Nevin Manimala

Ann Plast Surg. 2026 Jun 15. doi: 10.1097/SAP.0000000000004799. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the patterns, treatment practices, and outcomes of burn injuries over a 5-year period at a tertiary care center, focusing on mortality trends and factors influencing patient outcomes.

METHODS: A retrospective analysis was performed on 377 patients hospitalized for burns between 2020 and 2024 at a tertiary care center. Data were collected using a modified questionnaire and analyzed with IBM SPSS Statistics. We evaluated patient demographics, burn characteristics, treatment methods, and outcomes. We calculated the mean age and total body surface area (TBSA) and assessed mortality trends each year.

RESULTS: The study included 254 males (67.4%) and 123 females (32.6%) with a mean age of 33.4 years and a mean TBSA of 27.4%. Thermal burns were the main cause (282 patients, 74.8%), followed by electrical burns (86 patients, 22.8%) and chemical burns (9 patients, 2.4%). Most injuries were accidental (367 patients, 97.3%). We used allografts in 99 patients (26.3%), which helped with wound excision and lowered the risk of infection. The overall mortality rate was 21.8% (82 patients), with males more affected. Despite consistent burn severity, mortality showed a notable decrease from 23.9% in 2020 to 7.9% in 2024.

CONCLUSIONS: This study shows improvements in outcomes for major burn victims over the 5-year period, notably the drop in mortality rates. Introduction of measures such as barrier nursing and strict patient isolation, early aggressive tangential excision of wounds, along with the use of allografts postburn wound debridement. Ongoing investment in burn care infrastructure and access to better treatments may allow further reduction in complications and deaths related to burn injuries.

PMID:42295771 | DOI:10.1097/SAP.0000000000004799

JAMA Netw Open. 2026 Jun 1;9(6):e2616154. doi: 10.1001/jamanetworkopen.2026.16154.

ABSTRACT

IMPORTANCE: Despite advances in D2 gastrectomy (ie, gastrectomy with D2 lymphadenectomy) and adjuvant chemotherapy, the value of adding postoperative radiotherapy (RT) to adjuvant chemotherapy after D2 gastrectomy remains a topic of ongoing debate.

OBJECTIVE: To assess whether the addition of RT to the S-1 plus oxaliplatin (SOX) chemotherapy regimen increases disease-free survival (DFS) in patients with T4 or node-positive gastric cancer after D2 gastrectomy.

DESIGN, SETTING, AND PARTICIPANTS: This open-label, phase 3 randomized clinical trial was conducted between December 1, 2012, and August 30, 2022, at 5 large tertiary hospitals in China. Eligible patients were aged 18 to 70 years with gastric adenocarcinoma who underwent R0 resection with D2 lymphadenectomy, had pathologic stage T4 or node-positive disease, and had no evidence of metastasis (M0). Intention-to-treat statistical analyses were conducted from January 14 to March 31, 2025.

INTERVENTIONS: Participants were assigned 1:1 to receive concurrent chemoradiotherapy (SOX RT) or chemotherapy alone (SOX). The SOX RT group received 1 cycle of induction SOX, followed by RT (50.4 Gy in 28 fractions) with concurrent S-1 (50 mg twice daily), and then 3 cycles of SOX. The SOX group received 6 cycles of SOX (S-1 30-40 mg/m2 twice daily on days 1-14; oxaliplatin 130 mg/m2 on day 1, every 3 weeks).

MAIN OUTCOMES AND MEASURES: The primary end point was 3-year DFS. Secondary end points included overall survival (OS) and adverse events.

RESULTS: A total of 620 patients were randomly assigned to the SOX group (n = 311) or SOX RT group (n = 309). Patients had a median (IQR) age of 55 (47-62) years and included 401 males (64.7%). Overall, 274 patients (44.2%) had T4 disease, and 590 (95.2%) had node-positive disease. In the primary analysis for the prespecified 3-year DFS end point, there was no evidence of a between-group difference in DFS (SOX RT vs SOX: HR, 0.98; 95% CI, 0.73-1.33). Similarly, there was no evidence of a between-group difference in OS (HR, 0.86; 95% CI, 0.60-1.23). The Kaplan-Meier-estimated 3-year DFS rates were 70.5% in the SOX RT group and 69.3% in the SOX group (log-rank P = .93), and the corresponding 3-year OS rates were 80.8% and 78.4%, respectively (log-rank P = .41). At 5 years, the DFS rates were 60.0% and 57.3% (log-rank P = .76) and the corresponding OS rates were 73.7% and 71.4% (log-rank P = .55) in the SOX RT and SOX groups, respectively. Treatment-related adverse events were similar between groups.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of patients with T4 or node-positive gastric cancer who underwent D2 gastrectomy, SOX RT did not significantly improve DFS or OS. Accordingly, among patients with D2-resected gastric cancer, the findings do not support routine addition of adjuvant chemoradiotherapy to chemotherapy.

TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR-TRC-12002919.

PMID:42295761 | DOI:10.1001/jamanetworkopen.2026.16154

Indian J Med Res. 2026 Jun;163(6):829-837. doi: 10.25259/IJMR_256_2026.

ABSTRACT

Background and objectives In India, national nutrition programmes emphasise age-appropriate, nutrient-dense complementary foods for young children. This study aimed to optimise nutrient-dense complementary foods for children aged 12-35 months using locally sourced ingredients and a mixture design approach, in alignment with the Nutrition Norms of the Poshan 2.0 Programme under Schedule II of the National Food Security Act, 2013 (NFSA 2013), revised in 2023. Methods D-optimal mixture design is an advanced statistical design of experiments method used to determine the ideal proportions of ingredients in a mixture, where components sum to 100%. We used this design to optimise the proportions of cereals, pulses, milk powder, nuts, seeds, and oil to maximise iron, calcium, and zinc content while minimising phytate-to-mineral molar ratios. The optimised complementary base mix was standardised into three variants: one with reduced refined sugar and two without added refined sugar (one savoury-based mix and one dates powder-based mix). Mineral and phytic acid contents were analysed using standard analytical methods. Sensory evaluation was conducted using a nine- point hedonic scale with a semi-trained institutional panel. Results All optimised formulations met revised NFSA, 2013 nutrient standards for energy, protein, fat, carbohydrates, and key essential micronutrients, while reducing phytate-to-mineral molar ratios within practical formulation limits. Sensory evaluation showed good overall acceptability for all variants, with a mean score above 7.0. The savoury-based mix achieved the highest overall acceptability, followed by the reduced refined sugar-based mix and the dates powder-based mix. Interpretation and conclusions The findings demonstrate that a systematic formulation approach can be used to develop nutrient-dense, complementary food mixes with reduced or no added refined sugar using locally available ingredients without compromising micronutrient adequacy and sensory acceptability, supporting their potential relevance for public nutrition programmes.

PMID:42295725 | DOI:10.25259/IJMR_256_2026

Indian J Med Res. 2026 Jun;163(6):745-762. doi: 10.25259/IJMR_2554_2025.

ABSTRACT

Background and objectives Hypothyroidism is the most common thyroid disorder during pregnancy and, if not managed adequately, increases the risk of adverse foeto-maternal outcomes. The present systematic review and meta-analysis was conducted to assess the prevalence of hypothyroidism among Indian pregnant women and related foeto-maternal outcomes. Methods A systematic search was conducted across PubMed, Google Scholar, and preprint servers to identify observational studies reporting the prevalence of hypothyroidism and associated foeto-maternal outcomes among Indian pregnant women. A random-effects model was utilised to pool effect sizes, and heterogeneity was assessed using I2 statistic. Funnel plots, along with Begg’s and Egger’s tests, were used to assess publication bias. Data were analysed using STATA version 17. Results A total of 60 studies were included. The pooled prevalence of hypothyroidism among pregnant women was 17% [95% confidence interval (CI): 14%, 19%] with subclinical hypothyroidism at 15% (95% CI: 12%, 18%) and overt hypothyroidism at 3% (95% CI: 3%, 4%). In women with subclinical hypothyroidism, the pooled prevalence of adverse maternal outcomes was 9% (95% CI: 6%, 11%), while the prevalence of adverse foetal outcomes was 11% (95% CI: 9%, 14%). The pooled prevalence was 18% for preterm birth (95% CI: 11%, 25%), 17% for low birth weight (95% CI: 10%, 25%), 7% for intrauterine death (95% CI: 2, 14%), and 2% for stillbirth (95% CI: 0, 4%). Among women with overt hypothyroidism, the prevalence of adverse maternal and foetal outcomes was 12% (95% CI: 10%, 15%) and 14% (95% CI: 11%, 17%), respectively. The pooled prevalence was 22% for low birth weight (95% CI: 13%, 31%), 16% for preterm birth (95% CI: 9%, 24%), 16% for intrauterine death (95% CI: 7%, 27%), and 6% for stillbirth (95% CI: 1%, 13%). Most studies used trimester-specific TSH cut-offs based on the American Thyroid Association guidelines. One fourth (n=15) of the 60 studies applied alternative thresholds, with upper limits for normal TSH varying from 4.0-10.0 mIU/L. Interpretation and conclusions The rising burden and adverse consequences of hypothyroidism in pregnancy demand urgent attention. Uniform, evidence-based screening and management practices must be implemented at all levels of care. There is a pressing need for India-specific diagnostic cut-offs and large-scale prospective studies to inform treatment thresholds and long-term outcomes.

PMID:42295724 | DOI:10.25259/IJMR_2554_2025

Indian J Med Res. 2026 Jun;163(6):770-777. doi: 10.25259/IJMR_3570_2025.

ABSTRACT

Background and objectives Tuberculosis (TB) and viral hepatitis (hepatitis B and C) co-infection is a significant threat in low-and middle-income countries like India. To optimise treatment protocols and prevent liver-related complications, it is essential to estimate the burden of these co-infections. This systematic review and meta-analysis were conducted to determine the prevalence of hepatitis B and C co-infection with tuberculosis in India. Methods In line with PRISMA guidelines, a systematic search of PubMed, Scopus, Embase, CINAHL, and Web of Science was conducted for English-language observational studies published up to January 6, 2026, that reported hepatitis B or C co-infection among TB patients in India. Pooled prevalence estimates were calculated using a random-effects model, heterogeneity was assessed using the I2 statistic, and risk of bias was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool. Results A total of 11 studies with 4502 participants reporting hepatitis B or C co-infections in among TB patients in India were included. The pooled prevalence of hepatitis B was 10% [95% Confidence Interval (CI):5%-16%], while the pooled prevalence of hepatitis C was 6% (95% CI:5%-7%). Among TB patients co-infected with HIV, the pooled prevalence of hepatitis B was 17% and pooled prevalence of hepatitis B among drug-resistant TB patients was 11%. Higher rates were reported in Southern and Western India. Interpretation and conclusions High prevalence of hepatitis B and C co-infections among TB patients in India suggests the need for integrated screening and management of these co-infections within the national programme strategies.

PMID:42295712 | DOI:10.25259/IJMR_3570_2025

Indian J Med Res. 2026 Jun;163(6):838-846. doi: 10.25259/IJMR_2123_2025.

ABSTRACT

Background and objectives Household food security is defined as physical and economic access to sufficient, safe, and nutritious food for an active and healthy life. Evidence suggests that urban poor are more food insecure (51%-Delhi and 74.6%-Vellore) than rural poor. Food insecurity adversely affects under-five children’s nutritional status. This study aimed to assess prevalence, determinants, and its association with child-nutrition in urban slums of Salem district, Tamil Nadu. Methods A community-based cross-sectional study was conducted among 363 randomly selected households between January to September 2023 using multi-stage random sampling. Data were collected from primary-care-givers using a validated-semi-structured-questionnaire (USAID-HFIAS) followed by measurement of daily raw food consumption and anthropometry of under-five children. Statistical analysis was performed in SPSSv16.0 using Chi-square/Fisher’s test, ANOVA and regression with P<0.05 taken as significant. Results Household food insecurity prevalence was 82.1%, with 20.1% severe. Mean food consumption was significantly lower among insecure households. Determinants included age/gender of household head, single earning member, dependents, and irregular use of public distribution system. Children with normal nutrition had 2.75 [P<0.05;95% confidence interval (C.I):1.31-5.75] times odds of belonging to secure households. Interpretation and conclusions Food insecurity was closely linked to under-five malnutrition, underscoring the need for interventions addressing affordability and structural factors such as housing, healthcare access, and resource distribution.

PMID:42295709 | DOI:10.25259/IJMR_2123_2025

CNS Drugs. 2026 Jun 15. doi: 10.1007/s40263-026-01302-y. Online ahead of print.

ABSTRACT

BACKGROUND: TV-46000 (Uzedy^®) is a long-acting injectable antipsychotic for subcutaneous use that combines risperidone and an innovative, copolymer-based drug delivery technology in a suspension that was approved as a treatment for schizophrenia and bipolar I disorder by the US Food and Drug Administration (FDA) in April 2023 and October 2025, respectively. It is a risperidone injectable that can be administered once monthly or once every 2 months. As part of the clinical development of TV-46000, a Phase 1 open-label dose escalation study (TV46000-SAD-10055) was conducted to evaluate the safety and pharmacokinetics (PK) of TV-46000 in participants with schizophrenia or schizoaffective disorder.

METHODS: Individuals diagnosed with schizophrenia or schizoaffective disorder were assigned to 1 of 8 cohorts, which consisted of single escalating doses (50 to 225 mg) or 3 multiple doses (75 mg or 150 mg) administered every month for 3 months. Every cohort was preceded by a run-in period of 7 days with daily oral risperidone (2-6 mg) followed by a 7-day washout period before the TV-46000 injection. TV-46000 was administered in the abdomen in all but one cohort, where 225 mg was administered in the upper arm, to assess interchangeability between injection sites. Outcome measures reported were adverse events (AEs), local tolerability, changes in neurological and clinical assessments, and PK measures (determined by risperidone and 9-OH risperidone total active moiety [TAM] concentrations).

RESULTS: Of the 194 participants screened, 99 were included in the study. Of the 99 participants, 13 discontinued the study, but none of the discontinuations were related to the treatment. Most participants were Black or African American men, with a mean age of 44.2 years and a mean body mass index of 28.53 kg/m². Treatment-emergent AEs after TV-46000 administration included injection-site reactions, increased blood creatine phosphokinase, and weight gain. There were two serious AEs; one death due to suicide and one exacerbation of schizophrenia requiring hospitalization that were both unrelated to TV-46000. After a single dose injection of TV-46000 50 to 225 mg, TAM concentrations reached clinically relevant plasma concentrations of 10 ng/mL within 24 hours for all doses and remained within therapeutic range for 28-56 days, depending on dose. The systemic exposure parameters (maximum, minimum, and average plasma concentration) after the third monthly TV-46000 injections of 75 and 150 mg were comparable with the corresponding steady-state exposure of 3-5-mg/day oral risperidone.

CONCLUSIONS: Overall, TV-46000 was well tolerated with no new safety signals detected compared with other formulations of risperidone. The PK profile of TV-46000 exhibited favorable characteristics of an extended-release formulation, including rapid initial release for fast onset of action and prolonged systemic exposure adequate for monthly administration.

PMID:42295697 | DOI:10.1007/s40263-026-01302-y

Vet Med Sci. 2026 Jul;12(4):e70922. doi: 10.1002/vms3.70922.

ABSTRACT

BACKGROUND: The main goal of this study was to identify various brightness, motion and Doppler echocardiographic variables in small-breed dogs with myxomatous mitral valve disease.

ANIMALS: Sixty client-owned small-breed dogs with mitral regurgitation murmurs.

METHODS: Echocardiography was performed in brightness, motion and Doppler modality from the right parasternal view. On the basis of thoracic radiographs, the dogs were categorized into two groups: those with cardiomegaly and those without cardiomegaly. Additionally, on the basis of the jet area signal to left atrium ratio in colour Doppler echocardiography, the canines were divided into three groups: mild, moderate and severe mitral regurgitation. Furthermore, the dogs were classified into preclinical and clinical groups on the basis of the presence or absence of clinical signs, and various variables were compared across these groups.

RESULTS: This difference was statistically significant and more prevalent in intact dogs than in spayed/neutered dogs. Significant differences were observed in variables including LAmax, LA:Ao, LVIDd, LVIDs, VMA, VMG, VMV, GMV, VMA-GMVT, LVOT and GLVOT in dogs with myxomatous mitral valve disease of varying mitral regurgitation severity and between normal and enlarged hearts. Significant differences were also found in the FS, GMV, VLVOT and GLVOT variables between the clinical and preclinical groups. A moderate and statistically significant correlation was observed between LA:Ao and VMA, VMV and LVOT. Weak and mostly insignificant correlations were found between the Doppler and motion-mode variables.

CONCLUSIONS: Varying mitral regurgitation severity, heart size and the presence of clinical signs can significantly affect certain brightness, motion and Doppler echocardiographic variables in dogs with myxomatous mitral valve disease (valvular heart disease).

PMID:42295688 | DOI:10.1002/vms3.70922

Ther Innov Regul Sci. 2026 Jun 15. doi: 10.1007/s43441-026-00999-9. Online ahead of print.

ABSTRACT

OBJECTIVE: Medical Information plays a critical role in delivering accurate, evidence-based responses to unsolicited requests. At the heart of the response is the content developed by Medical Information. Additionally, the metrics and key performance indicators (KPIs) surrounding content development and delivery are necessary to gauge the utilization and impact of the content. Because the landscape has evolved significantly since the last survey in 2018, the need to re-examine content development approaches and KPIs is warranted. The objective of this benchmarking survey was to assess the evolving approach and tactics of content development and utilization of KPIs of phactMI member companies with a comparison to 2018 where applicable.

METHODS: In May 2024, an electronic survey containing 71 closed and open-ended questions was distributed to 36 phactMI member companies. The survey included demographics, development of specific content, scientific response documents (SRDs), custom response documents, and metrics and KPI. Results were analyzed with descriptive statistics.

RESULTS: Medical Information teams primarily develop content for HCPs (90%) versus patients (10%). Disease state content creation was more common among small/midsize companies (36%) than large companies (18%), though requests for such content were infrequent. Similar to 2018, SRDs remain predominantly traditional written documents (66%), with emerging use of frequently asked questions, infographics, HTML, and slide decks. Most companies (85%) maintain centralized SRD development, but the proportion without target timelines for SRD development increased from 37% in 2018 to 72% in 2024. AI adoption is in early stages, with 3 companies actively using it and 18 exploring applications, primarily for writing and paraphrasing. Omnichannel integration is reported by 59% of companies, and custom response documents account for 25% of inquiries. Similar to 2018, the most common KPIs in medical information departments include inquiry volume, turnaround time, and document updates. There is a growing emphasis on customer satisfaction and digital engagement. HCPs most frequently use email (52%) and phone (29%) for information, while digital channels remain underutilized.

CONCLUSION: This benchmarking survey highlights the need for ongoing innovation, strategic alignment, and robust quality assurance in Medical Information content development and KPI reporting. While many things are similar to 2018, customer expectations continue to evolve and technology has advanced. Organizations must balance operational efficiency with personalized engagement, while ensuring compliance and ethical standards. For the future, the three areas to prioritize are establishing non-traditional content development formats, processes, and workflows; expanding digital and mobile optimization; and strengthening governance around AI and content reuse.

PMID:42295686 | DOI:10.1007/s43441-026-00999-9

Updates Surg. 2026 Jun 15. doi: 10.1007/s13304-026-02715-6. Online ahead of print.

ABSTRACT

This study aimed to evaluate the need for intensive care unit (ICU) admission and identify factors associated with in-hospital mortality (IHM) in patients with Fournier’s gangrene (FG) using traditional statistical methods complemented by machine learning-based models. This retrospective cohort study included surgically treated FG patients at a tertiary referral center. Demographic, clinical, laboratory, and perioperative variables were analyzed. Established prognostic indices, including the Fournier’s Gangrene Severity Index, Uludağ Fournier’s Gangrene Severity Index, Laboratory Risk Indicator for Necrotizing Fasciitis, Systemic Immune-Inflammation Index, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio, were evaluated. Patients were stratified according to ICU requirement and survival status. Multivariable logistic regression was performed to identify independent predictors. In addition, exploratory machine learning models, including k-Nearest Neighbors (KNN), Random Forest (RF), Support Vector Machine, and Decision Tree algorithms, were applied to assess predictive performance. Multivariable logistic regression analysis revealed that PLR and heart failure (HF) were independent predictors of ICU requirement. Regarding IHM, PLR remained the only independent predictor. In the exploratory ML analysis, KNN and RF showed AUC values of 0.886 and 0.873 for ICU prediction, and 0.787 and 0.765 for IHM prediction, respectively. However, given the limited sample size and low number of outcome events, these performance estimates should be interpreted cautiously. This study highlights the prognostic relevance of inflammatory markers, particularly PLR, and comorbid conditions including HF, chronic kidney disease, cerebrovascular disease and concurrent malignancy, in disease severity and IHM in FG. Machine learning-based models showed promising performance, although these findings should be considered preliminary and require validation in larger, multicenter cohorts.

PMID:42295668 | DOI:10.1007/s13304-026-02715-6