Category: Nevin Manimala

Int J Clin Pharm. 2026 Jun 27. doi: 10.1007/s11096-026-02178-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Collaborative pharmacist prescribing in hospitals involves pharmacists, medical doctors, and patients working together to develop medicine plans that support shared decision-making and underpin pharmacist prescriptions. Shared decision-making is a process in which clinicians and patients make treatment decisions together, ensuring they reflect patient preferences and understanding. However, little is known about patient perspectives and experiences with collaborative pharmacist prescribing, particularly related to shared decision-making, in the inpatient hospital setting.

AIM: To examine patient perspectives and experiences of collaborative pharmacist prescribing in the hospital inpatient setting.

METHOD: A cross-sectional survey was conducted across four hospitals in South Australia. Eligible inpatients were aged ≥ 18 years and provided informed consent. The primary outcome was patient perspectives of collaborative pharmacist prescribing and experiences during medicine prescribing as an inpatient. Results were stratified by the type of prescribing model (collaborative pharmacist prescribing vs. medical prescribing) received by the patient during their admission. Free-text responses were thematically analysed using Braun and Clarke’s framework. Likert scale responses were summarised using descriptive statistics, and sub-group analysis compared categorical variables between groups.

RESULTS: Responses were received from 200 patients (100 who received collaborative pharmacist prescribing and 100 who received medical doctor prescribing). Overall, patients had a median age of 72 years and just over half were female. Qualitative analysis found that all respondents trust pharmacists’ expertise and ability to collaboratively prescribe. Patients in both groups perceived benefits of collaborative pharmacist prescribing including enhanced interprofessional communication, reductions in medication errors, and a better understanding of their medicines. These findings reinforced the quantitative results, with a higher proportion of patients who received collaborative pharmacist prescribing reporting feeling very or extremely involved in medicine decisions compared to patients who received medical prescribing (60% vs. 14%, p < 0.001).

CONCLUSION: Collaborative pharmacist prescribing enhances shared decision-making by actively involving patients in discussions about their medicines. It improves patients’ understanding of their medicines, which supports safer and more informed treatment decisions. These findings support wider adoption of collaborative pharmacist prescribing to improve patient-centered care in hospitals.

PMID:42364068 | DOI:10.1007/s11096-026-02178-0

J Endocrinol Invest. 2026 Jun 27. doi: 10.1007/s40618-026-02945-w. Online ahead of print.

ABSTRACT

BACKGROUND: The cardiovascular safety of testosterone replacement therapy (TRT) in older men with hypogonadism has been debated for over a decade, largely on the basis of underpowered trials and conflicting observational data. The TRAVERSE trial, published in 2023, provided the first adequately powered, placebo-controlled evidence on this question.

OBJECTIVES: This review synthesises current evidence on the cardiovascular safety of TRT in older men, with particular attention to the interpretation of TRAVERSE findings, the clinical significance of non-MACE safety signals, and the practical management of organic versus functional hypogonadism.

METHODS: A systematic search of PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted through March 2026. Approximately 450 articles were identified; 64 met the inclusion criteria and were selected for review. Evidence was appraised according to study design, with RCTs and meta-analyses weighted above observational data.

RESULTS: TRAVERSE demonstrated non-inferiority of TRT versus placebo for major adverse cardiovascular events (MACE) in men with confirmed hypogonadism and elevated cardiovascular risk (HR 0.96, 95% CI 0.78-1.17) [5]. Non-MACE signals – including atrial fibrillation (3.1% vs. 2.4%), pulmonary embolism (2.0% vs. 1.5%), and acute kidney injury (2.3% vs. 1.5%) – were numerically higher in the TRT arm but did not reach statistical significance within the trial. In contrast, large observational cohorts consistently report statistically significant associations between TRT and AF and VTE. Erythrocytosis was the most reproducible adverse effect (17.0% vs. 3.3%, p < 0.001). Functional hypogonadism secondary to obesity or metabolic syndrome responds to lifestyle intervention and GLP-1/GIP agonists, with testosterone normalisation in 81.4% at 6 months and 89.5% at 24 months after bariatric surgery [45].

CONCLUSIONS: TRT does not increase MACE risk in men with confirmed organic hypogonadism when titrated to physiological levels. Non-MACE signals warrant vigilance rather than contraindication. Metabolic optimisation should precede TRT in functional hypogonadism. Individualised monitoring and careful patient selection remain essential.

PMID:42364061 | DOI:10.1007/s40618-026-02945-w

Langenbecks Arch Surg. 2026 Jun 27. doi: 10.1007/s00423-026-04118-y. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to explore survival outcomes and prognostic factors between intrahepatic and extrahepatic cholangiocarcinoma after surgical resection.

METHODS: Patients diagnosed with primary intrahepatic or extrahepatic cholangiocarcinoma between 2010 and 2018 who underwent cancer-directed surgery were identified from the SEER database. A 1:1 Propensity Score Matching was performed. Survival outcomes were analyzed via Kaplan-Meier curves and Log-rank tests. Multivariable Cox proportional hazards regression models and Fine-Gray competing risk models were constructed.

RESULTS: A total of 1,586 eligible patients were included. After matching, 478 patients (239 per group) were balanced. In the matched cohort, intrahepatic patients exhibited significantly superior Overall Survival (OS) compared to extrahepatic patients (median OS: 45 vs. 25 months; HR = 1.244, 95% CI: 1.001-1.545, P = 0.049). Conversely, a Fine-Gray competing risk analysis showed no significant difference in Cancer-Specific Survival (CSS) between the subtypes (SHR = 0.818, 95% CI: 0.641-1.043, P = 0.105). Independent risk factors for OS included advanced age, T3/T4 stage, N1/N2 stage, and tumor size ≥ 5 cm. Notably, the retrieval of 4 or more lymph nodes was associated with improved OS (HR = 0.630, 95% CI: 0.469-0.846, P = 0.002), though its association with CSS was not statistically significant in the competing risk model.

CONCLUSIONS: Results from this PSM analysis suggest that intrahepatic location is associated with better OS compared to extrahepatic disease, but cancer-specific survival is similar between the subtypes after accounting for competing risks. This divergence implies that survival differences might be driven by competing risks, potentially distinct long-term surgical morbidities, rather than intrinsic biological lethality. Furthermore, adequate lymphadenectomy (≥ 4 nodes) correlated with improved overall survival and staging accuracy, highlighting its potential role as a surgical quality metric for both subtypes.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42364046 | DOI:10.1007/s00423-026-04118-y

J Neurol. 2026 Jun 27;273(7):428. doi: 10.1007/s00415-026-13952-5.

ABSTRACT

OBJECTIVE: Social cognition, particularly emotion recognition, can be impaired in neurological disorders involving brain damage and neurocognitive deficits. However, it remains unclear whether distinctive profiles of social versus general cognitive impairments exist across neurological patient groups: moderate-severe traumatic brain injury (mod-sevTBI), acute ischaemic stroke (AIS), aneurysmal subarachnoid haemorrhage (aSAH), frontal low-grade glioma (LGG), advanced Parkinson’s disease (PD), and behavioural variant frontotemporal dementia (bvFTD).

METHODS: Data were obtained from scientific studies and clinical records in four Dutch research centres. Neuropsychological testing included emotion recognition [Eckman 60-Faces test (EFT): total score and subscores], memory [Dutch Rey Auditory Verbal Learning Test (DRAVLT): encoding and retrieval], information processing speed, and cognitive control (Trail Making Test A and B). Scores were transformed into Z-scores using normative data and compared across groups.

RESULTS: Included were 710 patients: 118 mod-sevTBI, 93 AIS, 121 aSAH, 100 LGG, 147 PD, 131 bvFTD. EFT-total was impaired in all groups (p < .001), with significant group differences (F(5,704) = 30.8, p < .001). Emotion recognition was the most severely affected domain in bvFTD, mod-sevTBI, AIS, and LGG. Only bvFTD and mod-sevTBI showed impairments in specific emotions, mainly sadness and fear. MANOVA showed overall group differences in general cognition (Wilks’ Lambda = .69, p < .001). Memory encoding was impaired in all groups, but retrieval in none. Information processing speed and cognitive control were impaired only in bvFTD, mod-sevTBI, AIS, and PD.

INTERPRETATION: Emotion recognition is significantly affected across six neurological patient groups, with distinct profiles relative to general cognition. These findings support tailored neuropsychological assessment in clinical practice.

PMID:42364036 | DOI:10.1007/s00415-026-13952-5

Ann Hematol. 2026 Jun 27. doi: 10.1007/s00277-026-07156-0. Online ahead of print.

ABSTRACT

Sickle cell anaemia (SCA) is a major public health concern in Kenya, particularly affecting children and adolescents. Despite the inclusion of hydroxyurea in national treatment guidelines, its real-world use and effectiveness in Kenya remain under-documented, especially in tertiary care settings such as Kenyatta National Hospital (KNH). The drug is known to reduce vaso-occlusive crises (VOCs), transfusions, and hospitalizations, but its impact in resource-limited environments requires further investigation. Hence, this study aimed to assess the clinical and hematological effectiveness of hydroxyurea therapy in children and adolescents with sickle cell anaemia at Kenyatta National Hospital. A retrospective one-arm cohort design was used to review medical records of pediatric patients with sickle cell anaemia (≤ 16 years) who were treated with hydroxyurea at Kenyatta National Hospital between January 2020 and December 2023. Eligible patients had received hydroxyurea therapy for a minimum duration of six months and had at least 12 months of documented follow-up data. Clinical outcomes, including the frequency of vaso-occlusive crises, hospitalizations, acute chest syndrome, stroke events, and transfusion requirements, were assessed alongside hematological markers such as hemoglobin level, mean corpuscular volume, and reticulocyte count. Data were collected using a structured data abstraction tool adapted from previously published studies. Statistical analysis was conducted using IBM SPSS Statistics version 29, with one-way analysis of variance used to examine changes in clinical and hematological parameters across multiple follow-up time points. A total of 54 children and adolescents with sickle cell anaemia (mean age: 6.8 ± 4.4 years) were included, all of whom had a substantial burden of disease at baseline, marked by frequent vaso-occlusive crises (2.6 ± 1.9), hospital admissions (2.4 ± 2.0), blood transfusions (2.9 ± 1.7), and episodes of acute chest syndrome (1.3 ± 0.9). Over the 3, 6, 12, and 24-month follow-up period after initiation of hydroxyurea therapy, overall clinical outcomes showed a general decline in the proportion of patients experiencing vaso-occlusive crises, hospitalizations, transfusion needs, and infections compared with baseline. Hematological parameters demonstrated progressive improvement, with mean hemoglobin rising from 7.8 ± 1.1 g/dL at baseline to 10.5 ± 2.0 g/dL at 24 months, mean corpuscular volume increasing from 77.0 ± 21.1 fL to 96.7 ± 13.2 fL, and reticulocyte counts decreasing from 16.3 ± 11.9% to 6.0 ± 6.9%. Hydroxyurea therapy was associated with sustained improvements in hematological indices, characterized by increased hemoglobin levels and mean corpuscular volume, alongside a reduction in reticulocyte counts over the follow-up period. These changes were accompanied by reductions in key clinical complications, including vaso-occlusive crises and hospitalizations.

PMID:42364035 | DOI:10.1007/s00277-026-07156-0

Biomech Model Mechanobiol. 2026 Jun 27;25(4):75. doi: 10.1007/s10237-026-02102-5.

ABSTRACT

Cell migration plays a central role in numerous physiological and pathological processes and emerges from the coordinated interplay between intracellular force generation, adhesion dynamics, and mechanical interactions with the environment. A minimal, mechanistically grounded understanding of these processes is required to disentangle the respective contributions of cell-intrinsic and environmental cues. Here, a two-dimensional in silico cell motility model is introduced to describe mesenchymal migration driven by intracellular traction forces generated within actin-rich protrusions anchored to a substrate. The model explicitly accounts for adhesion nucleation, maturation, force buildup and rupture, and relies on a small set of physically interpretable parameters. A systematic mechanical analysis identifies parameter regimes that permit effective cell translocation and delineates conditions leading to stalled or mobile cells. Within motile regimes, the model reproduces a broad spectrum of cell morphologies and migratory behaviours. In particular, cell trajectories exhibit the statistical features of a persistent random walk, with a crossover from ballistic to diffusive motion that arises solely from adhesion dynamics and force balance, without imposing polarization or directional bias. Cell morphology is shown to strongly regulate migration speed, persistence, and pausing behaviour. Altogether, this model provides a minimal reference framework for cell migration on non-deformable substrates and establishes a baseline for future studies of mechanically driven guidance. By construction, it is well suited for extension to deformable fibrous substrates, where cell-induced matrix remodeling and stiffness feedback are expected to bias migration and regulate cell encounters relevant to tissue morphogenesis and anastomosis.

PMID:42364027 | DOI:10.1007/s10237-026-02102-5

Eur Spine J. 2026 Jun 27. doi: 10.1007/s00586-026-10142-9. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to assess the diagnostic efficacy of a novel integrated approach that combines a modified percutaneous disc biopsy technique with 16 S rRNA gene sequencing to enhance pathogen identification in patients with early suspected pyogenic spondylodiscitis (PS).

METHODS: A retrospective cohort study was conducted, enrolling 66 patients who underwent percutaneous biopsy based on clinical and MRI findings indicative of early PS between January 2021 and January 2024. Patients were categorized into two groups: Group A (n = 31), which received traditional transpedicular biopsy coupled with 16 S rRNA gene sequencing, and Group B (n = 35), which received the modified transpedicular-vertebral-discal biopsy combined with genetic testing. A composite follow-up, including clinical symptoms, imaging, and laboratory findings at ≥ 6 months, served as the gold standard. Pathogen detection rates, complication rates, and pathogen profiles were compared between the groups.

RESULTS: Baseline characteristics were comparable between the groups. The pathogen detection rate in Group B (85.7%, 30/35) was significantly higher than that in Group A (51.6%, 16/31), with a statistically significant difference (P < 0.01). No serious procedure-related complications were observed in either group. The predominant infection in both groups was monomicrobial bacterial infection, with Staphylococcus aureus identified as the most common pathogen.

CONCLUSION: The modified percutaneous biopsy technique combined with 16 S rRNA gene sequencing significantly improves pathogen detection in early pyogenic spondylodiscitis without increasing the risk of complications. This integrated approach demonstrates substantial diagnostic value and shows promise as a first-line minimally invasive diagnostic method.

PMID:42363976 | DOI:10.1007/s00586-026-10142-9

Eur Radiol. 2026 Jun 27. doi: 10.1007/s00330-026-12711-4. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate clinical outcomes and temporal bone remodeling after venous sinus stenting for pulsatile tinnitus (PT), and to compare remodeling rates between isolated sigmoid sinus wall dehiscence (SSWD) and diverticulum-associated SSWD.

MATERIALS AND METHODS: This retrospective cohort study included 70 consecutive patients who underwent venous sinus stenting for PT. Clinical success was defined as symptom improvement or complete resolution. The primary endpoints were short-term clinical success (at 3 months) and temporal bone remodeling on follow-up CT (n = 52). Long-term clinical success was evaluated as a secondary endpoint. Multivariable logistic regression, adjusted for age, sex, dehiscence size, diverticulum presence, and preoperative Tinnitus Handicap Inventory (THI) score, was used to identify predictors of temporal bone remodeling.

RESULTS: Short-term clinical success was achieved in 65/70 patients (92.9%). Remodeling occurred in 38/52 patients (73.1%) with follow‑up CT. Remodeling rates were significantly higher in patients with a diverticulum versus isolated SSWD (85.7% (30/35) vs 47.1% (8/17); adjusted OR, 8.08; 95% CI: 1.31-49.73; p = 0.024). Older age independently predicted temporal bone remodeling (adjusted OR per year, 1.14; 95% CI: 1.03-1.26; p = 0.012). Long-term clinical success was observed in 97.4% (37/38) of remodeled patients and 85.7% (12/14) of non-remodeled patients (p = 0.15).

CONCLUSION: Venous sinus stenting for PT results in a high rate of clinical success. The presence of a diverticulum strongly predicts subsequent temporal bone remodeling, whereas SSWD appears less likely to remodel, highlighting potential pathophysiological differences between these anatomical subtypes.

KEY POINTS: Question Venous sinus stenting for pulsatile tinnitus results in high clinical success, but temporal bone remodeling differs by anatomical subtype. Findings Patients with a sigmoid sinus diverticulum demonstrate significantly higher rates of postoperative bone remodeling compared to those with isolated dehiscence. Clinical relevance Identifying the specific anatomical anomaly may help to predict temporal bone remodeling and facilitate individualized patient counseling regarding long-term structural outcomes.

PMID:42363966 | DOI:10.1007/s00330-026-12711-4

Eur Radiol. 2026 Jun 27. doi: 10.1007/s00330-026-12710-5. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine if functional information from gadoxetate disodium-enhanced MRI is useful in assessing prognosis in primary sclerosing cholangitis (PSC).

MATERIALS AND METHODS: In this retrospective case-controlled study, 73 patients with PSC and gadoxetate-enhanced MRI were enrolled. Four radiologists independently assessed qualitative and quantitative MRI features. The value of these features in predicting adverse events (liver-related death, hepatic decompensation from grade III/IV hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis as well as need for liver transplantation) within 2 years of MRI were compared with recognized radiological scores as well as clinical scoring systems (Mayo Risk Score, Amsterdam-Oxford model and UK PSC score), using multivariate logistic regression and receiver operating characteristic curve analysis.

RESULTS: The cohort consisted of 42 males and 31 females, with a mean age of 41.9 years. In the 2-year period after MRI, 26 patients had adverse events, 8 had liver transplantation, and 6 died. On multivariate analysis, only Mayo Risk Score (p = 0.001) and relative enhancement of proximal extrahepatic bile ducts (REPD) (p = 0.035) were significant in predicting adverse outcomes. REPD of < 4.64 had 70% sensitivity and 63% specificity in such an event. The only variable that significantly predicted liver transplantation was ANALI non-gadolinium score (p = 0.0003). ANALI score of > 3 had a sensitivity of 87.5% and specificity of 74.2% for predicting the need for liver transplantation.

CONCLUSIONS: Relative enhancement ratio of extrahepatic bile ducts at 20 min after gadoxetate disodium provides useful information in predicting adverse events in PSC patients and is complementary or superior to the currently used clinical scoring systems.

KEY POINTS: Question Can functional hepatic and biliary parameters, obtained from gadoxetate-enhanced MRI, be useful in predicting adverse events in patients with primary sclerosing cholangitis? Findings The relative enhancement of proximal bile ducts (REPD) was useful in predicting adverse events and the need for liver transplantation within 2 years of MRI. Clinical relevance ANALI score predicts need for liver transplantation and may be included in MRI reports of patients with PSC. REPD is more difficult to measure on a routine clinical basis and may only be useful in drug trials.

PMID:42363965 | DOI:10.1007/s00330-026-12710-5

Eur Radiol. 2026 Jun 27. doi: 10.1007/s00330-026-12713-2. Online ahead of print.

ABSTRACT

OBJECTIVE: Carotid plaque composition, including calcifications, lipid-rich necrotic core (LRNC), and intraplaque haemorrhage (IPH), is associated with an increased risk of cardiovascular disease (CVD). Its association with cardiovascular risk factors remains unclear, particularly in midlife and across ethnic groups. We examined the relation between cardiovascular risk factors and carotid plaque components using MRI.

MATERIALS AND METHODS: We conducted 3-T MRI of the carotid arteries in 356 Dutch, South-Asian Surinamese, and Moroccan participants from the HELIUS study. Median follow-up time between the cardiovascular risk factor visit and MRI was 8.4 years. Multivariable logistic mixed regression models assessed associations between cardiovascular risk factors and plaque components RESULTS: At baseline, participants had a median age of 54.0 years [IQR: 48.0-59.0] with 42.1% women. Plaque calcifications, LRNC, and IPH were present in 62.6%, 21.3%, and 3.9% of participants, respectively. Hypertension was strongly associated with calcifications (OR 4.02, 95% CI: 1.59-10.12), while smoking was both related to the presence of calcifications (OR 4.94, 95% CI: 1.79-13.62) and LRNC (OR 2.88, 95% CI: 1.30-6.40). The significant associations between both history of CVD and diabetes with calcifications were attenuated after adjusting for other risk factors. No significant associations were found for IPH, likely due to its low prevalence. There were no differences in plaque component prevalence between South-Asian Surinamese and Dutch, while Moroccans had a lower prevalence of calcifications.

CONCLUSIONS: Unfavourable cardiovascular risk profiles in midlife were associated with an increased prevalence of carotid plaque components later in life, with ethnic differences in their prevalence.

KEY POINTS: Question There is limited understanding of how cardiovascular risk factors in midlife are associated with carotid plaque components across ethnicities, hampering targeted prevention of CVD. Findings Hypertension and smoking were strongly associated with carotid plaque calcifications; smoking was associated with LRNCs, while for IPH, no associations were found. Clinical relevance Unfavourable cardiovascular risk profiles in midlife increase the prevalence of carotid plaque components later in life, with ethnic differences in their prevalence, highlighting opportunities for personalised, targeted prevention strategies to reduce CVD.

PMID:42363964 | DOI:10.1007/s00330-026-12713-2