Category: Nevin Manimala

J Perianesth Nurs. 2026 Jun 30:S1089-9472(26)00106-1. doi: 10.1016/j.jopan.2026.04.003. Online ahead of print.

ABSTRACT

PURPOSE: Most studies assess emergence delirium (ED) in the postanesthesia care unit (PACU), but immediate post-extubation evaluation and its associated risk factors remain understudied. We aimed to evaluate the incidence of ED immediately after extubation and to identify risk factors associated with its occurrence during this early post-extubation period in surgical patients.

DESIGN: This study employed an observational, cross-sectional, correlational design with convenience sampling.

METHODS: A cross-sectional correlational study was conducted involving 299 adult patients who underwent surgery at a tertiary medical center. ED was assessed using the Nursing Delirium Screening Scale (Nu-DESC) immediately following extubation, which was performed once patients regained consciousness and were able to follow commands. Demographic and clinical data were collected, including age, sex, comorbidities, type and duration of surgery, and anesthetic agents used. Descriptive statistics and multivariable logistic regression were used to analyze the data.

FINDINGS: The incidence of ED was 45.5% (136/299). Multivariable logistic regression analysis demonstrated that anesthetic duration ≥76 min (OR 2.33; 95% CI, 1.23 to 4.42; P = 0.009), lower education level (≤9 years; OR 2.19; 95% CI, 1.17 to 4.08; P = 0.014), and a history of smoking (OR 2.12; 95% CI, 1.16 to 3.88; P = 0.014) were independently associated with an increased risk of ED.

CONCLUSIONS: Early identification of risk factors facilitates timely recognition of ED. Lower educational attainment, smoking history, and prolonged anesthetic duration were associated with an increased risk. Immediate assessment of delirium after extubation shows potential value. In the future, it may support targeted monitoring, inform preoperative risk stratification, and help improve anesthesia nursing plans to enhance patient safety.

PMID:42376720 | DOI:10.1016/j.jopan.2026.04.003

J Forensic Sci. 2026 Jun 30. doi: 10.1111/1556-4029.70398. Online ahead of print.

ABSTRACT

Next-generation sequencing (NGS) provides increased discriminatory power in forensic DNA analysis due to the detection of isoalleles. Differences in sequences between alleles allow for a second layer of differentiation between DNA contributors beyond the number of short tandem repeat (STR) repeat units. However, because NGS is a more time and resource-intensive analysis than conventional capillary electrophoresis (CE), laboratories may benefit from indicators that suggest NGS is likely to provide added value. This study examined whether CE migration offsets, measured as residuals in the OSIRIS analysis software, can differ significantly among STR isoalleles. Residuals represent the time offset between a sample allele peak and its corresponding allelic ladder peak. Paired CE and NGS data from 95 single source samples were analyzed for CE-based residual differences, as the NGS data provided the sequence information of the corresponding isoalleles. Residual values differed significantly among isoalleles at several STR loci. Statistically significant differences were identified at D16S539 and D3S1358, as well as at specific allele lengths within D12S391, D13S317, and D8S1179. These findings demonstrate that CE residual variation can reflect underlying STR sequence differences between contributors. In practice, residual-based metrics could help laboratories to identify casework reference samples where NGS is likely to provide additional discrimination, without the need for processing outside of a routine CE workflow. Due to the potentially large number of isoalleles, community wide efforts to aggregate CE residual differences versus isoallele sequences may be useful in the validation and implementation of this approach to add value to forensic DNA analyses.

PMID:42376694 | DOI:10.1111/1556-4029.70398

J Forensic Sci. 2026 Jun 30. doi: 10.1111/1556-4029.70401. Online ahead of print.

ABSTRACT

Determining the cause of death using postmortem fentanyl concentrations in femoral blood remains a major challenge in forensic toxicology. This is due to substantial concentration overlap between overdose deaths and incidental non-drug-related deaths. Existing literature largely reports descriptive statistics such as ranges and medians. These statistics do not provide an objective framework for evaluating the evidentiary value of a specific fentanyl concentration. Using distribution analysis, nonparametric tests, and likelihood ratios, we developed a four-zone statistical model to quantify overdose probability based on fentanyl concentrations in femoral blood. We also determined how polysubstance use alters these probabilities, leading to adjustments in the interpretive windows. Logistic regression modeling showed that age and sex contribute minimally to overdose probability and identified which drug classes best predict overdose classification. Together, these results provide a rigorous and objective method to determine postmortem overdose certainty in fentanyl-only and multi-drug intoxication cases.

PMID:42376689 | DOI:10.1111/1556-4029.70401

Eur Heart J Imaging Methods Pract. 2026 Jun 12;4(1):qyag107. doi: 10.1093/ehjimp/qyag107. eCollection 2026 Jan.

ABSTRACT

AIMS: Macrophages play a crucial role in coronary artery plaque development and can be quantified as circumferential arc features via optical coherence tomography (OCT). However, the prognostic implications of macrophage arc characteristics remain underexplored.

METHODS AND RESULTS: In this multicentre, retrospective study, consecutive patients with coronary artery disease (CAD) undergoing OCT between January 2017 and April 2023 were enrolled. The macrophage arc was evaluated using maximum arc, mean arc, and mean arc score (MAS) in the target vessel. Among 1025 patients (1173 vessels), 61 (5.9%) experienced major adverse cardiovascular events (MACEs). Receiver operating characteristic analysis identified optimal predictive thresholds: maximum arc ≥ 157.5°, mean arc ≥ 97.88°, and MAS ≥ 2.27 (all P < 0.001). Elevated mean arc [hazard ratio (HR) = 7.628, P < 0.0001], maximum arc (HR = 6.902, P < 0.0001), and MAS (HR = 6.704, P < 0.0001) were independently associated with MACEs. When combined with thin-cap fibroatheroma (TCFA) status, these parameters demonstrated enhanced predictive power: mean arc ≥ 97.88° + TCFA (HR = 8.779, P < 0.0001), maximum arc ≥ 157.5° + TCFA (HR = 8.149, P < 0.0001), and MAS ≥ 2.27 + TCFA (HR = 7.509, P < 0.0001). Notably, among TCFA-negative patients, a mean arc ≥ 97.88° showed markedly improved predictive capacity for MACEs (HR = 6.685, P < 0.001), as did maximum arc ≥ 157.5° (HR = 4.490, P < 0.001) and MAS ≥ 2.27 (HR = 5.126, P < 0.001).

CONCLUSION: Macrophage arc parameters are strongly associated with long-term cardiovascular risk, serving as novel OCT-derived biomarkers for patients with CAD.

PMID:42376680 | PMC:PMC13312119 | DOI:10.1093/ehjimp/qyag107

Digit J Ophthalmol. 2025 Jun 30;31(2):36-45. doi: 10.5693/djo.01.2025.01.001. eCollection 2025.

ABSTRACT

PURPOSE: To determine whether stage of diabetic retinopathy (DR) is associated with increased intraocular pressure (IOP).

METHODS: The medical records of patients seen in the outpatient ophthalmology clinic at Sidney & Lois Eskenazi Community Hospital in Indianapolis, Indiana, from January 2022 to August 2023 were reviewed retrospectively. The highest IOP of those presenting without type 2 diabetes mellitus (T2DM), T2DM without DR, and varying severity of DR was recorded. Main outcome measures included median and average IOPs recorded from patients who presented without diabetes, diabetes without retinopathy, and mild, moderate, severe nonproliferative and proliferative diabetic retinopathy. Comparisons between groups generated P values, with ≤0.05 indicating statistical significance.

RESULTS: A total of 389 patients (759 eyes) were included. Mean patient age was 58. Male patients accounted for 286 eyes (37.7%); Hispanic patients, for 270 eyes (35.6%); patients identifying as black, for 261 eyes (34.4%); white patients, for 195 eyes (25.7%); and Asian patients, for 33 eyes (4.3%). Overall, analysis showed IOP increased between eyes without T2DM compared with mild nonproliferative DR (P = 0.0373), mild DR compared to moderate nonproliferative DR (P = 0.0117), and moderate DR compared with severe nonproliferative DR (P = 0.0001). The IOP observed between severe nonproliferative DR to proliferative DR (P = 0.5351) was not statistically significant.

CONCLUSIONS: In our study cohort, there was a positive correlation between elevated IOP and more advanced stage of DR, indicating that patients with diabetes but no findings of DR on retinal examination seem to be at greater risk of elevated IOP than those with mild-to-moderate DR. These results suggest that IOP in patients with T2DM, with or without DR, should be closely monitored over time to prevent future IOP-related complications.

PMID:42376678 | PMC:PMC13313142 | DOI:10.5693/djo.01.2025.01.001

Front Oncol. 2026 Jun 15;16:1794390. doi: 10.3389/fonc.2026.1794390. eCollection 2026.

ABSTRACT

BACKGROUND: Implant-based breast reconstruction demonstrates notable psychological benefits, particularly in enhancing postoperative emotional well-being and self-perception among breast cancer survivors. However, its perioperative nursing process remains inconsistent, often relying on subjective clinical experience. There is a need for a standardized, evidence-based nursing protocol supported by effective training strategies to improve patient outcomes.

OBJECTIVE: This study aimed to develop and implement a perioperative nursing protocol for implant-based breast reconstruction, supported by a combined training program, and to evaluate its impact on patient satisfaction and postoperative complications.

METHODS: A quasi-experimental study was conducted. A nursing protocol was developed using literature review, Delphi consultation, and Analytic Hierarchy Process (AHP), covering preoperative assessment, intraoperative cooperation, and postoperative care. To standardize perioperative nursing procedures, we implemented a structured training program comprising model-based teaching, scenario-based simulations, and hands-on clinical practice. A total of 82 patients were enrolled, with 40 assigned to the experimental group and 42 to the control group. Outcome measures included satisfaction with breast appearance, satisfaction with surgical outcomes, satisfaction with nursing care, the incidence of postoperative complications and the grade of complication. Statistical analyses were conducted using the chi-square test, Fisher’s exact test, Mann-Whitney U test and the independent t-test.

RESULTS: The experimental group demonstrated significantly higher levels of satisfaction across all measured domains compared to the control group (breast satisfaction: 85.37 ± 5.45 vs. 80.32 ± 4.97; surgical outcome satisfaction: 83.66 ± 5.70 vs. 79.23 ± 5.21; care satisfaction: 88.72 ± 6.28 vs. 83.56 ± 5.99; P < 0.001). The 30-day postoperative complication incidence was 14.3% in the control group and 5.0% in the experimental group. Although a higher complication proportion was observed in the control group, no statistically significant difference was detected between the two groups (P>0.05).The distribution of Clavien-Dindo complication grades showed no statistically significant difference between the two groups (P>0.05).

CONCLUSIONS: Preliminary findings show the combined training model elevated patient satisfaction and tended to lower postoperative complications. This exploratory method is clinically viable and lays groundwork for subsequent large-scale and multicenter researches.

PMID:42376668 | PMC:PMC13310678 | DOI:10.3389/fonc.2026.1794390

Front Oncol. 2026 Jun 15;16:1868388. doi: 10.3389/fonc.2026.1868388. eCollection 2026.

ABSTRACT

Trastuzumab deruxtecan is a life-saving but costly therapy for HER2-positive cancers. While dose rounding strategies have been proposed to reduce drug waste, their safety and cost-saving potential in real-world Chinese patients remain understudied. This study aimed to evaluate the cost savings of dose rounding for trastuzumab deruxtecan in China and compare the safety profiles of upward rounding, downward rounding, and no rounding groups. We conducted a retrospective real-world study of patients receiving trastuzumab deruxtecan between 2024 and 2025. Drug waste, cost savings, and dose deviations were calculated for each administration. Adverse events including nausea, vomiting, fatigue, and hematologic toxicities were compared across the three groups. Among 141 patients with 829 administrations, dose rounding down led to a cost saving of CNY 897, 840, while dose rounding up avoided 4, 368.3 mg of drug waste. Dose deviations ranged from 0.10% to 9.97%, well within the 10% acceptable limit. The incidence and severity of adverse events were comparable across groups, with no statistically significant differences observed. These findings indicate that dose rounding of trastuzumab deruxtecan to the nearest full vial, within a 10% deviation range, can significantly reduce drug waste and pharmacy costs without compromising safety. This strategy is both safe and feasible in Chinese patients and provides preliminary evidence for cautious implementation, pending validation in larger studies.

PMID:42376667 | PMC:PMC13310667 | DOI:10.3389/fonc.2026.1868388

World J Pediatr Surg. 2026 Jun 25;9(3):e001163. doi: 10.1136/wjps-2025-001163. eCollection 2026.

ABSTRACT

BACKGROUND: Cleft lip and/or palate (CL/P) is a common congenital anomaly with multifactorial etiology. Data describing the phenotypic spectrum of CL/P in Pakistan is limited. This study aimed to describe the demographic and clinical characteristics, familial pattern, surgical intervention profile, and maternal risk factors associated with CL/P in a Pakistani cohort.

METHODS: Patients with CL/P were recruited from a tertiary care hospital in Faisalabad, Pakistan, into a cross-sectional study design during September 2023 and March 2024. Descriptive statistics were collected, and bivariable and multivariable logistic regression analyses were performed.

RESULTS: A total of 503 independent patients with CL/P were enrolled (53% male). CL/P was categorized into cleft lip (CL, 26%), cleft palate (CP, 36%), and cleft lip with palate (CLP, 38%). Male sex was associated with higher odds of CL, while female sex was associated with higher odds of CP. Rural residence was a significant predictor for CLP (adjusted odds ratio (aOR)=1.80, p<0.05), whereas age 1-5 years was strongly associated with CP (aOR=2.36, p<0.001). Parental consanguinity was notably high (77%), and 18% had a positive family history of CL/P. Only 38% of mothers reported folic acid supplementation. Pesticide exposure was reported in 32% of mothers. Surgical correction had been performed in only 27% of patients.

CONCLUSION: Cleft types demonstrate distinct demographic and maternal risk factor profiles. High rates of consanguinity, low folic acid uptake, and significant surgical gaps highlight critical areas for public health intervention in resource-limited settings.

PMID:42376653 | PMC:PMC13311566 | DOI:10.1136/wjps-2025-001163

JHLT Open. 2026 Apr 23;13:100572. doi: 10.1016/j.jhlto.2026.100572. eCollection 2026 Aug.

ABSTRACT

BACKGROUND: Combined en-bloc heart-lung transplantation (HLT) remains the optimal treatment for selected patients with end-stage cardiopulmonary disease. The indications for and utilization of HLT have changed significantly over time. We report the changing landscape of HLT in the UK over recent decades, identifying factors that may inform future organization of services.

METHODS: Data were extracted from the UK Transplant Registry spanning 1984 to December 2023. All patients who were registered for and/or underwent HLT were included in our analysis. Baseline characteristics and outcomes from listing and transplantation were compared between 2 eras: pre-2000 and post-2000.

RESULTS: Pre-2000, 1,199 patients were registered for HLT, and 915 received HLT, post-2000, there were 473 registrations and 200 transplantations, reflecting a significant decline in the use of this procedure. Those listed post-2000 were older, more symptomatic, and with more prior cardiac surgeries. Cystic fibrosis, the leading indication pre-2000, declined substantially in the later era. For patients requiring HLT in the later era, the risk of dying on the waiting list exceeded the chance of receiving a transplant. Median post-transplant survival improved from 4.07 (IQR 0.2, 12.3) to 7.9 (IQR 0.8, 21.6) years.

CONCLUSION: Although HLT activity has declined, a considerable need remains, particularly among patients with congenital heart disease and pulmonary hypertension. The changes in patient demographics and high waiting list mortality highlight systemic inefficiencies in organ allocation and underscore the need for a revised system to ensure timely and equitable access for this high-risk population.

PMID:42376646 | PMC:PMC13311178 | DOI:10.1016/j.jhlto.2026.100572

Transact Mach Learn Res. 2024 Oct;2024:2529.

ABSTRACT

Bayesian Neural Networks (BNNs) offer a principled and natural framework for proper uncertainty quantification in the context of deep learning. They address the typical challenges associated with conventional deep learning methods, such as data insatiability, ad-hoc nature, and susceptibility to overfitting. However, their implementation typically either relies on Markov chain Monte Carlo (MCMC) methods, which are characterized by their computational intensity and inefficiency in a high-dimensional space, or variational inference methods, which tend to underestimate uncertainty. To address this issue, we propose a novel Calibration-Emulation-Sampling (CES) strategy to significantly enhance the computational efficiency of BNN. In this framework, during the initial calibration stage, we collect a small set of samples from the parameter space. These samples serve as training data for the emulator, which approximates the map between parameters and posterior probability. The trained emulator is then used for sampling from the posterior distribution at substantially higher speed compared to the standard BNN. Using simulated and real data, we demonstrate that our proposed method improves computational efficiency of BNN, while maintaining similar performance in terms of prediction accuracy and uncertainty quantification.

PMID:42376641 | PMC:PMC13313050