Nevin Manimala

J Child Neurol. 2026 Mar 17:8830738261425433. doi: 10.1177/08830738261425433. Online ahead of print.

ABSTRACT

PurposeNeurogenic detrusor overactivity (NDO) can lead to elevated bladder pressure and pose significant risks to the upper urinary tract. This study aimed to evaluate the efficacy of combining solifenacin with biofeedback in treating pediatric NDO caused by primary tethered cord syndrome (TCS).MethodsThis study conducted a retrospective analysis of 32 children diagnosed with NDO caused by primary TCS, who were enrolled and assigned to two groups: group A (n = 16) received solifenacin alone, whereas group B (n = 16) underwent a combined regimen of solifenacin and biofeedback. Outcomes, including lower urinary tract symptoms, urodynamic parameters, and post-void residual urine (PVRU), were assessed at 4, 12, and 24 weeks.ResultsAt 4 and 12 weeks after the initial treatment, both groups showed improvement in lower urinary tract symptoms compared with baseline. However, no statistically significant differences were observed in both groups (P > .05). In assessments at 24 weeks, group B exhibited greater improvement in lower urinary tract symptoms and urodynamic parameters compared with group A (P < .05). These differences were particularly evident in bladder compliance and detrusor overactivity. Despite these superior outcomes, group B required lower cumulative doses of solifenacin than group A. Additionally, no statistically significant improvements were found in PVRU or detrusor function during voiding in either group throughout the follow-up period.ConclusionsThe combination of solifenacin and biofeedback proved to be an effective treatment for pediatric NDO caused by primary TCS, compared with solifenacin monotherapy. This combined approach not only enhanced clinical outcomes but also allowed for reduced solifenacin dosages.

PMID:41841338 | DOI:10.1177/08830738261425433

Epileptic Disord. 2026 Mar 17. doi: 10.1002/epd2.70223. Online ahead of print.

ABSTRACT

OBJECTIVE: Shortages of antiseizure medications (ASM) have been increasingly reported worldwide, threatening treatment continuity for patients with epilepsy. Since 2024, Colombia has experienced a nationwide shortage of medications for neurological diseases, particularly ASM, compromising disease control and healthcare outcomes. This study evaluated the impact of outpatient ASM shortages on seizure-related emergency department (ED) visits in a public hospital in Bogotá, Colombia.

METHODS: We conducted a retrospective, descriptive study of adult patients with epilepsy admitted to the ED between March-May 2023 (no shortage) and March-May 2024 (shortage period). Demographic, clinical, and hospitalization data were collected from medical records. Statistical analyses included Fisher’s exact and Mann-Whitney U tests, with significance set at p < .05.

RESULTS: A total of 281 patients were included (107 in 2023, 174 in 2024). Sixty-one admissions were directly related to lack of outpatient ASM (7 in 2023, 54 in 2024). ED visits due to ASM unavailability increased from 6.5% to 31% (p < .001; OR = 6.4; 95% CI 2.7-17.4). Patients affected by shortages showed a higher risk of seizure clusters (OR = 2.43; 95% CI 1.2-5.1; p = .012) and a trend toward longer hospital stays, though mortality and ICU admissions remained unchanged.

SIGNIFICANCE: Outpatient ASM shortages were associated with a marked rise in seizure-related ED visits and an increased risk of seizure clusters, reflecting greater hospital burden. Ensuring stable ASM supply through effective national distribution and monitoring strategies is essential to maintain seizure control and prevent avoidable complications in patients with epilepsy.

PMID:41841314 | DOI:10.1002/epd2.70223

JAMA. 2026 Mar 17. doi: 10.1001/jama.2026.2897. Online ahead of print.

ABSTRACT

IMPORTANCE: The effect of wrist-strap physical restraints on outcomes in patients receiving mechanical ventilation in the intensive care unit (ICU) remains uncertain.

OBJECTIVE: To investigate the effect of a low-use wrist-strap physical restraint strategy in critically ill patients receiving invasive mechanical ventilation.

DESIGN, SETTING, AND PARTICIPANTS: Open-label randomized clinical trial conducted across 10 ICUs in France. Between January 5, 2021, and January 2, 2024, 405 adult patients who had initiated invasive mechanical ventilation within the previous 6 hours and were expected to require ventilation for at least 48 hours were enrolled. Follow-up was completed on May 17, 2024. Statistical analysis was conducted from June 1, 2025, to December 15, 2025.

INTERVENTIONS: Patients were randomized to undergo either a restrictive, low-use physical restraint strategy (wrist straps avoided unless necessary because of severe agitation, defined as a Richmond Agitation-Sedation Scale score of ≥3 [on a scale from -5 (unresponsive) to 4 (combative)]; n = 201) or a liberal, high-use strategy (wrist straps applied systematically and reassessed daily; n = 204). Discontinuation of restraints was allowed in patients who were awake or extubated without delirium (measured via the Confusion Assessment Method for the ICU).

MAIN OUTCOMES AND MEASURES: The primary outcome was the number of days alive without coma or delirium during the first 14 days after randomization. Secondary outcomes included incidence of self-extubation and day-90 mortality.

RESULTS: Among 396 patients with available primary outcome data, the median (IQR) age was 65 (56-73) years, 245 (62%) were male, and the median (IQR) Sequential Organ Failure Assessment score was 7 (4-10). The mean days alive without coma or delirium were 6.67 days (95% CI, 5.69-7.65) in the low-use strategy group and 6.30 days (95% CI, 5.35-7.24) in the high-use strategy group (adjusted mean difference, 0.37 days [95% CI, -0.71 to 1.46]; P = .51). Self-extubation occurred in 18 patients (9.2%) in the low-use strategy group and 17 (8.5%) in the high-use strategy group, and day-90 mortality was 37.2% and 41.0%, respectively.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, among adult patients receiving mechanical ventilation in the ICU, a low-use wrist-strap physical restraint strategy compared with a high-use strategy did not reduce days free of delirium or coma at 14 days.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04273360.

PMID:41841304 | DOI:10.1001/jama.2026.2897

Clin Nephrol. 2026 Mar 17. doi: 10.5414/CN111893. Online ahead of print.

ABSTRACT

We conducted a retrospective chart review of adult kidney transplant recipients (KTxR) with type 2 diabetes treated with a glucagon-like peptide-1 receptor agonist (GLP-1RA). A total of 211, 207, 161, and 92 KTxR were followed for 6, 12, 36, and 60 months, respectively. Over 5 years, we observed statistically significant reductions in the primary endpoints of weight, HbA1c, and major adverse cardiovascular events (MACE). The mean weight reduction was as follows: 1.17 kg at 6 months (p < 0.006), 1.2 kg at 12 months (p < 0.03), 3.7 kg at 36 months (p < 0.0001), and 4.1 kg at 60 months (p = 0.001) compared to baseline. The HbA1c levels showed reductions of 0.6 mmol/mol at 6 months (p < 0.0001), 0.5 mmol/mol at 12 months (p = 0.0004), 0.3 mmol/mol at 36 months (p = 0.04), and 0.35 mmol/mol at 60 months (p = 0.35). MACE rates fell from 45.5% at GLP-1RA initiation to 18.9% during follow-up (OR 3.6 (2.3 – 5.6), p < 0.0001). Insulin requirements decreased from 50 to 27 units over 5 years. Kidney function reduces over time in KTx, likely secondary to hemodynamic or vascular-mediated risk factors, chronic immunosuppressive agents, treatment for rejections, and solitary transplanted kidney. In our study, estimated glomerular filtration rate (eGFR) not only stayed stable but also showed a trend towards improvement (eGFR improved from 50 to 53 mL/min/1.73m²). Further prospective randomized trials are needed to assess GLP-1RA efficacy and safety in KTxR.

PMID:41841288 | DOI:10.5414/CN111893

Eur J Psychotraumatol. 2026 Dec;17(1):2638114. doi: 10.1080/20008066.2026.2638114. Epub 2026 Mar 17.

ABSTRACT

Background: Children and adolescents exposed to adversities, such as those in residential care or those affected by domestic violence (DV) but not in care, experience elevated rates of trauma, placing them at risk for both posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD).Objective: Our objective is to validate the Portuguese adaptation of the International Trauma Questionnaire – Child and Adolescent Version (ITQ-CA) to assess for ICD-11 PTSD and CPTSD in at-risk Portuguese-speaking youths.Methods: The ITQ-CA was translated and culturally adapted following established guidelines. This study included 160 participants aged 7-17 years, comprising children in residential care and those exposed to DV. Confirmatory factor analyses (CFA) were conducted to test competing ICD-11 consistent latent structural models of PTSD and disturbances in self-organisation (DSO). Convergent validity was examined using the CRIES-13 and ITEM-CA, and divergent validity was assessed using the WHO-5. Exploratory factor analysis and network analysis were conducted as supplementary analyses and are reported in the Supplementary Materials.Results: CFA supported the two higher order correlated factors model with two-factor higher-order (PTSD and DSO), yielding adequate fit indices, χ²(52) = 104.189, RMSEA = 0.079, CFI = 0.923, TLI = 0.903. Internal consistency is strong (ω = 0.872; α = 0.871). The ITQ-CA demonstrated significant correlations with the CRIES-13 and ITEM-CA, supporting convergent validity, while negative correlations with the WHO-5 confirmed divergent validity.Conclusion: The Portuguese version of the ITQ-CA demonstrated strong psychometric properties, supporting its use as a valid and reliable tool for identifying PTSD and CPTSD symptoms in children and adolescents. Its integration into practice could support targeted trauma-informed interventions.

PMID:41841273 | DOI:10.1080/20008066.2026.2638114

Subst Use Addctn J. 2026 Mar 17:29767342261422061. doi: 10.1177/29767342261422061. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with opioid use disorder need prompt buprenorphine/naloxone (BUP/NX) and naloxone nasal spray (NNS) access from pharmacies, but audit studies report substantial availability deficits. No specific intervention has increased BUP/NX stocking, and little is known about the impact of transitioning specific NNS formulations to over-the-counter. The purpose of this study was to assess the impact of mailed academic detailing on BUP/NX availability and the ability to obtain NNS without a prescription.

METHODS: A prospective interventional study was conducted in a sample of 1000 Texas community pharmacies assigned 1:1 to intervention and control groups. The intervention group received academic detailing handouts with links to continuing education addressing BUP/NX and NNS. Pre- and post-intervention audits were conducted using a telephonic secret-shopper approach. Outcomes for BUP/NX included stocking, willingness to order if not stocked, and a composite outcome of stocking and willingness to order. NNS outcomes included availability without a prescription. McNemar and Wilcoxon signed-rank tests, and generalized estimating equations (GEE) were used for analyses.

RESULTS: Data from 757 pharmacies were included in analyses (374 intervention, 383 control). Baseline BUP/NX stocking was low (36.7%) with no statistically significant pre-to-post changes for either group. Most pharmacies were willing to order (60.5%) with no significant pre-to-post changes for either group. GEE analysis found no significant difference in odds of stocking between groups (aOR = 1.08, P = .73), but the intervention group had a significantly higher likelihood to order (aOR = 2.25, P = .02) and of achieving the composite outcome (aOR = 2.17, P = .01). NNS availability increased in both groups but did not differ significantly between groups (aOR = 1.00, P = .99).

CONCLUSIONS: A mailed academic detailing intervention did not change NNS availability or BUP/NX stocking but did modestly increase willingness to order BUP/NX. This intervention is easily replicable and scalable, but modifications to increase the magnitude of its effect are needed.

PMID:41841216 | DOI:10.1177/29767342261422061

Orthop Surg. 2026 Mar 17. doi: 10.1111/os.70278. Online ahead of print.

ABSTRACT

BACKGROUND: Massive rotator cuff tears (RCTs) often lead to superior migration and poor function. While superior capsular reconstruction (SCR) using the long head of the biceps tendon (LHBT) autograft is a promising technique, the optimal management of its distal portion (tenotomy vs. retention) remains unclear.

OBJECTIVE: To compare the clinical outcomes of SCR by a long head of the biceps tendon (LHBT) autograft with biceps tenotomy or not in massive RCTs.

METHODS: In this retrospective cohort study, we enrolled and followed 59 patients following SCR using the LHBT between 2016 and 2021. Patients were divided into two groups based on intraoperative management of the distal LHBT: the LHBT-retained group and the LHBT-tenotomy group. Statistical comparisons included repeated-measures ANOVA, two-way mixed-design ANOVA, chi-square/Fisher’s exact tests, and Mann-Whitney U tests as appropriate. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, constant score and range of motion (ROM), and the acromiohumeral distance (AHD) were assessed as outcome measures.

RESULTS: No major surgical complications were observed in any patient after surgery. The VAS score (7.0 vs. 0.6), AHD (3.2 ± 1.1 vs. 7.8 ± 0.8 mm), ASES (38 vs. 92), constant score (41 vs. 80), and ROM were statistically improved compared to their preoperative values. All patients were further subdivided into two groups according to the management of the distal end of the LHBT after transposition and fixation (retained group: the distal part of the LHBT was retained; tenotomy group: the distal part of the LHBT was resected). The two groups had comparable baseline demographic and clinical characteristics. We found that tenotomy group showed more significant function improvement within 12 months postoperatively (p < 0.05) compared with retained group. Nevertheless, compared with tenotomy group, the AHD of retsained group increased by 1.9 mm (5.0 ± 1.2 mm vs. 3.1 ± 0.8mm). Postoperative imaging assessment at 2 years revealed low and comparable retear rates (grades IV-V) between groups (retained group: 9.7% vs. tenotomy group: 7.1%).

CONCLUSION: SCR using the LHBT autograft significantly improves outcomes in massive RCTs. While both techniques are effective, patients with distal biceps tenotomy (tenotomy group) exhibited superior early functional recovery (within 12 months), whereas those with an intact distal LHBT (retained group) demonstrated significantly greater improvement in AHD. Both groups achieved comparably low retear rates.

LEVEL OF EVIDENCE: Level 4.

PMID:41841210 | DOI:10.1111/os.70278

Future Cardiol. 2026 Mar 17:1-10. doi: 10.1080/14796678.2026.2645012. Online ahead of print.

ABSTRACT

Cardiovascular diseases (CVDs) remain a leading cause of global morbidity and mortality, requiring precise risk prediction models for effective prevention and management. This review maps and evaluates globally utilized and country-specific CVD risk prediction models, including the Framingham Risk Score, Pooled Cohort Equations, PREVENT, WHO/ISH Risk Charts, INTERHEART, and SCORE2. A structured literature search was conducted using PubMed and Google Scholar, from which 30 relevant studies were selected. Most of the models integrate traditional risk factors such as age, sex, blood pressure, cholesterol, and smoking status to estimate CVD risk. While these models demonstrate moderate to good discrimination (C-statistics ranging from 0.66 to 0.80) and validation, their applicability varies across populations, with concerns about overestimation or underestimation in non-original cohorts. Notably, the WHO/ISH and Globorisk models address global diversity by incorporating regional calibrations, making them suitable for low- and middle-income countries. Similarly, the country-specific risk scores outperform global models due to their incorporation of local socio-demographics. Limitations persist across existing models, including the underrepresentation of younger individuals, ethnic minorities, and the exclusion of emerging risk factors. Future efforts must prioritize the development of locally validated, population-specific models to support equitable and effective CVD risk assessment and prevention.

PMID:41841199 | DOI:10.1080/14796678.2026.2645012

Int J Nurs Pract. 2026 Apr;32(2):e70134. doi: 10.1111/ijn.70134.

ABSTRACT

AIM: The aim of this study was to identify the effects of a hybrid maternal role enhancement program based on Meleis’ Transition Theory for working mothers.

METHODS: Using a non-equivalent control group pretest-post-test repeated-measures design, 46 participants were conveniently recruited and assigned to experimental (n = 24) and control (n = 22) groups. Data were collected before intervention (baseline), immediately after intervention (Post-test 1) and 2 weeks after intervention (Post-test 2) using structured questionnaires. The experimental group participated in the hybrid maternal role enhancement program, which included a 1-day offline workshop for both parents and 2 weeks of online support and counselling for mothers. Data were analysed using IBM SPSS Statistics 25.0.

RESULTS: The hybrid maternal role enhancement program had significant interaction effects (group × time effect) on parenting efficacy, maternal identity and spousal childcare support. Scores in the experimental group increased from baseline to Post-test 1 and Post-test 2, whereas the scores of those in the control group remained similar or decreased.

CONCLUSION: The nursing-led maternal role enhancement program developed based on the transition theory can be provided for working mothers with severe time and space restrictions as a hybrid program that combines online and offline programs.

PMID:41841183 | DOI:10.1111/ijn.70134

Neurooncol Adv. 2026 Feb 12;8(1):vdag034. doi: 10.1093/noajnl/vdag034. eCollection 2026 Jan-Dec.

ABSTRACT

BACKGROUND: Precise glioma segmentation in magnetic resonance imaging (MRI) is essential for accurate diagnosis, optimal treatment planning, and advancing clinical research. However, most deep learning approaches require complete, standardized MRI protocols that are frequently unavailable in routine clinical practice. This study presents and evaluates GlioMODA, a robust deep learning framework designed for automated glioma segmentation that delivers consistent high performance across varied and incomplete MRI protocols.

METHODS: GlioMODA was trained and validated on the BraTS 2021 dataset (1251 training, 219 testing cases), systematically assessing performance across 11 clinically relevant MRI protocol combinations. Segmentation accuracy was evaluated using Dice similarity coefficients (DSC) and panoptic quality metrics. Volumetric accuracy was benchmarked against manual ground truth, and statistical significance was established via Wilcoxon signed‑rank tests with Benjamini-Yekutieli correction.

RESULTS: GlioMODA demonstrated state-of-the-art segmentation accuracy across tumor subregions, maintaining robust performance with incomplete or heterogeneous MRI protocols. Protocols including both T1-weighted contrast-enhanced and T2-FLAIR sequences yielded volumetric differences vs manual ground truth that were not statistically significant for enhancing tumor (median difference 55 mm³, P = .157) and whole tumor (median difference -7 mm³, P = 1.0), and exhibited median DSC differences close to zero relative to the 4‑sequence reference protocol. Omitting either sequence led to substantial and significant volumetric errors.

CONCLUSIONS: GlioMODA facilitates reliable, automated glioma segmentation using a streamlined 2‑sequence protocol (T1‑contrast + T2‑FLAIR), supporting clinical workflow optimization and broader implementation of quantitative volumetry compatible with RANO 2.0 criteria. GlioMODA is published as an open-source, easy-to-use Python package at https://github.com/BrainLesion/GlioMODA/.

PMID:41841144 | PMC:PMC12989096 | DOI:10.1093/noajnl/vdag034