Category: Nevin Manimala

J Epidemiol Popul Health. 2026 Apr 9;74(4):203387. doi: 10.1016/j.jeph.2026.203387. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide, with chronic hepatitis B virus (HBV) infection being a major risk factor. To date, existing predictive scores of HCC are mainly based on traditional Cox proportional hazard (CPH) models. This study aimed to compare the variable selection process and performance of CPH models with those of machine learning (ML) and deep learning (DL) algorithms in predicting HCC among patients with chronic HBV infection.

METHODS: We used data from 4,370 individuals with chronic HBV infection enrolled in the French prospective multicentre ANRS CO22 HEPATHER cohort, of which 56 (1.3%) developed an HCC. Two published CPH-based scores (ADAPTT and SADAPTT) were compared to Random Survival Forest (RSF), Survival Support Vector Machine (SVM), Survival XGBoost, and DeepSurv algorithms. Models were evaluated using Harrell’s C-index, Inverse-Probability-of-Censoring Weighting win ratio statistic, and time-dependent area under the ROC curve at 3, 5, and 8 years. The same set of covariables was used to build all the models.

RESULTS: CPH models demonstrated similar or higher performances (C-index [95% confidence interval]: 0.84 [0.82-0.85]) for HCC prediction compared to ML and DL models, with less overfitting. Survival SVM and RSF performed similarly (0.81 [0.79-0.83] and 0.81 [0.79-0.82], respectively) without outperforming CPH models. Variable selection was consistent across top-performing models, though CPH models more effectively captured the predictive value of certain behavioural factors, such as soft drink intake.

CONCLUSIONS: In this dataset with a limited sample size and strongly imbalanced outcome, traditional CPH models provided robust, interpretable, and computationally efficient predictions for HCC risk. ML and DL methods did not outperform traditional models, reinforcing the validity of traditional statistical approaches in small to medium datasets.

PMID:41962179 | DOI:10.1016/j.jeph.2026.203387

J Neurosurg Pediatr. 2026 Apr 10:1-12. doi: 10.3171/2025.11.PEDS25377. Online ahead of print.

ABSTRACT

OBJECTIVE: Surgical management of hypothalamic hamartomas (HHs) presents substantial challenges due to their deep-seated location and proximity to critical neurovascular structures. Less invasive techniques, such as endoscopic disconnection and laser interstitial thermal therapy (LITT), have become preferred over traditional microsurgery to enhance seizure control while minimizing complications. Notably, LITT has steadily gained popularity in recent years. The aim of this study was to assess seizure, neurocognitive, and endocrine outcomes following endoscopic disconnection in patients with HH-related epilepsy, and to determine whether endoscopy remains a viable treatment option in the management of HH.

METHODS: This retrospective analysis included patients with HH-related epilepsy who underwent robotic-assisted endoscopic disconnection between 2011 and 2023 at a single institution. All patients received comprehensive presurgical evaluation, and formal assessments of global cognitive and neuropsychological function were conducted preoperatively and postoperatively in eligible patients.

RESULTS: Twenty-nine patients who underwent 37 procedures were included in this analysis. All patients experienced gelastic seizures, and most patients (51.7%) had type II HH according to the Delalande classification system. Twenty-two patients (75.9%) underwent a single intervention. The procedure was repeated 2 times in 6 patients and 3 times in 1 patient. Endoscopy proved effective in providing direct visualization, real-time monitoring, and histopathological sampling during procedures. Permanent postoperative complications occurred after 4 procedures (10.8%); these included mild CN VI deficit (n = 1), hypothalamic obesity (n = 1), and hypothyroidism (n = 2) after second procedure. Over a mean follow-up of 6.9 years, Engel class I seizure freedom was achieved in 65.5% of patients, with the best outcomes seen for those with type II HH. Among the 22 patients who underwent a single procedure, the long-term endocrinological status remained unchanged compared with the preoperative condition in 17 (77.3%), improved in 4 (18.2%), and worsened in 1 (4.5%). Among the 20 patients with available comparative data, cognitive outcomes remained stable or improved for most patients, although some exhibited decline. Statistical analysis revealed a moderate correlation between the HH type and postoperative Engel class outcome. Comparison between patients who underwent single versus multiple procedures revealed a significantly poorer seizure outcome in the repeat surgery group, while the complication rates were comparable. The outcome was significantly associated with the number of procedures.

CONCLUSIONS: Endoscopic disconnection remains a viable and minimally invasive surgical option for the treatment of HH-related epilepsy, particularly for newly diagnosed or residual HHs with intraventricular involvement.

PMID:41962169 | DOI:10.3171/2025.11.PEDS25377

J Neurosurg Spine. 2026 Apr 10:1-10. doi: 10.3171/2025.11.SPINE251323. Online ahead of print.

ABSTRACT

OBJECTIVE: Surgery on extramedullary tumors has a place among the most gratifying operations in neurosurgery. However, little data exist on permanent morbidity and long-term results. This paper provides these data and analyzes which factors influence them and how they can be managed.

METHODS: Among 2081 patients with tumors of the spinal canal presenting between 1991 and 2024, 605 patients were identified with intradural extramedullary tumors, of whom 500 patients underwent 570 operations. Multiple regression was used to identify factors influencing resection and morbidity rates. Short-term results were analyzed according to a neurological scoring system for individual symptoms, while long-term results were determined calculating recurrence-free outcome rates with Kaplan-Meier statistics.

RESULTS: The mean age for operated patients was 49.8 ± 18 years, presenting after a mean history of 21.2 ± 42 months. They were followed up by outpatient visits and questionnaires for up to 34 years (mean 43.3 ± 64 months). Overall, 87.4% of tumors were resected completely, while 11.2% underwent partial resection and 1.4% biopsy. Transient postoperative deteriorations were observed in 15.1% of surgeries. Permanent surgical morbidity occurred in 7.1%, that is, 4.8% for first surgeries and 18.4% for recurrent tumors (p < 0.0001). With complete resection, recurrence-free outcome rates of 80.5% and 77% after 5 and 10 years, respectively, were obtained, while partial resection reduced these rates to 40.0% and 36.4% after 5 and 10 years, respectively (p < 0.0001). Surgeons with > 100 operations achieved significantly higher recurrence-free outcome rates compared to surgeons with less experience at each postoperative time point. Schwannomas, meningiomas, ependymomas of the filum terminale, and hamartomas represented 89.8% of all pathologies and were analyzed separately. The best results for resection rates, permanent morbidity, and recurrence-free outcomes were observed for schwannomas. The highest morbidity rates were determined for ependymomas and hamartomas. Complete resection resulted in recurrence-free outcome rates of around 90% after 10 years for each histological group with the exception of meningiomas (73.3%).

CONCLUSIONS: Whenever an extramedullary tumor is completely resected, rates for surgical morbidity and 10-year recurrence-free outcomes are favorable. In contrast, with arachnoid adhesions, as in recurrent tumors and some hamartomas, complete resection rates decline, morbidity rates rise, and long-term results become less satisfactory. This emphasizes the importance of achieving complete resection, particularly in the first operation. Surgeons dedicated to spinal cord pathologies can expect to achieve superior long-term results.

PMID:41962167 | DOI:10.3171/2025.11.SPINE251323

J Neurosurg Pediatr. 2026 Apr 10:1-8. doi: 10.3171/2025.12.PEDS25501. Online ahead of print.

ABSTRACT

OBJECTIVE: Vagus nerve stimulator (VNS) insertion has become a common treatment for drug-resistant epilepsy in children. The growing number of children undergoing VNS insertion provides a strong incentive for studies aimed at optimizing postoperative care protocols. The objective of this retrospective study was to characterize the readmission and reoperation rates associated with VNS insertion in children.

METHODS: The National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database was queried from 2012 to 2022 to find patients who underwent VNS insertion (CPT code 64568). The primary outcome measured was unplanned readmission within 7 days of VNS insertion. Propensity score matching on the criteria of baseline demographics was applied. Multivariable logistic regression analysis was conducted to determine if age, race, or anesthesia time affected same-day discharge as well as unplanned readmission and reoperation rates.

RESULTS: A total of 4267 patients who underwent VNS insertion were identified in the NSQIP-P database from 2012 to 2022. After excluding patients with missing data and readmissions > 7 postoperative days, 3070 patients were included in the final analysis. Of those patients, 63 (2.1%) experienced an unplanned readmission within 7 days of their procedure. Propensity score matching differentiating between those with a total hospital length of stay of 0 days (same-day discharge) and > 0 days (inpatient admission) on the criteria of age (p = 0.63), sex (p = 0.77), race (p = 0.99), Hispanic ethnicity (p = 0.84), and American Society of Anesthesiologists classification (p = 0.18) showed no statistically significant difference in baseline characteristics between the two cohorts. No significant difference in unplanned readmissions was found between patients with same-day discharge versus those with inpatient admission (OR 1.19, 95% CI 0.72-1.99; p = 0.5).

CONCLUSIONS: Same-day discharge of pediatric patients undergoing VNS insertion was not associated with higher readmission rates compared to patients who stayed in the hospital for more than 1 day.

PMID:41962155 | DOI:10.3171/2025.12.PEDS25501

JMIR Public Health Surveill. 2026 Apr 10;12:e88806. doi: 10.2196/88806.

ABSTRACT

BACKGROUND: While prior studies have examined structural and individual-level barriers to pre-exposure prophylaxis (PrEP) uptake, little is known about the psychological mechanisms underlying resistance to PrEP, particularly among high-risk groups. The status quo bias (SQB) theory provides a theoretical framework for understanding why individuals may resist beneficial health innovations.

OBJECTIVE: The aim of this study was to examine the associations between SQB and PrEP resistance intention among Chinese men who have sex with men (MSM) and to test whether condom-use inertia moderated these relationships.

METHODS: We conducted a cross-sectional online survey among 1022 MSM in China from November 2024 to February 2025. Theory-guided multi-item measures were constructed to capture key dimensions of SQB. Their internal consistency and construct validity were examined using confirmatory factor analysis prior to regression modeling. Multiple linear regression models assessed main effects and moderation effects, adjusting for sociodemographic and behavioral covariates.

RESULTS: A total of 1022 MSM were included in the final analysis (mean age 29.6 y); the majority identified as homosexual (767/1022, 75.1%) and were unmarried (896/1022, 87.7%). Regression analyses revealed that transition costs were positively associated with PrEP resistance intention (β=0.26, 95% CI 0.17-0.35; P<.001), while social norms were negatively associated (β=-0.19, 95% CI -0.27 to -0.12; P<.001). Condom-use inertia significantly moderated both associations, amplifying the positive relationship between transition costs and resistance (β=0.04, 95% CI 0.01-0.09; P=.03) and enhancing the negative association of social norms (β=-0.05, 95% CI -0.09 to 0.00; P=.04). Subgroup analyses showed that the amplifying effect of condom-use inertia on transition costs was particularly evident among participants with postgraduate education (β=0.13, 95% CI 0.01-0.26; P=.04). Conversely, its strengthening effect on social norms was more pronounced among MSM 30 years or younger (β=-0.11, 95% CI -0.17 to -0.04; P=.001) and those identifying as homosexual (β=-0.07, 95% CI -0.12 to -0.02; P=.01).

CONCLUSIONS: This study suggests that SQB is an important psychological barrier to PrEP adoption among Chinese MSM. The moderating role of condom-use inertia highlights the relevance of habitual condom-use routines in shaping PrEP resistance. Behaviorally informed strategies that reduce transition costs and leverage social norms may help mitigate resistance and improve PrEP uptake.

PMID:41962129 | DOI:10.2196/88806

Swiss Med Wkly. 2026 Jan 6;156:4490. doi: 10.57187/s.4490.

ABSTRACT

BACKGROUND: Guidelines for diagnostic work-up in first-episode psychosis (FEP) vary worldwide. The German DGPPN S3 guidelines recommend a comprehensive work-up, including neuroimaging. However, real-world adherence to these recommendations remains unclear. This study examined guideline adherence in a Swiss tertiary psychiatric hospital.

METHODS: We conducted a retrospective cross-sectional study analysing electronic healthcare records of first-episode psychosis patients hospitalised with an ICD-10 chapter F2 diagnosis for the first time between October 2022 and September 2023. We assessed adherence to recommended mandatory DGPPN S3 assessments – neurological examinations, blood analyses, drug screening, MRI – and evaluated completion of optional assessments such as EEG and lumbar puncture.

RESULTS: A total of 68 first-episode psychosis patients were included from 364 patients screened: 44 (64.7%) were men; their median age was 29 (IQR: 23-33) years; 35 (51.5%) were involuntary admissions. Nearly all patients (n = 66 or 97.1%) received thorough neurological examinations and blood analyses, while 56 (82.4%) underwent drug screening (with 35 [44.6%] testing positive for cannabis). MRI was conducted in 38 (55.9%) cases. Non-completion of MRI was mainly due to patient refusal (n = 10 or 14.7%) or early discharge (n = 16 or 23.5%). Optional EEG and lumbar puncture were less frequently performed: in 26 (38.2%) and 4 (5.9%) patients, respectively.

CONCLUSIONS: Overall, guideline adherence was high, particularly for essential diagnostic procedures. However, only around half of the sample underwent MRI imaging, largely because of patient refusal or patient-requested discharge prior to completion of the suggested assessment. These findings highlight the need for optimised diagnostic workflows and enhanced patient education strategies to improve guideline adherence in FEP assessment.

PMID:41962128 | DOI:10.57187/s.4490

Neurology. 2026 May 12;106(9):e214860. doi: 10.1212/WNL.0000000000214860. Epub 2026 Apr 10.

ABSTRACT

BACKGROUND AND OBJECTIVES: Intensive blood pressure (BP) reduction may reduce the risk of poor functional outcomes in patients with acute intracerebral hemorrhage (ICH). Whether these potential benefits apply similarly to lobar and deep ICH, 2 biologically and clinically distinct subtypes, remains uncertain. We tested the hypothesis that intensive BP reduction has differential effects on functional outcomes based on ICH location.

METHODS: We performed a stepwise meta-analysis, stratified by ICH location, of 3 landmark randomized clinical trials of intensive BP reduction: Acute Cerebral Hemorrhage (ATACH-2), Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT2), and INTERACT3. Step 1 pooled ATACH-2 and INTERACT2 (3-month outcomes; intensive BP lowering only). Step 2 added INTERACT3 (6-month outcomes; care bundle protocol with intensive BP lowering plus glucose management, antipyresis, and anticoagulant reversal). For ATACH-2, we used pooled results from individual patient data (adjusted for age, Glasgow Coma Scale score, and presence of intraventricular hemorrhage), whereas for INTERACT2 and INTERACT3, we used their pooled, publicly available results. Our exposure of interest contrasted intensive systolic BP targets <140 mm Hg vs standard care 140-180 mm Hg. Our outcome of interest was poor functional outcome, defined as a modified Rankin Scale score of 4-6 in ATACH-2 and INTERACT3 and of 3-6 in INTERACT2.

RESULTS: Step 1 included a total of 2,983 patients with deep and 537 patients with lobar ICH (mean age 63 y/o, 37% female). Intensive BP reduction was not associated with a significant difference in poor functional outcome for either deep (odds ratio [OR] 0.89; 95% CI 0.40-1.98; I² = 0%) or lobar (OR 0.92; 95% CI 0.73-1.17; I² = 0%) ICH. Step 2 included a total of 7,917 patients with deep and 1,105 patients with lobar ICH (mean age 63 y/o, 37% female). Similarly, intensive BP reduction was not associated with a significant difference in poor outcome in both deep (OR 0.82; 95% CI 0.57-1.18; I² = 60%) and lobar (OR 0.97; 95% CI 0.76-1.24; I² = 0%) ICH.

DISCUSSION: In this stepwise meta-analysis of 3 landmark ICH trials, intensive BP reduction did not demonstrate a significant benefit in either deep or lobar ICH. Although our estimates did not reach statistical significance, the direction of effect in deep ICH and the substantial heterogeneity across trials, particularly with the inclusion of INTERACT3, limit firm conclusions. Given these uncertainties and the biological distinctions between deep and lobar ICH, future well-powered studies specifically designed to test whether intensive BP reduction has differential effects by hematoma location are warranted.

PMID:41962119 | DOI:10.1212/WNL.0000000000214860

Wiad Lek. 2026;79(3):508-517. doi: 10.36740/WLek/218271.

ABSTRACT

OBJECTIVE: Aim: This study aimed to assess adult perceptions and awareness of factors influencing longevity and healthy ageing in the UAE.

PATIENTS AND METHODS: Materials and Methods: A cross-sectional study was conducted among 446 adults in the UAE using a self-administered, structured online questionnaire comprised of different domains. Data was analyzed using SPSS version 29. Descriptive statistics summarized perception levels, and Chi-square tests assessed associations between sociodemographic, cultural, lifestyle, and healthcare-related factors and perceptions of longevity. A p-value <0.05 was considered statistically significant.

RESULTS: Results: Most participants demonstrated good overall longevity perception (87.9%). Lifestyle-related factors, including healthy diet (84.5%), regular physical activity (83.6%), stress management (84.8%), non-smoking (79.8%), and limited alcohol consumption (82.7%), were widely recognized as important contributors to longevity. Access to quality healthcare (83.6%) and financial security (79.4%) were also strongly endorsed. Significant associations were observed between longevity perception and nationality (p=0.011), education level (p=0.007), occupation (p=0.002), marital status (p=0.025), and age group (p<0.001). Preventive health beliefs, particularly stress management, healthy diet, and regular medical check-ups (p<0.001), showed strong associations with positive longevity perception.

CONCLUSION: Conclusions: Adults exhibit high awareness of modifiable lifestyle and healthcare determinants of longevity. Perceptions are shaped primarily by preventive health beliefs rather than cultural or caregiving exposure alone. Strengthening public health education and preventive healthcare initiatives is essential to support national healthy-ageing strategies.

PMID:41962090 | DOI:10.36740/WLek/218271

Wiad Lek. 2026;79(3):500-507. doi: 10.36740/WLek/218266.

ABSTRACT

OBJECTIVE: Aim: The primary aim of this study was to identify and analyze the socio-demographic determinants of constipation among elderly individuals (≥60 years) attending a tertiary care hospital in Ajman, United Arab Emirates, in order to address an important gap in regional geriatric gastrointestinal research.

PATIENTS AND METHODS: Materials and Methods: A record-based case-control study was conducted among patients aged 60 years and above attending a tertiary care hospital The cases were elderly patients with documented constipation, while the controls were elderly patients without constipation, selected in a 1:2 ratio. Data were extracted using a structured and validated proforma. Descriptive statistics, chi-square tests, and binary logistic regression were performed to examine associations. Crude and adjusted odds ratios with 95% confidence intervals were calculated, and a p-value ≤0.05 was considered statistically significant.

RESULTS: Results: Constipation was more frequently observed among males and in specific age groups. Participants aged 60-69 years constituted the largest proportion of cases (78.8%), while those aged 70-79 years were more commonly represented among controls. A significant association was observed between age group and constipation (p<0.01). Male participants accounted for 71.3% of cases compared to 37.4% of controls (p<0.01). In adjusted analysis, male gender remained a strong predictor of constipation (AOR: 4.41; 95% CI: 2.40-8.11).

CONCLUSION: Conclusions: Male gender and age group were key socio-demographic determinants of constipation among elderly patients in this tertiary care setting. These findings highlight the need for targeted screening, early recognition, and preventive strategies for constipation as part of routine geriatric care.

PMID:41962089 | DOI:10.36740/WLek/218266

Wiad Lek. 2026;79(3):491-499. doi: 10.36740/WLek/218230.

ABSTRACT

OBJECTIVE: Aim: This study aimed to find out predictors of chronic liver disease (CLD) in adults and evaluate key determinants that may influence healthy aging.

PATIENTS AND METHODS: Materials and Methods: A case-control study was conducted among adults who were receiving care at a tertiary care center. Demographics, lifestyle factors, and clinical variables like BMI were collected. Statistical analysis was performed using chi-square testing for association and logistic regression analysis to identify independent factors that predict CLD, p-value of <0.05 was used to identify significance for all information collected.

RESULTS: Results: Significant links were found between CLD and several factors. Males were significantly more affected with CLD (78.5%, p < 0.001), making gender one of the factors that predict CLD. Similarly, age was a significant factor, with those aged 40-60 being the most affected (33%, p = 0.039). Abnormal BMI was strongly associated with CLD, found in 84.6% cases (p = 0.008). Alcohol consumption demonstrated a marked association with chronic liver disease (p < 0.001), with former and current alcohol use substantially more common among cases. After logistics regression analysis, male gender, abnormal BMI, and alcohol consumption are significant independent predictors of CLD.

CONCLUSION: Conclusions: The study highlights gender (male), age (40-60), abnormal BMI and alcohol consumption as significant predictors of CLD in the studied population. These findings emphasize the urgent need for targeted screening and lifestyle-based preventive interventions, particularly focusing on metabolic health and weight management, to mitigate the rising burden of liver disease and promote healthy aging.

PMID:41962088 | DOI:10.36740/WLek/218230