Category: Nevin Manimala

J Neurosurg. 2026 Jul 24:1-13. doi: 10.3171/2026.2.JNS252393. Online ahead of print.

ABSTRACT

OBJECTIVE: Endoscopic transsphenoidal surgery (eTSS) is a common neurosurgical procedure used to treat pituitary adenomas (PAs). The authors evaluated the incidence of complications, early readmission, and early reoperation following eTSS for PAs and identified clinical, surgical, and tumor characteristics predictive of these outcomes.

METHODS: The data of all patients with histologically confirmed PAs who underwent eTSS at the authors’ institution between May 2011 and September 2024 were retrospectively reviewed. Thirty-day postoperative complications were grouped into surgical and medical categories. Early readmission and early reoperation were defined as occurring within 90 days of discharge and surgery, respectively.

RESULTS: A total of 709 endoscopic transsphenoidal operations (655 direct and 54 extended approaches) were performed in 693 patients. The median tumor diameter (IQR) was 24 (17-32) mm, and 656 cases (93%) were macroadenomas. Cavernous sinus invasion on MRI was noted in 32.2% of cases. Fifteen percent were reoperations. Gross-total resection was achieved in 63.5% of patients, and the median length of stay was 3 days. Surgical complications included postoperative CSF leakage (4.2%), epistaxis (2.7%), cranial nerve palsy (1.0%), worsened vision (1.0%), meningitis (1.0%), stroke (0.8%), hydrocephalus (0.7%), hematoma (0.6%), sinusitis (0.6%), abdominal hematoma or infection (0.4%), carotid artery injury (0.1%), and death (0.3%). Medical complications included transient diabetes insipidus (8.7%), permanent diabetes insipidus (2.4%), bacteremia/sepsis (0.7%), pneumonia (0.3%), and deep venous thrombosis/pulmonary embolism (0.1%). Early readmission and early reoperation were observed in 10.2% and 4.8% of cases, respectively. The most common reasons for early readmission were delayed hyponatremia (4.2%), CSF leakage (1.8%), infection (1.1%), epistaxis (0.7%), and hypocortisolemia (0.1%), while the most common reasons for early reoperation were CSF leakage (2.5%), residual tumor (1.3%), worsened vision (0.6%), infection (0.6%), and hematoma (0.3%). Predictors of complications included increasing tumor diameter, firm tumor consistency, the presence of an intraoperative CSF leak, and use of an extended approach. While not statistically significant, rates of postoperative CSF leakage (5.1% vs 3.4%), early readmission (11.4% vs 9.1%), and early reoperation (5.7% vs 4.0%) decreased from the first half of the cohort to the second half of the cohort.

CONCLUSIONS: Endoscopic TSS for PAs is associated with low morbidity and mortality, although a number of complications are possible. Readmission and reoperation following eTSS occur less frequently when endocrine readmissions can be averted. The results of this study provide information on the risks associated with eTSS and serve as a guide for neurosurgeons to counsel patients undergoing this procedure.

PMID:42497462 | DOI:10.3171/2026.2.JNS252393

J Neurosurg Pediatr. 2026 Jul 24:1-7. doi: 10.3171/2026.3.PEDS25569. Online ahead of print.

ABSTRACT

OBJECTIVE: Early referral of patients with suspected sagittal suture synostosis is important as it enables minimally invasive surgery. To encourage early referrals, the authors’ craniofacial center has increased its efforts to educate referring healthcare providers. This study evaluated the developments of timely referral and age at referral of patients with sagittal suture synostosis.

METHODS: Nonsyndromic patients born between 2000 and 2020 were included in this cohort study. The type of surgery was mainly based on age at referral: frontobiparietal remodeling was done if the patient was older than 6 months of age, and a minimally invasive procedure was done if the patient was younger. Logistic regression was performed to assess the relationship between the year of birth and the probability of a timely first visit (i.e., before 5.5 months).

RESULTS: A total of 698 patients were included, with a median age at first visit of 3.6 months. Of the patients born in 2000, 60% had their first visit before the age of 5.5 months, compared to 77% of those born in 2020. Since 2010, there has been a statistically significant positive association between the year of birth and the probability of having the first visit on time (OR 1.10, 95% CI 1.03-1.18). Overall, pediatricians were the most frequent referrers.

CONCLUSIONS: The proportion of timely referred patients with nonsyndromic sagittal suture synostosis has increased over the past 20 years, and since 2010, there has been a statistically significant increase in the probability of timely referral, allowing for more patients to be treated with minimally invasive spring-assisted correction. Further efforts are needed to increase timely referrals and raise awareness among parents and healthcare providers.

PMID:42497457 | DOI:10.3171/2026.3.PEDS25569

Cancer Res Commun. 2026 Jul 24. doi: 10.1158/2767-9764.CRC-26-0165. Online ahead of print.

ABSTRACT

Black/African American populations, globally, bear the greatest prostate cancer (CaP) burden compared to other racial/ethnic groups. Addressing CaP disparities in Black men is complex, requiring a patient-centered, community-centric and comprehensive approach. This study integrates iCCaRE Consortium findings and broader literature to address unmet needs in survivorship care. The iCCaRE Consortium implemented five complementary pilot studies using mixed-methods designs, including feasibility trials, qualitative research, and observational analyses across the United States and sub-Saharan Africa. Descriptive statistics, subgroup analyses, and qualitative thematic analyses were performed across these studies. Collectively, projects addressed multilevel determinants including social, behavioral, and biological drivers of disparities. Project 1 implemented a Virtual Reality Assistant (ViRA) across clinical and community settings, with ongoing evaluation in pragmatic trials. Project 2 showed strong patient preference for home-based cancer care. Project 3 enrolled demonstrated trends toward improved health-related quality of life. Project 4 identified key themes influencing survivorship experiences. Project 5 identified biological mechanisms linking stress, immune modulation, and symptom burden. The iCCaRE pilot projects demonstrate the feasibility and early impact of a consortium-based, transdisciplinary approach to addressing CaP disparities in Black men. These findings highlight the importance of integrating patient-centered interventions, community engagement, and biological insights to inform scalable strategies aimed at improving survivorship outcomes and advancing health equity. The iCCaRE Consortium demonstrates that a transatlantic, patient-centered, and multidisciplinary approach integrating social, clinical, and biological factors can generate scalable strategies to improve survivorship outcomes and advance equity in CaP care for Black men.

PMID:42497456 | DOI:10.1158/2767-9764.CRC-26-0165

J Magn Reson Imaging. 2026 Jul 24. doi: 10.1002/jmri.70458. Online ahead of print.

ABSTRACT

BACKGROUND: Assessment of amyloid-β (Aβ) burden and associated iron deposition and neurodegeneration is important for Alzheimer’s disease (AD) management. Although quantitative susceptibility mapping (QSM) detects iron and myelin changes, conventional metrics suffer from signal cancelation between paramagnetic and diamagnetic components. Consequently, spatial interactions between these independent susceptibility sources and Aβ burden remain unestablished.

PURPOSE: To investigate spatial associations between regional Aβ burden and independent paramagnetic and diamagnetic susceptibility sources using χ-separation.

STUDY TYPE: Prospective.

POPULATION: A total of 77 participants with mild cognitive impairment or dementia (mean age, 74 years; women, 50) examined using QSM and amyloid positron emission tomography (PET) (¹⁸F-flutemetamol or ¹⁸F-florbetapir).

FIELD STRENGTH/SEQUENCE: 3 T/QSM (3-dimensional multi-echo gradient-echo sequence).

ASSESSMENT: χ-separation decomposed QSM data into paramagnetic (χ-para) and diamagnetic (χ-dia) components. Centiloid-scale maps standardized PET quantification for voxel-wise analysis. The spatial relationship between Aβ load and susceptibility metrics was analyzed using voxel-wise correlations within AD-signature cortical regions.

STATISTICAL TESTS: Voxel-wise spatial associations between Centiloid values and QSM metrics were evaluated using Pearson’s coefficients. Spatial association was considered statistically significant if the 99% confidence interval (CI) did not cross zero.

RESULTS: Conventional QSM showed near-zero cortical susceptibility and obscured pathological details owing to physiological cancelation. χ-separation unmasked susceptibility sources. Local Aβ deposition was consistently associated with reduced absolute χ-dia across cortical regions (mean r range: -0.267 to -0.098; all 99% CIs did not cross zero), consistent with alterations in net diamagnetic susceptibility sources, potentially involving myelin-related components. χ-para showed weaker and regionally heterogeneous associations with Aβ burden, with a positive association most evident in the precuneus (mean r = 0.072, 99% CI: 0.052-0.092).

DATA CONCLUSION: χ-separation reveals region-specific cortical alteration associated with regional Aβ pathology. By separating these susceptibility sources, this method may provide complementary information to conventional QSM, offering a refined, noninvasive approach for characterizing amyloid-associated tissue changes in AD.

EVIDENCE LEVEL: 2.

TECHNICAL EFFICACY: Stage 2.

PMID:42497445 | DOI:10.1002/jmri.70458

Turk J Pediatr. 2026 Jun 30;68(3):549-550. doi: 10.24953/turkjpediatr.2026.8711.

NO ABSTRACT

PMID:42497443 | DOI:10.24953/turkjpediatr.2026.8711

Turk J Pediatr. 2026 Jun 30;68(3):547-548. doi: 10.24953/turkjpediatr.2026.7960.

NO ABSTRACT

PMID:42497441 | DOI:10.24953/turkjpediatr.2026.7960

Turk J Pediatr. 2026 Jun 30;68(3):439-449. doi: 10.24953/turkjpediatr.2026.7593.

ABSTRACT

BACKGROUND: Respiratory colonization with Pseudomonas aeruginosa is associated with increased morbidity and mortality in cystic fibrosis (CF) patients. This study aims to assess the clinical characteristics and associated factors of CF infants under two years of age with P. aeruginosa colonization in Türkiye.

METHOD: Of the 1637 patients registered in the Cystic Fibrosis Registry of Türkiye in 2019, 284 patients under two years of age were included in this retrospective cross-sectional study. Patients were classified into two groups: those with P. aeruginosa colonization (Group 1) and those without (Group 2). Cystic fibrosis transmembrane conductance regulator (CFTR) gene functions were categorized according to CFTR mutation functional class.

RESULTS: Twenty-three patients (8.1%) were categorized as Group 1 and 262 participants (91.9%) were classified as Group 2. Infants with P. aeruginosa colonization (Group 1) were more likely to have minimal CFTR function compared with those without colonization (87% vs. 39.8%, p = 0.017). In addition, both Staphylococcus aureus colonization (47.8% vs. 7.3%, p < 0.001) and methicillin-resistant S. aureus positivity (17.4% vs. 6.1%, p = 0.042) were observed more commonly in Group 1. There were no statistical differences between the groups in terms of age at diagnosis, gender, mean z-scores of weight and height, newborn screening test positivity, sweat chloride test results, and pancreatic insufficiency (p > 0.05). Univariate logistic regression analysis did not identify significant associated factors for P. aeruginosa colonization.

CONCLUSIONS: Our findings suggest that minimal CFTR function and S. aureus colonization are associated with P. aeruginosa colonization in CF patients under two years of age. Further studies are needed to investigate associated factors for early P. aeruginosa colonization, eradication treatment effectiveness, and longitudinal outcomes of in CF patients under two years of age.

PMID:42497434 | DOI:10.24953/turkjpediatr.2026.7593

Turk J Pediatr. 2026 Jun 30;68(3):369-380. doi: 10.24953/turkjpediatr.2026.6619.

ABSTRACT

BACKGROUND: Functional gastrointestinal disorders (FGIDs) significantly impact infant well- being and healthcare utilization, yet comprehensive data using updated Rome IV criteria in Turkish populations remains limited. Our objective was to determine the prevalence and characteristics of FGIDs in Turkish infants and examine associations with feeding patterns, sleep quality, and maternal depression.

METHODS: A cross-sectional study was conducted in a tertiary hospital between February and August 2020. A total of 459 infants aged 1-12 months were enrolled. FGIDs were diagnosed according to Rome IV criteria. Feeding characteristics, sleep quality assessed by the Brief Infant Sleep Questionnaire, and maternal depression measured using the Edinburgh Postnatal Depression Scale were recorded through face-to-face interviews. Comparisons were primarily performed between infants with and without FGIDs. Multivariable logistic regression adjusted for infant age was used to evaluate the association between feeding type and FGIDs.

RESULTS: At least one FGID was identified in 53.2% of infants (n=244). Co-occurrence of multiple FGIDs was observed in 92 infants. Infants with FGIDs were significantly younger than those without FGIDs with a median age of 3 months (interquartile range [IQR]: 2-5) vs 6 months (IQR: 3-9) (p<0.001). Poor sleep was markedly more prevalent among infants with FGIDs compared to those without (45.1% vs 22.3%, p<0.001). Mothers of infants with FGIDs had higher depression scores than mothers of infants without FGIDs (median: 7.0 [IQR: 4-11] vs 5.0 [3-10], p=0.030). In multivariable logistic regression analysis adjusted for infant age, the overall feeding model was not statistically significant (p=0.240); however, mixed breast milk and formula feeding was associated with increased FGID risk compared to exclusive breastfeeding (adjusted odds ratio: 2.16, 95% confidence interval: 1.17-3.98, p=0.014).

CONCLUSIONS: FGIDs affect over half of Turkish infants and are associated with sleep disturbances and maternal depressive symptoms. Mixed breast-formula feeding independently increased FGID risk after age adjustment. Integrated care approaches addressing feeding practices, sleep quality, and maternal mental health are warranted.

PMID:42497431 | DOI:10.24953/turkjpediatr.2026.6619

Turk J Pediatr. 2026 Jun 30;68(3):471-484. doi: 10.24953/turkjpediatr.2026.7149.

ABSTRACT

BACKGROUND: In this study, we aimed to investigate peer bullying and its psychosocial consequences in children with celiac disease. We examined the relationship between adherence to diet and anxiety and depressive symptoms.

METHODS: The sample in this cross-sectional study consisted of 124 pediatric celiac patients on a gluten-free diet for one year or more. One hundred thirty-nine healthy children comparable in age and sex were enrolled as the control group. The Revised Olweus Bully Victim Questionnaire (OBVQ) was used to evaluate the peer victimization. The Revised Child Anxiety and Depression Scale and Strengths and Difficulties Questionnaire were used to assess children’s anxiety and depressive symptoms, and emotional and behavioral symptoms, respectively. Hierarchical logistic regression analysis was performed to identify independent predictors of dietary non-adherence.

RESULTS: The proportion of children classified as bullying victims based on the OBVQ was significantly higher in the celiac disease group than in the healthy controls. Children who did not comply with diet therapy experienced significantly higher rates of peer bullying than those who adhered to the diet (p=0.004). However, multivariate analysis indicated that depressive symptoms appeared to account for this relationship – while bullying initially predicted dietary non-adherence (odds ratio [OR]: 3.274, p=0.004), this effect became non-significant when depression was controlled (OR: 2.177, p=0.098), whereas depression remained a significant independent predictor (OR: 1.093, p=0.044). Significant positive correlations were observed between peer bullying and anxiety and depression symptom scores. Peer bullying also exhibited positive correlations with emotional and behavioral symptoms.

CONCLUSIONS: The study findings show that children with celiac disease experience higher rates of peer bullying than their healthy peers. More importantly, our results suggest that the association between bullying and dietary adherence may be largely explained by co-occurring depressive symptoms. We therefore recommend that depressive symptom screening and treatment should be integrated into the management of celiac disease in children, particularly for those experiencing peer victimization.

PMID:42497424 | DOI:10.24953/turkjpediatr.2026.7149

JMIR Med Inform. 2026 Jul 24;14:e79808. doi: 10.2196/79808.

ABSTRACT

BACKGROUND: The accurate documentation of medical treatments for combat-injured personnel has historically posed significant challenges for prehospital medical teams. During recent US Army conflicts in Afghanistan and Iraq, only 18%-25% of casualties had any form of prehospital documentation. In the Israel Defense Forces (IDF), traditional manual and paper-based documentation has proven inefficient. During the 2014 Israel-Hamas conflict in Gaza, the completion rate for full documentation was notably low; only 11% (82/704) of casualties had casualty cards from the field. The sudden outbreak of the 2023-2024 Israel-Hamas war required an immediate re-evaluation of battlefield medical documentation practices. The IDF identified an urgent need for an innovative documentation approach to address the challenges of managing and tracking casualties in high-pressure scenarios. The integration of this system underscores the importance of real-time, robust documentation in improving continuity of care, minimizing medical error, and enhancing operational efficiency.

OBJECTIVE: This study outlines the rapid development and deployment of the Digital Casualty Card System (DCCS), designed to enhance the accuracy and efficiency of field documentation by medical teams during the 2023-2024 Israel-Hamas war.

METHODS: The DCCS was designed to streamline real-time medical data capture, enhance information transfer along the evacuation chain, and improve battlefield casualty care. A strategic decision was made to prioritize rapid deployment by focusing on a user-friendly, digital application, deliberately excluding advanced features such as sensor integration and real-time data transfer between echelons. This system became operational within 2 weeks of the project’s initiation and comprises military-grade tablets embedded with a dedicated software application for documenting casualty status and plastic memory cards worn around the casualty’s neck for data transfer between medical teams. This study uses patient data from the IDF Trauma Registry, relying on data from point of injury casualty cards (DCCS), after-action reports, and data entry by on scene and en route providers.

IMPLEMENTATION (RESULTS): Overall, since the beginning of the distribution, over 700 DCCS kits were embedded in combat units, medical evacuation units, and training units. During the ground operation in Gaza, out of 2984 casualties, 1175 (39%) arrived with DCCS documentation.

CONCLUSIONS: The rapid development and deployment of DCCS during the ongoing war proved to be feasible and contributed to the substantial improvements in both documentation rates and the quality of data collected in the field compared to traditional paper-based casualty cards.

PMID:42497409 | DOI:10.2196/79808