Nevin Manimala

Indian J Ophthalmol. 2026 Mar 12. doi: 10.4103/IJO.IJO_1856_25. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the use of red and green lasers in studying retinoblastoma seeds in pathological samples.

METHODS: This study was a retrospective, laboratory-based experimental study, conducted at a tertiary care eye center of northeast India. Medical records were retrospectively analyzed in a 7-year period from 2016 to 2023 to identify enucleated retinoblastoma (RB) eyeballs having tumor seedings. All pathological specimens that were studied using red and green laser pointers (Class III Laser product) were included. Lasers of wavelength 532 nm (green) and 630 nm (red) were used under the objective of compound microscopes to study different RB seeds. The activities of seeds were studied by the use of lasers. The seeds were documented under the objective of the compound microscope. For statistical analysis, IBM SPSS 26 was utilized. The descriptive statistics of the quantitative variables was reported through the metric mean. The categorical variables were described using count and percentages. Independence of categorical variable was carried out using Chi-square test and P values.

RESULTS: Thirty-eight specimens with RB seedings at different locations were included in the study. RB seeds in anterior segment (n = 2 cases), over ciliary process (n = 2 cases), vitreous seeds (n = 18 cases), retinal seeds (n = 2 cases), retinal pigment epithelium seeds (n = 3 cases), subretinal seeds (n = 5 cases), combined vitreous and subretinal seeds (n = 6 cases), and calcified seeds (n = 2 cases) were noted. With red and green lasers, varied changes were observed in the RB seeds, particularly the presence and absence of electron dense clouding within the seeds. Active seeds could be differentiated from inactive seeds using the laser technique.

CONCLUSION: Use of laser in the present study was first of its kind, carried out to visualize RB seeds at different sites in raw or wet specimens of the enucleated eyeballs. By this technique, active seeds could be differentiated from the inactive seeds based on electron dense clouds within the seeds’ configurations.

PMID:41817580 | DOI:10.4103/IJO.IJO_1856_25

Indian J Ophthalmol. 2026 Mar 12. doi: 10.4103/IJO.IJO_1572_25. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the functional outcomes and complications of pars plana vitrectomy with scleral flaps covered with a two-point sutured scleral-fixated intraocular lens (SFIOL).

METHODS: A retrospective, single-center, single-surgeon case study, including 97 cases. About 25 G pars plana vitrectomy with a two-point sutured scleral-fixated IOL was used as a surgical modality.

RESULTS: This study included 97 patients and eyes with scleral IOL fixation, with a mean follow-up of 6 months. The indications for SFIOL were divided into cases of surgical aphakia (63, 64.94%), hyper-mature cataract not suitable for routine procedure (5,5.15%), traumatic cataracts not suitable for routine procedures (18,18.5%), and other categories (11,64.94%). In this study, the median ± standard deviation of best-corrected visual acuity (BCVA) values in logarithm of the minimum angle of resolution (LogMAR) pre, post 1 month, 3 months, 6 months showed statistically significant improvement in VA with P value <0.001. The most common complications as number of cases seen in our study were cystoid macular edema (four cases), Descemet membrane folds (three cases), epiretinal membrane (five cases), exposed suture knots (one case), iatrogenic retinal break (two cases), iatrogenic retinal touch (two cases), IOL edge glare (one case), IOL tilt (one case), secondary glaucoma (three cases), post-op uveitis (one case), retinal detachment (one case), no complications 73 cases out of total cases.

CONCLUSION: The mean BCVA improved from preoperative to postoperative 1 day, 1 month, 3 months, and 6 months (P < 0.001) using this technique. This technique, which is more time-consuming, offers advantages over other available options, including improved stability, reduced risk of complications, and enhanced visual outcome.

PMID:41817571 | DOI:10.4103/IJO.IJO_1572_25

Indian J Ophthalmol. 2026 Mar 12. doi: 10.4103/IJO.IJO_2659_25. Online ahead of print.

ABSTRACT

Type 2 diabetes mellitus (T2DM) and obesity are commonly treated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs). However, there have been growing concerns over the possibility that these medications may result in ocular adverse events, such as nonarteritic anterior ischemic optic neuropathy (NAION). Standard clinical care can overlook these potentially fatal adverse effects. The purpose of this review was to compile the most recent data on ocular side effects associated with GLP-1 RA therapy, assess their clinical relevance, and highlight necessary preventative and monitoring measures. A thorough search of the literature was conducted using Medline/PubMed/PMC, Google Scholar, Scopus, Web of Science, and ScienceDirect. Relevant literature, including observational studies, randomized trials, case reports, and pharmacovigilance data, was selected for its discussion of GLP-1 RAs and associated eye-related adverse events. Semaglutide, a GLP-1 RA, has been associated in a number of studies and safety assessments with an increased risk of NAION and the progression of diabetic retinopathy, especially in patients with underlying eye disorders. Findings, however, were mixed because no statistically significant link was found in a number of cohort studies and meta-analyses. The necessity for additional research was supported by data from adverse event reporting systems that showed disproportionality signals. Clinicians should be mindful of the potential ocular hazards associated with GLP-1 RAs, even though these medications remain useful in treating T2DM and obesity. Closer ophthalmologic monitoring may be beneficial for patients with known diabetic eye problems. Further prospective research with well-defined ocular outcomes is required to elucidate these correlations and guarantee the secure administration of GLP-1 RAs.

PMID:41817564 | DOI:10.4103/IJO.IJO_2659_25

Indian J Ophthalmol. 2026 Mar 12. doi: 10.4103/IJO.IJO_1506_25. Online ahead of print.

ABSTRACT

PURPOSE: To assess the impact of omega-3 fatty acid (O3FA) supplements on tear inflammatory cytokines in dry eye patients with an omega-3 index below 4%.

METHODS: This randomized controlled study involved 102 dry eye patients with an omega-3 index below 4%. Participants received either four capsules of O3FAs (325 mg eicosapentaenoic acid, 175 mg docosahexaenoic acid) or a placebo containing olive oil twice daily for 6 months. Patients were evaluated at baseline and 1, 3, and 6 months. The primary outcome measured changes in tear cytokines (IL-1β, IL2, IL4, IL5, IL6, IL8, IL10, IF-γ, and TNF-α). Secondary outcomes included improvements in dry eye symptoms, Nelson grade, goblet cell density, Schirmer test values, and tear film breakup time. Group means (pretreatment, 1, 3, and 6 months) were compared using repeated measure analysis of variance.

RESULTS: At baseline, impression cytology revealed that mRNA levels of IL-1β, IL-6, IL-8, and TNF-α were elevated by 1.6- to 2.4-fold in the O3FA group and 1.74 to 2.6-fold in the placebo group (P = 0.123). The O3FA group experienced a statistically significant reduction (P < 0.05) in tear cytokines. This group showed a 60% increase in the omega-3 index at 6 months, indicating high adherence to treatment. The dry eye symptom score, goblet cell density, and Nelson grade improved significantly in the O3FA group. However, these changes were not significant in the placebo group.

CONCLUSION: This study underscores the potential advantages of O3FA supplementation in decreasing tear inflammatory cytokines in dry eye patients with an omega-3 index below 4%.

PMID:41817560 | DOI:10.4103/IJO.IJO_1506_25

J Healthc Manag. 2026 Mar-Apr 01;71(2):122-139. doi: 10.1097/JHM-D-24-00185.

ABSTRACT

GOAL: This study examines the impact of supportive processes, work-life balance, and leadership on employees’ job satisfaction, intention to stay, and job engagement at US health centers.

METHODS: This study utilizes secondary data from the Health Center Workforce Well-Being Survey conducted by the Health Resources and Services Administration from late November 2022 to mid-February 2023. We conducted cross-sectional moderated mediation analyses using Model 60 from the Hayes PROCESS macro to examine the effects of supportive health center processes, work-life balance, and leadership on employee job satisfaction and, subsequently, employees’ intentions to stay and job engagement.

PRINCIPAL FINDINGS: The mediation analyses demonstrated that job satisfaction mediates the relationship between supportive processes and both intention to stay and job engagement. Moreover, work-life balance and leadership moderate the relationship between supportive processes and job satisfaction with different patterns. Leadership also plays a dual moderating role, reducing dependence on job satisfaction for employee intention to stay while amplifying its effect on job engagement.

PRACTICAL APPLICATIONS: Our findings highlight the need for targeted workforce strategies in health center settings. Healthcare leaders should first enhance employees’ job satisfaction by investing in workplace supportive processes, work-life balance initiatives, and leadership development tailored to their organizational context. After job satisfaction is strengthened, its influence on employees’ intention to stay and job engagement remains contingent on leadership. The decision about how much to invest in leadership initiatives should be guided by the organization’s current job satisfaction levels.

PMID:41817541 | DOI:10.1097/JHM-D-24-00185

J Healthc Manag. 2026 Mar-Apr 01;71(2):109-121. doi: 10.1097/JHM-D-24-00244.

ABSTRACT

GOAL: Burnout in healthcare remains a significant problem, with implications not only for physicians and advanced practice providers but also for the entire US healthcare system, including patients and payers. Significant work has been done to understand the antecedents of burnout and develop successful intervention strategies. Much of the attention has focused on either improving the work environment or enhancing individual resilience, with suboptimal results. Consequently, we examined individual fortitude-including resilience and other attributes-and its interaction with organizational support to extend the research into both individual- and workplace-level antecedent factors in burnout.

METHODS: Physicians and advanced practice providers from six healthcare systems were invited to participate in this study, with 753 completing the survey. The survey included valid and reliable instruments for burnout, fortitude, and perceived organizational support. Multiple methods of assessment were used to triangulate the interactive effects of fortitude (i.e., individual attributes or factors) and organizational support (i.e., workplace-related factors) on burnout. First, correlation analyses were performed to identify statistically significant relationships between individual- and workplace-related factors. Next, stepwise regression modeling was used to test the simultaneous impact of individual- and workplace-related factors by examining the interaction between fortitude and organizational support on burnout. Finally, a path model was developed to test for the mediating effect of fortitude on the relationship between organizational support and burnout.

PRINCIPAL FINDINGS: Significant negative correlations between both individual fortitude and perceived organizational support in the workplace on burnout were evident. Similarly, there was a positive association between fortitude and organizational support. Stepwise regression showed that the interaction of individual attributes and organizational support had the highest degree of significance (β = -.67, p < .01), with an adjusted R2 of .44. Fortitude was added in the second step (β = -.37, p < .01) and provided significant improvement over the previous model, consisting of the interaction variable. The adjusted R2 increased to .52 (X2 = 11.18, p < .01, Δ adj R2 = .08). While organizational support was significantly related to burnout, the addition of this variable to the model showed no significant improvement in explained variance (X2 = 0.18, ns, Δ adj R2 = .00). Subsequent path modeling showed that fortitude can partially mediate the relationship between organizational support and burnout. Empirically, this demonstrates that fortitude significantly affects the relationship between organizational support and reduced burnout.

PRACTICAL APPLICATIONS: The causes of burnout are multifaceted and unique to individuals. Organizational attempts to improve the work environment or increase individual resilience have been suboptimal, as burnout rates have remained stubbornly elevated. By considering the interaction of individual fortitude and organizational support, leaders can develop more effective intervention strategies to support healthcare providers.

PMID:41817540 | DOI:10.1097/JHM-D-24-00244

JAMA Netw Open. 2026 Mar 2;9(3):e260222. doi: 10.1001/jamanetworkopen.2026.0222.

ABSTRACT

IMPORTANCE: Adverse childhood experiences (ACEs) are key risk factors for major depressive disorder (MDD), but their associations with treatment-resistant depression (TRD) remain unclear, particularly after accounting for unmeasured confounding, such as shared genetic and familial environmental factors.

OBJECTIVE: To examine the association between ACEs and TRD while accounting for unmeasured confounding within families.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a co-twin control design and was based on 2 Swedish Twin Registry cohorts: the Study of Twin Adults: Genes and Environment (STAGE) and the Young Adult Twins in Sweden Study (YATSS). The sample included twins born from 1959 to 1992 who completed surveys in 2005 to 2006 (for the STAGE cohort) or in 2013 to 2014 (for the YATSS cohort). Both cohorts were linked to Sweden’s National Patient Register and Prescribed Drug Register for follow-up until the end of 2016. Data analysis was conducted from September to November 2024.

EXPOSURE: ACEs, which were assessed using 7 yes or no items adapted from the Life Stressor Checklist-Revised: emotional neglect or abuse, physical neglect, physical abuse, sexual abuse, rape, hate crime, and witnessing family violence before age 19 years.

MAIN OUTCOMES AND MEASURES: TRD, which was defined as MDD diagnosed clinically or meeting the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria based on self-reported symptoms and having had at least 2 antidepressant switches of adequate duration (≥6 weeks) with no more than 14 weeks between consecutive prescriptions.

RESULTS: The full cohort included 21 192 twins, among whom 17 814 (10 205 females [57.3%]; mean [SD] age, 32.10 [7.82] years) were included in the main analysis. A total of 5558 individuals (31.2%) reported exposure to at least 1 ACE, and 996 (5.6%) reported 3 or more ACEs. The prevalence of TRD was 1.3% (n = 230) overall. Each additional ACE exposure was associated with increased odds of TRD (odds ratio [OR], 1.69; 95% CI, 1.56-1.84). In co-twin control analyses, the association remained within monozygotic and dizygotic twins (OR, 2.23; 95% CI, 1.30-3.83). Among ACE types, physical neglect (OR, 5.73; 95% CI, 3.75-8.75) and sexual abuse (OR, 5.01; 95% CI, 3.47-7.23) showed the greatest magnitude of associations with TRD.

CONCLUSIONS AND RELEVANCE: In this cohort study, ACE exposure was associated with an increased risk of TRD even after accounting for unmeasured familial confounding. The findings highlight the importance of preventing ACEs and incorporating ACE history into clinical assessment to identify individuals with MDD who may be at elevated risk for treatment resistance.

PMID:41817529 | DOI:10.1001/jamanetworkopen.2026.0222

JAMA Netw Open. 2026 Mar 2;9(3):e260237. doi: 10.1001/jamanetworkopen.2026.0237.

ABSTRACT

IMPORTANCE: Cost-related delayed or forgone care is an issue affecting Latino adults and may lead to increased emergency department (ED) visits.

OBJECTIVES: To examine the association between cost-related delayed or forgone physical and mental health care and ED visits among Latino adults aged 18 to 64 years in the US and to estimate within-group differences in ED visits by language, place of birth, heritage, citizenship status, and insurance status, after adjusting for delayed or forgone care.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed pooled data from January 1, 2019, to December 31, 2024 (2019-2024 waves) in the National Health Interview Survey, a nationally representative survey of noninstitutionalized US residents. The analytic sample included Latino adults aged 18 to 64 years.

EXPOSURE: Self-reported cost-related delayed or forgone physical and mental health care.

MAIN OUTCOME AND MEASURES: The primary outcome consisted of self-reported ED visits in the past 12 months (yes or no). Weighted multivariable logistic regression models estimated adjusted odds ratios (AORs) and 95% CIs, controlling for survey year and sociodemographic, health-related, and geographic factors.

RESULTS: A total of 17 344 Latino adults were included, with a median age of 36.7 (IQR, 26,0-48.1) years. In weighted proportions, 50.7% were female, 58.5% had a high school education or less, and 16.9% reported delayed or forgone care. Respondents who reported cost-related delayed or forgone care had significantly higher odds of reporting at least 1 ED visit in the past 12 months (AOR, 1.78; 95% CI, 1.59-2.01) compared with those who did not report delaying or forgoing care. Females (AOR, 1.33; 95% CI, 1.21-1.47) and individuals with lower educational attainment (AOR for less than high school vs college graduate, 1.60; 95% CI, 1.34-1.92), public insurance (AOR, 1.69; 95% CI, 1.49-1.91), non-Mexican heritage (AOR, 1.18; 95% CI, 1.07-1.30), and poorer self-rated health (AOR, 4.09; 95% CI, 3.05-5.48) had higher odds of at least 1 ED visit. Compared with US-born individuals, those born outside the US had lower odds of having at least 1 ED visit (AOR, 0.75; 95% CI, 0.65-0.86). All estimates were adjusted for delayed or forgone care.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study including Latino US adults, cost-related delays and forgone care were associated with increased ED use, underscoring the need for policies that reduce financial barriers to timely health care.

PMID:41817528 | DOI:10.1001/jamanetworkopen.2026.0237

JAMA Netw Open. 2026 Mar 2;9(3):e261385. doi: 10.1001/jamanetworkopen.2026.1385.

ABSTRACT

IMPORTANCE: Delivering integrated atrial fibrillation (AF) care to rural patients remains challenging. Patients aged 75 years and older in rural areas represent a particularly at-risk subgroup, and effective and scalable strategies to optimize AF care in this population are urgently needed.

OBJECTIVE: To evaluate the effectiveness of a village doctor-led, telemedicine-supported integrated care model in rural patients aged 75 years and older with AF.

DESIGN, SETTING, AND PARTICIPANTS: This was a prespecified subgroup analysis of the Novel Model of Integrated Care of Older Patients With Atrial Fibrillation in Rural China (MIRACLE-AF) cluster randomized clinical trial, which was conducted across 30 village clinics in Jiangdu County, Jiangsu Province, China, from December 2020 to May 2024. Patients with AF aged 65 years and older and residing in rural villages under study were eligible for the MIRACLE-AF trial. In this prespecified subgroup study, patients aged 75 years and older were analyzed. Additional age cutoffs (≥70, ≥75, and ≥80 years) were applied to assess the consistency of intervention benefits across age groups.

INTERVENTIONS: Village doctor-led, telemedicine-supported integrated AF care or usual care.

MAIN OUTCOMES AND MEASURES: A composite of cardiovascular death, ischemic or hemorrhagic stroke, hospitalization for worsening heart failure or acute coronary syndrome, and emergency visits for AF.

RESULTS: Among 1039 patients included in the primary analysis of the MIRACLE-AF trial (mean [SD] age, 75.8 [5.7] years; 460 women [44.3%]), 589 patients with AF aged 75 years or older (median [IQR] age, 79 [77-82] years; 273 women [46.3%]) were included in this analysis. Among them, 297 patients received the MIRACLE-AF intervention and 292 patients received usual care. Over 36 months of follow-up, the MIRACLE-AF intervention resulted in a significantly lower risk of the primary composite outcome compared with usual care (7.4%; 95% CI, 5.6%-9.2% vs 11.3%; 95% CI, 8.5%-14.1% per year; rate difference, -3.93 percentage points; 95% CI, -7.41 to -0.44 percentage points; P = .02; adjusted hazard ratio, 0.70; 95% CI, 0.49 to 0.98; P = .04).

CONCLUSIONS AND RELEVANCE: In this prespecified subgroup analysis of the MIRACLE-AF trial, a novel care model significantly improved outcomes in patients with AF aged 75 years or older in rural settings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04622514.

PMID:41817526 | DOI:10.1001/jamanetworkopen.2026.1385

JAMA Netw Open. 2026 Mar 2;9(3):e261543. doi: 10.1001/jamanetworkopen.2026.1543.

ABSTRACT

IMPORTANCE: Evidence of cost-effectiveness is needed to demonstrate the value of smoking cessation behavioral interventions.

OBJECTIVE: To evaluate the cost-effectiveness of motivation and problem-solving (MAPS) against standard treatment (ST) for smoking cessation among patients with a history of cervical intraepithelial neoplasia or cervical cancer.

DESIGN, SETTING, AND PARTICIPANTS: In this economic evaluation, a cost-effectiveness analysis was conducted from the perspective of cancer centers using data collected in a randomized clinical trial conducted between February 2017 and January 2020 with follow-up until August 2021 that compared MAPS with ST. MAPS is a behavioral intervention that emphasizes smoking cessation and relapse prevention while addressing life events, stressors, and other individual concerns. The trial included up to 6 counseling sessions of MAPS delivered over 12 months. Data were analyzed from January 2024 to December 2025.

EXPOSURE: Inclusion in a smoking cessation randomized clinical trial that compared MAPS with ST.

MAIN OUTCOMES AND MEASURES: Deterministic and probabilistic cost-effectiveness analyses were conducted and findings were reported as incremental cost-effectiveness ratio and cost-effectiveness acceptability curve, respectively, for 7-day point prevalence abstinence at months 12 and 18.

RESULTS: The analysis included 194 participants. Study participants had a mean (SD) age of 47.8 (10.8) years, had a mean (SD) smoking history of 29.1 (12.1) years, and smoked a mean (SD) of 15.5 (8.7) cigarettes per day. Mean costs were $522.74 (95% CI, $500.19 to $545.29) and $389.26 (95% CI, $362.67 to $415.84) per participant for MAPS (98 participants) and ST (96 participants), respectively. At month 12, abstinence rates were 26.5% and 12.5% for MAPS and ST, respectively. The deterministic analysis found that the incremental cost for MAPS vs ST was $921 per quit at month 12 and $7458 per quit at month 18. The probabilistic analysis found that at the societal willingness to pay of $10 000 per quit, the probability that MAPS is cost-effective at month 12 was nearly 100% but reduced to 52% at month 18. Subgroup analysis found a lower incremental cost-effectiveness ratio when comparing the high MAPS engagement subgroup with the ST group. The cost-effectiveness of MAPS (vs ST) was sustained at month 18 among the high MAPS engagement subgroup despite a decline in 7-day abstinence.

CONCLUSIONS AND RELEVANCE: In this cost-effectiveness analysis, there was robust evidence supporting the cost-effectiveness of MAPS (vs ST) at month 12 and moderate evidence at month 18 in terms of incremental cost per quit. The attenuation of intervention outcome over time was more pronounced among participants with less than 4 sessions of MAPS.

PMID:41817524 | DOI:10.1001/jamanetworkopen.2026.1543