Category: Nevin Manimala

Lancet Digit Health. 2027 Jun 30:101045. doi: 10.1016/j.landig.2026.101045. Online ahead of print.

NO ABSTRACT

PMID:42624704 | DOI:10.1016/j.landig.2026.101045

Pain Manag Nurs. 2026 Aug 20:S1524-9042(26)00243-2. doi: 10.1016/j.pmn.2026.07.010. Online ahead of print.

ABSTRACT

PURPOSE: This trial compared the efficacy of distraction and therapeutic touch for reducing labor pain in primiparous women.

DESIGN: A single-center, randomized controlled trial.

METHODS: A randomized controlled trial was conducted in Khalkhal County, Iran, involving 93 primiparous women at 28-32 weeks of gestation. Participants were selected through convenience sampling and then allocated via blocked randomization into three groups: distraction, therapeutic touch, and a control group receiving routine care. The intervention groups participated in structured educational sessions prior to delivery. At the onset of active labor (dilation ≥6 cm), pain intensity was assessed at multiple time points using both the Wong-Baker FACES Pain Rating Scale (WB-FACES) and the visual analog scale. Data were analyzed using a repeated‑measures ANOVA framework, with adjustment for covariates via ANCOVA and appropriate corrections for sphericity. A p value of less than 0.05 was considered statistically significant.

RESULTS: Despite baseline differences in occupation (p = .003) and education (p = .047), a significant group × time interaction emerged (p < .05). Therapeutic touch significantly reduced labor pain vs control on the visual analog scale at hours 3 (MD: -1.24, p = .041) and 4 (MD: -1.76, p = .012) and on WB-FACES at hour 4 (MD: -1.71, p = .008), representing reductions of 7.1%-9.7%. Distraction showed no significant reduction vs control. Moreover, no statistically significant difference was found between therapeutic touch and distraction.

CONCLUSIONS: Therapeutic touch significantly reduces labor pain vs routine care. Its comparative efficacy over distraction requires further investigation.

CLINICAL IMPLICATIONS: Based on the trial results, therapeutic touch can be recommended as an effective nonpharmacological intervention to significantly reduce labor pain in primiparous women.

PMID:42624695 | DOI:10.1016/j.pmn.2026.07.010

Br J Anaesth. 2026 Aug 20:S0007-0912(26)00565-9. doi: 10.1016/j.bja.2026.07.015. Online ahead of print.

ABSTRACT

BACKGROUND: Extracorporeal life support (ECLS) is used as rescue therapy for refractory cardiopulmonary failure. Population-level evidence on prognosis and long-term sequelae in patients requiring ECLS during pregnancy or the peripartum period remains limited.

METHODS: We performed a nationwide retrospective dual-cohort study using linked Taiwanese databases (2001-22). In the delivery cohort, 247 ECLS pregnancies were compared with 3 970 948 non-ECLS pregnancies. In the ECLS cohort, 247 pregnancy-associated ECLS cases were compared with 2112 non-pregnant women of reproductive age receiving ECLS. Outcomes included 42-day maternal mortality and complications, neonatal outcomes, and long-term maternal outcomes beyond 42 days postpartum.

RESULTS: The incidence of pregnancy-associated ECLS was 6.2 per 100 000 deliveries and increased over time (P trend <0.001). Leading indications were amniotic fluid embolism (26.7%), peripartum cardiomyopathy (18.6%), and respiratory failure (12.6%), with highest mortality in obstetric indications. Maternal mortality at 42 days was 41.3%, with renal failure (36.4%), major bleeding (11.3%) and stroke (10.9%) as major morbidities. Neonates had higher risks of preterm birth, low birth weight, and major morbidity. Beyond 42 days postpartum, ECLS-exposed pregnant patients had higher all-cause mortality (adjusted hazard ratio [aHR] 28.0, 95% confidence interval [CI] 16.8-46.8), cardiovascular mortality, permanent dialysis, and psychiatric disorders. In the ECLS cohort, pregnancy-associated ECLS had lower in-hospital mortality (43.7% vs 53.8%) and better long-term survival (aHR 0.42, 95% CI 0.23-0.78) than nonpregnant recipients.

CONCLUSIONS: Pregnancy-associated ECLS is rare but is increasing in incidence, and identifies a clinically high-risk population with substantial early maternal and neonatal risk. Multidisciplinary follow-up is required for survivors of pregnancy-associated ECLS in view of their ongoing risk of long-term cardiovascular, renal, and psychiatric sequelae.

PMID:42624670 | DOI:10.1016/j.bja.2026.07.015

Br J Anaesth. 2026 Aug 20:S0007-0912(26)00569-6. doi: 10.1016/j.bja.2026.07.019. Online ahead of print.

ABSTRACT

Although systematic reviews, meta-analyses, and network meta-analyses are central to evidence-based medicine, most of those assessing the effectiveness of perioperative analgesic interventions have critical limitations that may lead to flawed conclusions, making them clinically uncertain: major concerns include the lack of rigorous inclusion and exclusion criteria, failure to critically assess the quality of the studies, heterogeneity of included studies, and poor quality of included studies (bias, use of basic analgesics, lack of dynamic pain scores, inadequate follow-up, fragility, spin, inaccurate interpretation, etc.). Importantly, clinical guidelines based on such meta-analyses may be inaccurate, despite the use of well-recognised sophisticated complex statistical analyses, which may not compensate for the inherent flaws or study heterogeneity. A properly conducted meta-analysis would have a meticulous systematic review with inclusion of homogenous RCTs, and the included studies would be assessed critically for current clinical relevance including well-defined early mobilisation, the use of basic analgesics, assessment of functional pain and recovery, and clinically relevant reductions in pain and opioid use. Overall, critical appraisal, careful interpretation, and judicious application of meta-analyses are necessary before using them in guidelines and day-to-day practice.

PMID:42624669 | DOI:10.1016/j.bja.2026.07.019

J Nucl Med. 2026 Aug 20:jnumed.125.271556. doi: 10.2967/jnumed.125.271556. Online ahead of print.

ABSTRACT

Prostate-specific membrane antigen (PSMA)-targeted PET/CT (PSMA PET/CT) has become the first-line imaging modality used for staging and restaging prostate cancer. Its utility after minimally invasive focal therapy (high-intensity focused ultrasound, laser ablation, cryoablation) remains unclear. This study evaluated PSMA PET/CT for detecting and localizing recurrence after focal therapy. Methods: This retrospective single-center study included patients with prior focal therapy for prostate cancer who underwent ⁶⁸Ga-PSMA-11 PET/CT for suspected recurrence between 2016 and 2023 without intervening treatment. Three masked readers analyzed whole-body PET/CT images using a per-region (prostate, pelvic nodes, distant metastases) majority rule for per-patient positivity. Interreader agreement was determined using Fleiss κ. In a subcohort of 39 patients with both MRI and biopsy results available within 3 mo of PSMA PET/CT, per-patient and per-segment (12 prostate segments) accuracy was assessed. One masked reader evaluated PET/CT at 60 min (whole-body) and 90 min (pelvic) postinjection, and one prostate MRI expert independently read the MRI scans. Biopsy pathology-confirmed clinically significant prostate cancer, defined as International Society of Urological Pathology grade 2 or greater, served as the reference standard. Results: In total, 112 patients were included. PSMA PET/CT showed 82% positivity for intraprostatic recurrence, 15% for pelvic nodes, and 9% for distant metastases. Interreader agreement was moderate (κ = 0.4; 95% CI, 0.32-0.54). In the subcohort, per-patient sensitivity was 85% for PET vs. 82% for MRI. All cases with an SUV_max of 10 or greater had an ISUP grade group of 3 or greater. Conclusion: PSMA PET/CT effectively localizes prostate cancer recurrence after focal therapy, outperforming MRI on sensitivity.

PMID:42624652 | DOI:10.2967/jnumed.125.271556

J Nucl Med. 2026 Aug 20:jnumed.126.272348. doi: 10.2967/jnumed.126.272348. Online ahead of print.

ABSTRACT

Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft-tissue sarcomas that can develop either de novo or as a result of malignant transformation of neurofibromas. Diagnostic modalities of choice, such as MRI or ¹⁸F-FDG PET/CT, show high sensitivity for the detection of MPNSTs but moderate specificity, as MPNSTs and benign peripheral nerve sheath tumors (BPNSTs) can initially present similar clinical and radiologic pictures. PET/CT with ⁶⁸Ga-labeled fibroblast activation protein inhibitor (⁶⁸Ga-FAPI) showed specific uptake in sarcomas and enabled differentiation of benign and malignant lesions in other entities. Here, we analyzed the ability of ⁶⁸Ga-FAPI PET/CT to differentiate between MPNSTs and BPNSTs. Methods: Twenty-six patients with suspected or histologically confirmed peripheral nerve sheath tumors who were scheduled to have surgical resection/biopsy underwent ⁶⁸Ga-FAPI-46 PET/CT with static and dynamic acquisition. SUV_max, SUV_mean, maximum and mean tumor-to-background ratios, and time-activity curves were evaluated using volume-of-interest-based analysis (isocontour 50%). Time to peak was derived from time-activity curves. Statistical analyses were performed, and receiver-operating-characteristic curves were calculated. Exemplary target validation by fibroblast activation protein immunohistochemistry was performed in 13 cases. Results: Eighteen patients (4 with MPNSTs, 5 with neurofibromas, 9 with schwannomas) were included in the final analysis. MPNSTs showed significantly higher ⁶⁸Ga-FAPI uptake compared with BPNSTs. Neurofibromas showed higher ⁶⁸Ga-FAPI uptake compared with schwannomas. In dynamic imaging, time to peak of MPNSTs and neurofibromas was prolonged compared with schwannomas. Analysis of receiver-operating-characteristic curves displayed high sensitivity (100%) and specificity (92.86%) of ⁶⁸Ga-FAPI PET/CT for discrimination of MPNSTs and BPNSTs, for an exploratory SUV_max cutoff value of 7.53. Fibroblast activation protein expression was strong in MPNSTs and moderate in BPNSTs. Conclusion: ⁶⁸Ga-FAPI PET/CT may aid in differentiating between MPNSTs and BPNSTs, thereby improving lesion characterization in indeterminate MRI or ¹⁸F-FDG PET/CT scenarios.

PMID:42624647 | DOI:10.2967/jnumed.126.272348

BMJ Open Respir Res. 2026 Aug 20;13(1):e004039. doi: 10.1136/bmjresp-2025-004039.

ABSTRACT

INTRODUCTION: Intensive care unit-acquired weakness (ICU-AW) in patients with acute respiratory failure requiring invasive mechanical ventilation (IMV) is associated with reduced functional exercise capacity and increased mortality. Early mobilisation in the ICU may improve functional outcomes and reduce length of stay; however, evidence remains limited, protocols are heterogeneous and post-discharge rehabilitation is frequently lacking. This study aims to evaluate the effects of a continuous care programme combining early intensive ICU mobilisation with post-hospitalisation rehabilitation on functional exercise capacity, with inflammation, quality of life, mortality and cost-effectiveness as secondary outcomes in critically ill patients receiving IMV.

METHODS AND ANALYSIS: This blinded, multicentre, randomised controlled trial will include adult patients undergoing invasive MV for at least 24 hours. Participants will be randomly allocated to one of four groups: intervention group (IG)-Rehab, control group (CG)-Rehab, IG-Home or CG-Home. During hospitalisation, the IG will receive an intensive mobilisation protocol (30-60 minutes/day), while the CG will receive routine care (up to 10 min/day). After hospital discharge, participants will undergo either 8 weeks of face-to-face rehabilitation (Rehab) or a home-based programme (Home), with follow-up for 6 months. Exploratory analyses will evaluate clinical parameters, severity indices, functional status, pulmonary function and mechanics, additional measures of functional exercise capacity, muscle strength and mass, energy expenditure, and symptoms of anxiety and depression. The 2×2 factorial design will allow for the evaluation of the independent effects of in-hospital mobilisation intensity and post-discharge rehabilitation strategy. Statistical analyses will use appropriate parametric or non-parametric tests, with significance set at p<0.05.

ETHICS AND DISSEMINATION: The study will follow the Brazilian National Health Council guidelines, the Brazilian General Data Protection Law and Research Electronic Data Capture standards. Results will be disseminated through peer-reviewed journals, scientific meetings and social media. The trial is registered at ClinicalTrials.gov (NCT06405529; 8 May 2024) and follows Consolidated Standards of Reporting Trials guidelines.

PMID:42624643 | DOI:10.1136/bmjresp-2025-004039

BMJ Open Respir Res. 2026 Aug 20;13(1):e003996. doi: 10.1136/bmjresp-2025-003996.

ABSTRACT

OBJECTIVES: This prospective surveillance study aimed to estimate the burden of laboratory-confirmed respiratory syncytial virus (RSV) in under 3-year-olds in the United Kingdom.

SETTING: The study was implemented in Merseyside and Bristol, encompassing 11 primary care sites, 5 walk-in centres, 2 secondary care hospitals and 2 tertiary care hospitals.

PARTICIPANTS: Children aged under 3 years presenting with lower respiratory tract infection (LRTI) symptoms were included, with a substudy in primary care recruiting children with upper respiratory tract infection (URTI).

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome of the study was the prevalence of RSV infection in primary, secondary and tertiary healthcare settings. Secondary outcomes included severity outcomes (rates of hospitalisation and high dependency care admissions), risk factors for severe disease, economic burden of disease and coinfection prevalence.

RESULTS: 2000 children were included in the analysis (410 primary care and 1590 secondary/tertiary care). 318 were included in the URTI substudy. RSV prevalence was 50.0% (95% CI 46.7% to 53.3%) in children admitted to hospital via emergency departments (ED), 36.3% (95% CI 31.7% to 41.0%) in ED discharges, 36.5% (95% CI 24.7% to 49.6%) in primary care (LRTI) and 12.7% (95% CI 8.6% to 17.9%) in primary care URTI. Healthy term-born children accounted for 70.1% of RSV hospitalisations. Risk factors for severe disease included any level of prematurity, age <3 months and congenital cardiac disease. RSV-positive cases incurred a higher mean cost per participant (£1811, 95% CI £1720 to £1903) than RSV-negative cases (£1295, 95% CI £1220 to £1370).

CONCLUSIONS: The findings revealed a substantial burden associated with RSV. Even moderate prematurity was a risk factor for severe disease, and these children may not benefit from maternal RSV vaccination due to missed late gestation antibody transfer. Furthermore, they would not be eligible for Nirsevimab under UK guidance, which supports consideration of broadening eligibility to include these children.

PMID:42624642 | DOI:10.1136/bmjresp-2025-003996

BMJ Open Ophthalmol. 2026 Aug 20;11(3):e002819. doi: 10.1136/bmjophth-2026-002819.

ABSTRACT

OBJECTIVE: To evaluate the estimated lens diameter (eLD) of the crystalline lens in a large European cohort.

METHODS AND ANALYSIS: Data sets from an Austrian population acquired between 2020 and 2022 were analysed in this study. Measurements included optical biometry (IOLMaster 700, Carl Zeiss Meditec AG, Germany) as well as anterior segment optical coherence tomography (CASIA2, Tomey, Japan). For eLD prediction, three different machine learning approaches were implemented.

RESULTS: In total, 2352 eyes of 2352 patients were included in this study. The eLD was normally distributed with a mean value of 10.18±0.56 mm, showing a statistically significant difference (p=0.008) between females and males (10.16±0.54 mm and 10.22±0.57 mm, respectively). There was a low but significant correlation (p<0.01 for all) with age (r=0.246), lens thickness (r=0.265), white-to-white (r=0.122), corneal radii (r=0.090), axial eye length (r=0.092), anterior chamber depth (r=-0.060), decentration (r=-0.087) and tilt (r=-0.159), respectively. Subanalysis of short and long eyes yielded no significant difference in eLD. For eLD prediction, age and lens thickness appeared to be relevant parameters, with all three models demonstrating low predictive accuracy.

CONCLUSION: The crystalline lens diameter followed a normal distribution with no significant differences between short and long eyes. All three models demonstrated low predictive accuracies, suggesting that reliable prediction of eLD is currently not attainable.

PMID:42624621 | DOI:10.1136/bmjophth-2026-002819

BMJ Open. 2026 Aug 19;16(8):e115665. doi: 10.1136/bmjopen-2025-115665.

ABSTRACT

OBJECTIVES: To assess the impact of non-communicable diseases (NCDs) by number and pattern on productivity loss costs (PLCs) and health-related quality of life (HRQoL) in a large working-age population in Japan.

DESIGN: Cross-sectional analysis of linked claims-survey data with sex-stratified multivariable regression.

SETTING: Employment-Based Health Insurance Associations in Japan. Administrative claims using International Classification of Diseases, Tenth Revision codes were linked to an online questionnaire (November 2022).

PARTICIPANTS: Insured workers and families aged 18-65 years who completed the survey (n=18 236; mean age 48.7 years; 66.2% men).

PRIMARY AND SECONDARY OUTCOME MEASURES: Primary: PLC, estimated from the Work Productivity and Activity Impairment instrument using the Human Capital Method (annual US$).

SECONDARY: HRQoL measured using the EuroQoL 5-Dimension 5-Level index. Exposures were NCD categories, multimorbidity counts and high-impact disease combinations. Models adjusted for sex, age and the number of other conditions.

RESULTS: Multimorbidity (≥2 conditions) was present in 58.4% (56.3% men; 62.5% women); 29.3% had ≥5 conditions. Women had higher NCD prevalence (76.9% vs 70.0%), higher median PLC (US$3683 vs US$117) and lower median HRQoL (0.89 vs 1.00) than men. In adjusted analyses, neuropsychiatric conditions were associated with higher PLC in both sexes (men: US$2393 (95% CI 1966 to 2820); women: US$2097 (US$1442 to US$2751)). Musculoskeletal disorders were statistically significant in men but not in women (US$809 (US$381 to US$1236)), whereas genitourinary disorders were statistically significant in women but not in men (US$701 (US$121 to US$1282)). Neuropsychiatric disorders were associated with lower HRQoL in both sexes (men: -0.040 (-0.045 to -0.034); women: -0.044 (-0.053 to -0.035)); musculoskeletal disorders showed similar decrements (men: -0.031 (-0.037 to -0.025); women: -0.040 (-0.049 to -0.031)). Combinations involving sleep and neuropsychiatric disorders produced the highest PLC (eg, depressive episode and sleep disorder: men: US$5219.9 (US$3646.4 to US$6793.4); women: US$5858.5 (US$2634.4 to US$9082.5)). Each additional condition was independently associated with higher PLC and lower HRQoL.

CONCLUSIONS: In this cross-sectional study of Japanese workers, specific combinations of chronic conditions, particularly neuropsychiatric conditions co-occurring with sleep disorders and musculoskeletal disorders, were associated with greater productivity loss and lower HRQoL than predicted by the number of co-occurring diseases alone. These findings suggest that workplace health strategies addressing high-impact disease combinations may warrant further investigation in longitudinal studies.

PMID:42624608 | DOI:10.1136/bmjopen-2025-115665