Category: Nevin Manimala

Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Oct 20;33(4):470-478. doi: 10.5606/tgkdc.dergisi.2025.28290. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: This study aims to evaluate our experience with magnetic resonance lymphangiography in single-ventricle congenital heart disease patients and to examine the association between imaging findings and clinical outcomes and postoperative outcomes.

METHODS: Between November 2022 and May 2025, a total of 33 patients (22 males, 11 females; median age: 44 months; range, 37 to 57.5 months) with single-ventricle congenital heart disease who underwent T2-weighted magnetic resonance lymphangiography at our center were retrospectively analyzed. The T2-weighted sequences were chosen for their high-resolution depiction of lymphatic structures without the need for contrast agents. The imaging findings were analyzed for preoperative risk evaluation or suspected postoperative lymphatic complications.

RESULTS: Lymphatic abnormalities were categorized into types 1 to 3 based on the extent and distribution of T2-hyperintense signals. No patients in this cohort exhibited type 4 abnormalities. Among 33 patients, 11 (33%) were classified as type 1, 18 (55%) as type 2, and four (12%) as type 3. Although not statistically significant, patients with type 3 patterns had the longest median pleural effusion duration (27.5 days) and length of hospital stay (61 days). One patient showed early postoperative progression from type 2 to type 3, which resolved clinically and radiologically after fenestration ballooning. In the late period, two patients developed protein-losing enteropathy, and one had Fontan failure.

CONCLUSION: Magnetic resonance lymphangiography provides critical information about structural lymphatic abnormalities. It also aids risk stratification prior to the Fontan procedure and guides individualized management of postoperative complications, ultimately guiding treatment and improving outcomes.

PMID:41510542 | PMC:PMC12728969 | DOI:10.5606/tgkdc.dergisi.2025.28290

Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Oct 20;33(4):451-459. doi: 10.5606/tgkdc.dergisi.2025.27992. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: This study aims to investigate the effects of deep parasternal intercostal plane block on left internal thoracic artery vasospasm in coronary artery bypass grafting patients.

METHODS: Between March 2024 and August 2024, a total of 29 patients (24 males, 5 females; mean age: 60.1±8.3 years; range, 56 to 66 years) who were scheduled for elective coronary artery bypass grafting were included in this prospective study. An ultrasound-guided bilateral deep parasternal intercostal plane block was performed with 15 mL of 0.25% bupivacaine per side after anesthesia induction. Left internal thoracic artery peak systolic velocity, end-diastolic velocity, and resistive index, along with heart rate and mean arterial pressure, were recorded immediately before the block (T0) and 30 min after (T1). Demographics, body mass index, and comorbidities of the patients were noted.

RESULTS: After deep parasternal intercostal plane block administration, the left internal thoracic artery resistivity index decreased significantly (p=0.041), and the left internal thoracic artery diameter increased significantly (p=0.004). Although the peak systolic velocity increased and the end-diastolic velocity decreased following the block, these changes were not statistically significant (p=0.145 and p=0.135, respectively).

CONCLUSION: Our study findings suggest that deep parasternal intercostal plane block administration may prevent left internal thoracic artery vasospasm by increasing arterial conduit diameter and reducing the resistivity index. Based on these findings, we believe that this method can be safely applied under ultrasound guidance without complications.

PMID:41510541 | PMC:PMC12728966 | DOI:10.5606/tgkdc.dergisi.2025.27992

Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Oct 20;33(4):528-537. doi: 10.5606/tgkdc.dergisi.2025.27905. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: This study aims to encourage the use of percutaneous transthoracic biopsies by thoracic surgeons as a diagnostic method.

METHODS: This retrospective study was conducted between January 1, 2015, and January 31, 2024, with 793 patients (632 males, 160 females; mean age: 65±12 years; range, 11 to 93 years) who underwent lung tru-cut biopsy under computed tomography guidance. Patients whose radiologic and pathology records were accessible via the Hospital Information System and the Picture Archiving and Communication System were included.

RESULTS: A total of 973 tru-cut biopsy procedures were performed. There was no statistically significant difference in age distribution between sexes (p=0.15). Most biopsies were performed on the upper lobes, predominantly the right upper lobe (33.2%). The supine position was the most commonly used during the procedure (49.4%). The mean lesion diameter and distance from the chest wall were 49±17 mm and 51±16 mm, respectively. A definitive diagnosis was obtained on the first attempt in 78.6% of patients, while repeat biopsies were required in 21.4%. Primary lung malignancy was diagnosed in 63% of cases. Postprocedural complications included pneumothorax in 16.1%, intraparenchymal hemorrhage in 0.1%, hemoptysis in 0.1%, and hemothorax in 0.1% of patients. Complications were most frequently observed following biopsies of the left lower lobe (32.4%). Lesions located in the upper lobes were significantly more likely to be malignant (p=0.01). A significant increase in complication rates was observed with greater parenchymal tissue penetration during the procedure (p=0.001).

CONCLUSION: Computed tomography-guided percutaneous lung biopsies can be performed more safely by thoracic surgeons due to their procedural experience. Additionally, in the event of complications, thoracic surgeons are more capable of providing prompt and effective intervention, thereby enhancing patient safety. Thoracic surgeons should be actively involved in all diagnostic stages of pulmonary or mediastinal nodules or masses, including procedures such as tru-cut lung biopsy and endobronchial ultrasonography.

PMID:41510537 | PMC:PMC12728956 | DOI:10.5606/tgkdc.dergisi.2025.27905

Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Oct 20;33(4):432-441. doi: 10.5606/tgkdc.dergisi.2025.27779. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: This study aims to compare the effects of measurements taken with indocyanine green fluorescence imaging (IFI) and transittime flowmeter measurement (TTFM) methods on the surgical outcomes of coronary artery bypass grafting.

METHODS: Between December 2023 and May 2024, a total of 70 patients (53 males, 17 females; mean age: 64.2±9.1 years; range, 43 to 82 years) who underwent on-pump coronary artery bypass grafting via median sternotomy by the same surgical team were included in this prospective study. The control group (TTFM group, n=35) consisted of patients who had intraoperative TTFM, while the remaining patients received both TTFM and IFI measurements during surgery (TTFM+IFI group, n=35). The groups were compared in terms of first-month survival, ejection fraction preservation, intra-aortic balloon pump use, need for extracorporeal membrane oxygenation, postoperative myocardial infarction, and length of intensive care unit and hospital stay.

RESULTS: In our clinic, distal anastomoses were performed in a mean of 3.3±0.7 vessels in the TTFM group and in a mean of 3.7±0.8 vessels in the TTFM+IFI group. The total number of distal anastomoses in the TTFM group and TTFM+IFI group was 115 and 130, respectively. According to the TTFM and IFI measurements taken during the surgery, no revision was required in any of the grafts. There was no statistically significant difference between the two compared groups in terms of early survival, postoperative myocardial infarction, need for intra-aortic balloon pump, need for extracorporeal membrane oxygenation, preservation of ejection fraction, length of stay in the intensive care unit, and time to discharge (p>0.05).

CONCLUSION: The use of IFI yields no significant effect on early-term outcomes and TTFM is solely adequate for assessing graft functionalities in coronary artery bypass grafting.

PMID:41510535 | PMC:PMC12728974 | DOI:10.5606/tgkdc.dergisi.2025.27779

OTA Int. 2026 Jan 7;9(1):e461. doi: 10.1097/OI9.0000000000000461. eCollection 2026 Mar.

ABSTRACT

OBJECTIVES: The burden of orthopaedic trauma has continued to increase with a disproportionate impact on low- and middle-income countries (LMICs), in part due to inadequacy of resources for operative fracture fixation. The objective of this study was to evaluate the available literature regarding the availability of equipment and implants for operative fracture care in LMICs and the barriers to accessing these resources.

DATA SOURCES: A comprehensive literature search was conducted in the PUBMED, SCOPUS, EMBASE, and WEB OF SCIENCE databases for the period January 2003 to December 2023 using search terms including “implants,” “hardware,” “availability,” “accessibility,” and “access” to identify relevant records published in English.

STUDY SELECTION: All studies that assessed the availability of implants for operative fracture fixation in LMICs were included.

DATA EXTRACTION: Articles were critically appraised for their methodological quality using the JBI critical appraisal checklist for qualitative research. Data were manually extracted into a predesigned data extraction template.

DATA SYNTHESIS: Data were synthesized through basic pooling and summarized using descriptive statistics, including percentages and proportions.

RESULTS: Seven hundred twenty-two records were identified, and 11 articles comprising 488 health care facilities from 8 LMICs met the inclusion criteria for analysis. The included studies were all observational, including 8 cross-sectional surveys and 3 qualitative case studies. Findings included little to no capability of performing internal or external fixation at small, community hospitals. Resources were still generally inadequate for treating orthopaedic injuries at larger, tertiary hospitals. Private hospitals and tertiary hospitals with medical schools are the best equipped. Barriers identified included the high cost of implants and reliance on imported implants, lack of government funding and trauma system organization, patients needing to procure their own implants, and even corruption and poor leadership. Solutions proposed included improved funding for trauma care, prioritizing orthopaedic services and providing continuing trauma education, defining essential equipment necessary for orthopaedic care, strengthening resource monitoring and organization, and encouraging local implant manufacturing.

CONCLUSIONS: Inadequate availability of fracture fixation implants and equipment is a major challenge in LMICs. There is little known about the availability of specific orthopaedic equipment and implants at the specialist level of fracture care. A future study aimed at evaluating the availability of specific orthopaedic equipment and implants necessary for specialized fracture care in these countries is recommended to identify key areas for improvement. Ideally, orthopaedic surgeons working in these settings could be surveyed to determine which resources are most critically lacking and should be prioritized to enhance the delivery of adequate care.

LEVEL OF EVIDENCE: IV.

PMID:41510526 | PMC:PMC12778074 | DOI:10.1097/OI9.0000000000000461

Methodology (Gott). 2025 Jun;21(2):144-160. doi: 10.5964/meth.14733. Epub 2025 Jun 30.

ABSTRACT

Dose-response relationships between continuous risk factors and disease outcomes are necessary for understanding the risks related to different levels of exposure. Dose-response risk curves can lead to more targeted public health messaging, prevention efforts, and policy implementation. Meta-analyses are often used to combine statistical results from different studies and can be used to model dose-response relationships. However, several challenges are encountered when performing dose-response meta-analysis, such as having heterogeneous reference categories, inconsistent measures of risk, and determining the most accurate shape of the curve. In this paper, we propose a three-step process for estimating dose-response relationships via meta-analysis, which involves: 1) harmonizing the measures of risk, 2) homogenizing the reference category, and 3) selecting meta-regression models. We use data obtained from a systematic review on the dose-response relationship between alcohol consumption and the risk of chronic liver disease to provide an example of the proposed process.

PMID:41510522 | PMC:PMC12779110 | DOI:10.5964/meth.14733

SAGE Open Nurs. 2026 Jan 6;12:23779608251409854. doi: 10.1177/23779608251409854. eCollection 2026 Jan-Dec.

ABSTRACT

INTRODUCTION: Migration from Albanian healthcare professionals to Western countries has been widespread since Albania emerged from communism in 1991. The migration of Albanian physicians and nurses has significant impacts on the country’s healthcare system.

OBJECTIVE: The manuscript addresses the migration intentions of Albanian healthcare professionals, including physicians and nurses focusing on their inclination to emigrate to Western countries.

METHODS: This cross-sectional study included 315 participants from two municipalities, Fier and Vlore, examining various factors that impact their desire to seek employment abroad. A structured, culturally adapted questionnaire (18 items; four subscales: migration intention, social worth, teamwork climate, financial dissatisfaction) adapted from Goštautaitė et al. was used; internal consistency was high (Cronbach’s α = 0.885).

RESULTS: Results indicate a moderate-to-high level of migration intention, particularly pronounced among younger healthcare workers, those with fewer years of professional experience, and individuals working in high-stress departments such as emergency medicine and intensive care. Statistically significant associations were found between migration intention and key variables, including age (p < .01), ward of employment (p < .05), and self-reported financial dissatisfaction (p < .01). Participants citing greater dissatisfaction with income and professional growth opportunities were more likely to express a desire to emigrate. Additionally, poor teamwork climate and low perceived social worth were moderately associated with higher migration intentions, though not all associations reached statistical significance. These findings highlight a widespread perception of undervaluation and burnout, particularly in public sector facilities and among early-career professionals.

CONCLUSIONS: Financial dissatisfaction and stressful work settings were associated with higher migration intention; policy measures may mitigate these risks. Several systems have piloted targeted retention levers (remuneration, career ladders, dual practice), offering transferable options. Similar interventions could mitigate the brain drain in Albania, improving job satisfaction and financial stability for healthcare workers.

PMID:41510499 | PMC:PMC12775355 | DOI:10.1177/23779608251409854

IJID Reg. 2025 Nov 30;18:100817. doi: 10.1016/j.ijregi.2025.100817. eCollection 2026 Mar.

ABSTRACT

OBJECTIVES: During the COVID-19 pandemic, airport-based measures, such as fever screening and polymerase chain reaction (PCR) testing were implemented in Japan. Okinawa Prefecture introduced a voluntary airport PCR testing program for domestic travelers at Naha Airport (OKA). Their indirect behavioral effects on travelers remain underexplored. This study aims to describe self-reported pre-travel health awareness among participants in this program.

METHODS: In February-March 2021, we conducted a cross-sectional questionnaire survey among Naha Airport PCR test Project (NAPP) participants (n = 4545; March subset n = 1859). The survey assessed demographics, travel purpose, awareness of airport screening (fever screening and PCR testing), pre-travel health awareness, COVID-19 history, and symptoms. Logistic regression evaluated factors associated with self-reported symptoms in the March subset.

RESULTS: Among respondents aware of fever screening and PCR testing, 94.1% and 96.4%, respectively, reported increased attention to their physical condition before travel. Overall, 3.9% reported symptoms, mainly mild respiratory complaints. The proportion symptomatic varied by reason for testing; workplace-mandated testers reported fewer symptoms than family-motivated testers (adjusted odds ratio 0.36, 95% confidence interval 0.15-0.78).

CONCLUSIONS: Awareness of voluntary airport screening measures was associated with greater self-reported pre-travel health awareness among voluntary testers. These findings may inform context-specific behavioral strategies aimed at promoting health-conscious travel during infectious disease outbreaks.

PMID:41510495 | PMC:PMC12774711 | DOI:10.1016/j.ijregi.2025.100817

IJID Reg. 2025 Nov 13;18:100804. doi: 10.1016/j.ijregi.2025.100804. eCollection 2026 Mar.

ABSTRACT

OBJECTIVES: Maternal and neonatal tetanus (MNT) remains a major public health concern in Somalia, where health infrastructure is still recovering. Despite the availability of a safe and effective tetanus toxoid (TT) vaccine, coverage remains low. This study aimed to identify factors influencing TT vaccine uptake among reproductive-age women in Mogadishu, Somalia.

METHODS: A community-based cross-sectional study was conducted from June to August 2025 in Mogadishu, Somalia. A two-stage cluster sampling technique combined with systematic random sampling was used to select 350 households. Data were collected using a structured, interviewer-administered questionnaire, and the primary outcome was adherence to at least two doses of the TT vaccine during pregnancy. Data were analyzed using bivariate and multivariable logistic regression to identify independent predictors of TT vaccine uptake.

RESULTS: A total of 350 women participated in the study. Coverage of the TT vaccine was low, with only 19.7% receiving two or more doses during their last pregnancy. Multivariate analysis showed that women aged 36-49 years were more likely to be protected compared to those aged 15-25 years (AOR = 6.62; 95% confidence interval [CI]: 1.74-25.21; P = 0.006). Planned pregnancy was associated with higher protection (AOR = 8.35; 95% CI: 3.25-21.45; P <0.001). Attendance at health centers for antenatal care (AOR = 0.35; 95% CI: 0.18-0.69; P = 0.002), visits by health extension workers (AOR = 8.13; 95% CI: 4.35-15.22; P <0.001), and good behavior of health workers (AOR = 3.48; 95% CI: 1.15-10.46; P = 0.027) were positively associated with TT protection. Women from households with a monthly income below 57 US$ were significantly less likely to be protected (AOR = 0.04; 95% CI: 0.01-0.22; P <0.001).

CONCLUSIONS: TT vaccination coverage among women was low. Older age, planned pregnancy, antenatal care at health centers, visits by health extension workers, and good behavior of health workers were associated with higher protection, while low household income was linked to lower uptake. Strengthening targeted interventions is needed to improve TT coverage.

PMID:41510494 | PMC:PMC12775988 | DOI:10.1016/j.ijregi.2025.100804

IJID Reg. 2025 Nov 25;18:100810. doi: 10.1016/j.ijregi.2025.100810. eCollection 2026 Mar.

ABSTRACT

OBJECTIVES: Pulmonary tuberculosis (PTB) often leads to impaired health-related quality of life (HRQoL). The study evaluates the impact of a pharmacist-led educational counseling intervention on the HRQOL in individuals with PTB.

METHODS: This single-blind, randomized controlled trial employed a parallel-group design at a tertiary care hospital in Malaysia. A total of 206 adults diagnosed with PTB were randomized (1:1) to receive either standard care under the directly observed therapy (DOT) strategy (control group) or DOT plus structured pharmacist-led counseling (intervention group) for 6 months. HRQoL was assessed at baseline and at treatment completion using the EQ-5D-3L and visual analog scale (VAS). Data analyses were performed using SPSS.

RESULTS: There was a statistically significant difference between the control group and the intervention group on the quality-of-life scores post-intervention. Baseline HRQoL was comparable between groups (P >0.05). At treatment completion, significant improvements were observed in the intervention group compared with the control group for self-care (P = 0.03), mobility (P = 0.05), and pain/discomfort (P = 0.01). Mean VAS scores were also higher in the intervention group (P <0.001).

CONCLUSIONS: Pharmacist-led education and counseling interventions significantly improve the quality of life of patients with PTB.

PMID:41510493 | PMC:PMC12775972 | DOI:10.1016/j.ijregi.2025.100810