Nevin Manimala

Phlebology. 2026 May 8:2683555261451570. doi: 10.1177/02683555261451570. Online ahead of print.

ABSTRACT

BackgroundLipedema is a chronic, progressive adipose tissue disorder affecting mainly women, characterized by bilateral, disproportionate fat accumulation in the lower extremities. The condition is often associated with pain, heaviness, and functional limitations. While the adipose tissue changes in lipedema are well-described, its impact on muscle mass, strength, and functional performance remains underexplored. This study aimed to evaluate the prevalence of sarcopenia and its relationship with lipedema severity.Materials and methodsA cross-sectional observational study was conducted on 48 women with clinically diagnosed lower-extremity lipedema. Diagnosis followed the International Lipoedema Association and German S2k guidelines. Sarcopenia was assessed using a multidimensional approach, including ultrasonographic rectus femoris thickness, handgrip strength, the Five Times Sit-to-Stand Test, and four-m walking speed. The lipedema stage was determined using morphological criteria. Statistical analyses evaluated the relationships between sarcopenia, functional parameters, and lipedema stage.ResultsParticipants had a mean age of 47.2 ± 8.4 years and a BMI of 33.0 ± 4.3 kg/m². Sarcopenia was identified in 33.3% of participants, with 14.6% classified as severe. Those with sarcopenia exhibited lower rectus femoris thickness and slower walking speed (p < .05). Advancing lipedema stage correlated with reduced muscle thickness, weaker handgrip strength, slower gait, and prolonged Five Times Sit-to-Stand Test duration (p < .05). Stage 3 patients demonstrated the highest prevalence of sarcopenia, indicating progressive impairment in muscle mass and functional performance with disease severity (p < .05). No significant associations were found between age or BMI and muscle parameters (p > .05).ConclusionsSarcopenia is prevalent in women with lower-extremity lipedema and increases with disease stage. Comprehensive musculoskeletal assessment should be integrated into lipedema management to address functional impairment and optimize patient care.

PMID:42102393 | DOI:10.1177/02683555261451570

Medwave. 2026 May 8;26(4):e3176. doi: 10.5867/medwave.2026.04.3176.

ABSTRACT

INTRODUCTION: Depression is currently one of the most impactful mental health conditions worldwide, with more than 280 million reported cases. However, there is a critical lack of data on Indigenous populations due to language barriers and the absence of culturally adapted assessment tools, limiting timely diagnosis and appropriate care. The aim of this work is to culturally and linguistically adapt the Patient Health Questionnaire-9 (PHQ-9) into the Shawi language and to evaluate its psychometric properties among Indigenous adults in Alto Amazonas, Peru.

METHODS: A rigorous cultural adaptation process was carried out, including translation by bilingual experts and back-translation. Validation involved expert technical review and a pilot phase conducted within the participating community. Content validity was assessed using Aiken’s V coefficient as a statistical indicator. The internal structure was evaluated using confirmatory factor analysis and structural equation modeling.

RESULTS: The sample consisted of 432 members of the Shawi community. The instrument showed excellent content validity (V = 0.90 to 1.00). Confirmatory factor analysis supported a unidimensional model with good fit (comparative fit index: 0.98; root mean square error of approximation: 0.06) and adequate internal consistency (α = 0.80; ω = 0.81). In addition, invariance of the PHQ-9 was demonstrated across age, sex, educational level, and marital status, supporting its applicability across different population subgroups.

CONCLUSIONS: The Shawi version of the Patient Health Questionnaire-9 has proven to be a reliable and valid tool for detecting depressive symptoms in this Indigenous population. This advancement represents a significant contribution to reducing mental health disparities by facilitating culturally appropriate diagnoses and improving care in historically underserved Amazonian communities.

PMID:42102351 | DOI:10.5867/medwave.2026.04.3176

Anesthesiology. 2026 May 8. doi: 10.1097/ALN.0000000000006133. Online ahead of print.

ABSTRACT

BACKGROUND: Deep brain stimulation for Parkinson’s disease is often performed under conscious sedation or general anesthesia. However, anesthetic agents may influence intraoperative microelectrode recording, and the optimal anesthesia method for microelectrode recording remains unclear. This study compared general anesthesia and conscious sedation in preserving microelectrode recording signal intensity during deep brain stimulation.

METHODS: In this prospective, noninferiority randomized controlled trial, patients with Parkinson’s disease (UK Brain Bank criteria) undergoing elective bilateral surgery were randomized 1:1 to the conscious sedation or the general anesthesia group. During surgery, a desflurane anesthetic titrated against the quality of the electrophysiologic signal was applied in the general anesthesia group, whereas patients in the conscious sedation group received dexmedetomidine anesthesia. The primary outcome was the proportion of patients with high-quality microelectrode recording (normalized root mean square, nRMS >2.0), assessed postoperatively off-line. Secondary outcomes included operation and recording duration, 6-month clinical efficacy, and complication rates.

RESULTS: Of 188 randomized patients (94 general anesthesia, 93 conscious sedation), desflurane anesthesia was noninferior for high nRMS proportion (89.4% vs. 90.3%; difference, -0.96%; 95% CI, -9.62 to 7.70). The general anesthesia group had shorter operative time (difference, -9.07 minutes; 95% CI, -13.99 to -4.14; P<0.001). At 6 months, changes in Unified Parkinson’s Disease Rating Scale score (difference, -2.50; 95% CI, -7.20 to 2.20; P=0.297), levodopa equivalent daily dose (difference, -58.4 mg; 95% CI, -133.56 to 16.75; P=0.128) and the complication rates (general anesthesia: 10.9% vs. conscious sedation: 8.9%; p=0.655) were comparable between the groups.

CONCLUSION: General anesthesia is noninferior to conscious sedation for microelectrode-guided subthalamic nucleus deep brain stimulation, providing equivalent signal intensity and clinical outcomes while improving procedural efficiency, supporting its use as a valid clinical option.

PMID:42102350 | DOI:10.1097/ALN.0000000000006133

J Pediatr Orthop. 2026 May 8. doi: 10.1097/BPO.0000000000003321. Online ahead of print.

ABSTRACT

BACKGROUND: Elastic stable intramedullary nailing (ESIN) is an established treatment for unstable pediatric forearm fractures. Although routine radiographic follow-up at 4 weeks is widely performed, its clinical benefit is unclear. This study aimed to evaluate the relevance of routine 4-week radiographs and to develop a risk-adapted follow-up protocol.

METHODS: We retrospectively analyzed all patients aged 0 to 18 years treated with ESIN for diaphyseal forearm fractures at a level I trauma center between 2014 and 2024. Clinical and radiologic findings at the scheduled 4-week follow-up visit were assessed retrospectively. Radiologic abnormalities were defined as secondary displacement, implant-related problems, or signs of infection. Therapeutic consequences were recorded. Statistical analyses included χ2 or Fisher exact tests, Mann-Whitney U tests, and logistic regression.

RESULTS: Of 610 patients screened, 553 were included (mean age: 8.0±3.5 y, 61.1% male). At the 4-week follow-up, 65.5% (362/553) were asymptomatic. Radiologic abnormalities were rare (1.3%, n=7). Importantly, none of the 362 asymptomatic patients showed relevant radiologic findings. Radiologic abnormalities were more frequent in children with clinical abnormalities (2.6% vs. 1.1%). In multivariable analysis, radiologic abnormalities remained the only independent predictor of therapeutic consequences (aOR: 11.9, 95% CI: 2.3-62.3; P=0.003).

CONCLUSION: Routine 4-week radiographs after ESIN osteosynthesis in pediatric forearm fractures do not lead to therapeutic consequences in asymptomatic patients. An algorithm for risk-adapted x-ray is proposed, although further prospective evaluation is needed.

LEVELS OF EVIDENCE: Level III-retrospective cohort study.

PMID:42102347 | DOI:10.1097/BPO.0000000000003321

Neurology. 2026 Jun 9;106(11):e218067. doi: 10.1212/WNL.0000000000218067. Epub 2026 May 8.

ABSTRACT

BACKGROUND AND OBJECTIVES: Patients with multiple sclerosis (MS) require increasing health care support, particularly in the last year of life. Despite the benefits of palliative care in addressing symptom burden and improving quality of life, its integration into MS care remains inconsistent. This study aimed to characterize health care utilization and palliative care access among people with MS in the last years of life and to identify key factors associated with hospital death and receipt of palliative care.

METHODS: A retrospective cohort study was conducted using linked health administrative databases in Ontario, Canada. The cohort consisted of all decedents aged 18 years or older who died in Ontario between April 2016 and March 2020, and we compared health care utilization in decedents with MS to the rest of the cohort. The identification of MS cases was based on a validated algorithm. Demographics, health care utilization, palliative care involvement, and medical interventions were analyzed. Predictors of palliative care receipt and hospital deaths were evaluated using multivariable logistic regression models.

RESULTS: MS decedents (n = 1,975; mean age 68 years; 66.4% female) were younger and had fewer comorbidities than non-MS decedents (n = 500,904; mean age 77). High percentage of MS decedents had outpatient neurology visits in the last 5 years of life (49.4%) but a steep decline closer to death (2.7% in the last month). Palliative care use was similar (58.0% vs 56.9%) but occurred earlier in MS (61.9% vs 59.6% in the last 5 years). Multivariable regression showed that rural residence was associated with increased odds of hospital death (odds ratio [OR] 1.81, 95% CI 1.21-2.70) and lower odds of receiving palliative care (OR 0.74, 95% CI 0.55-0.99), while receiving palliative care within the last 5 years of life reduced the odds of hospital death (OR 0.47, 95% CI 0.37-0.60). Higher comorbidity and increased outpatient visits to urology were associated with a greater odd of receiving palliative care (OR 3.64, 95% CI 2.50-5.29 and OR 1.47, 95% CI 1.20-1.80).

DISCUSSION: Although palliative care receipt was comparable between MS and non-MS decedents, rural disparities and high hospital deaths persist. Earlier palliative integration, particularly through neuropalliative care, could improve quality of life and reduce hospitalizations.

PMID:42102338 | DOI:10.1212/WNL.0000000000218067

J Pediatr Orthop. 2026 May 8. doi: 10.1097/BPO.0000000000003313. Online ahead of print.

ABSTRACT

BACKGROUND: Free fibular flaps (FFF) and pedicled fibular grafts (PFG) are established techniques for reconstructing pediatric long bone defects. While the FFF provides versatility through microvascular transfer, PFGs avoid anastomosis but are limited by anatomic constraints. Clinical questions remain regarding optimal fixation strategies, donor-site morbidity, and graft outcomes in children.

METHODS: This retrospective cohort study analyzed 22 pediatric patients undergoing FFF or PFG between 1994 and 2025. Outcomes included time to radiographic union, time to weight bearing, fibular regeneration, and donor-site complications. Subgroup analyses compared external fixation use, periosteal sleeve preservation, and graft type/location.

RESULTS: The average time to radiographic union was 41 weeks. External fixation was associated with shorter radiographic union time (30.1 vs. 86.4 wk) and earlier full weight bearing on the graft-receiving limb (52.0 vs. 127.2 d), though these findings should be interpreted as exploratory given the limited sample size and inconsistent significance across statistical tests. Younger patient age correlated with faster union (r = 0.60, P = 0.004). Preservation of a periosteal sleeve at the donor site significantly promoted fibular regeneration (P = 0.0004) and may hasten donor limb recovery. Ankle valgus deformity was associated with shorter residual distal fibula length (mean 5.6 cm, P = 0.0498). All grafts showed remodeling over time. Tibial graft location and use of PFG were significantly associated with need for refixation (P = 0.0001 and P = 0.0002, respectively).

CONCLUSION: Pediatric FFF reconstruction demonstrates high union and remodeling rates with favorable functional outcomes. External fixation was found to be weakly associated with acceleration of union and weight bearing, while periosteal sleeve preservation supports fibular regeneration and potentially expedites return to weight bearing on the donor limb. PFGs may be effective in select tibial cases but showed higher reoperation rates. Preserving an adequate distal fibula segment may mitigate ankle valgus. These findings support tailored fixation strategies and highlight the importance of surgical planning to optimize outcomes and minimize donor-site morbidity in pediatric patients.

LEVEL OF EVIDENCE: Level III-therapeutic study.

PMID:42102320 | DOI:10.1097/BPO.0000000000003313

JMIR Nurs. 2026 May 8;9:e87930. doi: 10.2196/87930.

ABSTRACT

BACKGROUND: Understanding current nursing workflows is essential to informing future workforce redesign strategies, including virtual nursing roles. However, granular insights into current nursing workflows over a 24-hour period and across different staff grades are lacking.

OBJECTIVE: This study aimed to (1) quantify how registered and enrolled nurses in the general acute medicine wards distribute their time across direct and indirect care tasks over a 24-hour period, (2) identify multitasking burdens and temporal distributions, and (3) identify opportunities for the development of a virtual nursing role.

METHODS: Using time-and-motion methodology, we observed registered and enrolled nurses in 3 general medicine wards over a 24-hour period between April 2024 and June 2024. We observed 3 task categories (administrative, communication, and bedside tasks), with multiple individual tasks monitored under each category. Multitasking (ie, the occurrence of 2 or more tasks concurrently) was also tracked. The checklist was piloted and refined before data collection.

RESULTS: We observed a total of 48 nursing shifts. During the daytime, registered nurses spent 70% (587/834 min) of their time on indirect care tasks compared with 54% (412/764 min) of the time for enrolled nurses. At night, the proportion of time spent on indirect care tasks decreased to 58% (410/705 min) for registered nurses and 39% (274/711 min) for enrolled nurses. During a 24-hour period, registered nurses spent 209 (SD 51.8) minutes multitasking in the day and 117 (SD 41.0) minutes at night, whereas enrolled nurses spent 152 (SD 54.7) minutes multitasking in the day and 110 (SD 75.9) minutes at night.

CONCLUSIONS: These findings highlight opportunities for virtual nursing roles, which, if thoughtfully designed, may help redistribute indirect care tasks, reduce multitasking burden, and enhance overall efficiency without compromising care quality.

PMID:42102318 | DOI:10.2196/87930

J Pediatr Orthop. 2026 May 8. doi: 10.1097/BPO.0000000000003306. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to identify all pediatric femoral neck fractures and determine the prevalence of autism spectrum disorder (ASD) and other neurodevelopmental disorders (NDD) among these patients. In addition, it aimed to assess their impact on clinical and radiographic outcomes.

METHODS: A total of 289 pediatric patients with proximal femoral fractures were initially identified, of whom 140 met the inclusion criteria for femoral neck fractures after excluding pathologic fractures, polytrauma, and incomplete records. Demographic, clinical, and radiographic data, including the presence of ASD and other NDD conditions, were collected. Intraoperative and postoperative complications were recorded. Statistical analyses were performed using (IBM SPSS Statistics; IBM Corp., Armonk, NY) with associations between variables assessed using t tests and χ2 tests, and significance set at P<0.05.

RESULTS: Among 140 pediatric patients with femoral neck fractures, 39 (28%) were diagnosed with ASD or NDD. Compared with non-ASD patients, those with ASD exhibited more frequent additional neurological and gastrointestinal/endocrinologic comorbidities, higher prevalence of low preoperative vitamin D levels, and a greater incidence of home-related injuries (all P<0.05). Intraoperative and postoperative complications, including infection and avascular necrosis, were infrequent and did not differ significantly between groups. The mean time for return to daily activities was similar between ASD and non-ASD patients.

CONCLUSION: A significant association was observed between pediatric femoral neck fractures and ASD or other NDD, including intellectual disabilities. Children with ASD or NDD demonstrated higher rates of medical comorbidities, low preoperative vitamin D levels, and home‑related injuries, suggesting unique risk profiles in this population.

LEVEL OF EVIDENCE: Level III.

PMID:42102315 | DOI:10.1097/BPO.0000000000003306

Biomol Biomed. 2026 May 8. doi: 10.17305/bb.2026.14216. Online ahead of print.

ABSTRACT

Dynamic retinal vessel analysis is a non-invasive approach for assessing retinal microvascular endothelial function, yet the extent to which eye selection, interocular variability, and systemic physiological factors influence dynamic retinal vessel analyzer (DRVA)-derived biomarkers remains insufficiently defined. This prospective methodological study aimed to evaluate the interocular symmetry and absolute and relative reliability of arterial flicker-induced dilation (aFID), venular flicker-induced dilation (vFID), and arteriolar constriction (aCON), and to determine whether these parameters are moderated by eye dominance, peak oxygen uptake (V̇O₂ peak), or intraocular pressure (IOP) in healthy individuals. Twenty apparently healthy adults completed two laboratory visits. During the first visit, aerobic capacity was assessed by cardiopulmonary exercise testing until volitional exhaustion. During the second visit, IOP, resting blood pressure, eye dominance, and retinal vascular endothelial function were assessed using DRVA in both eyes in randomized order. Interocular differences were examined using paired comparisons, Bland-Altman analysis, reliability statistics, and linear mixed-effects models accounting for bilateral measurements within participants. No significant differences were observed between the left and right eyes for aFID, vFID, or aCON. Bland-Altman analysis showed no systematic interocular bias across DRVA-derived parameters, although the limits of agreement were widest for aFID, indicating greater interocular variability. Relative reliability was highest for vFID, followed by aCON, whereas aFID showed only fair agreement. Similarly, absolute reliability analyses identified vFID as the most stable biomarker, with the lowest coefficient of variation, while aFID demonstrated the greatest variability. Linear mixed-effects models showed no significant moderating effects of eye dominance, V̇O₂ peak, or IOP on aFID, vFID, or aCON. These findings suggest that retinal vascular endothelial responses measured by DRVA are not systematically influenced by eye dominance or selected systemic physiological factors in healthy young adults. However, given the observed interocular variability, particularly for aFID, assessment of both eyes should be considered in clinical and research settings to improve measurement precision and reproducibility.

PMID:42102314 | DOI:10.17305/bb.2026.14216

Am J Occup Ther. 2026 Jul 1;80(4):8004205080. doi: 10.5014/ajot.2026.051493.

ABSTRACT

IMPORTANCE: Sleep health supports child development and family well-being. Toddlers with Down syndrome experience elevated sleep difficulties, yet few studies have examined their sleep within a multidimensional framework.

OBJECTIVE: To apply the Pediatric Sleep Health framework (Peds B-SATED) to characterize multidimensional sleep health and sleep-related practices of toddlers with Down syndrome (12-36 mo).

DESIGN: Secondary analysis of cross-sectional descriptive data.

SETTING: Clinics and organizations serving families of children with Down syndrome.

PARTICIPANTS: Twenty-four mothers of children with Down syndrome were recruited.

OUTCOMES AND MEASURES: Parent-reported Brief Infant Sleep Questionnaire items mapped onto the Peds B-SATED domains (Behavior, Satisfaction, Alertness, Timing, Efficiency, Duration). Descriptive statistics summarized sleep profiles and parental practices.

RESULTS: Fifty percent of the sample demonstrated multidomain sleep difficulties; 33% had difficulties in a single domain, and 17% had none. Behavior was the most problematic domain (63%), followed by satisfaction and efficiency (29% each), timing (25%), and duration (13%). Most children had structured sleep behaviors (consistent bedtimes/routines ≥80%; falling asleep independently, 70%; limited prebedtime screen exposure, 67%) and high parental satisfaction. Most children woke up happy and took one daytime nap (>90%). Sleep timing and efficiency were characterized by early bedtimes (median lights-out 8 p.m.; median wake 7 a.m.), no night awakenings (71%), and mean sleep latency of 13.5 min. Mean 24-hr sleep duration was 12.5 hr.

CONCLUSIONS AND RELEVANCE: A multidimensional approach to characterizing sleep health reveals heterogeneous sleep profiles across domains and offers clinicians and researchers an in-depth view of intervention targets for toddlers with Down syndrome. Plain-Language Summary: This study examined the sleep health of toddlers with Down syndrome ages 12-36 months by using the Pediatric Sleep Health framework, which looks at multiple aspects of sleep, including routines, quality, timing, and duration. Parents of 24 children completed a questionnaire about their child’s sleep, and then we mapped their responses to this sleep health framework. We found that most children went to bed and woke up early, slept about 12.5 hr per day, and were described as good sleepers. However, many children had at least one area of difficulty, most often related to bedtime behaviors (63%). In general, about 17% had no sleep-related concerns, whereas the remainder experienced challenges in one or more areas. These findings show that even when overall sleep appears good, specific sleep behaviors may still benefit from attention. Using a multidimensional sleep health framework can help identify these patterns and better describe sleep health of young children with Down syndrome.

PMID:42102306 | DOI:10.5014/ajot.2026.051493