Category: Nevin Manimala

Support Care Cancer. 2026 Jul 29;34(8):812. doi: 10.1007/s00520-026-10998-z.

ABSTRACT

BACKGROUND: Patient navigation programs (PNPs) have been increasingly applied in breast cancer (BC) care of underserved clients, as they can significantly assist them with coordinating services across the care continuum. However, existing evidence has produced inconclusive findings regarding the empirical adequacy of BC-related caring interventions developed from PNPs. Hence, the aim of the present systematic review and meta-analysis was to clarify the benefits of PNPs across all phases of the BC care continuum. Primary outcomes comprised care-continuum indicators extracted predominantly from medical records, while secondary outcomes included client-reported healthcare measures.

METHODS: Five electronic data sources were searched for randomized controlled trials (RCTs) that investigated the effectiveness of PNPs across the BC care continuum from 1995 to January 10, 2025, with no restrictions on clients’ sociodemographic characteristics. A random-effects model, using both the DerSimonian-Laird (DL) method and the Hartung-Knapp (HK) adjustment, was applied to estimate standardized mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes, with 95% confidence intervals (CIs).

RESULTS: Thirty-seven RCTs met the inclusion criteria, including four cluster RCTs and 33 individual RCTs. Quantitative synthesis was not feasible for time-to-resolution, adherence to adjuvant or post-treatment follow-up care, timely treatment initiation, treatment completion, satisfaction with care, or psychological distress; therefore, the effectiveness of PNPs for these outcomes remains uncertain. Meta-analyses of individual RCTs, all conducted using a DL random-effects model, indicated that PNPs significantly improved diagnostic follow-up compliance (OR, 2.42; 95% CI, 1.64, 3.59; P < 0.001); screening mammogram adherence (OR, 2.18; 95% CI, 1.71, 2.77; P < 0.001); and timely diagnostic resolution (OR, 2.51; 95% CI, 1.21, 5.24; P = 0.014). Using the same DL model, PNPs also improved quality of life (SMD, 0.44; 95% CI, 0.09, 0.79; P = 0.014) and reduced anxiety (SMD, -0.94; 95% CI, -1.66, -0.22; P = 0.010). However, no statistically significant effects were observed under the DL model for depression (SMD, -0.34; 95% CI, -0.71, 0.04; P = 0.076) or BC knowledge (SMD, 0.27; 95% CI, -0.19, 0.73; P = 0.247). Substantial heterogeneity was observed across most pooled outcomes (I² = 63.9%-93.0%), accompanied by wide prediction intervals that included the null value. After applying the HK adjustment, the previously observed beneficial effects of PNPs on timely diagnostic resolution, quality of life, and anxiety were no longer statistically significant.

CONCLUSION: Although initial analyses suggested that PNPs may improve several BC-related outcomes, these observed benefits were reduced in magnitude and, in some cases, no longer statistically significant after applying more conservative adjustment methods. Moreover, substantial heterogeneity across studies and the overall low methodological quality limit the certainty of the evidence. Therefore, the current findings should be interpreted cautiously, and further high-quality RCTs are needed to draw more definitive conclusions about the effectiveness of PNPs across the BC care continuum.

PROSPERO REGISTRATION: CRD42023487495.

PMID:42525303 | DOI:10.1007/s00520-026-10998-z

Hernia. 2026 Jul 29;30(1):304. doi: 10.1007/s10029-026-03798-1.

ABSTRACT

PURPOSE: Mesh suture is a suture device designed to distribute pressure at the suture-tissue interface to decrease suture pull-through. The primary aim of this study was to evaluate the feasibility and short-term clinical outcomes in isolated umbilical hernia repairs.

METHODS: A retrospective cohort of patients undergoing umbilical hernia repair using mesh suture was analyzed between January 2023-2025. Patients were identified through institutional implant logs. Outcomes evaluated included surgical site infection (SSI), surgical site events (SSE), hernia recurrence, readmissions, and reoperations.

RESULTS: Fifty-eight isolated umbilical hernia repairs with mesh suture were performed by twenty-four surgeons. The mean hernia width was 1.7 cm (± 0.7). The 90-day SSI rate was 5.2% (n = 3), consisting of two superficial infections and one organ space infection. The 90-day SSE rate was 5.2% (n = 1 fascial dehiscence, n = 2 hematomas). There were seven readmissions (12.1%) within 90 days, of which only one was related to the abdominal wall closure. There were three reoperations within 90 days (5.2%): two hematoma washouts and one fascial dehiscence repair. The mean length of follow up was 594 days (± 284). There were no cases of hernia recurrence.

CONCLUSIONS: Mesh suture provides the simplicity of suture repair with increased force distribution properties of mesh. In this initial multicenter experience, mesh suture demonstrated feasibility and acceptable short-term clinical outcomes for isolated umbilical hernia repair. Future randomized controlled trials comparing mesh suture versus planar mesh and standard suture are needed to compare techniques most effectively.

PMID:42525301 | DOI:10.1007/s10029-026-03798-1

Wien Klin Wochenschr. 2026 Jul 29. doi: 10.1007/s00508-026-02799-5. Online ahead of print.

ABSTRACT

BACKGROUND: Treatment goal limitations, such as “do not resuscitate”, “do not escalate” and “comfort terminal care” are frequent in acute hospital care for patients with advanced illness, multimorbidity or impending death. Their ethical defensibility depends on transparent documentation of medical indications, proportionality and, where relevant, patient will.

OBJECTIVE: To examine whether documentation made medical rationale, patient will, advance directives, relatives’ involvement or ethics consultation visible.

METHODS: We retrospectively analyzed documentation in an Austrian internal medicine department with intensive care over 12 months. Documents were identified in the hospital information system and descriptively analyzed. Deceased patients with documented limitations underwent manual review. Data were anonymized and analyzed using Microsoft Excel for Microsoft 365 (Microsoft Corporation, Redmond, WA, USA) and IBM SPSS Statistics, version 29 (IBM Corp., Armonk, NY, USA).

RESULTS: Across 3998 inpatient stays involving 1829 patients, 277 patients had a documented treatment goal limitation (15.1%). Among 174 deceased patients, 111 had a documented limitation at death (63.8%). The most frequent order was combined do not resuscitate/do not escalate (75/111; 67.6%), followed by isolated do not resuscitate (23/111; 20.7%). Complete records were available for 101 cases; in 10 the rationale was not clearly traceable. Among the 101 manually reviewed cases, an explicit or presumed patient will was documented in 7 cases (6.9%), involvement of relatives in 13 cases (12.9%) and ethics consultation in 1 case (1.0%); medical rationale or physician decision was documented in 90 of 91 cases with traceable rationale (98.9%).

CONCLUSION: Treatment goal limitations were common and usually medically justified in the records. The findings do not imply inappropriate decisions or lack of communication but show limited reconstruction of patient-centered reasoning. Documentation should make clearer how benefit, care, respect for autonomy and justice informed treatment limitation.

PMID:42525299 | DOI:10.1007/s00508-026-02799-5

Int Ophthalmol. 2026 Jul 29;46(1):316. doi: 10.1007/s10792-026-04193-6.

ABSTRACT

PURPOSE: To evaluate whether umbilical cord blood platelet lysate (UCB-PL) can preserve the morphology and characteristics of human corneal endothelial cells during organ culture and serve as a xeno-free alternative to fetal bovine serum (FBS).

METHODS: Paired human donor corneas were cultured for 28 days in α-MEM-based medium supplemented with either 2% FBS or 2% UCB-PL. Endothelial morphology, cell density, viability, and mosaic regularity were assessed at predefined time points. Metabolic activity was evaluated by measuring pH, glucose, and lactate concentrations in the culture media. Endothelial integrity, apoptosis, and proliferation were analyzed by whole-mount immunofluorescence staining for ZO-1, Na⁺/K⁺-ATPase, caspase-3, and Ki-67.

RESULTS: Corneas stored in UCB-PL-supplemented medium demonstrated endothelial morphology, cell density decline, and viability comparable to those observed in FBS-supplemented medium throughout the culture period. No significant differences were detected between groups at any time point. Metabolic analysis showed sustained glucose availability and expected lactate accumulation in both media, without evidence of nutrient depletion. Immunofluorescence confirmed preserved endothelial junctional organization and pump protein expression, with no signs of endothelial apoptosis or proliferation.

CONCLUSION: In this pilot feasibility study, UCB-PL supported preservation of human corneal endothelial morphology and endothelial-associated protein expression during organ culture and demonstrated similar trends to FBS. These findings support further investigation of UCB-PL as a potential xeno-free alternative for corneal storage media.

PMID:42525298 | DOI:10.1007/s10792-026-04193-6

Naunyn Schmiedebergs Arch Pharmacol. 2026 Jul 29. doi: 10.1007/s00210-026-05765-0. Online ahead of print.

ABSTRACT

Hypertonic saline solution (HSS) combined with furosemide has been proposed as a strategy to enhance decongestion in acute decompensated heart failure (ADHF). We aimed to compare two HSS regimens with conventional furosemide therapy with respect to neurohormonal and echocardiographic markers of decongestion at 72 h. In this prospective, open-label, randomized, three-arm comparative study, 78 patients with ADHF (NYHA class III) were randomized to the following: group 1 (n = 28): HSS 50 mL BID + furosemide 3 × 2 amp IV bolus; group 2 (n = 25): HSS 100 mL OD + furosemide bolus-to-infusion; and group 3 (n = 25): conventional furosemide bolus-to-infusion. Primary endpoints were NT-proBNP reduction and IVC diameter change at 72 h. HSS groups achieved significantly greater reductions in NT-proBNP (- 2317 vs. – 416 pg/mL; p = 0.010) and IVC diameter (- 0.32 vs. – 0.20 cm; p = 0.036) compared with conventional therapy. Urine output and body weight reduction were numerically higher in the HSS groups but did not reach statistical significance (p = 0.089 and p = 0.114, respectively). HSS was associated with superior preservation of plasma sodium and potassium (both p = 0.001). No neurological or cardiopulmonary adverse events were observed. The addition of HSS to furosemide in patients with ADHF was associated with greater improvement in neurohormonal and echocardiographic indices of decongestion while maintaining electrolyte homeostasis compared with conventional furosemide therapy. These findings support further evaluation of this therapeutic approach in larger prospective randomized studies.

PMID:42525296 | DOI:10.1007/s00210-026-05765-0

Eur J Pediatr. 2026 Jul 29;185(8):623. doi: 10.1007/s00431-026-07268-9.

ABSTRACT

Continuous Positive Airway Pressure (CPAP) is the first-line respiratory support for preterm neonates with respiratory distress, but 15-30% fail and require invasive mechanical ventilation (IMV). Lung ultrasound (LUS) has emerged as a radiation-free, point-of-care imaging modality with demonstrated superiority over chest radiography for diagnosing neonatal respiratory conditions, whose serial performance for predicting IMV across a broad preterm cohort is not well characterised. Objective: To evaluate the diagnostic accuracy of serial LUS scores on Days 1-3 for predicting IMV within 7 days in preterm neonates (< 37 weeks), and to identify independent predictors of IMV. Methods: This prospective diagnostic accuracy cohort study was conducted in a Level III NICU between November 2022 and November 2024. 207 preterm neonates with respiratory distress underwent standardised 6-zone, 18-point lung ultrasound (LUS) scoring on Days 1, 2, and 3. ROC analysis determined optimal LUS score cut-offs for predicting IMV, while multivariable logistic regression identified independent predictors after multicollinearity assessment, model performance was evaluated using goodness-of-fit testing. Results: Among 207 preterm neonates (gestational age 32.5±2.5 weeks; birth weight 1779±626 g), 28 (13.5%) required IMV by Day 7. Day-1 LUS ≥4 predicted IMV with AUC 0.72 (95% CI 0.59-0.84), sensitivity 64%, specificity 78%, NPV 93%; Day-2 LUS ≥2 improved specificity (87%) and NPV (97%); Day-3 LUS showed limited accuracy (AUC 0.61). Surfactant use, shock, and SNAPPE-II score independently predicted the requirement of IMV within the first 7days of life.

CONCLUSIONS: Serial lung ultrasound scoring demonstrated good clinical utility, with a high negative predictive value (NPV) of the Day-1 LUS score (cut-off ≥ 4) for identifying preterm neonates unlikely to require invasive mechanical ventilation within the first 7 days of life. Integration with clinical scoring may optimize early respiratory triaging in resource-limited NICUs. Multicentre validation against newer consensus frameworks is needed before routine adoption.

WHAT IS KNOWN: • LUS is an accurate, radiation-free bedside tool for diagnosing neonatal respiratory disorders, predicting surfactantrequirement in preterm infants. • Most studies have used single-time-point LUS assessments and focused on a single outcome.

WHAT IS NEW: •A Day-1 LUS score ≥4 identifi ed infants at low risk of invasive mechanical ventilation (NPV 93%). • Surfactant requirement (OR 28.60), shock (OR 6.18), and SNAPPE-II (OR 1.06 per point) independently predictedIMV.

PMID:42525288 | DOI:10.1007/s00431-026-07268-9

Environ Monit Assess. 2026 Jul 29;198(8):891. doi: 10.1007/s10661-026-15708-0.

ABSTRACT

The expansion and intensification of agriculture in the Argentine Pampas have increased pesticide use, raising concerns about groundwater contamination in aquifers used for drinking water. In this context, contamination risk assessment is a key tool for environmental management, although results may vary depending on the methodology applied. This study compares two approaches for assessing pesticide-related groundwater contamination risk in the Quequén Grande River watershed (Argentina). Risk was defined as the interaction between aquifer contamination hazard and population vulnerability. Hazard was estimated by combining aquifer vulnerability (DRASTIC-P) with two representations of contaminant load: (i) a land-use-based approach derived from LANDSAT imagery, and (ii) an empirical model based on pesticide leaching experiments relating mobility to soil organic matter. Social vulnerability was assessed using a census-based index. All analyses were conducted within a GIS framework. Results show that the two approaches produce markedly different spatial risk patterns. These differences were evaluated through methodological comparison and preliminary field evidence, but not through a comprehensive independent basin-wide validation. The land-use-based method identified a larger proportion of high-risk areas (20.1%), whereas the laboratory-based approach yielded more restrictive estimates (9.4%) and greater spatial differentiation. These differences reflect the conceptual assumptions underlying each method. The results highlight that method selection strongly influences risk assessment outcomes and should be aligned with management objectives, data availability, and acceptable levels of uncertainty.

PMID:42525282 | DOI:10.1007/s10661-026-15708-0

Eur Radiol. 2026 Jul 29. doi: 10.1007/s00330-026-12763-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the malignancy risk of peripheral lung lesions with non-diagnostic percutaneous transthoracic needle biopsy (PTNB) findings and to evaluate contrast-enhanced ultrasound (CEUS) guidance for reducing non-diagnostic outcomes.

MATERIALS AND METHODS: This retrospective study included patients who underwent PTNB at three institutions between October 2018 and March 2023. PTNB results were categorized as diagnostic (malignancy or specific benignity) or non-diagnostic (nonspecific benignity, atypical epithelia, insufficient samples, or sampling failure). The risk factors for malignancy and the effectiveness of CEUS for guiding PTNB were analyzed.

RESULTS: This study included 1591 peripheral lung lesions from 1558 patients (median age: 63 y; range: 18-87 y). Among these patients, 1072 were male, and 486 were female. Approximately 40% of PTNBs yielded non-diagnostic results. Malignancy risk increased with increasing lesion size (p < 0.001). Granulomatous inflammation/organizing pneumonia was a protective factor. Compared with atypical cells of undetermined significance, atypical cells suspicious of malignancy conferred a higher malignancy risk (p < 0.001). No significant difference in malignancy rates was observed between insufficient samples and sampling failures (p > 0.05). Compared with non‑contrast enhanced US guidance, CEUS guidance demonstrated a significantly greater sampling success rate, higher diagnostic accuracy, and higher sensitivity, particularly for lesions measuring 3.1-5.0 cm (all p < 0.05).

CONCLUSION: In terms of non-diagnostic PTNB results, lesions with atypical epithelia have the highest malignancy risk, whereas nonspecific benign lesions have the lowest risk. This study suggests that CEUS-guided PTNB is significantly effective for diagnosing lesions ranging from 3.1 to 5.0 cm in size, aiding the selection of imaging guidance.

KEY POINTS: Question What is the malignancy risk in peripheral lung lesions of non-diagnostic PTNB results, and can CEUS guidance effectively improve diagnostic accuracy and reduce inconclusive outcomes? Findings Malignancy risk varies significantly across different non-diagnostic pathological categories, while CEUS guidance demonstrated improved overall diagnostic performance, particularly for lesions measuring 3.1 to 5.0 cm. Clinical relevance This study provides a risk-stratification framework for managing non-diagnostic biopsies and demonstrates that integrating CEUS can optimize sampling success, reduce repeated procedures, and ensure timely, accurate diagnosis for patients with peripheral lung lesions.

PMID:42525281 | DOI:10.1007/s00330-026-12763-6

Strabismus. 2026 Jul 29:1-8. doi: 10.1080/09273972.2026.2708089. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the influence of ocular misalignment on social trait attribution in children and to evaluate whether isolated variations in ocular alignment affect early social perception.

METHODS: In this prospective, cross-sectional study, 100 children aged 8-14 years evaluated standardized visual stimuli depicting characters that differed in ocular alignment (orthotropic, esotropic, and exotropic). The illustrations were neutrally designed to control for facial expression, symmetry, gender, and skin tone. Four questionnaire forms were created, each containing three images, and each participant completed only one form. Within each form, one image represented each ocular alignment condition, so that no child viewed more than one alignment version of the same base character. This design was intended to reduce direct comparison bias. Participants assigned predefined social traits – including intelligence, bravery, success, and friendliness – to each character. Responses were recorded in a binary format and statistically compared across alignment conditions.

RESULTS: Characters with ocular misalignment were less frequently assigned favorable attributes. Orthotropic characters were significantly more likely to be rated as intelligent, successful, and brave compared with both esotropic and exotropic characters (p < .05 for all comparisons). For friendliness, orthotropic characters were more frequently perceived as friendly than exotropic characters (p = .002). No significant differences were observed between esotropic and exotropic depictions. Age subgroup analysis (8-11 vs. 12-14 years) revealed similar perception patterns across groups.

CONCLUSION: Ocular alignment appears to influence social trait attribution in childhood. Even under controlled visual conditions, misalignment was associated with reduced attribution of positive characteristics. These findings highlight the potential role of early perceptual bias in the psychosocial experience of children with strabismus and underscore the broader clinical and societal relevance of ocular alignment beyond visual function.

PMID:42522688 | DOI:10.1080/09273972.2026.2708089

Cult Health Sex. 2026 Jul 29:1-13. doi: 10.1080/13691058.2026.2702631. Online ahead of print.

ABSTRACT

In this study we examine how intersecting gendered and ethnic identities shape access to sexual and reproductive health (SRH) information among Zezuru and Karanga people in rural Zimbabwe. While SRH policies in Zimbabwe promote universal access, they overlook intra-ethnic differences that produce uneven patterns of knowledge, service engagement, and autonomy. Using the theory of intersectionality, we investigate how cultural norms, religious beliefs, and socio-economic structures interact to create differentiated access to information and services. Data were collected through a cross-sectional quantitative survey conducted in Mashonaland East and Masvingo. The sample consisted of 418 respondents aged 18-49, selected using stratified multistage sampling. To analyse the data, we used descriptive and inferential statistics. Results show significant disparities where 84.3% (Karanga) compared to 55.9% (Zezuru) reported limited access to information. Additionally, men reported lower engagement with SRH information and services than women. Access to SRH information was shaped by intersecting factors including gender, ethnicity, religion, education, and livelihood insecurity. Findings call for SRH programmes and interventions that are locally entrenched, culturally responsive, and supported by strengthened community-based health systems.

PMID:42522653 | DOI:10.1080/13691058.2026.2702631