Category: Nevin Manimala

Arch Esp Urol. 2026 Jul;79(6):1038-1049. doi: 10.56434/j.arch.esp.urol.20267906.119.

ABSTRACT

BACKGROUND: To systematically compare general anaesthesia (GA) and regional anaesthesia in patient undergoing minimally invasive surgery for urinary calculi, focusing on operative outcomes (e.g., operative time, length of hospital stay, stone-free rate [SFR]) and early postoperative outcomes (e.g., pain measured by the visual analog scale [VAS] and complication rate), and to provide evidence to guide anaesthetic selection.

METHODS: PubMed, Embase, and the Cochrane Library were searched from database inception to December 2025 for randomized controlled trials (RCTs) comparing GA with regional anaesthesia in minimally invasive urinary stone procedures. Study quality was assessed using the Cochrane Risk of Bias tool. Meta-analyses were conducted using RevMan 5.4. Heterogeneity was quantified using the I² statistic; fixed-effects models were used when I² < 50% and random-effects models when I² ≥ 50%. Sensitivity analyses were conducted to evaluate the robustness of pooled estimates. The analysis included seven RCTs (525 participants) with regional anaesthesia administered to n = 257 and GA to n = 268.

RESULTS: Regional anaesthesia was associated with a shorter operative time compared with GA (weighted mean difference [WMD] = -8.90 minutes, 95% confidence interval [CI] = -14.53 to -3.27; p = 0.002). After excluding studies that contributed to heterogeneity, the effect remained consistent (I2= 43%; p = 0.004). No statistically significant between-group differences were observed for length of hospital stay or SFR (p > 0.05). In the primary analyses, postoperative 4-8 hours VAS scores and complication rates showed no significant differences (p > 0.05). Sensitivity analyses suggested that, after exclusion of influential studies, regional anaesthesia was associated with higher VAS scores (WMD = 1.11, 95% CI: 0.59 to 1.64; p < 0.001), and one sensitivity model suggested a higher complication rate in the regional anaesthesia group (odds ratio [OR] = 2.79, 95% CI = 1.49 to 5.20; p = 0.001). Risk-of-bias assessment varied across domains, with concerns mainly related to performance bias and incomplete reporting in some trials.

CONCLUSIONS: Regional anaesthesia may shorten overall procedure-related time in minimally invasive surgery for urinary calculi. However, its effects on postoperative pain and complications remain uncertain, and the complication outcome was sensitive to individual studies. Length of hospital stay and SFR do not appear to substantially differ between anaesthesia strategies. The PROSPERO Registration: The protocol for this meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420261326142, https://www.crd.york.ac.uk/PROSPERO/view/CRD420261326142).

PMID:42608373 | DOI:10.56434/j.arch.esp.urol.20267906.119

Arch Esp Urol. 2026 Jul;79(6):958-968. doi: 10.56434/j.arch.esp.urol.20267906.112.

ABSTRACT

BACKGROUND: This study aimed to investigate the significance of integrating multiparametric magnetic resonance imaging (mp-MRI) assessment with proactive nursing care for patients undergoing radical prostatectomy for prostate cancer.

METHODS: A retrospective cohort study was conducted, collecting clinical data from 130 patients who underwent radical prostatectomy for prostate cancer in the Department of Urology of the Affiliated Hospital 2 of Nantong University from June 2023 to October 2025. Patients were divided into a study group (n = 65) and a control group (n = 65) based on perioperative nursing care protocols. The control group underwent routine perioperative nursing care in the urology department, whereas the study group received mp-MRI assessment combined with proactive nursing guidance and routine care. The urinary continence recovery rate, urodynamic parameters, nursing compliance and complication rate at different postoperative time points were compared between the two groups.

RESULTS: At 6 months postoperative follow-up, the total urinary continence rate (complete + social continence) and the absence of severe incontinence in the study group were significantly higher than those in the control group (p < 0.05), with statistically significant differences between the groups (p < 0.05). Repeated-measures analysis of variance (ANOVA) confirmed significant group effects for all urodynamic parameters, with comparable recovery trajectories between the groups, except for residual urine volume.

CONCLUSIONS: In this retrospective cohort study, an enhanced nursing programme based on mp-MRI assessment was associated with improved urinary continence recovery and urodynamic parameters in patients undergoing radical prostatectomy. However, these findings require confirmation in prospective randomised controlled trials.

PMID:42608366 | DOI:10.56434/j.arch.esp.urol.20267906.112

Arch Esp Urol. 2026 Jul;79(6):915-921. doi: 10.56434/j.arch.esp.urol.20267906.107.

ABSTRACT

BACKGROUND: Very high-risk (VHR) bladder tumors represent a subcategory of non-muscle-invasive bladder cancer (NMIBC) with a high potential for progression to muscle-invasive bladder cancer (MIBC). Early radical cystectomy (ERC) is the standard treatment. However, for patients unfit for or refusing surgery, intravesical Bacillus Calmette-Guérin (BCG) immunotherapy remains a commonly used bladder-preserving approach. This study aimed to assess oncological outcomes in patients with VHR NMIBC treated with intravesical BCG or ERC.

METHODS: We conducted a retrospective cohort study, including patients with VHR NMIBC treated with BCG or ERC between July 2008 and May 2023. Data were collected from an institutional electronic database. Only patients who received adequate BCG treatment, according to predefined induction and early maintenance criteria, were included in the BCG group. We analyzed clinical and pathological features, overall survival (OS), and cancer‑specific survival (CSS). Secondary objectives included progression and high-grade intravesical recurrence rates among BCG-treated patients.

RESULTS: Among 112 patients included, 99 received BCG and 13 underwent ERC. Patients undergoing ERC were younger and more frequently presented with adverse pathological features, including lymphovascular invasion and variant histology. No statistically significant differences in OS or CSS were observed between the groups. The estimated 60-month CSS was 91.1% in the BCG group and 100% in the ERC group. In the BCG cohort, 48 patients (48.5%) experienced recurrence and 15 progressed to muscle-invasive disease.

CONCLUSIONS: In this retrospective cohort of patients with VHR NMIBC, intravesical BCG was associated with acceptable oncological outcomes in selected cases. However, due to significant baseline imbalances and the small size of the ERC group, these findings should be interpreted with caution, and cannot be considered evidence of equivalence between treatment strategies. Further prospective multicenter studies are needed to refine patient selection and optimize treatment strategies in this population.

PMID:42608361 | DOI:10.56434/j.arch.esp.urol.20267906.107

Clin Transplant. 2026 Aug;40(8):e70651. doi: 10.1111/ctr.70651.

ABSTRACT

PURPOSE: In lung transplantation (LTx), optimal cold ischemia time (CIT) is considered <6 h, but is often extended to maximize allograft utilization. Given the limited analysis of how variation in CIT impacts outcomes, we examined its correlation with graft survival, patient mortality, and prolonged length of stay (PLOS), defined as ≥30 days.

METHODS: Using the United Network for Organ Sharing database, we retrospectively analyzed 39 806 adult LTx between May 4, 2005, and December 1, 2025. Ex-vivo lung perfusion (EVLP) cases (n = 1378) were isolated for separate analysis. The remaining 39 161 were categorized into hourly CIT increments. We conducted univariate and multivariate analyses with three outcomes of interest: PLOS, graft survival, and patient mortality.

RESULTS: CIT correlated more strongly with PLOS than graft survival or patient mortality. CIT <5 h was protective against PLOS, while >6 h increased risk. A steady and significant increase in odds of PLOS with increasing CIT was observed, with risks lowest at 3-4 h (odds ratio [OR], 0.829; 95% confidence interval [CI], 0.755-0.911) and highest at 11-12 h (OR, 2.02; 95%CI, 1.61-2.54). Isolated EVLP analysis showed no such significant correlation.

CONCLUSION: Nearly every hour increases in CIT showed a significant impact on odds of PLOS after LTx. Minimizing CIT is critical to reduce posttransplant PLOS and associated healthcare costs. Novel methods of preservation may be key to mitigate this risk.

PMID:42608347 | DOI:10.1111/ctr.70651

Clin Transplant. 2026 Aug;40(8):e70654. doi: 10.1111/ctr.70654.

ABSTRACT

BACKGROUND: Immune biomarkers could assess levels of immunosuppression and predict infections in transplant recipients. We aimed to evaluate the absolute lymphocyte count (ALC), absolute neutrophil count (ANC), Quantiferon-Monitor and the mitogen component of the Quantiferon-CMV assay alone and combined to predict serious opportunistic infections (SOI) in lung transplant recipients.

METHODS: Patients were prospectively recruited from 2015-17, with blood collected at 3, 6 and 12 months post-transplant. Infections were classified as SOI if requiring hospitalization and caused by an opportunistic pathogen. Logistic regression was used to calculate odds ratios (OR).

RESULTS: Within 18 months post-transplant, 35/80 patients experienced 46 SOI’s. Low ALCs were associated with SOI between 3-6 (median 1.4 vs. 1.0×1000 cells/µL, OR 5.38 per unit decrease, 95% CI 1.38-21.02, p = 0.02) and 6-12 (1.3 vs. 0.8×1000 cells/µL, OR 3.48, 95% CI 1.20-10.1, p = 0.02) months. Mitogen values were significantly lower with SOI between 3-6 months (5.8 vs. 0.3 IU/mL, OR 0.78, 95% CI 0.63-0.97, p = 0.02). Area under the ROC curve for all biomarkers combined were modestly higher compared to ALC alone. Negative predictive values were high.

CONCLUSIONS: Immune biomarkers have the potential to measure net immunosuppression and identify transplant recipients at higher risk for SOI. ALC was the most useful single test although incorporating 3 other biomarkers modestly improved predictions. Negative predictive values were high indicating that patients with high ALC values were unlikely to experience SOI. While this approach could inform decision-making regarding immunosuppression dosing, intensity of monitoring and antimicrobial prophylaxis, further research is required before clinical implementation.

PMID:42608343 | DOI:10.1111/ctr.70654

Aust Health Rev. 2026 Sep 3;50(3):AH26080. doi: 10.1071/AH26080.

ABSTRACT

OBJECTIVE: This study aims to describe national trends in pancreatic enzyme replacement therapy (PERT) dispensing in Australia and assess changes following the introduction of 60-day prescription dispensing, in the context of medicine shortages and market changes.

METHODS: Publicly available Pharmaceutical Benefits Scheme (PBS) data for pancreatic enzyme extract dispensings were analysed from February 2014 to October 2025. Monthly dispensing rates per 100,000 population were calculated using Australian Bureau of Statistics population estimates. Medicine shortage periods, including sustained shortages in 2025, were identified using the Therapeutic Goods Administration (TGA) database. Interrupted time-series analyses were conducted to evaluate changes in dispensing of 5000 U, 10,000 U, 25,000 U, and 35,000 U strengths before (July 2021-August 2023) and after (October 2023-October 2025) implementation of 60-day dispensing.

RESULTS: PERT dispensing increased from 33 to 85 dispensings per 100,000 population per month between February 2014 and October 2025 (160% increase). Dispensing patterns varied across formulations in response to market changes. Following the introduction of the 35,000 U strength in July 2021, its share of total dispensings increased, whereas dispensing of the discontinued 40,000 U strength declined from November 2020. Interrupted time-series analyses indicated a statistically significant immediate change in dispensing only for the 5000 U strength of PERT. Statistically significant changes in dispensing were observed following introduction of the policy for the 25,000 and 35,000 strengths, but the absolute difference in dispensings per 100,000 population per month was minimal.

CONCLUSIONS: PERT use in Australia has increased over time, reflecting growing clinical need. Although medicine shortages influenced utilisation patterns across strengths, the introduction of 60-day dispensing was not associated with significant changes in PBS dispensing of PERT. Ongoing monitoring is warranted given reliance on a single-brand therapy.

PMID:42608336 | DOI:10.1071/AH26080

Aust Health Rev. 2026 Sep 3;50(3):AH26115. doi: 10.1071/AH26115.

ABSTRACT

OBJECTIVE: This study aimed to describe pathway timing and 90-day outcomes for long-stay inpatients discharged to residential aged care homes (RACHs), predominantly new entrants, and to explore potentially modifiable factors associated with delays and the composite unsuccessful placement outcome.

METHODS: A retrospective cohort study using the Metro South Hospital and Health Service long-stay dashboard was used. Adults flagged as long-stay with a primary reason of awaiting RACH admission (1 January-31 May 2025) and subsequently admitted to a RACH within the health service were included. Key intervals were hospital admission-to-readiness for the RACH pathway and readiness-to-RACH admission (including interim care bed length of stay, where applicable). The primary outcome was the composite of unsuccessful placement within 90 days, defined as emergency department presentation, unplanned readmission, or non-return placement failure.

RESULTS: Of 293 flagged patients, 198 were admitted to a RACH and included. Median age was 83 years, and 48% were male; 49% had documented dementia. Median acute length of stay was 28 days; median time from admission to readiness was 10 days, and from readiness to RACH admission was 24 days. Within 90 days, 32% attended an emergency department, 22% were readmitted, and 5% experienced non-return placement failure; 36% met the composite outcome.

CONCLUSION: Long-stay inpatients discharged to RACH experience substantial pathway delays and frequent early acute-care utilisation. Strengthening early family engagement and goals-of-care documentation may support safer transitions and help target quality improvement.

PMID:42608335 | DOI:10.1071/AH26115

Personal Ment Health. 2026 Aug;20(3):e70096. doi: 10.1002/pmh.70096.

ABSTRACT

Brief interventions have been proposed as a means of increasing access to psychological treatment for people with personality disorder. However, evidence of their effectiveness is limited to date. A recent large-scale trial of Structured Psychological Support (SPS) for people with probable personality disorder showed little evidence of patient benefit. However, questions remain about whether shorter term psychological interventions may be suitable for some patients. We therefore conducted a secondary analysis of trial data to examine whether baseline level of personality dysfunction, duration of prior contact with mental health services and practitioner treatment sequence were associated with differential outcomes from SPS. Data from 336 participants recruited across seven NHS sites in England were analysed using multiple linear regression. We added interaction terms to examine moderation of treatment effects on social functioning and emotional dysregulation at 6 months. There was no clear evidence that practitioner treatment sequence influenced outcomes. There was also no strong statistical evidence that baseline personality dysfunction moderated treatment response, although exploratory analyses found weak evidence that SPS may be advantageous for emotional dysregulation among participants with lower levels of personality dysfunction. In addition, there was weak evidence that SPS was associated with improved social functioning among participants with shorter histories of contact with mental health services. Further research is needed to examine whether shorter term psychological interventions have a role for people with mild personality disorder or as part of early intervention pathways for people at an earlier stage of their contact with mental health services.

PMID:42608329 | DOI:10.1002/pmh.70096

Diabetes Obes Metab. 2026 Aug 17. doi: 10.1111/dom.71200. Online ahead of print.

ABSTRACT

AIMS: To further characterise the effects of retatrutide on cardiometabolic risk, lipoprotein and inflammatory biomarkers were assessed post hoc in phase 2 trials of adults with obesity/overweight with or without type 2 diabetes (T2D).

MATERIALS AND METHODS: Data were analysed from two randomised, double-blind, placebo-controlled phase 2 trials. In Study 1, adults with obesity/overweight and T2D received once-weekly retatrutide (0.5/4/8/12 mg), dulaglutide (1.5 mg) or placebo for 36 weeks; in Study 2, adults with clinical obesity without T2D received retatrutide (1/4/8/12 mg) or placebo for 48 weeks. Fasting blood samples were collected at baseline and during treatment to assess lipids, apolipoproteins, lipoprotein particle subclasses and inflammatory biomarkers. Mixed models for repeated measures estimated placebo-adjusted change from baseline. Statistical significance was defined as a false discovery rate-adjusted p < 0.05.

RESULTS: Mean body mass index was 35.4 kg/m² (Study 1) and 37.4 kg/m² (Study 2). In both studies, retatrutide was associated with significant reductions in non-high-density lipoprotein cholesterol (Study 1: up to -21.0%, Study 2: up to -26.9%), apolipoprotein B (-21.4%, -24.2%), total triglyceride-rich lipoprotein particles (-22.5%, -33.7%), large triglyceride-rich lipoprotein particles (-84.4%, -76.6%), triglyceride-rich lipoprotein cholesterol (-29.4%, -38.6%), total low-density lipoprotein particles (-19.7%, -23.5%) and small low-density lipoprotein particles (-32.6%, -32.3%). Retatrutide was associated with significant reductions in high-sensitivity C-reactive protein (-54.8%) and interleukin-6 (-29.6%) in Study 2 but not Study 1.

CONCLUSIONS: In adults with obesity/overweight, with or without T2D, retatrutide treatment was associated with reductions in atherogenic lipoproteins and inflammatory biomarkers linked to cardiovascular disease risk.

TRIAL REGISTRATION: ClinicalTrials.gov numbers NCT04881760 and NCT04867785.

PMID:42608321 | DOI:10.1111/dom.71200

Zhongguo Dang Dai Er Ke Za Zhi. 2026 Aug 15;28(8):991-997. doi: 10.7499/j.issn.1008-8830.2511119.

ABSTRACT

OBJECTIVES: To establish a genotype-phenotype database and machine learning models for pseudohypertrophic muscular dystrophy (PMD), and to explore genotype-phenotype correlations of the disease.

METHODS: Clinical data of children with PMD admitted to Xiangya Hospital, Central South University from January 2010 to December 2024, together with cases retrieved from the PubMed database between January 1987 and December 2024, were retrospectively collected to construct a genotype-phenotype database, with an online query function via a WeChat mini-program. Based on this database, Random Forest, Extreme Gradient Boosting, and Light Gradient Boosting Machine algorithms were integrated using a soft voting ensemble strategy to build a machine learning model predicting clinical phenotypes associated with small variants. The predictive performance of the model was compared with that of the reading-frame rule. The model was deployed online via the Streamlit platform.

RESULTS: The database included 17 053 PMD cases, comprising 472 patients in the local cohort and 16 581 literature-derived cases. Modeling and validation were performed on a filtered dataset comprising small variants. In the internal test set, the machine learning model achieved an area under the receiver operating characteristic curve (AUC) of 0.924 (95%CI: 0.881-0.963), significantly higher than the reading-frame rule AUC of 0.652 (95%CI: 0.591-0.717) (P<0.001). In the external test set, the machine learning model achieved an AUC of 0.854 (95%CI: 0.736-1.000), compared to 0.667 (95%CI: 0.500-1.000) for the reading-frame rule, with no statistically significant difference (P>0.05).

CONCLUSIONS: The constructed PMD genotype-phenotype database and machine learning prediction model provide an efficient and reliable novel tool for phenotype prediction in PMD.

PMID:42608308 | DOI:10.7499/j.issn.1008-8830.2511119