evaluation, and Egger test for quantitative identification. Significant publication bias is indicated by a P < 0.05. A software called STATA 15.1 was utilized for statistical analysis.

RESULTS: Initially, 2001 articles were retrieved in total, and this study comprised twelve trials with 4439 individuals with cancer overall. Our findings demonstrated a substantial correlation between a low CCR and a reduced overall survival (OS) in individuals with cancer (HR 1.71, 95% CI 1.49-1.96). Similarly, a strong correlation between CCR and progression-free survival (PFS) CCR was also noted (HR 1.51, 95% CI 1.29-1.77).

CONCLUSION: This meta-analysis revealed that in individuals with cancer, a low CCR was strongly correlated with OS and PFS. Therefore, in clinical practice, CCR may be a promising and affordable prognostic biomarker for individuals with cancer.

PMID:41774383 | DOI:10.1007/s10147-025-02885-0

Ann Biomed Eng. 2026 Mar 3. doi: 10.1007/s10439-026-04002-2. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Computed tomography-based fractional flow reserve computation (CT-FFR) is widely used in clinical practice, based on its efficacy demonstrated in many studies. However, major assumptions remain with the outflow boundary conditions (BCs) representing coronary microvasculature, especially in hyperaemia. We here propose a novel method to estimate patient-specific microvascular response to hyperaemia for CT-FFR calculations, based on patients’ routinely available demographic data.

METHODS: A statistical model to predict microvascular flow response (MFR) from routinely collected patient demographic parameters was derived using PET-based perfusion data of 101 patients with coronary artery disease. CT-FFR computations were then conducted with patient-specific anatomical models and outflow BCs derived from various MFR models including the proposed approach. The FFR values were calculated for an independent test cohort of 10 patients who had undergone CT coronary angiography, CT perfusion imaging and invasive FFR measurement. Computed FFR values were compared against invasive FFR and other CT-FFR algorithms.

RESULTS: A multivariate regression model predicting patient-specific MFR was derived as a function of sex, diabetes and smoking status of the patient. FFR values computed using our model agreed well with the invasive FFR (0.76 ± 0.09 vs. 0.75 ± 0.10, P = 0.217). The FFRs predicted with our model were also comparable to those calculated using outflow BC tuned with patient-specific perfusion data (FFR: 0.74 ± 0.10, P = 0.233 vs. invasive FFR) and showed marked improvement over the conventional approach (FFR: 0.68 ± 0.11, P = 0.004 vs. invasive FFR). Diagnostic accuracy vs. invasive FFR were 100, 91 and 82% for CT-FFR with CTP-based MFR, demography-based MFR, and conventional approach, respectively.

DISCUSSION: The proposed demography-based MFR model significantly improves FFR computation accuracy compared with a typical conventional model that assumes constant, healthy and population average MFR. Although its diagnostic accuracy is slightly lower than that of CT-FFR calibrated with patient-specific perfusion imaging data (91 vs. 100%), the demography-based model offers a substantial practical advantage by not requiring additional non-standard data acquisition, such as perfusion imaging. Consequently, it shows strong potential as a practical enhancement to conventional CT-FFR algorithms.

PMID:41774380 | DOI:10.1007/s10439-026-04002-2

Ann Biomed Eng. 2026 Mar 3. doi: 10.1007/s10439-026-04028-6. Online ahead of print.

ABSTRACT

PURPOSE: Established in silico frameworks for assessing Torsade de Pointes (TdP) risk primarily rely on single-cell electrophysiological biomarkers, which have demonstrated strong predictive capabilities. However, ventricular transmural electrophysiological heterogeneity is known to influence repolarization dynamics and arrhythmogenic mechanisms. Explicitly incorporating endocardium, epicardium, and mid-myocardium representations may enhance physiological interpretability, but direct integration of multi-cell features can introduce severe multicollinearity and compromise model stability. To address this challenge, we propose an ordinal logistic regression (OLR) framework that integrates multi-cell qNet information through probability averaging, preserving physiological context while maintaining robust statistical behavior.

METHODS: $I{C}_{50}$ values and Hill coefficients for 28 CiPA drugs were implemented in two ventricular cell models, the CiPAORdV1.0 and the ORd in silico models. qNet was computed independently for endocardium, epicardium, and mid-myocardium cells. Cell-specific OLR models produced class probabilities that were then averaged to generate the final prediction. Performance was compared against single-cell and direct multi-cell implementations across Manual and ChanTest datasets.

RESULTS: For CiPA-ORd v1.0 using the ChanTest dataset, qNet achieved substantial performance, with AUCs for ROC1 and ROC2 of 1.000 and 0.958, respectively, and also meeting seven “excellent” classification criteria. In the ORd model, probability averaging consistently improved performance for both the Manual and ChanTest datasets relative to single-cell and direct multi-cell approaches.

CONCLUSION: Probability-averaged integration of multi-cell qNet predictions mitigates multicollinearity while preserving physiological relevance, yielding more stable and accurate in silico TdP risk classification and supporting broader applicability to preclinical safety assessment.

PMID:41774378 | DOI:10.1007/s10439-026-04028-6

Int J Cardiovasc Imaging. 2026 Mar 3. doi: 10.1007/s10554-026-03676-y. Online ahead of print.

ABSTRACT

Echocardiography is crucial in the diagnosis of infectious endocarditis (IE). We assessed the correlation between transesophageal echocardiography (TEE) and surgical findings. A retrospective study of IE patients who underwent surgery. Discrepancies between TEE and surgical findings were defined as ≥ 1 infected valves, vegetations and abscess, and vegetations size ≥5 mm. Descriptive statistics and regression analysis were performed. Eighty patients were included. Mean age was 55.03 years, 26.3% had prosthetic valves. S. aureus and S. viridans spp were identified in 22.5% and 20% of cases, respectfully. On TEE, 84% had vegetations, and 31.2% had abscesses. Mitral and aortic valves were affected in 51%, and 40%, respectfully. TEE and surgical findings highly correlated regarding abscess count, valve involvement, and vegetation size. Significantly, more vegetations were observed during surgery compared to TEE (19% vs. 11%). In 46 patients (57.5%) (Group 1) no discrepancies were found. In 34 patients (42.5%) ≥ 1 discrepancy was found (Group 2). Patients in Group 1 vs. 2 presented with significantly more weakness (80.4% vs. 52.9%) and confusion (21.2% vs. 2.9%). Mitral valve involvement [21 (45.7%) and 24 (70.6%)], and larger vegetations on TEE (15.17 mm vs. 20 mm) were significantly more common in Group 2. S. viridans was linked to more discrepancies (p = 0.07). In a multivariate model Charlson index and vegetation size were associated with discordant findings. Discrepancies were observed between TEE and surgical findings, especially in patients with S. viridans IE or mitral valve involvement. These differences did not affect surgery appropriateness.

PMID:41774377 | DOI:10.1007/s10554-026-03676-y

Obes Surg. 2026 Mar 3. doi: 10.1007/s11695-026-08564-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Roux-en-Y Gastric Bypass (RYGB) is a common treatment option for obesity. After RYGB, loss of both adipose tissue and lean body mass is seen. In this study, we have investigated the dynamic metabolic changes of hyaluronan (HA) and associated biomarkers reflecting the extracellular matrix after RYGB.

MATERIALS AND METHODS: In this exploratory cohort study, a total of 306 serum samples were collected at 5 different times from 96 RYGB patients, preoperatively until 6 months after surgery, where 44/96 (46%) contributed samples at 6 months. HA and the cell-surface receptor CD44 were studied by enzyme-linked immunosorbent assay (ELISA), while Luminex Multiplex assays were used for MMP-2, MMP-9, TNF-α, IL-1β, IL-6 and IL-10.

RESULTS: Preoperatively, an elevated HA-concentration (> 120 ng/ml) was seen in 39.6% of the study population. From baseline to day of surgery, we found a statistically significant decrease (p < 0.05) in HA (Δ-21.4ng/mL [-42.6, -0.27]), CD44 (Δ-26.7ng/mL [-46.4, -6.9]), MMP-2 (Δ-32.4 ng/mL [-41.4 -23.4]) and MMP-9 (Δ-138.2 ng/mL [-188.0, -88.4]), TNF-α(Δ-3.1 pg/mL [-5.4, -0.8]), IL-1β (Δ-14.4 pg/mL [-22.2, -6.6]) and IL-6 (Δ-2.0 pg/mL [-3.1, -0.9]). At one month postoperatively, a subsequent increase was seen. Although the mean concentration of HA was unchanged at 6 months, patients with baseline HA ≥ 120 ng/mL demonstrated a decrease, (Δ-37.1 [-55.8 to -14.7] p < 0.01; exploratory analysis) CONCLUSION: Although mean HA levels returned to baseline at 6 months, a significant transient decrease was observed immediately postoperatively, and patients with elevated preoperative HA (> 120ng/ml) showed a sustained reduction. The postoperative increase of MMP-2 suggests a continuous remodeling of the extracellular matrix.

PMID:41774373 | DOI:10.1007/s11695-026-08564-x

Ann Surg Oncol. 2026 Mar 3. doi: 10.1245/s10434-026-19379-6. Online ahead of print.

ABSTRACT

PURPOSE: Our objective was to evaluate clinical outcomes and vascular graft patency following portal vein/superior mesenteric vein (PV/SMV) reconstruction using recanalized autologous ligamentum teres hepatis (LTH) grafts.

METHODS: This study enrolled 387 patients, stratified into three groups: (1) pancreaticoduodenectomy alone, (2) pancreaticoduodenectomy with vascular resection and reconstruction via end-to-end anastomoses or lateral venorrhaphy, and (3) pancreaticoduodenectomy with PV/SMV resection and reconstruction using autologous LTH grafts. This retrospective study compared operative time, intraoperative blood loss, postoperative complication rates, mortality, and length of postoperative hospital stay across these groups.

RESULTS: The study included 336 patients who underwent pancreaticoduodenectomy, 23 who underwent pancreaticoduodenectomy with vascular resection and reconstruction via end-to-end anastomosis or lateral venorrhaphy, and 28 who underwent pancreaticoduodenectomy with PV/SMV resection and reconstruction using autologous LTH grafts. The group using autologous LTH grafts exhibited an operative time of 484.86 ± 103.77 (285-685) min; intraoperative blood loss of 236.79 ± 141.95 (80-800) mL; a postoperative complication rate of 42.86%; 30-day mortality rate of 7.14%; and postoperative hospital stay of 20.82 ± 8.25 (9-49) days. Statistical analysis revealed a significantly longer operative time in the autologous LTH grafts group than in the other groups (p < 0.001), with no significant intergroup differences in blood loss, postoperative complication rates, mortality, or hospitalization. Partial thrombosis involving ≤50% of vessel diameter without obstruction was observed in four cases involving autologous LTH grafts. All reconstructed vessels maintained 100% patency throughout the follow-up period.

CONCLUSIONS: Using autologous LTH grafts for PV/SMV reconstruction during pancreaticoduodenectomy was safe and feasible, demonstrating favorable vascular graft patency rates and supporting its role as a viable alternative conduit for vascular restoration.

PMID:41774366 | DOI:10.1245/s10434-026-19379-6