Category: Nevin Manimala

Eur J Cardiovasc Nurs. 2026 Apr 10:zvag101. doi: 10.1093/eurjcn/zvag101. Online ahead of print.

ABSTRACT

BACKGROUND: The foundation for future educational and job opportunities is laid during the crucial years of primary education. Navigating them while a parent has heart disease adds a potential stressor. We investigated whether childhood experience of parental heart disease was associated with I) primary and secondary education completion, and II) grade point average (GPA) in primary education.

METHODS AND RESULTS: This national register study included adolescents from the Danish Fertility Register born between 1979 and 2003. Through the National Patient Register adolescents were linked with their parents who either had ischaemic heart disease, arrhythmia, heart failure or heart valve disease. Statistical analyses included descriptive statistics, multivariate logistic and linear regression models. The population consisted of 102,829 adolescents with at least one parent diagnosed with heart disease. The matched reference population included 411,311 children without parental heart disease. Having a parent with heart disease was associated with lower odds of not completing primary education (OR: 0.56, 95% CI 0.52;0.62), corresponding to absolute risks of 0.6% among exposed and 1.9% among unexposed adolescents, and a lower GPA (estimate: -0.10, 95% CI: -0.12; -0.08) compared to peers. Parental ischaemic heart disease was associated with higher odds of not completing secondary education (OR: 1.31, 95% CI 1.17;1.47).

CONCLUSION: Exposure to parental heart disease was associated with lower odds of non-completion of primary education and slightly lower GPA, with small absolute differences, and showed no overall association with secondary education completion. Adolescents with a parent diagnosed with ischaemic heart disease had a lower completion of secondary education. These findings indicate diagnosis-specific differences in educational outcomes, with an overall limited impact on educational completion.

PMID:41967126 | DOI:10.1093/eurjcn/zvag101

Interdiscip Cardiovasc Thorac Surg. 2026 Apr 9:ivag106. doi: 10.1093/icvts/ivag106. Online ahead of print.

ABSTRACT

BACKGROUND: Uniportal video-assisted thoracoscopic surgery (U-VATS) has been increasingly adopted for anatomical segmentectomy because of its minimally invasive nature and favourable recovery profile. However, whether perioperative outcomes differ between complex and simple segmentectomy when performed via U-VATS remains uncertain. This study compared perioperative outcomes between complex and simple U-VATS segmentectomy.

METHODS: A systematic review and meta-analysis were conducted according to PRISMA 2020 and AMSTAR 2 guidelines, and the study was registered in PROSPERO (CRD420251151464). Six databases were searched for studies comparing complex and simple U-VATS segmentectomy for pulmonary lesions. Primary outcomes were operative time, intraoperative blood loss, and conversion to thoracotomy. Secondary outcomes included chest tube duration, hospital stay, and postoperative complications. Random-effects models were used for pooled analyses.

RESULTS: Five retrospective studies, including 1,051 patients (707 complex; 344 simple), were analysed. No statistically significant differences were detected in operative time (MD = 15.25 minutes, 95% CI: -1.25 to 31.75; P = 0.07; I2 = 88%), intraoperative blood loss (MD = -1.33 mL, 95% CI: -11.95 to 9.29; P = 0.81; I2 = 58%), or conversion to thoracotomy (OR = 0.46, 95% CI: 0.10 to 1.99; P = 0.30; I2 = 0%). Secondary outcomes also showed no significant differences, including chest tube duration (MD = -0.15 days, 95% CI: -0.41 to 0.11; P = 0.25; I2 = 26%), hospital stay (MD = -0.16 days, 95% CI: -0.73 to 0.40; P = 0.57; I2 = 66%).

CONCLUSION: No statistically significant differences were detected in key perioperative outcomes between complex and simple U-VATS segmentectomy; however, given substantial clinical heterogeneity and limited retrospective evidence, findings should be interpreted cautiously and are most applicable to selected patients treated in experienced, high-volume centres.

PMID:41967114 | DOI:10.1093/icvts/ivag106

Biostatistics. 2026 Jan 20;27(1):kxag007. doi: 10.1093/biostatistics/kxag007.

ABSTRACT

High-dimensional longitudinal data are increasingly available in biomedical research, especially from omics platforms, but pose substantial challenges for joint modeling with survival outcomes. These challenges include modeling complex temporal dynamics, accommodating cross-feature dependencies, and maintaining computational feasibility. We propose a novel joint modeling framework that addresses these issues using supervised low-rank functional tensor decomposition to capture latent structure in multivariate longitudinal data and proportional hazards modeling for time-to-event outcomes. The longitudinal process is represented as a multivariate functional tensor, with a low-rank approximation that incorporates supervision from baseline covariates. Estimation is performed using a likelihood-based Monte Carlo Expectation-Maximization algorithm, enabling coherent inference and individualized prediction. Our method produces dynamic predictions of both longitudinal feature trajectories and survival probabilities. Simulation studies demonstrate substantial improvements in estimation accuracy and predictive performance over a standard two-stage approach, particularly under high censoring and limited sample sizes. In application to the Alzheimer’s Disease Neuroimaging Initiative lipidomics data, the proposed model explains over 99% of variation with four components, and identifies significant subject-level latent predictors of dementia onset. This framework provides a scalable and interpretable strategy for integrating high-dimensional longitudinal biomarkers into joint models for disease progression and risk stratification.

PMID:41967112 | DOI:10.1093/biostatistics/kxag007

Can J Ophthalmol. 2026 Apr 8:S0008-4182(26)00129-8. doi: 10.1016/j.jcjo.2026.03.017. Online ahead of print.

ABSTRACT

OBJECTIVE: Glaucoma is the leading cause of irreversible blindness worldwide. No postmarketing study has comprehensively assessed Food and Drug Administration (FDA)-approved drugs for glaucoma risk by subtype, therapeutic class, and sex. This study sought to identify systemic and ophthalmic drugs associated with glaucoma-related adverse events (AEs).

DESIGN: Population-based pharmacovigilance analysis of FDA Adverse Event Reporting System (FAERS) reports (January 2004-December 2024).

PARTICIPANTS: All glaucoma-related AEs, including normal-tension glaucoma (NTG), open-angle glaucoma (OAG), and angle-closure glaucoma (ACG).

METHODS: Events were identified with the Medical Dictionary for Regulatory Activities Preferred Terms. Disproportionality was assessed using reporting odds ratios (RORs; 95% CI), Evans’ criteria (n > 2; χ² > 4, Proportional reporting ratio > 2) and Bayesian confirmation (information component, lower 95% bound [IC₀₂₅] > 0). Analyses were stratified by subtype and sex.

RESULTS: Among 13,237,811 FAERS reports, 2 165 involved glaucoma-related events: 67 NTG, 372 OAG, and 1 726 ACG. Ranibizumab showed the strongest NTG signal (ROR = 83.73; 95% confidence interval [CI] = 38.20-183.66), especially in females (ROR = 162.36; 95% CI = 62.14-424.21). In OAG, significant signals were found for ranibizumab (ROR = 27.13; 95% CI = 15.60-47.19), topiramate (ROR = 21.58; 95% CI = 12.14-38.37), duloxetine (ROR = 9.09; 95% CI = 4.85-17.03), alendronate (ROR = 13.52; 95% CI = 8.78-20.82), and female-specific methylphenidate (ROR = 42.57; 95% CI = 20.94-86.51). In ACG, top signals included tropicamide (ROR = 166.10; 95% CI = 105.18-262.30), topiramate (ROR = 109.19; 95% CI = 98.54-121.00), imipramine (ROR = 33.96; 95% CI = 20.05-57.53), phentermine (ROR = 25.25; 95% CI = 16.73-38.13), and chlorpromazine (ROR = 13.93; 95% CI = 7.69-25.21). Tropicamide, topiramate, and imipramine showed stronger ACG signals in males. All associations were statistically significant (p < 0.0001; IC₀₂₅ > 0).

CONCLUSIONS: This large-scale FAERS analysis provides the most comprehensive assessment of drug-associated glaucoma risk to date. It confirms known associations and identifies novel signals across anti-vascular endothelial growth factor, cardiovascular, psychiatric, and respiratory drugs. Subtype- and sex-specific patterns underscore the need for individualized risk assessment, targeted postmarketing surveillance, and cautious prescribing to reduce preventable glaucoma-related vision loss.

PMID:41967096 | DOI:10.1016/j.jcjo.2026.03.017

Eur J Prev Cardiol. 2026 Apr 9:zwag206. doi: 10.1093/eurjpc/zwag206. Online ahead of print.

ABSTRACT

AIMS: To examine the bidirectional association between myocardial infarction (MI) and depression and to summarize shared comorbidities and cardiovascular risk factors underlying their co-occurrence.

METHODS: PubMed, Embase, and PsycINFO were searched from inception to 31 December 2025 for prospective cohort and longitudinal studies reporting time-to-event estimates for either direction of the MI-depression association. Random-effects meta-analyses were used to pool adjusted hazard ratios (HRs), with heterogeneity assessed using the I2 statistic. Study quality was evaluated using the Newcastle-Ottawa Scale. Subgroup analyses by sex and age and sensitivity analyses restricted to high-quality studies and studies with only clinically diagnosed depression were performed. Antidepressant treatment class was examined exploratorily, and shared comorbidities and cardiovascular risk factors were synthesized descriptively.

RESULTS: Nine population-based cohort studies were included. Meta-analysis of two studies showed that MI was associated with an increased risk of subsequent depression (pooled adjusted hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.24-1.61; I2 = 0%). Eight studies examining depression as the exposure demonstrated an increased risk of incident MI (pooled adjusted HR 1.42, 95% CI 1.29-1.57), with substantial heterogeneity (I2 = 84.7%). Stratified estimates from individual studies suggested stronger relative associations among younger individuals and sex-specific differences according to the direction of the association. Sparse evidence indicated that tricyclic antidepressant use was associated with a higher observed risk of MI, whereas selective serotonin reuptake inhibitors were not. Cardiometabolic and mental comorbidities, including diabetes, hypertension, dyslipidaemia, coronary heart disease, stroke, anxiety, and post-traumatic stress disorder, alongside chronic kidney disease, were commonly reported across both temporal directions.

CONCLUSIONS: MI and depression show bidirectional associations, with each condition conferring an increased risk for the other. These associations are observed alongside demographic differences and shared cardiometabolic and mental comorbidities, stressing the importance of integrated cardiovascular and mental health assessment; however, these findings should be interpreted cautiously given the limited available evidence.

PMID:41967088 | DOI:10.1093/eurjpc/zwag206

JNCI Cancer Spectr. 2026 Apr 9:pkag037. doi: 10.1093/jncics/pkag037. Online ahead of print.

ABSTRACT

Thyroid nodule ultrasound (US) images and their features are of great importance in thyroid nodule diagnosis, and can be helpful for radiologists’ clinical decision-making. To evaluate whether an AI-assisted system can accurately characterize thyroid nodule ultrasound features and assist radiologists in diagnosing thyroid cancer. The AI-assisted system (MDT-TC) was trained and internally validated on B-mode US images from 7204 lesions in 6884 patients in Southwest Hospital (SW). The model performance was validated using three independent external validation cohorts. Echogenicity (ECH) and shape (SHA) are features of high importance for model recognition, and these features lead to excellent model performance. The model achieved up to 87.56% accuracy in determining ECH attributes and 69.21% in identifying shape categories. The AUC of the internal validation cohort and three independent external validation cohorts for MDT-TC were 0.951, 0.837, 0.816, and 0.871, respectively. The sensitivity values were 98.7%, 91.2%, 90.3%, and 85.6%, respectively. The AUC for the accurate diagnosis of radiologists with MDT-TC assistance was significantly higher than that of radiologists without MDT-TC assistance (p < 0.001). In addition, the AUC for the accurate diagnosis of junior doctors with MDT-TC assistance was significantly higher than that for those who did not (p < 0.01). MDT-TC incorporates radiomic features extracted from thyroid lesion US images, and can significantly improve the diagnostic performance of radiologists. This result was particularly strong for junior doctors. Therefore, our data support the idea that MDT-TC can help to identify patients with thyroid cancer and could greatly benefit clinical practice.

PMID:41967078 | DOI:10.1093/jncics/pkag037

J Sex Med. 2026 Apr 9;23(5):qdag086. doi: 10.1093/jsxmed/qdag086.

ABSTRACT

INTRODUCTION: Mid-urethral slings (MUS) are widely used to treat urinary incontinence. However, there is limited evidence of their long-term effects on female sexual function.

OBJECTIVES: To address this gap, this meta-analysis of randomized controlled trials evaluates changes in Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 scores at 6, 12, 24, and 36 months postoperatively.

METHODS: We systematically searched PubMed, Cochrane Central, and Embase for studies evaluating the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 scores 6, 12, 24, and 36 months after MUS surgery. We performed a single-arm meta-analysis of single means along with their 95% confidence intervals (CIs) by applying a random-effects model. Subgroup analyses based on MUS types (single-incision, retropubic, and transobturator) were performed to evaluate their specific impacts on sexual function outcomes. Statistical analyses were conducted using Review Manager v5.4 and R v4.3.3.

RESULTS: We included 11 randomized controlled trials comprising a total of 2909 patients, of whom 1747 (60.1%) received a transobturator sling, 505 (17.4%) underwent retropubic sling placement, and 657 (22.6%) were treated with a single-incision sling. At 6 months, pooled analysis showed an improvement in sexual function, with a mean change from baseline of 4.49 points (95% CI 3.51 to 5.46). By 12 months, a decrease of 2.68 points (95% CI 0.67 to 4.70) was observed compared with the 6-month assessment. At 24 months, sexual function also declined slightly of -0.52 points (95% CI -2.71 to 1.68; P = 0.31), while at 36 months, there was a slight increase of 0.11 points (95% CI -1.95 to 2.17; P = 0.53). Regarding subgroup analysis, no significant differences among sling types, except at 12 months, when the transobturator group showed greater decline.

CONCLUSIONS: Our findings indicate that MUS are associated with an initial improvement in sexual function, particularly at 6 months. However, this improvement is not maintained in long-term follow-up, with scores declining or stabilizing at later time points. These findings are important for patient education and for setting realistic expectations regarding postoperative sexual function.

PMID:41967068 | DOI:10.1093/jsxmed/qdag086

J Antimicrob Chemother. 2026 Apr 3;81(5):dkag127. doi: 10.1093/jac/dkag127.

ABSTRACT

OBJECTIVES: Aminopenicillin associated with parenteral cephalosporins provides synergistic activity against Enterococcus faecalis. Oral consolidation treatment is an option for infective endocarditis E. faecalis (EFIE), but optimal oral regimen remains under debate. We aimed to assess the in vitro activity of combinations based on amoxicillin plus an oral cephalosporin, namely, cephalexin or cefixime, against E. faecalis strains.

METHODS: MIC and MBC values were determined against 6 clinical isolates of endocarditis-associated E. faecalis. Time-kill (TK) experiments were performed using amoxicillin (½MIC) plus cephalexin or cefixime at different concentrations (Cmax, ½Cmax and Cmin). Comparator regimens were amoxicillin/cefazolin and amoxicillin/ceftriaxone. TK experiments were carried out at standard (∼5 × 105 cfu/mL) and high inoculum (∼108 cfu/mL).

RESULTS: Using amoxicillin combined with Cmax, ½Cmax or Cmin of oral cephalosporin at standard inoculum, synergy or additivity was observed in 66, 33 and 0% of E. faecalis isolates with adjunctive cephalexin; and in 83, 50 and 33% of isolates with adjunctive cefixime, respectively. In comparator regimens, synergy was found in all isolates at standard inoculum. At high inoculum, amoxicillin/cefixime at Cmax had similar efficacy to amoxicillin/ceftriaxone, showing synergy in 50% of E. faecalis isolates, while amoxicillin/cephalexin at Cmax and amoxicillin/cefazolin only achieved synergy in 17% of isolates.

CONCLUSIONS: The combination of amoxicillin/cefixime exhibits synergy in most E. faecalis strains at standard inoculum. Cefixime could represent an interesting adjunctive therapy to amoxicillin for oral consolidation treatment of EFIE.

PMID:41967057 | DOI:10.1093/jac/dkag127

Age Ageing. 2026 Apr 4;55(4):afag084. doi: 10.1093/ageing/afag084.

ABSTRACT

BACKGROUND: Polypharmacy is a major concern among older adults in long-term care facilities (LTCFs), as it increases the risk of potentially inappropriate medications (PIMs) and related adverse outcomes. Medication review and deprescribing interventions may help optimise therapy and reduce harm.

DESIGN: Systematic review and meta-analysis.

METHODS: This study was conducted according to PRISMA guidelines (PROSPERO: CRD42023486056). PubMed, Embase and Scopus were searched up to 27 August 2024, for experimental studies evaluating the impact of medication review/deprescribing interventions in older LTCF residents with polypharmacy. Outcomes included medication appropriateness indexes, falls, hospitalisations and mortality. We calculated risk ratios for dichotomous data and mean differences for continuous data [with 95% confidence intervals (CIs)]. The quality of the studies was assessed using RoB 2 for the randomised controlled trials (RCTs) and the ROBINS-I for non-randomised studies.

RESULTS: From 3548 records, 38 studies (22 RCTs, 16 quasi-experimental) were included. Pooled analyses demonstrated significant reductions in the number of drugs per patient [within 12 months: -0.89 (95% CI -1.46, -0.32); at ≥12 months: -1.60 (95% CI -2.68, -0.52)] and in PIMs [at 6 months: -0.48 (95% CI -0.74, -0.22); at ≥12 months: -0.26 (95% CI -0.40, -0.13)]. No significant effects were observed on falls, hospitalisations or mortality. Studies showed wide methodological heterogeneity and had moderate to high risk of bias (23 moderate, 14 high, 1 low).

CONCLUSIONS: Comprehensive medication review interventions improved prescribing appropriateness in older LTCF residents with polypharmacy but did not significantly affect clinical outcomes (i.e. falls, hospitalisations and mortality). Further high-quality studies using standardised approaches are needed.

PMID:41967033 | DOI:10.1093/ageing/afag084

Dis Esophagus. 2026 Mar 2;39(2):doag032. doi: 10.1093/dote/doag032.

ABSTRACT

Esophageal dilation is a cornerstone therapeutic intervention in managing esophageal narrowing, using various types of dilation devices. While highly effective, it carries risks, including patient-related adverse events (PRAE) and device-related failures (DRF). Analysis of these complications is imperative for decision-making with the goal of enhancing procedural safety. Reports from the Manufacturer and User Facility Device Experience (MAUDE) database from January 2014 to June 2024 were analyzed. Although circulation numbers are unknown, event occurrence per device was compared using weighted averages of events and Poisson regression. A total of 1418 reports were identified, yielding 117 PRAE and 1845 DRF. The overall weighted average of PRAE was 0.07 (95% CI: 0.03, 0.11) per report, while DRF were 1.24 (95% CI: 1.13-1.36) per report. The most common PRAE was perforation (n = 32; 27%), with the most reports attributed to Rigiflex Pneumatic II (n = 13) and Savary-Giliard/American (n = 9). The most common DRFs pertained to material integrity issues which occur at relative rates 2.4 to 3.9 times higher than other device-related complications. About 117 PRAE reports were identified in the entire cohort. After excluding pneumatic dilation cases, it was determined that 70% (n = 71) of all PRAEs co-occurred with a material integrity issue. MAUDE analysis suggests variability in safety profiles across esophageal dilators. Perforation is the most reported PRAE across esophageal dilation procedures in general and may be linked to the co-occurrence of material integrity issues and aberrant guidewires in certain wire-guided polyvinyl dilators. To reduce PRAE occurrences, we encourage operators to recognize these patterns and their potential impact on adverse patient outcomes.

PMID:41967027 | DOI:10.1093/dote/doag032