Nevin Manimala

World J Urol. 2026 Mar 22;44(1):254. doi: 10.1007/s00345-026-06291-7.

ABSTRACT

PURPOSE: Post-prostatectomy urinary incontinence (PPI) significantly impacts quality of life. While an artificial urinary sphincter is the standard surgical treatment for PPI, adjustable continence therapy balloons (ProACT) have emerged as a less invasive alternative over the past two decades. ProACT implantation is considered technically challenging and limited to three high-volume Dutch medical centers, yet little is known about the surgical learning curve. This study aims to assess the learning curve to inform training requirements for ProACT implantation.

METHODS: This retrospective single-center study included all ProACT implantations performed by one urologist at Erasmus University medical Center, Rotterdam. Surgery success was defined as postoperative use of a maximum of one ‘safety pad’, less than 10 mL urine loss or ≥ 95% subjective improvement of continence. Multivariable logistic regression assessed the learning curve.

RESULTS: A total of 108 surgeries between 2019 and 2024 were included, of which 15 were supervised by an experienced surgeon. No statistical relation was found between the progressive surgeon’s experience and surgical success (per 10 surgeries, OR 0.89, 95%CI: 0.75-1.07, p = 0.2). Preoperative incontinence (pads/day) was statistically significantly associated with surgical success (OR 0.65, 95%CI: 0.47-0.89, p = 0.009). The overall surgical success rate was 61%, with an additional 20% achieving > 50% continence improvement. Complication rate within six months was 21% of which six (5.6%) included explantations of the ProACT device.

CONCLUSION: ProACT implantation achieves consistent outcomes after brief supervised training, with no statistically significant learning curve. This supports a broader adoption of this technique by urologists treating PPI.

PMID:41865333 | DOI:10.1007/s00345-026-06291-7

Pharmacoeconomics. 2026 Mar 22. doi: 10.1007/s40273-026-01611-6. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic kidney disease (CKD) is a major global cause of morbidity and mortality. Recent nephroprotective therapies have improved CKD management, yet their cost effectiveness across settings remains uncertain. This review systematically identified and compared cost-effectiveness studies of novel CKD treatments for both broad CKD populations and disease-specific subgroups.

METHODS: A systematic search was conducted in PubMed and the Cochrane Library using terms related to “chronic kidney disease,” “cost-effectiveness,” “cost-utility,” “health technology assessment,” “SGLT2 inhibitor,” and commercial and generic names of nephroprotective drugs approved since 2013. Eligible studies were full-length articles in English published between January 2015 and September 2025. Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were extracted. All monetary values were standardized to 2025 US dollars.

RESULTS: The search yielded 172 records, of which 26 met inclusion criteria. A supplementary search identified ten additional studies, resulting in 36 evaluations. Most studies assessed sodium-glucose cotransporter 2 inhibitors or finerenone. Across evaluations, these therapies consistently improved outcomes, with QALY gains reported in all studies (0.012-1.44 QALYs gained). Most concluded that the interventions were cost effective compared with standard of care, and 13 reported cost-saving results. Only three studies reported an incremental cost-efffectiveness ratio above $100,000 per QALY threshold. Cost effectiveness was observed in both general CKD and CKD with diabetes mellitus, although estimates varied by country, time horizon, and analytic perspective.

CONCLUSIONS: Current evidence indicates that novel nephroprotective therapies for CKD are generally cost effective, and in some settings cost saving. These findings support their value in both general CKD and diabetic populations and highlight the importance of early treatment adoption to delay disease progression and reduce long-term healthcare costs.

PMID:41865332 | DOI:10.1007/s40273-026-01611-6

J Relig Health. 2026 Mar 22. doi: 10.1007/s10943-026-02621-6. Online ahead of print.

ABSTRACT

Although humility is the opposite end of the same continuum as the dark triad, little is known about how this virtue can be cultivated to prevent the negative influence of narcissistic, Machiavellian, and psychopathic attitudes in the workplace. Based on the relational spirituality framework and trait activation theory, this paper proposes the verification of the mechanism underlying the link between religious practices and dark triad personality traits. Here, humility acts as a mediator and the perception of bond with God acts as a moderator in the relationship between religious practices and humility, and a caring ethical climate acts as a moderator in the link between humility and dark triad traits. The study involved 1071 employees from Poland. Consistent with the relational spirituality approach, the perception of a strong and trustful relationship with God amplified the positive effect of religious practices on humble attitude. In addition, in line with trait activation theory, the perception of a caring ethical climate strengthened the negative effects of humility on Machiavellianism and psychopathy but not on narcissism. Moreover, statistically significant mediating effects of humility moderated by the perception of bond with God were noticed on the relationship between prayer and Machiavellianism and between prayer and Mass attendance and psychopathy, but not narcissism.

PMID:41865331 | DOI:10.1007/s10943-026-02621-6

Pediatr Surg Int. 2026 Mar 22;42(1):160. doi: 10.1007/s00383-026-06401-x.

ABSTRACT

OBJECTIVE: Adjuvant steroids in the treatment of BA remains controversial. We sought to characterize variations in steroid use and their effect on postoperative outcomes in a multi-institutional cohort of BA patients.

STUDY DESIGN: PHIS was queried for all patients between 2017 and 2024 who were diagnosed with BA and underwent KPE. Patients who received ≥ 3 contiguous days of steroids within 7 days of KPE were considered to have received postoperative steroids. The primary outcome was native liver survival, calculated using Kaplan-Meier analysis.

RESULTS: 504 patients from 37 hospitals with a median age of 52 days (IQR: 35-69 days) met inclusion criteria. 139 patients (28.6%) received adjuvant steroids. The steroid-treated cohort had a significantly longer postoperative LOS (P < 0.001) and high-volume-KPE hospitals were significantly more likely to use adjuvant steroids (P < 0.001). The majority of patients were started on steroids on POD#0. 5 hospitals utilized steroids in > 50% of their patients after KPE. Kaplan-Meier analysis showed no difference in two-year native liver survival.

CONCLUSION: In this large multi-institutional cohort study, steroids were used early, with significant intra-hospital variation, and were associated with increased postoperative LOS and higher KPE volume. Larger multi-institutional studies with standardized steroid dosage regimens and extended long-term follow up are needed.

LEVEL OF EVIDENCE: III.

PMID:41865321 | DOI:10.1007/s00383-026-06401-x

Environ Geochem Health. 2026 Mar 22;48(6):253. doi: 10.1007/s10653-026-03129-4.

ABSTRACT

Mining-induced heavy metal contamination poses a potential threat to the water security of Central India’s tribal-dominated zones, despite the scarcity of integrated hydrogeochemical studies with multi-pathway health risk appraisals. To investigate the seasonal variations in spring water (n = 15) and groundwater (n = 47) quality within four river basins in the region of the Bailadila Iron Ore Mining area, Chhattisgarh using hydrogeochemical diagrams, multivariate statistical analysis, and comprehensive health risk modeling were adopted. The samples collected during two seasons, namely pre-monsoon and post-monsoon were analyzed for eleven heavy metals, major ions, and physico-chemical parameters utilizing the standard methods. The Gibbs plots suggested the weathering of rocks as the major geochemical process, while Piper diagrams showed predominantly Ca-Mg-HCO₃ water types associated with carbonate dissociation. Principal Component Analysis and Hierarchical Cluster Analysis were used to distinguish three sources of contamination, i.e., geogenic weathering, mining operations, and agricultural activities. Strong correlations between mining-related metals (Cr-Pb: r = 0.71) and agricultural indicators (Na-K-Nitrate: r = 0.94-0.95) were observed based on Pearson correlation. The ANNOVA results revealed that the Sankani and Talperu basins had the highest levels of contamination, with considerable geographical differences (F = 39.14, p < 0.001). Health risk assessment revealed elevated non-carcinogenic hazards (89% samples THI > 1.0; range 0.73-3.93), with children most vulnerable (pre-monsoon avg. THI 1.85). Arsenic dominated carcinogenic risk (82-92% TCR contribution; max 0.13 mg/L pre-monsoon vs. WHO/BIS 0.01 mg/L), while iron (max 13.33 mg/L vs. WHO 0.3 mg/L, BIS 1.0 mg/L) and manganese (max 0.34 mg/L vs. WHO 0.4 mg/L, BIS 0.1 mg/L) drove 69% of non-carcinogenic risks. These findings underscore the importance of implementing long‑term remediation strategies to safeguard vulnerable indigenous communities from mining‑related health risks.

PMID:41865317 | DOI:10.1007/s10653-026-03129-4

Pediatr Pulmonol. 2026 Mar;61(3):e71569. doi: 10.1002/ppul.71569.

ABSTRACT

BACKGROUND: Asthma rates are rising globally, posing a significant public health challenge. In Qatar, childhood asthma affects 34.6% of children, making it a common chronic condition. The global scope of existing literature on the association between childhood asthma and perinatal and neonatal risk factors may not fully account for Qatar’s distinctive socio-cultural, genetic, and healthcare aspects. Therefore, this research aims to emphasize the importance of considering regional variations in health outcomes.

OBJECTIVES: To investigate the association between childhood asthma development and mode of delivery, gestational age, and birthweight in Qatar.

METHODS: A hospital-based case-control study was conducted in Qatar across Hamad General, Al Wakrah, and Al Khor hospitals from January 2020 to July 2023, including 830 asthma cases and 1,512 non-asthma controls aged 6-14 years. Secondary data from Electronic Medical Records were analyzed using logistic regression, with odds ratios (ORs) and adjusted odds ratios (aORs) calculated for each factor. Confounders were managed through Directed Acyclic Graphs (DAG), and multiple imputations addressed missing data.

RESULTS: Asthma prevalence was 35.4%. Compared to controls, asthma cases were more likely to be males (65% vs. 41%) and have a family history of asthma (31.3% vs. 1.7%). In addition, Cesarean delivery (aOR 1.15, 95% CI 0.92, 1.44), preterm birth (aOR 1.07, 95% CI 0.79), and low birth weight (aOR 1.03, 95% CI 0.61, 1.73) showed slight increases in asthma risk. However, none of these associations reached statistical significance.

CONCLUSION: Despite non-significant associations, findings underscore the importance of considering regional variations and context-specific research.

PMID:41865305 | DOI:10.1002/ppul.71569

Int J Soc Psychiatry. 2026 Mar 22:207640261427415. doi: 10.1177/00207640261427415. Online ahead of print.

ABSTRACT

BACKGROUND: Since the 2022 full-scale invasion of Ukraine, civilians have experienced substantial war-related trauma, yet little is known about the prevalence and risk factors of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) among internally displaced persons (IDPs) actively seeking medical or psychological care.

AIMS: To examine the prevalence of PTSD and CPTSD in a clinical sample of Ukrainian IDPs, compare diagnostic rates between psychological and medical treatment-seekers, and identify sociodemographic and war-related predictors of diagnostic outcomes.

METHODS: A total of 224 adult IDPs attending an outpatient clinic in Chernivtsi oblast completed the International Trauma Questionnaire. Descriptive statistics, bivariate analyses, and multinomial logistic regression models were used to assess prevalence and identify predictors of PTSD and CPTSD.

RESULTS: In the full sample, 24.5% met criteria for ICD-11 PTSD and 7.6% for CPTSD. Among psychological treatment-seekers, prevalence was higher (PTSD: 28.3%; CPTSD: 9.0%) compared to those seeking exclusively medical care (PTSD: 13.8%; CPTSD: 3.4%). Losing someone close due to the war significantly predicted both PTSD and CPTSD in the final multivariable model, while male gender independently predicted CPTSD.

CONCLUSIONS: PTSD rates in this sample were broadly comparable to global estimates for conflict-affected populations, whereas CPTSD prevalence appeared lower than that reported in other Ukrainian samples. Relocation to safer areas within one’s own country-without the additional stressors associated with forced international migration-together with the relatively older age of the sample, may have contributed to a reduced CPTSD risk. Sociocultural expectations surrounding masculine roles during wartime might also play a role in male vulnerability to CPTSD, though further evidence is needed. Individuals bereaved by the war may represent a subgroup at heightened risk, highlighting the potential value of targeted psychosocial support. Longitudinal, multi-site studies with diverse samples are needed to clarify symptom trajectories and contextual risk factors in displaced civilians.

PMID:41865301 | DOI:10.1177/00207640261427415

Pediatr Pulmonol. 2026 Mar;61(3):e71580. doi: 10.1002/ppul.71580.

ABSTRACT

BACKGROUND: Pediatric inflammatory bowel disease (IBD) is increasingly recognized as a systemic disorder with potential pulmonary involvement, although abnormalities are often subclinical and underdiagnosed.

OBJECTIVE: To systematically review and meta-analyze pulmonary function in children with IBD.

METHODS: PubMed and Scopus were searched from inception to June 30, 2025 for observational studies reporting pulmonary function tests in patients younger than 18 years with Crohn’s disease (CD) or ulcerative colitis (UC), using relevant keywords. Data were synthesized qualitatively and, where possible, pooled using random-effects meta-analysis. Study quality was appraised using the NIH quality assessment tools for observational and case-control studies.

RESULTS: Eight studies involving 395 children and adolescents (244 with CD, 151 with UC) were included. Spirometry indices were largely preserved: pooled estimated mean difference (MD) for FEV₁% predicted was -2.9 (95% CI: -6.0 to 0.3; p = 0.08) and for FVC% predicted -0.8 (95% CI: -2.1 to 0.5; p = 0.21). FEV₁/FVC ratios showed no significant differences (MD -0.5, 95% CI: -1.6 to 0.5). Lung volumes were comparable (TLC% predicted MD -0.8, 95% CI: -1.9 to 0.3). The most consistent abnormality, although not statistically significant, was reduced diffusing capacity: DLCO% predicted was lower in IBD patients (MD -5.8, 95% CI: -12.4 to 0.9; p = 0.09). FeNO levels were similar (MD 0.2 ppb, 95% CI: -3.4 to 3.8).

CONCLUSIONS: Pediatric IBD is associated with predominantly subclinical pulmonary involvement, with reduced diffusing capacity emerging as the most consistent abnormality despite preserved spirometry. Longitudinal studies are needed to clarify the clinical significance and evolution of these findings.

PMID:41865300 | DOI:10.1002/ppul.71580

Diabetes Metab Res Rev. 2026 Mar;42(3):e70159. doi: 10.1002/dmrr.70159.

ABSTRACT

BACKGROUND: The optimal timing for basal insulin initiation in diabetic ketoacidosis (DKA) remains unclear. British guidelines endorse early basal insulin (EBI), while the American Diabetes Association emphasises overlap duration with intravenous insulin, without mention of timing. This meta-analysis evaluates whether EBI administration of basal insulin improves clinical outcomes in adults with DKA.

METHODS: A systematic review and meta-analysis were performed according to the PRISMA guidelines. Databases searched included MEDLINE, Embase, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials through December 11, 2024. Inclusion criteria included articles in the English-language randomised controlled trials (RCTs) or observational studies evaluating EBI in adult DKA patients. Non-human studies, conference abstracts, and case reports were excluded. The primary outcome for this study was hospital length of stay (LOS). Additional outcomes included intensive care unit (ICU) LOS, time to DKA resolution, hypoglycemia, and rebound hyperglycemia between EBI and usual care. Risk of bias was assessed using the Cochrane and Newcastle-Ottawa tools. Grading of Recommendations Assessment, Development, and Evaluation was performed to evaluate the quality of evidence.

RESULTS: From 1214 identified studies, eight (4 RCTs, 4 observational) met inclusion criteria for a total of 247 patients in the EBI group and 552 patients in the control group. No significant difference in hospital LOS was found (mean difference -11.17 h; 95% CI: -29.91 to 7.56). ICU LOS, time to DKA resolution, incidence of hypoglycemia, and rebound hyperglycemia also did not demonstrate any significant differences between groups. Significant heterogeneity existed across studies for most outcomes. All studies had a high risk of bias, and the quality of evidence was very low.

CONCLUSION: EBI did not result in significant differences in hospital LOS, ICU LOS, or time to DKA resolution; however, there were no increased adverse events with EBI. Current studies of early EBI have significant limitations. Future research should focus on developing high-quality RCTs.

PMID:41865288 | DOI:10.1002/dmrr.70159

J Trop Pediatr. 2026 Feb 9;72(2):fmag007. doi: 10.1093/tropej/fmag007.

ABSTRACT

Human milk is the optimal source of nutrition for preterm infants, significantly reducing neonatal morbidities and enhancing neurodevelopmental outcomes. However, preterm neonates face challenges in direct breastfeeding due to immaturity, maternal-infant separation, and inadequate milk production. The aim of this study is to compare the impact of a structured early intervention package on exclusive breastfeeding rate and compare that to a control group that had no structured early intervention package regarding exclusive breastfeeding at 6 months of chronological age in neonates born at less than 34 weeks. Eligible mother-infant dyads were divided into the control and intervention groups. While both the groups received breastfeeding counseling, the control group received routine counseling as per WHO guidelines during antenatal visits, hospital stay, and follow-up immunization visits. In contrast, the intervention group received structured, frequent counseling using specially developed education materials, including intrapartum counseling in the pre-labor area, early initiation of expression facilitated by designated personnel, and scheduled postnatal sessions. Breast milk output was measured at days 3, 7, and 14 or discharge. Exclusive breastfeeding rates were assessed at 6 months. Among 90 enrolled dyads, the exclusive breastfeeding rate at 6 months was significantly higher in the intervention group (75.0%) compared to the control group (47.3%) (P value = .015). Breast milk output on day 3 was also significantly higher in the intervention group (P value = .008). The findings indicate that integrating structured lactation support into neonatal care can improve breastfeeding outcomes, and larger studies are needed to validate these results.

PMID:41865274 | DOI:10.1093/tropej/fmag007