Category: Nevin Manimala

JAMA Netw Open. 2026 Jun 1;9(6):e2618698. doi: 10.1001/jamanetworkopen.2026.18698.

ABSTRACT

IMPORTANCE: Patient-directed discharge, common among hospitalized patients with opioid use disorder (OUD) experiencing opioid withdrawal, is associated with poor outcomes. Increasingly, hospital-based clinicians are using short-acting opioids alongside methadone and buprenorphine to treat opioid withdrawal. However, no published studies have examined the association between this practice and patient-directed discharge.

OBJECTIVE: To examine associations between dosing of short-acting opioids and time to first dose of short-acting opioid with early patient-directed discharge (within 72 hours).

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included hospitalizations involving adults with OUD who were treated with short-acting opioids between February 7 and December 31, 2024, using an opioid withdrawal order set in the electronic health record at an urban safety-net hospital. Statistical analysis was conducted between October 2024 and October 2025.

EXPOSURES: Total daily dose of short-acting opioids (oxycodone and hydromorphone) expressed in morphine milligram equivalents, and time from emergency department intake to first dose of short-acting opioid.

MAIN OUTCOMES AND MEASURES: The primary outcome was early patient-directed discharge, adjusted for age, race and ethnicity, gender, other substance use disorder, receipt of medications for OUD, and addiction care team consultation.

RESULTS: A total of 669 hospitalizations, representing 520 unique patients, were included. Patients were a mean (SD) age of 44.1 (12.2) years, with most identifying as male (531 of 669 [79.4%], with 122 of 669 female [18.2%] and 16 of 669 gender minority [2.4%]) and unhoused (555 of 669 [83.0%]). A total of 92 hospitalizations (13.8%) resulted in early patient-directed discharge. In the final adjusted model, each doubling of the patient’s daily dose of short-acting opioids was associated with an 8% reduction in the hazard of early patient-directed discharge (adjusted hazard ratio, 0.92 [95% CI, 0.86-0.99]; P = .03). There was no statistically significant association between time to first dose of short-acting opioid and patient-directed discharge within 72 hours.

CONCLUSIONS AND RELEVANCE: In this cohort study of hospitalized adults with OUD, treatment of opioid withdrawal with short-acting opioids exhibited a dose-dependent association with reduced hazard of early patient-directed discharge. These findings support the use of short-acting opioids alongside methadone and buprenorphine for inpatient treatment of opioid withdrawal.

PMID:42301710 | DOI:10.1001/jamanetworkopen.2026.18698

JAMA Netw Open. 2026 Jun 1;9(6):e2618878. doi: 10.1001/jamanetworkopen.2026.18878.

ABSTRACT

IMPORTANCE: Treatment of opioid use disorder (OUD) with buprenorphine reduces overdose and all-cause mortality, yet access and retention remain limited. Much of the literature describing barriers to buprenorphine access and retention has focused on practitioner-level or patient-level barriers, but less is known about how potential policy and payment levers may influence prescribing behaviors and treatment practices from the practitioner perspective.

OBJECTIVE: To explore perspectives among OUD treatment program clinicians and staff about how broader policy and payment structures influence adoption of buprenorphine treatment and low-barrier care practices that promote access and retention.

DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, semistructured interviews were conducted from December 2022 to July 2023. Participants included clinicians and staff from a range of outpatient treatment programs providing buprenorphine in Philadelphia, Pennsylvania.

MAIN OUTCOMES AND MEASURES: Interviews examined prescribing practices and the influence of policy, payment structures, and regulatory requirements on clinical care. Transcripts were analyzed using thematic content analysis.

RESULTS: A total of 28 practitioners and staff (13 men [46%]; 11 [39%] aged 41-50 years), including medical clinicians, therapists, and other administrative staff, were interviewed. Participants included 17 physicians (61%), 7 therapists (25%), 1 advanced practice practitioner (4%), 1 administrator (4%), and 2 other staff (8%). Twenty-four participants (86%) had at least 5 years of experience treating OUD, and all clinicians had obtained a DATA-2000 waiver, also called an X-waiver, to prescribe buprenorphine. Participants viewed the X-waiver as a symbolic barrier, but identified policy factors like insurance coverage, reimbursement rates, payer policies, and licensure requirements as key variables influencing clinical practice. Clinics relied on supplemental funding to sustain care for uninsured patients. Participants reported that payer-imposed requirements, such as prior authorizations and rigid attendance-based reimbursement, undermined timely access and individualized care and that regulatory frameworks often conflicted with harm reduction principles and created staffing and documentation burdens.

CONCLUSIONS AND RELEVANCE: This qualitative study of clinicians and staff in buprenorphine treatment programs found that broader policy and payment reforms could help support low-barrier buprenorphine treatment. Enhancing reimbursement, reducing administrative burdens, and aligning licensure and payer policies with evidence-based practices may improve access and retention. These findings offer actionable insights for policymakers, payers, and health systems seeking to address persistent gaps in OUD treatment.

PMID:42301709 | DOI:10.1001/jamanetworkopen.2026.18878

Ann Indian Acad Neurol. 2026 Jun 12. doi: 10.4103/aian.aian_1101_25. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the efficacy and safety of sodium phenylbutyrate-taurursodiol (PB-TURSO) and its components in slowing disease progression and improving survival in patients with amyotrophic lateral sclerosis (ALS).

METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing PB-TURSO or its components to placebo or standard of care in adults with ALS were included. The primary outcomes were functional decline (Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised [ALSFRS-R]) and survival. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. A random-effects model was used for the meta-analysis, and a narrative synthesis was conducted for Tauroursodeoxycholic Acid (TUDCA) monotherapy and secondary analyses from the CENTAUR trial.

RESULTS: Two RCTs (n = 801) were included in the meta-analysis. The pooled analysis demonstrated no statistically significant difference in either ALSFRS-R decline (mean difference [MD] 1.51, 95% confidence interval [CI] -1.01 to 4.02; P = 0.24; I² =71%) or survival (hazard ratio [HR] 0.90, 95% CI 0.73-1.11; P = 0.31; I² = 61%). A separate trial of TUDCA monotherapy ( n = 34) demonstrated significant functional benefits. Post hoc analyses of the CENTAUR trial reported a survival benefit of 6.5-10.6 months and delayed progression to major disease milestones. Biomarker analyses suggested anti-inflammatory effects. The risk of bias was moderate to high, and the certainty of evidence was rated very low by GRADE.

CONCLUSIONS: Based on very low certainty evidence, the available RCT data do not support a definitive conclusion regarding the efficacy of PB-TURSO in ALS. Post hoc exploratory analyses suggest a potential survival benefit, which requires confirmation in adequately powered, prospectively designed trials; current results are hypothesis-generating rather than practice-defining.

PMID:42301697 | DOI:10.4103/aian.aian_1101_25

J Postgrad Med. 2026 Jun 16. doi: 10.4103/jpgm.jpgm_89_26. Online ahead of print.

ABSTRACT

As the WHO puts it, breastfeeding is the cornerstone of child survival, nutrition, development, and maternal health. According to NFHS data of India, only 71.2% of children under six months are exclusively breastfed in Maharashtra. The problem may be more prevalent in tribal communities due to their geographical location and strong cultural norms. This community-based cross-sectional observational study was conducted among consenting mothers of the Scheduled Tribe category with children aged six months to one year residing in the area under the Primary Health Center in a tribal village. A list of mothers fulfilling inclusion criteria was obtained from seven subcentres, and participants were selected by random sampling from each. Data was obtained by a structured interview schedule. Descriptive analysis estimated the prevalence of exclusive breastfeeding (EBF), and the association between qualitative variables was assessed by the Chi-square test. Multivariate logistic regression was applied to determine the predictors of EBF, using the software SPSS-28. A P value of ≤ 0.05 was used as the cut-off for statistical significance. Prevalence of EBF was 63.4%. Factors like age, education, occupation of mother, maternal education, place of delivery, practice of colostrum feeding, are statistically significantly associated with the practice of EBF. Multivariate logistic regression revealed that the age of the mother and the education of the father are determinants of EBF. The prevalence of EBF in the study area is lower than the state prevalence, highlighting the need for focused intervention. Furthermore, EBF practices are influenced by a mix of social, cultural, and economic factors.

PMID:42301696 | DOI:10.4103/jpgm.jpgm_89_26

Ann Indian Acad Neurol. 2026 May 1;29(3):343-352. doi: 10.4103/aian.aian_1101_25. Epub 2026 Jun 12.

ABSTRACT

OBJECTIVE: To evaluate the efficacy and safety of sodium phenylbutyrate-taurursodiol (PB-TURSO) and its components in slowing disease progression and improving survival in patients with amyotrophic lateral sclerosis (ALS).

METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing PB-TURSO or its components to placebo or standard of care in adults with ALS were included. The primary outcomes were functional decline (Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised [ALSFRS-R]) and survival. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. A random-effects model was used for the meta-analysis, and a narrative synthesis was conducted for Tauroursodeoxycholic Acid (TUDCA) monotherapy and secondary analyses from the CENTAUR trial.

RESULTS: Two RCTs (n = 801) were included in the meta-analysis. The pooled analysis demonstrated no statistically significant difference in either ALSFRS-R decline (mean difference [MD] 1.51, 95% confidence interval [CI] -1.01 to 4.02; P = 0.24; I² =71%) or survival (hazard ratio [HR] 0.90, 95% CI 0.73-1.11; P = 0.31; I² = 61%). A separate trial of TUDCA monotherapy ( n = 34) demonstrated significant functional benefits. Post hoc analyses of the CENTAUR trial reported a survival benefit of 6.5-10.6 months and delayed progression to major disease milestones. Biomarker analyses suggested anti-inflammatory effects. The risk of bias was moderate to high, and the certainty of evidence was rated very low by GRADE.

CONCLUSIONS: Based on very low certainty evidence, the available RCT data do not support a definitive conclusion regarding the efficacy of PB-TURSO in ALS. Post hoc exploratory analyses suggest a potential survival benefit, which requires confirmation in adequately powered, prospectively designed trials; current results are hypothesis-generating rather than practice-defining.

PMID:42301686 | DOI:10.4103/aian.aian_1101_25

J Postgrad Med. 2026 Jun 15. doi: 10.4103/jpgm.jpgm_861_25. Online ahead of print.

ABSTRACT

To explore the potential of virtual reality (VR) as a training tool for basic life support (BLS) and other emergency procedures to achieve higher levels of knowledge in the cognitive, psychomotor, and affective domains. Sixty trainees, divided into two groups of thirty each, were trained first using conventional methods, followed by VR devices, and then crossed over in this randomized crossover trial. Data indicators included a pre-validated set of thirty-one mixed response questions administered via Google Forms and a checklist of twelve parameters. Assessment was performed using “Direct observation of procedural skills” at four time periods, at T0 (before training), T1 (post-completion of training with the conventional or immersive technique), T2 (post-completion of training with the immersive or conventional technique), and T3 (post-three months of last training with either the conventional or immersive technique). Inferential statistics were performed using the Chi-square test for categorical variables and analysis of variance (ANOVA) for continuous variables. Intra-group comparison revealed a significant difference from T0 to T3 for all parameters in groups I and II, except for the “compression depth” parameter in group I. Inter-group comparison at T0 and T3 revealed no statistically significant difference between the two techniques. Overall satisfaction levels from T0 to T3 in both groups revealed an increasing learning preference for the VR method (46.6%-73.3% in group I and 50%-80% in group II). Immersive teaching-learning methods using VR provided a scalable and consistent learning experience, highlighting its utility for BLS training in remote or resource-constrained environments. Trainees’ preferences and VR’s ability to foster a desired teaching-learning environment are promising signs, warranting exploration of its long-term synergistic impact with other immersive teaching-learning methods.

PMID:42301684 | DOI:10.4103/jpgm.jpgm_861_25

J Postgrad Med. 2026 Jun 11. doi: 10.4103/jpgm.jpgm_159_26. Online ahead of print.

ABSTRACT

INTRODUCTION: Adverse drug reactions (ADRs) are an important cause of morbidity, prolonged hospital stay, and increased healthcare costs. Monitoring and reporting ADRs through pharmacovigilance systems help identify drug-related risks and improve patient safety. This study aimed to describe the pattern, characteristics, and outcomes of ADRs reported at a tertiary care teaching hospital under the Pharmacovigilance Programme of India (PvPI).

MATERIALS AND METHODS: A retrospective, observational, cross-sectional study was conducted at the ADR Monitoring Center of a tertiary care teaching hospital. Individual Case Safety Reports submitted to the Vigiflow database between January 2023 and December 2024 were analyzed. This study got approval by ethics committee. Data were evaluated for patient demographics, suspected drugs, system organ class involvement, seriousness, outcomes, and causality using the World Health Organization-Uppsala (WHO-UMC) scale. Descriptive statistics were used to summarize the data.

RESULTS: A total of 299 ADRs were described and analyzed. Adults accounted for the majority of cases, with a slight male predominance. Antimicrobials (29%) were the most commonly implicated drug class. Most ADRs were non-serious. On causality assessment, the majority of reactions were classified as “probable (90.63%)”. The most common adverse event was headache (8.6%). The ADR outcome was recovered/resolved in 64.6%.

CONCLUSION: ADRs are commonly encountered in tertiary care settings, with antimicrobials being the most frequent contributors. Describing and analyzing reported ADR data, increasing awareness among medical students, healthcare professionals, and encouraging regular ADR reporting are essential steps to enhance patient safety and promote rational drug use.

PMID:42301674 | DOI:10.4103/jpgm.jpgm_159_26

Saudi J Gastroenterol. 2026 Jun 9. doi: 10.4103/sjg.sjg_91_26. Online ahead of print.

ABSTRACT

BACKGROUND: During follow-up of IPMN, attention should be paid to both IPMN-derived carcinoma and PDAC concomitant with IPMN (concomitant PDAC). Concomitant PDAC lacks clear risk factors and is often detected late. This study evaluated non-contrast MRI performance for early detection and identification of optimal imaging sequences.

METHODS: Patients histologically diagnosed with PDAC between May 2012 and March 2024 who underwent MRI at diagnosis were retrospectively included. PDAC located ≥5 mm from an IPMN was defined as concomitant PDAC. Cases of IPMC and main-duct IPMN were excluded. MRI sequences (T1WI, T2WI, MRCP, and DWI with ADC maps) were reviewed. Tumor detection was defined as (1) mass identification on T1WI/T2WI, (2) Main pancreatic duct (MPD) stricture or poor visualization with upstream dilatation on MRCP, or (3) hyperintense mass on DWI. Two radiologists independently evaluated all images.

RESULTS: Sixty-four cases (28 females; median tumor diameter, 21 mm) were analyzed. The median age at diagnosis was 74.5 years (interquartile range: 68-80 years), Blood test values showed median CA19-9 levels of 78 U/mL. The detection sensitivities by radiologists A and B were T1WI, 76.7%/68.3% (κ0.71); T2WI, 31.3%/29.7% (κ0.71); DWI, 71.4%/71.4% (κ0.87); and MRCP, 43.4%/35.8% (κ0.84). Combined sensitivities were 89.1%/82.8% for “T1WI and DWI” and 92.2%/85.9% for “T1WI, DWI and MRCP”.

CONCLUSIONS: Among single sequences, T1WI demonstrated the highest sensitivity. The combination of “T1WI, DWI, and MRCP” showed the highest sensitivity, although the differences were not statistically significant and should be interpreted cautiously for detecting PDAC concomitant with IPMN.

PMID:42301667 | DOI:10.4103/sjg.sjg_91_26

Indian Dermatol Online J. 2026 Jun 9. doi: 10.4103/idoj.idoj_80_25. Online ahead of print.

ABSTRACT

BACKGROUND: Narrowband ultraviolet B (NBUVB) phototherapy is an established treatment for vitiligo. However, real-world practices vary significantly, particularly in dosing strategies, maintenance schedules, and the use of minimal erythema dose (MED) testing, impacting treatment outcomes.

AIM AND OBJECTIVES: To assess NBUVB phototherapy practices among Indian dermatologists, evaluate patient characteristics and treatment outcomes, and identify variations in clinical protocols.

PATIENTS AND METHODS: An online, questionnaire-based survey was conducted among 80 Indian dermatologists who responded actively using NBUVB. The questionnaire was validated through expert review, pilot testing, and reliability assessment before deployment. Validation included content validation by three senior dermatologists with more than 15 years of phototherapy experience to ensure item relevance and clarity. A pilot test among 10 dermatologists confirmed internal consistency. Data were analyzed using descriptive statistics.

RESULTS: Among 80 respondents (response rate of 5%), 65% had >10 years’ experience. Most respondents (52.5%) used only NBUVB whole-body units, while others employed combination or targeted phototherapy devices. MED testing was performed by only 30%, typically using visual test dose methods; 70% used empirical starting doses. A 200 mJ/cm² starting dose was most common (60%). Maintenance therapy was administered every 1-2 weeks in 75%. Early clinical improvement was observed after 10-20 sessions, and >50% re-pigmentation in vitiligo occurred after 50-70 sessions in 85%. Acral vitiligo showed a mixed response, with poor or limited response in 60% of cases. Mild erythema (80%) and burning (60%) were the most reported side effects.

LIMITATIONS: The study is limited by self-reported data, possible recall bias, and lack of detail on MED testing procedures.

CONCLUSION: There is marked variability in NBUVB protocols among Indian dermatologists. Emphasizing standardized guidelines and MED-based personalized dosing could improve therapeutic outcomes and patient safety in vitiligo management.

PMID:42301666 | DOI:10.4103/idoj.idoj_80_25

Indian J Cancer. 2026 Jan 1;63(1):41-51. doi: 10.4103/ijc.ijc_1006_23. Epub 2026 Jun 9.

ABSTRACT

BACKGROUND: Exposure of a cell to carcinogens leads to an increase in the chromosomal aberrations, while such karyotypic anomalies and elevated deoxyribonucleic acid content have been observed in a plethora of oral precancerous lesions and conditions, and are expressed in the form of micronuclei. The aim of the present study was to correlate the frequency of these micronucleated cells (MNCs) with the severity of the disease process in oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) patients.

METHODS: The present cross-sectional, hospital-based study consisted of 150 subjects in an age range from 15 to 80 years including patients who were clinically diagnosed and histopathologically proven as OSMF and OSCC patients, along with age and sex matched, normal, healthy controls. Also, cytological analysis was carried out using the oral exfoliative cytology procedure, while the frequency of MNCs was calculated using a differential counter.

RESULTS: The mean MNC% in the control group was calculated as 0.3% ± 0.35% in the present study as against the mean MNC% of 1.22% ± 0.37% in the OSMF, and 2.0% ± 0.60% in the OSCC groups, while the difference was statistically significant ( P < 0.001). Also, the mean MNC% was calculated to be 0.71% ± 0.08% in Stage I OSMF as against 1.31% ± 0.18% and 1.59% ± 0.17% in Stage II and Stage III OSMF, respectively, with the difference being statistically significant ( P < 0.001). Similarly, the difference in the mean MNC% when calculated between the different stages of OSCC was, also, statistically significant ( P < 0.001) with the mean MNC% in Stage I OSCC being 1.15% ± 0.11% as against 1.59% ± 0.25% in Stage II, and 2.23% ± 0.30% in Stage III and 2.68% ± 0.19% in Stage IV OSCC, respectively.

CONCLUSIONS: Based on the results obtained in the present study, it can, thus, be concluded that the mean MNC% increased significantly in OSCC patients when compared with the control and OSMF groups, and in the OSMF group in comparison with control group, thus, suggesting micronuclei assay as a useful diagnostic adjunct for screening populations which are at high risk for developing various oral precancerous lesions and conditions, and frank oral cancers.

PMID:42301658 | DOI:10.4103/ijc.ijc_1006_23