Nevin Manimala

J Vasc Access. 2026 Mar 28:11297298261435727. doi: 10.1177/11297298261435727. Online ahead of print.

ABSTRACT

INTRODUCTION: The use totally implantable venous access devices (TIVAD) has significantly improved the quality of care and comfort of life of oncology patients.

AIM: The aim of this study was to retrospectively analyze the incidence and etiology of infections in patients with TIVAD, with a distinction between oncology and hematology patients. In addition, the influence of age, tumour type, presence of neutropenia and palliative status on the prevalence of specific pathogens was assessed.

MATERIALS AND METHODS: The medical records of patients hospitalized in the oncology and haematology departments of the municipal hospital in Warsaw between 2022 and 2023 were retrospectively analysed. IBM SPSS Statistics 29 software was used for data analysis. Infection characteristics, age of patients, type of bacteria by type of cancer, type of bacteria versus age of patients, type of bacteria versus patient status are presented in tables.

RESULTS: On the Oncology ward there were 24 infections in 21 patients, while on the haematology ward there were 43 infections in 28 patients. On the Oncology ward, TIVAD infections occurred in 57.14% of patients with gastrointestinal cancer, while on the Haematology ward they occurred in 78.57% of patients with lymphoma. The results as infection density per inpatient TIVAD in oncology department it was 1.24 per 1000 person-days of TIVAD stay. In contrast, in the hematology department results as infection density per inpatient TIVAD it was 3.40. Gram-negative infections accounted for 80.60% (n = 54) and Gram-positive infections for 19.40% (n = 13). The distribution was similar in both wards (75.00% Gram-negative in oncology, 83.72% in haematology).

CONCLUSIONS: Hematology patients were more likely to have TIVAD infections than oncology patients. In most studies, patients with solid tumours and hematological malignancies were analysed together, despite significant clinical differences. Therefore, we decided to analyze these two groups of patients separately.

PMID:41902444 | DOI:10.1177/11297298261435727

Acta Obstet Gynecol Scand. 2026 Mar 28. doi: 10.1111/aogs.70187. Online ahead of print.

ABSTRACT

INTRODUCTION: Labor epidural analgesia (LEA) is widely used for intrapartum pain management, but its effects on uterine activity (UA) remain unclear. Electrohysterography (EHG) is a promising non-invasive method for intrapartum UA monitoring. The aim of this study was to explore the effect of LEA on UA by means of EHG, to develop better understanding of labor physiology, and inform clinical decision-making.

MATERIAL AND METHODS: Patients in active labor with singleton, term pregnancies who received electrophysiological monitoring from 60 min before until 120 min after LEA initiation were included. Contraction parameters such as frequency, duration, area under the curve (AUC), baseline, and maximum amplitude were obtained from an EHG-derived tocogram using a computer-based algorithm. The primary outcome was the difference in mean uterine contraction frequency before and after initiation of LEA. Secondary outcomes included the comparison of various contraction parameters, derived from EHG, before and after LEA initiation, as well as their temporal changes over time. The effect of possible confounders on UA was examined. Mixed effects models were used for statistical analyses.

RESULTS: In total, 86 patients were included. No significant difference in mean uterine contraction frequency and contraction duration was found before and after LEA initiation. Nevertheless, start of LEA was associated with a significant reduction in AUC, baseline activity, and signal amplitude.

CONCLUSIONS: LEA initiation does not affect uterine contraction frequency or duration, but it is associated with a significant reduction in relative EHG-derived amplitude parameters (AUC, baseline tone, and maximum amplitude), which could potentially affect progression of labor. Further studies are required to explore these parameters and their clinical implications.

PMID:41902441 | DOI:10.1111/aogs.70187

Headache. 2026 Mar 28. doi: 10.1111/head.70070. Online ahead of print.

ABSTRACT

OBJECTIVES: This study was designed to examine the distribution of chronotypes among individuals with migraine and tension-type headache and to evaluate the association between chronotype and clinical headache characteristics in a population-based sample.

BACKGROUND: Although previous research has demonstrated associations between chronotype and migraine, there is limited population-level evidence regarding its relationship with tension-type headache or clinical features of these headache disorders.

METHODS: We conducted a cross-sectional analysis using baseline data from a nationwide population-based survey, conducted in the Republic of Korea in October 2020, which involved adults 20-59 years old. The chronotype was assessed using the Morningness-Eveningness Questionnaire and categorized into morning (score >58), intermediate (score 41-58), and evening (score <41) chronotypes.

RESULTS: Among 2838 participants, the evening chronotype was more prevalent in the migraine (58 of 160, 36.3%) and tension-type headache (225 of 890, 25.3%) groups than in the nonheadache control group (185 of 1005, 18.4%, p < 0.001). Among participants with migraine, depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) differed across chronotypes in the overall comparison (p = 0.035 and p = 0.047, respectively), with the morning type showing lower levels than those shown by the intermediate and evening types; however, no pairwise differences were statistically significant in the post hoc analyses. Among participants with tension-type headache, depression and anxiety differed across chronotypes in the overall comparison (Patient Health Questionnaire-9, p < 0.001 and Generalized Anxiety Disorder-7, p = 0.006), which was driven by higher levels in the evening type than in both the morning and intermediate types; however, the morning and intermediate types did not differ. In participants with migraine, a higher Morningness-Eveningness Questionnaire score (greater morningness) was marginally associated with more severe headache days per 30 days (p = 0.046), whereas no significant association was found in those with tension-type headache (p = 0.126). Headache days per 30 days, crystal-clear days per 30 days, headache intensity (Visual Analog Scale), and the impact of headache (Headache Impact Test-6) were not significantly associated with Morningness-Eveningness Questionnaire scores in participants with migraine or tension-type headache.

CONCLUSION: Participants with migraine and tension-type headache showed a significantly higher prevalence of evening chronotype compared with the nonheadache controls. However, greater morningness was associated with more severe headache days in the migraine group but not in the tension-type headache group.

PMID:41902429 | DOI:10.1111/head.70070

ANZ J Surg. 2026 Mar 27. doi: 10.1111/ans.70633. Online ahead of print.

ABSTRACT

BACKGROUND: Minimal-invasive surgery (MIS) was proven beneficial in Crohn’s Disease (CD). Intracorporeal anastomosis (ICA) represents a further improvement as it is associated with decreased complications and shorter hospitalization. Extracorporeal anastomosis (ECA) is preferred to ICA as it allows haptic feedback of the bowel and mesentery, which is historically required for bowel resection in CD to minimize recurrences. We compared ICA and ECA in terms of recurrences and complications.

METHODS: All patients between 2016 and 2022 with Crohn’s disease who underwent a MIS ileocecectomy were identified and divided into ICA and ECA groups. Exclusion criteria were open surgery, end ileostomies, follow-up < 1 month, and ileocecectomy not due to CD.

RESULTS: 107 patients were included in the ICA group (44.9% male, mean age of 40.2 [±16.6] years), while 270 patients were in the ECA group (46.7% male, mean age of 41.9 [±17.3] years). The rate of endoscopic recurrences with a Rutgeerts score > 2, clinical recurrence, and surgical recurrence were not statistically different between the two cohorts. On the multivariable analysis for endoscopic and clinical recurrences, the ICA/ECA approach was not significant. The ECA group revealed a higher overall complication rate (30.4% versus 15.9%, p = 0.004). The median length of stay was significantly reduced in the ICA group (p < 0.001).

CONCLUSION: ICA seems to be safe in ileocecectomies for CD. The complication rate and length of stay were reduced while not affecting the endoscopic, clinical, and surgical recurrence rates. MIS technology provides enhanced visualization and haptic feedback, which could be used as surrogates for the tactile evaluation intra-operatively.

PMID:41902409 | DOI:10.1111/ans.70633

Hand (N Y). 2026 Mar 27:15589447261428585. doi: 10.1177/15589447261428585. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this prospective cohort study was to evaluate the risk of lymphedema and perioperative complications in patients undergoing elective upper-extremity surgery with a history of breast cancer and ipsilateral lumpectomy/mastectomy with axillary lymph node sampling.

METHODS: Validated volumetric measurements of the limb were obtained presurgery and postsurgery. All complications were recorded. A total of 104 patients enrolled prospectively, and 78 met inclusion criteria with 30 patients in the no tourniquet group and 48 in the tourniquet group. Patients were followed up at 2-week, 6-week, 3-month, 6-month and 12-month intervals. The median number of lymph nodes dissected was 8 (no tourniquet), compared to 7 (tourniquet). Sixty-six percent (no tourniquet) and 58% (tourniquet) had previous radiation. Twenty-eight percent (no tourniquet) and 31% (tourniquet) had previous history of lymphedema. Eight patients (9%) had been previously advised to never have surgery on the involved limb.

RESULTS: There were 3 cases of lymphedema at 2 weeks: 2 patients (no tourniquet) and 1 patient (tourniquet). One patient (no tourniquet) had lymphedema at 2 weeks; only that resolved at 6 weeks. Additional complications include 1 patient (no tourniquet) had pin displacement after distal radius fixation at 2 weeks, 1 patient (tourniquet) had postoperative hematoma after a mass excision, and 1 patient (tourniquet) had hand stiffness following carpal tunnel release. Patient satisfaction between the two groups was high and not statistically different at any time point.

CONCLUSIONS: Surgery in patients with a history of breast cancer with lymph node sampling appears to be equally safe with or without the use of a tourniquet and carries a low rate of overall complications, including exacerbation of their lymphedema.

PMID:41902407 | DOI:10.1177/15589447261428585

HGG Adv. 2026 Mar 26:100595. doi: 10.1016/j.xhgg.2026.100595. Online ahead of print.

ABSTRACT

The genetic liability to a complex phenotype can be assessed via polygenic risk scores (PRS) and is calculated as the sum of genotypes, weighted by effect size estimates derived from summary statistics of genome-wide association study (GWAS) data. Due to different allele frequencies (AF) and linkage disequilibrium (LD) patterns across populations, PRS that were developed on one population drop drastically in predictive performance when transferred to another. One of the major factors contributing to AF and LD heterogeneity is genetic drift, which acts strongly during population bottlenecks and is influenced by the dominance of certain alleles. In particular, since the causal variants on empirical data are typically not known, the presence of population specific LD-patterns will strongly affect transferability of PRS models. In this work, we therefore conducted demographic simulations to investigate the influence of the dominance coefficient on the transferability of PRS among European, African and Asian populations. By modifying the length and size of the bottleneck leading to the split of Eurasian and African populations, we gain a deeper understanding of the underlying dynamics. Finally, we illustrate that in our simulations PRS models that are adapted to the underlying dominance coefficient can substantially increase the prediction performance in out-of-target populations.

PMID:41902401 | DOI:10.1016/j.xhgg.2026.100595

Pharmacoepidemiol Drug Saf. 2026 Apr;35(4):e70362. doi: 10.1002/pds.70362.

ABSTRACT

Immunocompromised individuals experience an impaired immune function due to conditions that might be either congenital or acquired over the course of their lives. Epidemiological studies often rely on clinical definitions which, in some cases, benefit from being translated into machine-readable algorithms for application to electronic health records (EHRs) databases. The transient nature of certain immunocompromised states and the variability of phenotypes, definitions, coding practices, and data availability entangle this operation. To address these challenges, we conducted a scoping review of existing immunocompromised status definitions in MEDLINE, focusing on epidemiologic and pharmacoepidemiologic studies involving immunocompromised populations. Data extraction was guided by clinical experts, categorizing conditions and medications into seven categories: genetic/hereditary conditions, infectious diseases, malignancies and chemotherapy, organ and stem-cell transplantations, severe systemic conditions, immunosuppressive drugs, and autoimmune conditions associated with immunosuppressant use. Out of 137 citations, 56 studies were included. Most of the studies focused on a particular disease or therapeutic area. Frequently cited diagnoses included HIV/AIDS (17.9%) and organ transplantation (14.2%). Methotrexate, corticosteroids, TNF-alpha inhibitors, and calcineurin inhibitors were the most common drugs used to define immunocompromised status. Building on this review and expert opinion, we developed a phenotype algorithm that combines diagnostic, therapeutic, and procedural data in a modular way to identify immunocompromised populations in EHR data sources. The proposed phenotype algorithm can be applied across diverse data sources, settings and research questions. Future research should test its applicability across heterogeneous EHR data sources.

PMID:41902365 | DOI:10.1002/pds.70362

Trauma Violence Abuse. 2026 Mar 27:15248380261429956. doi: 10.1177/15248380261429956. Online ahead of print.

ABSTRACT

Experiences of instability and unpredictability within the family context have been demonstrated to augment risk for child abuse and neglect. This scoping review aimed to synthesize and evaluate current evidence of the association between childhood instability and risk for maltreatment. Studies were identified using predetermined search terms and parameters across three electronic databases. Inclusion criteria for this review were peer-reviewed empirical articles, written in English, that conducted statistical analysis of the relationship between instability and child maltreatment. A total of 64 articles were included in the review, the majority of which focused on residential instability (n = 23), followed by economic instability (n = 11) and relational instability (n = 11), housing instability (n = 10), school instability (n = 6), and psychological instability (n = 4). Across over 4 decades of research, our review suggests that childhood instability is a multifaceted construct that is often associated with elevated exposure to abuse and neglect. In addition, the association between childhood instability and risk for maltreatment was pronounced among younger children. This review underscores the importance of examining childhood instability as a dynamic factor implicated in the etiology of child maltreatment. Integrating the multiple dimensions of childhood instability into a unified conceptual framework may facilitate the development of more precise maltreatment risk models that are both informed by and responsive to the complex and evolving needs of vulnerable families.

PMID:41902360 | DOI:10.1177/15248380261429956

Pharmacoepidemiol Drug Saf. 2026 Apr;35(4):e70361. doi: 10.1002/pds.70361.

ABSTRACT

PURPOSE: Pregnant women in Norway are offered routine ultrasound examinations in the first and second trimester during gestational weeks 11-13 and 17-19, but attendance rates are unknown. With the introduction of maternal pertussis vaccination, we sought to investigate whether ultrasound attendance during pregnancy could identify the target population for maternal vaccination. Our study aims to investigate if pregnancy-related ultrasound codes alone can provide reliable estimates of ongoing pregnancies before data is available in birth records.

METHODS: In this nationwide population-based register study, we linked individual-level data from women with births in the Medical Birth Registry of Norway (MBRN) and first or second trimester ultrasound codes in the Norwegian Patient Registry (NPR) during 2018-2023. We calculated the proportion of pregnancies with pregnancy-related ultrasound examination codes, with trimester-specific codes from 2022, and median gestational age at ultrasound stratified by code.

RESULTS: For the entire study period (2018-2023), we retrieved data on 323 549 pregnancies for 249 915 women. Of the 59 739 pregnancies identified through MBRN in 2022-2023, 57 416 (96.1%) had at least one recorded routine trimester-specific ultrasound. The second trimester ultrasound was recorded in 92.9% (55 503/59 739) of pregnancies, with 87.7% (48 672/55 503) at the recommended time. The first trimester ultrasound code was recorded in 61.6% (36 799/59 739) of pregnancies, and 58.4% (34 886/59 739) had both codes.

CONCLUSIONS: The high attendance rate of at least one routine ultrasound examination during pregnancy (96.1%) in 2022-2023 confirms the reliability of trimester-specific ultrasound codes as an indicator for ongoing pregnancies. This provides valuable data for timely assessment of interventions targeting pregnant women, before information is available in birth registries.

PMID:41902358 | DOI:10.1002/pds.70361

Pharmacoepidemiol Drug Saf. 2026 Apr;35(4):e70355. doi: 10.1002/pds.70355.

ABSTRACT

OBJECTIVE: To assess the safety of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in pregnant women in the United States using data from the Vaccine Adverse Event Reporting System (VAERS).

DESIGN, SETTING: We searched VAERS for reports of Tdap in pregnant women vaccinated during July 2015 through September 2023. We reviewed reports and available medical records for pregnancy and non-pregnancy specific adverse events (AEs) in Tdap recipients. Reporting rates were estimated for reports of preterm birth, hypertensive disorders of pregnancy (HDP), and stillbirths and compared to published background rates for these conditions.

RESULTS: VAERS received a total of 654 reports after Tdap vaccine in pregnancy and 137 (20.9%) were serious; no maternal or infant deaths were reported. The most common pregnancy specific conditions reported were preterm birth (45, 6.9%), hypertensive disorders of pregnancy (40, 6.1%), and stillbirth (18, 2.8%). Two reports of verified Guillain-Barré Syndrome (GBS) were reported. The most common non-pregnancy specific conditions reported were pain (120, 18.3%), nausea (93, 14.2%), and fever (87, 13.3%). Reporting rates for preterm birth, HDP, and stillbirths were below background rates for these conditions.

CONCLUSION: Most reports were non-serious and the most common AEs were similar to those observed in pre- and post-licensure studies. No new or unexpected AE was identified.

PMID:41902357 | DOI:10.1002/pds.70355