Category: Nevin Manimala

Paediatr Anaesth. 2026 Jan 6. doi: 10.1111/pan.70082. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric preassessment is recommended for all children undergoing general anesthesia. It has the potential to improve safety and quality outcomes for both the patient and the organization.

AIMS: This study aimed to establish the proportion of children who underwent preassessment before general anesthesia, the format of that preassessment, and the impact of preassessment on outcomes such as on-the-day cancelation, and patient anxiety.

METHODS: This multi-center prospective observational cohort study outlines preassessment delivery in the UK and its effect on outcome. Invitation to participate was via Pediatric Anesthetic Trainee Research Network. Data collected included demographic data, details of the patient’s preassessment, and their outcome.

RESULTS: Data were verified from 96 hospitals on 6818 patients between 1 and 16 years old having elective procedures under general anesthetic. The proportion of children ≤ 16 years old who received preassessment was 60.1% (4082 children). There was a large variation in the delivery of preassessment with the majority being nurse-led. The perioperative journey of most children proceeded as planned (6454 patients, 94.6% of cases). There was a significant difference in the proportion of children with perioperative anxiety between those who did (12.0%, n = 482) and did not (16.5%, n = 438) have a preassessment (p < 0.001). Preassessment did not make a statistically significant difference to overall cancelation rates. The most common reasons for cancelation were intercurrent illness and anxiety. A greater proportion of procedures were delayed or canceled if anxiety was identified as a perioperative challenge: 20.8% (n = 191) compared to 3.6% (n = 210, p < 0.001).

CONCLUSION: These data suggest that improved outcomes could be achieved through a reduction in anxiety. A service offering screening calls in the days before surgery could prevent on-the-day cancelation due to intercurrent illness. The priorities for preassessment in children require further clarification and standardization nationally to maximize the potential benefits from services.

PMID:41492692 | DOI:10.1111/pan.70082

Arch Esp Urol. 2025 Dec;78(10):1485-1492. doi: 10.56434/j.arch.esp.urol.20257810.193.

ABSTRACT

OBJECTIVE: To investigate the application value of an operating room nursing protocol based on the Enhanced Recovery after Surgery (ERAS) concept in patients with prostate cancer undergoing laparoscopic radical prostatectomy (LRP).

METHODS: A retrospective collection was conducted on patients who were scheduled to undergo LRP and admitted to the urology department of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2024 to June 2025. The general preoperative, surgical-related and clinical data of the two groups of patients were collected and compared.

RESULTS: A total of 147 patients with LRP were collected during the study. These patients were divided into the traditional nursing (n = 73) and ERAS (n = 74) groups in accordance with different nursing plans. No significant difference was found in the general data of the two groups before surgery (p > 0.05). In the ERAS group, the moments marking the first discharge and exhaust, along with the lengths of time of urinary catheter indwelling and overall hospital stays, were all markedly shorter than those in the group receiving traditional nursing care, with the disparities between the two groups being statistically significant (p < 0.001). Additionally, the patients in the ERAS group exhibited a notably higher average urinary flow rate than their counterparts in the traditional nursing group (p < 0.001). The first voiding time of the patients in the ERAS group was earlier than that of the patients in the traditional nursing group (p < 0.001). At 8, 12, 24 and 48 h after surgery, the Numerical Rating Scale scores of the patients in the ERAS group were lower than those of the patients in the traditional nursing group (p < 0.001). The results of repeated analysis of variance revealed a significant difference in the time-group main effect (p < 0.001). The Incontinence Quality of Life Questionnaire scores of the patients in the ERAS group were higher than those of the patients in the traditional nursing group at three days after surgery and discharge (p < 0.001).

CONCLUSIONS: The operating room nursing protocol based on the ERAS concept has clinical value in patients with prostate cancer undergoing LRP.

PMID:41492681 | DOI:10.56434/j.arch.esp.urol.20257810.193

Arch Esp Urol. 2025 Dec;78(10):1410-1417. doi: 10.56434/j.arch.esp.urol.20257810.184.

ABSTRACT

OBJECTIVE: Catheter-associated urinary tract infection (CAUTI) is a common type of hospital-acquired infection in the emergency intensive care unit (EICU). The aim of this study was to explore effective nursing management programs to reduce the incidence of CAUTI in patients with EICU.

METHODS: This retrospective study collected the clinical data of critically ill patients from the Department of Emergency Medicine of Soochow University in China from January 2024 to December 2024. Patients admitted from January to June 2024 were treated in the usual care group, and patients admitted from July to December 2024 were treated in the CAUTI prevention care group. The monthly incidence of CAUTI, the duration of urinary catheter indwelling, the duration of bladder irritation symptoms, the number of days of hospitalisation and the adverse reaction rate of patients in the two time periods were compared.

RESULTS: A total of 833 patients were admitted to the EICU for observation, and they were divided into the usual care group (n = 427) and the CAUTI prevention care group (n = 406). Ninety-seven patients developed CAUTI, with an overall incidence rate of 11.64%. Among them, 64 cases (14.99%) of CAUTI occurred in the conventional nursing group, which was higher than that in the CAUTI prevention care group (33 cases, 8.13%), and the difference was statistically significant (p < 0.05). The duration of urinary catheterisation, duration of bladder irritation, length of hospital stay and incidence of adverse reactions in patients with CAUTI in the CAUTI prevention care group were lower than those in the usual care group (p < 0.05).

CONCLUSIONS: Reasonable nursing management program is related to a low incidence of CAUTI in EICU and has a certain effect on its prevention.

PMID:41492672 | DOI:10.56434/j.arch.esp.urol.20257810.184

Arch Esp Urol. 2025 Dec;78(10):1377-1384. doi: 10.56434/j.arch.esp.urol.20257810.180.

ABSTRACT

BACKGROUND: This study aims to evaluate long-term surgical outcomes and identify predictive factors associated with urethroplasty failure in patients with anterior urethral strictures.

METHODS: A retrospective study was conducted on 419 patients who underwent urethroplasty between January 2009 and December 2024. Eleven different surgical techniques were performed based on the location, length and aetiology of strictures as well as prior interventions. Clinical data including demographics, surgical history, stricture characteristics and complications were analysed. Surgical success was defined as the absence of any further urethral intervention and maximum voiding flow rate above 15 mL/s months or years after the surgery. Statistical analysis included Cox regression, Chi-square and Kaplan-Meier survival analysis.

RESULTS: The overall surgical success rate was 74.7% (313/419 patients), with a complication rate of 10.2%. Recurrence occurred in 25.3% of cases. Univariate analysis revealed that body mass index (BMI), stricture length, number of previous direct vision internal urethrotomies (DVIUs), prior urethroplasty and panurethral strictures (>10 cm) were significantly associated with surgical failure. Multivariate analysis identified increased BMI and number of previous DVIUs as independent predictors of failure (p < 0.05).

CONCLUSIONS: History of prior interventions and BMI are key factors influencing outcomes. Early referral for definitive surgical management is recommended to avoid progression and reduce failure risk.

PMID:41492668 | DOI:10.56434/j.arch.esp.urol.20257810.180

Arch Esp Urol. 2025 Dec;78(10):1353-1361. doi: 10.56434/j.arch.esp.urol.20257810.177.

ABSTRACT

BACKGROUND: Percutaneous nephrolithotomy (PCNL) is the preferred technique for kidney stones larger than 20 mm in maximum diameter. The objective of this study is to evaluate the effect of the nephrostomy tube technique vs. that of the tubeless technique in patients undergoing supine PCNL, focusing on postoperative complications and hospital stay duration.

METHODS: This retrospective observational study was conducted from January 2018 to June 2024. A total of 243 patients underwent supine PCNL. Clinical, surgical and postoperative variables were compared between patients with and without nephrostomy tubes. Complications were classified into clinically relevant categories: Infectious (fever ≥38 °C), haemorrhagic (postoperative haemoglobin drop >1 g/dL within 48 h or the requirement for blood transfusion) and severe (including nephrectomy and mortality). A binary logistic regression model was used to identify independent predictors of complications. Stone-free status was assessed by noncontrast computed tomography (CT) at six weeks. All analyses were performed with IBM SPSS Statistics 26.0.

RESULTS: In 50% of patients, a nephrostomy tube was placed at the end of the procedure. The overall complication rate was 14.4% and was significantly higher in patients with nephrostomy tubes (22.9% vs. 6.7%; p < 0.001) than in those without. Hospital stay was longer in patients with nephrostomy tubes (median 3 days (interquartile range (IQR) 2-4) vs. 1 day (IQR 1-2); p < 0.001) than in those without. Stone-free rate was comparable between groups (80.9% vs. 77.8%; p = 0.529). In multivariate analysis, nephrostomy remained independently associated with complications (odds ratio 4.15; 95% confidence interval 1.72-10.02; p = 0.001).

CONCLUSIONS: In this retrospective series, tubeless PCNL was associated with significantly reduced overall complication rates, mainly as a result of a low number of bleeding events, and short hospital stay without compromising stone-free rates. These findings support the safety of a tubeless approach in appropriately selected patients.

PMID:41492665 | DOI:10.56434/j.arch.esp.urol.20257810.177

Lancet Reg Health Eur. 2025 Nov 20;60:101508. doi: 10.1016/j.lanepe.2025.101508. eCollection 2026 Jan.

ABSTRACT

BACKGROUND: To further reduce new HIV diagnoses in the Netherlands, individual and structural barriers hindering prevention must be addressed. We aimed to estimate the disproportional burden of new HIV diagnoses and explore how intersecting socio-demographic, socio-economic, and health-related factors jointly influence the risk of a new HIV diagnosis.

METHODS: We combined data from the ATHENA cohort, an ongoing nationwide HIV cohort, with registry data from Statistics Netherlands. We selected individuals with a new HIV diagnosis between 1 January 2012 and 31 December 2023 and matched them to individuals from the general population. We assessed determinants of a new HIV diagnosis using a multivariable generalized linear model. We used Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to quantify the joint and individual contribution of intersecting variables.

FINDINGS: 6055 men and 1020 women were newly diagnosed with HIV. Having a migration background and a low to middle income or income below the poverty line was associated with a higher risk of a new HIV diagnosis for both men (low to middle: adjusted odd ratio (aOR) = 1.24, 95% confidence interval (CI) = 1.17-1.31; below the poverty line: aOR = 1.75, 95% CI = 1.62-1.89) and women (low to middle: aOR = 2.49, 95% CI = 2.05-3.01; below the poverty line: aOR = 4.71, 95% CI = 3.80-5.83). Use of mental health care (aOR = 1.14, 95% CI = 1.01-1.27) or antidepressants (aOR = 1.66, 95% CI = 1.50-1.84) also increased the risk among men; while receiving social welfare (aOR = 1.39, 95% CI = 1.15-1.67) and use of antipsychotic medication (aOR = 1.66, 95% CI = 1.21-2.28) increased the risk among women. Of all intersections identified in MAIHDA, men with a first-generation migration background, income below the poverty line, and who used antidepressants had the highest predicted probability of an HIV diagnosis (0.036%, 95% confidence interval (CI) = 0.025-0.052). Women with a first-generation background, income below the poverty line, who received social welfare, and who used antipsychotic medication had the highest predicted risk (0.019%, 95% CI = 0.011-0.035).

INTERPRETATION: A disproportionally higher burden of a new HIV diagnosis was observed for individuals with a migration background and economic and mental health vulnerabilities. HIV prevention and testing need to be reinforced in these groups.

FUNDING: Dutch Ministry of Health, Welfare and Sport; TKI Health Holland.

PMID:41492655 | PMC:PMC12765169 | DOI:10.1016/j.lanepe.2025.101508

Cancer Inform. 2026 Jan 3;25:11769351251411074. doi: 10.1177/11769351251411074. eCollection 2026.

ABSTRACT

BACKGROUND AND OBJECTIVES: Next-generation sequencing (NGS) is transforming clinical diagnostics by enabling the detection of genetic variation with unprecedented precision. However, successful implementation of NGS workflows necessitates stringent quality control. This study introduces Molecular Genetics Dashboard (MGDB), a novel bioinformatics tool designed to enhance quality control in clinical NGS workflows.

METHODS: Using the Python dash framework for visualizations and MySQL databases, we have developed a novel tool for variant-level monitoring of clinical NGS sequencing runs. MGDB uses a docker-compose containerization for improved portability and can flexibly include or exclude samples from accumulated statistics with notes from interpreters.

RESULTS: MGDB facilitates variant-level run-to-run monitoring, ensuring the consistency of variant detection across sequencing cycles. The tool provides an interactive platform for visualizing and assessing variant data, identifying potential inconsistencies or outliers and improving data management and interpretation compared to traditional methods. MGDB was tested using samples sequenced with Oncomine Focus/Comprehensive Plus assays on S5 sequencers and analyzed via IonReporter software.

CONCLUSIONS: MGDB offers a robust and user-friendly solution for enhancing quality control in clinical NGS workflows, contributing to greater accuracy and reliability in variant detection. The tool is freely available on GitHub: https://github.com/acri-nb/GeneticVariantsDB.

PMID:41492654 | PMC:PMC12764754 | DOI:10.1177/11769351251411074

Cureus. 2025 Dec 4;17(12):e98478. doi: 10.7759/cureus.98478. eCollection 2025 Dec.

ABSTRACT

AIM: To estimate the proportion of living kidney donors (completed one year post-donation) who have developed proteinuria, an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m², hypertension, or suboptimal renal compensation (defined as <70% of pre-donation glomerular filtration rate (GFR)) during post-donation follow-up. The study also aimed to evaluate the association between donor-related factors and clinical outcomes. To assess the emotional well-being and overall satisfaction of donors through structured, in-person interviews.

PATIENTS AND METHODS: A cross-sectional prospective study design was undertaken to contact all donors of recipients under regular review who had completed at least one year post-donation. Among approximately 250 living renal transplant recipients in active follow-up, about 200 corresponding donors had crossed the one-year post-donation period. Of these, 160 donors responded to the call for follow-up, and 140 completed a comprehensive clinical and laboratory assessment in accordance with the institutional follow-up protocol. Written informed consent was obtained from all participants, and pre-donation records were retrieved for comparative analysis. The emotional well-being and overall satisfaction of donors were assessed through structured, in-person (in formal) interviews. Results were analyzed with IBM SPSS Statistics Software, version 20.0 (IBM Corp., Armonk, New York, USA).

RESULTS: The mean age at donation was 45.4 ± 9.4 years (range: 20-69 years), and the mean age at follow-up was 51.5 ± 9.9 years. The median duration of follow-up was 7 ± 4 years (interquartile range (IQR): 1-23 years), with 30% (n = 42) of donors followed for more than 10 years post-donation. Female donors predominated (77.2%; n = 108), yielding a female-to-male ratio of approximately 3.4:1. Mothers constituted the largest donor subgroup (52.8%; n = 74). Perioperative complications occurred in 8% (n = 7) of donors. Hypertension was noted in 34 (24.3%). Proteinuria (protein-to-creatinine ratio (PCR) > 0.2) was seen in 34 donors (24.3%). Mean eGFR pre- and post-donation was 91.6 ± 16.0 ml/min and 80.3 ± 18.5 ml/min, with a decline of 11 ml/min. One hundred twenty-two donors (87.1%) have eGFR >60 ml/min/1.73 m². Overall, 84.3% (n = 118) achieved optimal and 15.7% (n = 22) showed suboptimal compensation. On multivariate analysis, only suboptimal renal compensation remained an independent predictor of eGFR < 60 ml/min (adjusted OR: 31.43; 95% CI: 7.19-137.2; p < 0.001). Neither donor age nor gender showed a significant association with outcomes such as proteinuria, hypertension, eGFR <60 mL/min/1.73 m²,and suboptimal compensation. A vast majority (91%, n = 127) expressed happiness and complete satisfaction with their decision to donate.

CONCLUSION: In this cohort, female predominance reflected persistent sociocultural patterns. The prevalence of hypertension was comparable to that of the general population. These findings reinforce that modest post-donation changes in proteinuria or eGFR should not discourage donation, given its profound benefits to recipients, donors, and society. Establishing dedicated renal donor clinics for structured, lifelong surveillance is vital to safeguard donor health.

PMID:41492638 | PMC:PMC12764397 | DOI:10.7759/cureus.98478

Cureus. 2025 Dec 3;17(12):e98424. doi: 10.7759/cureus.98424. eCollection 2025 Dec.

ABSTRACT

Background Maternal mortality remains a pressing health concern, especially in low‑ and middle‑income countries. Understanding the demographic, temporal, and contextual factors that lead to these deaths is essential for designing effective interventions. This study aimed to examine maternal mortality through the lens of the three delays model using data from Pakistan. Methods We conducted a retrospective analysis of the Pakistan Maternal Mortality Survey 2018‑2019, drawing on the Pakistan Demographic and Health Survey Verbal Autopsy dataset. Descriptive statistics and stratified analyses were used to profile maternal deaths by demographic characteristics, timing, and place of death. We also quantified delays in deciding to seek care, reaching a facility, and receiving treatment. Results Of the 1,177 maternal deaths analyzed, the mean age was 34 years. Most deaths occurred in health facilities and were classified as direct obstetric causes such as hemorrhage and sepsis. Women experienced an average delay of 3.8 days in deciding to seek care, 3.7 hours in reaching a facility, and 7.6 minutes in receiving treatment. More than half of the deaths occurred within 42 days postpartum. Financial hardship, geographic isolation, and limited resources emerged as prominent reasons for delay. Women who reached a health facility were less likely to die on the first day of admission than those who did not. Conclusions Maternal mortality in Pakistan reflects a web of sociodemographic inequalities and systemic shortcomings. Addressing these deaths requires more than clinical solutions. It calls for policies that improve the timeliness and quality of maternal health services, tackle financial and geographic barriers, and strengthen the healthcare system. Interventions grounded in the three delays framework could help reduce maternal mortality and advance maternal health equity in low‑resource settings.

PMID:41492636 | PMC:PMC12765515 | DOI:10.7759/cureus.98424

Cureus. 2025 Dec 5;17(12):e98524. doi: 10.7759/cureus.98524. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: The role of the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker for community-acquired pneumonia (CAP) has not been extensively studied in India. Therefore, we conducted this study to assess the role of the NLR in determining prognosis and severity among hospitalized CAP patients from Northeast India.

MATERIALS AND METHODS: This prospective observational study was conducted from October 2023 to November 2024 in a tertiary care hospital in southern Assam, Northeast India. A total of 162 adult patients with CAP were recruited for the study via consecutive sampling. Statistical analysis included descriptive statistics, chi-square tests, correlation analysis, and logistic regression to evaluate associations between NLR, severity scores (CURB-65), and patient outcomes.

RESULTS: A strong positive correlation (r = 0.72) was noted between the NLR and CURB-65 score. A level of NLR ≥ 9.5 anticipated the need for intensive care unit (ICU) admission (40.74%, n=66 out of 162), while NLR ≥ 16 was associated with a higher death rate (80%, n=16; out of 20 deaths) compared to NLR <16 (20%, n=4). Most patients (55%) were middle-aged men. Right middle zone pneumonia (22.8%) was the most frequent radiological finding, while 85.18% patients had sterile sputum culture. Both Klebsiella pneumoniae (6.2%) and Streptococcus pneumoniae (6.2%) were the most typical organisms noted in the culture specimen. Conclusion: An elevated NLR is a strong predictor of disease severity, ICU requirement and mortality amongst Indian CAP patients.

PMID:41492633 | PMC:PMC12765456 | DOI:10.7759/cureus.98524