Category: Nevin Manimala

Perfusion. 2026 Mar 26:2676591261439568. doi: 10.1177/02676591261439568. Online ahead of print.

ABSTRACT

ObjectiveMyocardial protection research in adult cardiac surgery has increasingly examined single dose del Nido cardioplegia alongside conventional multidose blood cardioplegia. Using a scientometric modeling approach, this study aims to quantitatively evaluate whether the thematic emphasis of this literature has expanded over time from pure protection efficacy toward workflow-related procedural parameters.MethodsA total of 269 focal publications published between 2000 and 2025, representing a 25-years analytical period, comparing myocardial protection strategies were analyzed using the Web of Science (WoS) Core Collection database. Author keywords were stratified by two independent reviewers into two predefined conceptual domains: the Efficacy Domain, including terms related to physiological myocardial protection (e.g., troponin, ischemia-reperfusion), and the Efficiency Domain, including workflow-related procedural parameters (e.g., cross-clamp time, minimally invasive surgery, single dose cardioplegia), with strong inter-rater agreement (Cohen’s κ = 0.92). Temporal trends were quantified using weighted linear regression models to evaluate the association between publication year and the relative prominence of efficiency-domain terminology.ResultsAnalysis of publication volume reveals a marked increase in literature, particularly from 2018 onwards. Keyword network analysis identified three distinct clusters: (1) traditional blood cardioplegia, (2) modern adult surgery/minimally invasive applications, and (3) evidence synthesis. Trend analysis demonstrated a statistically significant increase in the prominence of efficiency-related terms over the study period (β = 0.027 per year, 95% CI 0.014-0.040; p for trend <0.01).ConclusionThis scientometric analysis indicates an increasing emphasis in the literature on workflow-related procedural parameters in the evaluation of cardioplegia strategies in adult cardiac surgery. Contemporary studies increasingly report workflow-related procedural parameters such as uninterrupted surgical flow, cross-clamp time, and compatibility with minimally invasive or robotic techniques in the evaluation of cardioplegia strategies. These findings indicate an expanding investigational emphasis within the literature toward workflow-related procedural parameters alongside traditional efficacy and safety-oriented outcomes.

PMID:41886766 | DOI:10.1177/02676591261439568

Obstet Gynecol. 2026 Mar 26. doi: 10.1097/AOG.0000000000006271. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate postpartum type 2 diabetes testing and classification using the revised 2022 American Diabetes Association (ADA) diagnostic criteria, in comparison with the American College of Obstetricians & Gynecologists’ (ACOG) criteria, in women with gestational diabetes mellitus (GDM) across inpatient and outpatient testing settings. Secondarily, we aimed to evaluate whether the timing of administration of the screening test was associated with differences in results.

METHODS: This was a retrospective cohort study of patients with GDM who delivered at a single institution between 2023 and 2025. The traditional cohort (January-December 2023) was recommended an outpatient 75-g, 2-hour oral glucose tolerance test (OGTT). The hybrid cohort (June 2024-June 2025) was given the option of inpatient screening during the delivery hospitalization or outpatient testing. The primary outcome was OGTT completion. Secondary outcomes were diagnoses of glucose intolerance or diabetes. In January 2022, the ADA revised postpartum diagnostic criteria so that a diabetes diagnosis would require two abnormal values instead of a single abnormal OGTT value. The ACOG and 2022 ADA criteria were applied to OGTT results retrospectively to estimate their effect on postpartum diabetes classification. In a subgroup analysis, we examined whether the timing of postpartum OGTTs influenced the results.

RESULTS: In the traditional cohort, 6,689 deliveries occurred; of these, 309 patients (4.6%) had GDM and met inclusion criteria. In the hybrid cohort, 6,312 deliveries occurred; of these, 276 (4.4%) patients met inclusion criteria. Rates of OGTT completion were higher in the hybrid cohort than in the traditional cohort (73.9% vs 31.7%, P<.001). Inpatient testing yielded higher rates of glucose intolerance (48.0%) and diabetes (15.4%) than outpatient testing in either cohort (traditional: 19.4% glucose intolerance and 4.1% diabetes; hybrid: 20.7% glucose intolerance and 3.4% diabetes). Application of the 2022 ADA criteria resulted in the reclassification of most ACOG-defined diabetes results as glucose intolerant (Bowker χ2=24, P<.001). In an adjusted multinomial regression that used ACOG criteria, inpatient testing was associated with glucose intolerance (adjusted odds ratio [aOR] 3.06; 95% CI, 1.57-5.97) and overt diabetes (aOR 4.65; 95% CI, 1.14-18.9) when compared with outpatient testing. Testing on postpartum day 1 relative to outpatient testing was associated with glucose intolerance (aOR 2.20; 95% CI, 1.36-3.57) and overt diabetes (aOR 3.92; 95% CI, 1.69-9.06), whereas testing on or after postpartum day 2 did not show a statistically significant association.

CONCLUSION: Inpatient screening improves the rate of postpartum testing, but diagnostic classification varies widely by the criteria used (ACOG vs ADA) and test timing (postpartum day 1 vs 2), which underscores the need for national guidance on optimal timing and interpretation of postpartum OGTTs.

PMID:41886750 | DOI:10.1097/AOG.0000000000006271

JMIR Cancer. 2026 Mar 26;12:e87347. doi: 10.2196/87347.

ABSTRACT

BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that requires rapid diagnosis and intervention. However, identifying these patients is difficult because the HLH-2004 diagnostic criteria are complex and not always captured systematically in electronic health records (EHRs). Furthermore, it is unclear how clinicians use these criteria to diagnose HLH and make treatment decisions. There is a critical need for validated computable phenotypes to accurately identify patients and study treatment-related outcomes in HLH.

OBJECTIVE: The aim of this study is to compare different approaches to using the EHR to build computable phenotypes of patients with HLH and to evaluate characteristics and outcomes of patients meeting the HLH-2004 diagnostic criteria who received HLH-directed therapies compared to those who did not.

METHODS: Three approaches to computable phenotype development in the EHR were taken by identifying patients (1) with an HLH-specific International Statistical Classification of Diseases, Tenth Revision (ICD-10) code, (2) with an HLH-specific treatment plan, and (3) meeting the HLH-2004 clinical criteria for diagnosis of HLH. Among patients who met the HLH-2004 criteria, we evaluated the characteristics and outcomes of patients who received HLH-directed therapies compared to those who did not. HLH treatment was defined as either any chemotherapy or HLH-specific therapy (dexamethasone, methylprednisolone, anakinra, ruxolitinib, cyclosporine, etoposide, or emapalumab).

RESULTS: We identified 388 patients with possible HLH across the three cohorts. An HLH ICD-10 diagnosis (n=220) and meeting 5 or more clinical criteria (n=245) were much more common than a HLH treatment plan (n=42). Among the patients meeting HLH-2004 clinical criteria, 193 (79%) received HLH-directed therapy. There was no difference in any specific HLH criteria between those who did and did not receive HLH-directed therapy. In-hospital mortality was very high among both groups and was 15% among those who received HLH-directed therapy and 13.5% among those who did not receive HLH-directed therapy. Among 1325 patients with an elevated ferritin and fever, only 252 (19%) met >5 clinical criteria.

CONCLUSIONS: Constructing HLH cohorts from EHR data is challenging, with diagnosis codes, treatment plans, and clinical criteria each capturing distinct but overlapping populations.

PMID:41886745 | DOI:10.2196/87347

JMIR Public Health Surveill. 2026 Mar 26;12:e81849. doi: 10.2196/81849.

ABSTRACT

BACKGROUND: Renal disease represents a significant and growing public health concern globally and within Saudi Arabia. Despite the increasing burden of noncommunicable diseases, population-based data on the prevalence and determinants of renal disease in Saudi Arabia remain limited. Understanding epidemiology, including prevalence and associated risk factors of renal disease in the context of Saudi Arabia, is essential for designing preventive and early detection strategies.

OBJECTIVE: This study aims to estimate the prevalence of renal disease and to identify sociodemographic, behavioral, and clinically associated factors among adults attending primary health care centers (PHCs) in Riyadh, Saudi Arabia.

METHODS: A cross-sectional, community-based study was conducted between March 2023 and July 2023 across 48 PHCs within Riyadh, using a consecutive sampling strategy. Adults aged 18 years and older were recruited and completed a validated, interviewer-administered electronic questionnaire assessing sociodemographic characteristics, lifestyle behaviors, and medical history, including comorbid conditions and health care access. Multivariable logistic regression was used to determine factors associated with self-reported renal disease, with results expressed as adjusted odds ratios (AORs) and 95% CIs, ensuring model adequacy and precision.

RESULTS: A total of 14,239 participants were surveyed (n=7519, 52.8% female; mean age 41.6, SD 13.2 y). The prevalence of self-reported renal disease (including chronic kidney disease and kidney stones) was 3.5% (n=504). Individuals aged younger than 50 years had higher odds of renal disease (AOR 1.22, 95% CI 1.02-1.47). Female individuals were more likely to report renal disease than males (AOR 1.51, 95% CI 1.24-1.84). Participants with health insurance had increased odds (AOR1.74; 95% CI 1.44-2.11). Smoking was strongly associated with renal disease (AOR 3.07, 95% CI 2.38-3.96). Other important associated factors included comorbidities such as diabetes (AOR 1.51, 95% CI 1.12-2.04), hypertension (AOR 2.27, 95% CI 1.67-3.08), obesity (AOR 12.75, 95% CI 9.97-16.30), hypercholesterolemia (AOR 1.93, 95% CI 1.43-2.60), and heart disease (AOR 6.84, 95% CI 5.14-9.10).

CONCLUSIONS: This large, community-based cross-sectional study identifies a significant burden of renal disease among adults in Riyadh and highlights several modifiable risk factors that could be targeted in preventive health programs. The findings emphasize the importance of integrating renal health screening within PHCs and strengthening public health strategies addressing obesity, hypertension, and smoking. While the study relied on self-reported data without biomarker or clinical confirmation, potentially underestimating true prevalence and introducing misclassification bias, it provides a crucial population-level baseline that can guide resource allocation and inform the development of nationwide surveillance systems for early detection of renal disease.

PMID:41886734 | DOI:10.2196/81849

PLoS One. 2026 Mar 26;21(3):e0339187. doi: 10.1371/journal.pone.0339187. eCollection 2026.

ABSTRACT

This study introduces Bot Fit, an innovative hip-joint exoskeleton designed for the objective assessment of lower limb muscular strength and exercise performance. A total of 25 participants underwent baseline strength assessments using conventional fitness equipment before performing resistance exercises under two controlled conditions: a 10-second test without speed restrictions and a 30-second test at a constant speed. Bot Fit recorded motor signals and performance metrics, capturing key indicators such as repetitions and movement patterns. To analyze the relationship between muscle parameters and exercise performance, we employed correlation analysis, hierarchical cluster analysis (HCA), and regression analysis. The results demonstrated strong associations between lower limb strength and key exercises, including squats, knee-ups, and reverse lunges, particularly in short-duration and constant-speed conditions. HCA successfully clustered participants based on three exercise-related metrics with an accuracy of 0.89, while the regression model achieved a correlation coefficient of 0.86, indicating high statistical power. These findings suggest that Bot Fit provides a reliable, data-driven method for muscular strength assessment, offering valuable insights for optimizing exercise programs, preventing injuries, and enhancing physical performance. The integration of wearable robotic technology into health and fitness monitoring enables personalized exercise interventions and supports evidence-based decision-making in sports science, rehabilitation, and performance enhancement.

PMID:41886733 | DOI:10.1371/journal.pone.0339187

JCO Glob Oncol. 2026 Mar;12(3):e2500698. doi: 10.1200/GO-25-00698. Epub 2026 Mar 26.

ABSTRACT

PURPOSE: Exercise improves outcomes for patients with cancer, yet implementation of exercise counseling and referral in oncology care remains inconsistent in Latin America. This study evaluated current practices, barriers, promoters, and provider/practice factors influencing exercise counseling.

METHODS: We conducted a cross-sectional survey in Spanish and Portuguese among oncology physicians in Latin America (December 2024-February 2025). Eligible participants included medical, surgical, radiation oncologists, and palliative care specialists providing direct patient care. A culturally adapted questionnaire assessed practices, barriers, promoters, and demographics. Analyses included descriptive statistics, Chi-square tests, and regression to examine predictors of counseling behaviors.

RESULTS: A total of 454 physicians completed the survey (response rate: 29.5%). Although 62.5% routinely assessed physical activity, only 26.4% did so at every visit. Half regularly recommended exercise (50.7%), and 27.1% never referred patients to exercise programs. Barriers included patient factors (eg, fatigue, side effects, low motivation), provider insecurity/lack of knowledge (65.9%), and cultural norms favoring rest (76.7%). Promoters included prior training, personal exercise experience, and institutional support. Medical oncologists and hospital-based providers were more likely to assess, recommend, and refer (all P < .01). Regression showed prior training strongly predicted counseling behaviors (P < .001), while years in practice was negatively associated.

CONCLUSION: Despite awareness of exercise benefits, counseling and referral remain suboptimal in Latin America. Barriers include structural, knowledge, and cultural factors, while provider training and institutional support improve practices. These findings support the need for targeted educational, system investments, and culturally adapted guidelines to enhance exercise integration in cancer care.

PMID:41886716 | DOI:10.1200/GO-25-00698

JCO Glob Oncol. 2026 Mar;12(3):e2500345. doi: 10.1200/GO-25-00345. Epub 2026 Mar 26.

ABSTRACT

PURPOSE: Breast cancer (BC) outcomes are highly time-sensitive, yet delays in referral and treatment remain a major, often overlooked threat to survival in low- and middle-income countries. Understanding referral patterns may provide critical insights to address gaps in BC care delivery. This study examined referral patterns and delays related to breast complaints across the care continuum at a tertiary hospital in Rwanda.

METHODS: We conducted a retrospective cohort study of patients presenting with breast complaint(s) at Rwanda Military Referral and Teaching Hospital between January 2022 and June 2023. Electronic medical records and paper files were reviewed to extract preclinical and clinical data. Descriptive statistics were used. Chi-square and Fisher’s exact tests assessed associations between patient characteristics and BC diagnosis. Multivariable logistic regression identified factors associated with time delays. Statistical significance was set at P < .05.

RESULTS: Among 297 participants, 96.3% were female. The most common chief complaint was breast mass (87.9%). Nearly one third (32.0%, n = 95) were diagnosed with BC. Of 91 participants with documented stage, 74.7% presented with late-stage disease, including 60.4% (n = 55) at stage III and 14.3% (n = 13) at stage IV. Median presentation delay was 240 days (IQR, 90-720), biopsy interval 9 days (IQR, 4-18), pathology interval 10 days (IQR, 7-14), and treatment interval 29 days (IQR, 15-74). The median time from symptom onset to treatment initiation among confirmed BC patients was 13 months (IQR, 5-25). Age at diagnosis was significantly associated with malignancy (P < .001), with most malignant patients occurring among individuals age 31-50 years (51.1%, n = 47).

CONCLUSION: Substantial delays persist across the BC care continuum, particularly before diagnosis and treatment initiation.

PMID:41886715 | DOI:10.1200/GO-25-00345

Neurology. 2026 Apr 28;106(8):e214863. doi: 10.1212/WNL.0000000000214863. Epub 2026 Mar 26.

ABSTRACT

BACKGROUND AND OBJECTIVES: Medication-overuse headache (MOH) commonly co-occurs with and complicates chronic migraine (CM). This trial evaluated efficacy and safety of eptinezumab, an anti-calcitonin gene-related peptide monoclonal antibody for migraine prevention-combined with a standardized brief educational intervention (BEI)-in adults with CM and MOH. We report results from the 12-week placebo-controlled period, of which weeks 1-4 was the primary time point.

METHODS: The phase 4, double-blind, placebo-controlled RESOLUTION trial was conducted at 76 specialist clinics across 11 countries. Eligible participants were adults diagnosed with CM and MOH and were randomized 1:1 to eptinezumab 100 mg IV with BEI or placebo IV with BEI. The primary end point was mean change from baseline in monthly migraine days (MMDs; weeks 1-4). Key secondary end points (multiplicity-controlled) included changes from baseline in monthly headache days, monthly days with acute migraine medication use, and average daily pain, as well as fulfillment of thresholds defining CM and MOH. Treatment-emergent adverse events (TEAEs) were assessed.

RESULTS: Between July 2022 and March 2025, 608 participants were randomized, and 596 (98%) completed the placebo-controlled period. Of 604 participants treated, 517 (86%) were female and 87 (14%) were male; the mean age was 45.5 years (SD 12.0). The primary end point, mean change from baseline in MMDs (weeks 1-4), favored eptinezumab with BEI vs placebo with BEI (-6.9 vs -3.7; group difference -3.2; 95% CI -4.2 to -2.2; p < 0.0001). All key secondary end points showed statistically significant improvements with eptinezumab with BEI vs placebo with BEI; the greater reductions in disease burden observed during weeks 1-4 were sustained through weeks 1-12. The proportion of participants with TEAEs was similar with eptinezumab (41.9%) and placebo (36.9%); no new safety signals were identified.

DISCUSSION: In adults with CM and MOH who also received patient education, eptinezumab was statistically superior to placebo on the primary and all key secondary end points, reducing disease burden as early as weeks 1-4 and throughout weeks 1-12. Eptinezumab was generally well tolerated, with no new safety signals identified. Together, data from this trial indicate that eptinezumab in combination with patient education is an effective treatment for reducing disease burden in patients living with CM complicated by medication overuse.

TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov Identifier: NCT05452239 (clinicaltrials.gov/study/NCT05452239); EudraCT Number: 2021-003049-40 (clinicaltrialsregister.eu/ctr-search/search?query=2021-003049-40); EU CTR Number: 2024-510729-24-00 (euclinicaltrials.eu/search-for-clinical-trials/?lang=en&EUCT=2024-510729-24-00). EudraCT Number obtained: May 25, 2021. ClinicalTrials.gov Identifier obtained: July 6, 2022. First patient enrolled: July 1, 2022.

CLASSIFICATION OF EVIDENCE: This clinical trial provides Class I evidence that eptinezumab with patient education is superior to placebo with patient education in reducing MMDs in adults with CM and MOH.

PMID:41886713 | DOI:10.1212/WNL.0000000000214863

JCO Clin Cancer Inform. 2026 Mar;10:e2500166. doi: 10.1200/CCI-25-00166. Epub 2026 Mar 26.

ABSTRACT

PURPOSE: Access to care is an important component of cancer center catchment area (CA) analytics, where CAs are defined as the geographic scope of cancer center operations. Spatial access to care is one piece of the access to care continuum that is useful for quantifying population travel to health care providers. As no studies have comprehensively calculated CA spatial access to providers, we examined access to oncology, cancer care, and primary care providers for all 65 National Cancer Institute-designated cancer center CAs in the 48 contiguous US states.

METHODS: We used the 2024 end-of-year Centers for Medicare and Medicaid Services National Downloadable File and the enhanced two-step floating CA method to compute spatial accessibility. We stratified analyses by cancer center, census division, 2020 urban/rural status, 2023 area deprivation, and cancer center type, and produced select CA maps.

RESULTS: Census tracts in the Montefiore Einstein Comprehensive Cancer Center CA had the highest oncology and cancer care spatial access, while the Masonic Cancer Center had the highest primary care spatial access. New Jersey, New York, and Pennsylvania CAs had the highest oncology and cancer care spatial access (P < .001), while midwestern CAs had the highest primary care spatial access (P < .001). Across area deprivation index quartiles and all provider groupings, urban tracts had higher spatial access than rural tracts (P < .001). Comprehensive cancer centers had higher spatial access to oncology and primary care than noncomprehensive cancer centers (P < .001), while noncomprehensive cancer centers had higher spatial access to cancer care providers (P < .001).

CONCLUSION: We observed significant differences in CA spatial access to oncology, cancer care, and primary care by region, urban/rural status, socioeconomic position, and cancer center type.

PMID:41886708 | DOI:10.1200/CCI-25-00166

JCO Clin Cancer Inform. 2026 Mar;10:e2500326. doi: 10.1200/CCI-25-00326. Epub 2026 Mar 26.

ABSTRACT

PURPOSE: Measuring clinical practice guideline (CPG)-consistent care through electronic health record (EHR) queries provides a scalable and efficient approach to evaluating quality of care. Template care pathways are used to operationalize CPGs. Goals were to (1) identify care pathway actions for supportive care in pediatric oncology that are amenable to EHR-based evaluation, (2) prioritize five care pathway actions for further assessment, (3) develop EHR queries to identify patients who received care pathway-consistent care, and (4) describe the proportion of pediatric patients with cancer who received care pathway-consistent care.

METHODS: Within established template care pathways for pediatric cancer supportive care, we identified actions amenable to measurement using structured EHR data. Prioritization was performed by six pediatric oncology clinicians, resulting in five care pathway actions for further evaluation. We created EHR-based queries for each action at one site and applied them to a second site. Once queries were validated at both sites, we described care pathway-consistent care.

RESULTS: The five high-value care pathway actions focused on (1) management of highly emetogenic chemotherapy, (2) chest computed tomography for prolonged fever and neutropenia investigation, (3) antifungal prophylaxis in AML, (4) treatment of Clostridioides difficile infection, and (5) cisplatin ototoxicity prevention. Queries created at one institution were successfully executed at the second institution. Care pathway-consistent proportions ranged from 16% for sodium thiosulfate administration in patients with nonmetastatic hepatoblastoma to 91% for antifungal prophylaxis in patients with AML.

CONCLUSION: We successfully used the EHR to benchmark care pathway-consistent care. The prevalence of care pathway-consistent care was variable and low for some actions.

PMID:41886707 | DOI:10.1200/CCI-25-00326