Nevin Manimala

Scand J Urol. 2026 Mar 26;61:72-79. doi: 10.2340/sju.v61.45602.

ABSTRACT

BACKGROUND: Muscle invasive bladder cancer (MIBC) is an aggressive disease with a high mortality rate. Radical cystectomy (RC) is the standard treatment for MIBC and selected non-muscle invasive bladder -cancer (NMIBC) cases. The NorCys-study (NCT04523038, NCT04537221 and NCT04523025) aims to validate biomarkers predicting RC outcomes. This report describes RC practice patterns across the Nordic countries.

MATERIALS AND METHODS: This prospective, multi-institutional study included bladder cancer patients undergoing RC with or without preoperative chemotherapy in all five Nordic countries from 5/2020 to 1/2025. Clinical and pathological data were collected prospectively into REDCap database and analysed using descriptive statistics, Wilcoxon rank sum and Pearson’s Chi-squared tests.

RESULTS: A total of 1,642 patients from 15 centres were enrolled. Of these, 35% (531) had clinical NMIBC (T1-Tis-Ta), and 65% (999) had cT2-4 disease. Preoperative chemotherapy was administered to 398/929 (43%) cT2-4 or node-positive patients. The most common neoadjuvant chemotherapy (NAC) regimens were gemcitabine – cisplatin (GC) (275/475 [58%]) and dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (dd-MVAC) (144/475 [30%]). Robot-assisted RC was the most common surgical approach administered in 886 of 1,472 (60%) cases, with variation between centres. Ileal conduit was the predominant diversion method in 1,375 out of 1,465 cases (94%). Median surgical time was 322 min, blood loss was 300 mL and hospital stay was 9 days. Final pathology demonstrated pT0 in 29%, ≥pT2 in 43% and lymph node metastases 203 (17%).

CONCLUSION: This study reports current RC practices amongst Nordic countries. Patient cohorts did not differ between countries, and although the practices were generally similar, some differences were noted in chemotherapy regimens, the use of robotic-assisted surgery and rates of early RC.

PMID:41884949 | DOI:10.2340/sju.v61.45602

Indian J Ophthalmol. 2026 Apr 1;74(4):580-583. doi: 10.4103/IJO.IJO_1933_25. Epub 2026 Mar 26.

ABSTRACT

PURPOSE: To evaluate the safety and efficacy of a collagen matrix implant (CMI) as an adjunct in ocular surface reconstruction for moderate to severe post-chemical injury symblepharon.

METHODS: This prospective interventional pilot study included ten eyes of nine patients (all male, mean age 17.90 ± 9.48 years) with moderate (n = 4) or severe (n = 6) symblepharon secondary to chemical injury. All patients underwent symblepharon lysis, followed by ocular surface reconstruction using mucous membrane graft and amniotic membrane graft, with the additional placement of a CMI secured with 6-0 vicryl sutures. A symblepharon ring was placed postoperatively for 6-8 weeks. All patients were followed for at least 6 months. Surgical success was defined as ≥30% forniceal depth (FD) correction at 3 months, categorized as excellent (75 – 100%), good (60 to <75%), or poor (30 to <60%). Recurrence was defined as a >2 mm decrease in FD from the 3-month value. Statistical analysis was performed using SPSS v23.

RESULTS: All nine patients completed 6 months of follow-up. There was no case of failure or recurrence. The mean percent depth correction at 3 months was 78.32% in the upper eyelid and 74.47% in the lower eyelid. The mean upper middle FD increased significantly from 4.40 mm preoperatively to 12.20 mm at 3 months, stabilizing at 11.40 mm at 6 months. Similarly, the mean lower middle FD improved from 2.42 mm to 7.57 mm at 3 months, maintaining 7.28 mm at 6 months (Friedman test: χ2 = 10.78, P = 0.00455). Anatomical outcomes were excellent in 8 eyes, good in 1 eye, and poor in 1 eye. Two patients showed significant visual acuity improvement. One patient developed postoperative orbital cellulitis, and three had pyogenic granuloma (not implant-related). There were no cases of implant extrusion.

CONCLUSION: The collagen matrix implant appears to be a safe and effective adjunct for ocular surface reconstruction in moderate to severe post-chemical injury symblepharon, demonstrating encouraging short-term anatomical outcomes with no recurrences at 6 months. Further studies with longer follow-up are warranted.

PMID:41884917 | DOI:10.4103/IJO.IJO_1933_25

Indian J Ophthalmol. 2026 Apr 1;74(4):499-507. doi: 10.4103/IJO.IJO_1977_25. Epub 2026 Mar 26.

ABSTRACT

PURPOSE: The purpose of this report is to characterize the effects of eye muscle surgery on children with achromatopsia and infantile nystagmus syndrome (INS) who have had no previous surgery.

DESIGN: This is a prospective, single-center, interventional case series analysis of 17 patients’ clinical and electrophyisological data before and after eye muscle surgery.

METHODS: Outcome measures included: demographic and clinical characteristics, binocular best-corrected visual acuity (BCVA), strabismic deviation (SD), anomalous head posture (AHP), contrast sensitivity function (CSF), and the expanded nystagmus acuity function (NAFX). Postoperative data were collected between 6 and 9 months after surgery and statistical analysis perfomed.

RESULTS: The age at surgery ranged from 19 months to 12 years (~7.2 years), 53% were male, and 23% were other than Caucasians. Follow-up ranged 9 months -10 years (~ 4.3 years). Nine patients had strabismus. All had a significant refractive error, and 7 patients had amblyopia. Sixteen had abnormal SD-OCT dysmorphology. All had the unique INS waveform of dual-jerk. In 13 patients, a molecular diagnosis was obtained. A surgical algorithm involving at least 2 recti muscles on each eye was perfomed on every patient. There were no surgical complications with a reoperation rate of 12%. Along with unique unexpected improvements in blepharospasm and photophobia, there were improvements in AHP, SD, BCVA, CSF, and the NAFX.

CONCLUSIONS: Achromatopsia has unique associations of a vertical AHP and dual-jerk INS waveforms. In spite of their associated retinal disease, patients with achromatopsia show improvements in many afferent and efferent measures of ocular motor and visual functions after eye muscle surgery for nystagmus.

PMID:41884912 | DOI:10.4103/IJO.IJO_1977_25

J Pediatr Orthop. 2026 Mar 26. doi: 10.1097/BPO.0000000000003269. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies have evaluated risk factors of residual acetabular dysplasia (RAD) following closed reduction (CR). However, none of them have focused on the association between the age at fusion of the ischiopubic synchondrosis and RAD. The objective of this study was to determine whether the age at fusion of the ischiopubic synchondrosis was associated with RAD after CR and to evaluate other predictors for RAD.

METHODS: We retrospectively reviewed children who underwent closed reduction for developmental dysplasia of the hip (DDH) between 2008 and 2018 and were followed for at least 5 years. Exclusion criteria included inadequate follow-up, a diagnosis of teratologic hip dislocation or the presence of other neuromusculoskeletal diseases, and inadequate radiographs and clinical records. RAD was defined as a Severin classification grade of3 at last follow-up or having undergone a secondary reconstructive surgery. The AP pelvis plain radiograph was used to identify the age at fusion of the ischiopubic synchondrosis, IHDI grade, avascular necrosis (AVN), and to measure the acetabular index (AI). Statistical analysis was performed.

RESULTS: A total of 150 children (187 hips) with an average age of 13.6 months (range: 4 to 22 mo) at closed reduction were included. For an average duration of 7.6±2.1 years (range: 5 to 14 y) of follow-up, 53 (28.3%) hips were classified in Severin grade 3/4, and 73 (39%) hips underwent a secondary procedure. There was a significant difference in AI pre-CR and post-CR between the non-RAD and RAD groups. Analysis of the groups showed that the RAD group had a higher IHDI grade than the non-RAD group (P<0.01). The incidence of RAD was significantly higher in children with ischiopubic synchondrosis fused younger than 5 years compared with those with ischiopubic synchondrosis fused 5 years and older (82.9% vs. 63.2%, respectively; P=0.02). The mean AI declined after a reduction in both groups, with the greatest fall occurring in the first year. Cutoff values of AI were 30 degrees at 1 year and 27 degrees at 2 to 3 years post-CR.

CONCLUSION: In patients with CR of DDH, higher IHDI grade and larger AI pre-CR were associated with increased RAD. Age at fusion of the ischiopubic synchondrosis is a predictor for RAD. The acetabulum continued to remodel for 5 years after CR, suggesting long-term observation to identify acetabular dysplasia.

PMID:41884888 | DOI:10.1097/BPO.0000000000003269

Imaging Neurosci (Camb). 2026 Mar 23;4:IMAG.a.1170. doi: 10.1162/IMAG.a.1170. eCollection 2026.

ABSTRACT

Delay discounting is a promising paradigm for transdiagnostic research because both excessive and insufficient tendency to discount future rewards have been reported across diagnoses. Because delay discounting involves multiple neurocognitive functions, researchers have used many strategies to characterize brain activity during delay discounting. However, which of these analytic approaches yield truly robust and replicable findings remains unclear. To this end, we conducted a meta-analysis of 80 fMRI studies of delay discounting, testing which statistical contrasts give rise to reliable effects across studies. Despite being a widely used analytic approach, comparing impulsive and patient choices did not reliably yield the expected effects. Instead, subjective value contrasts reliably engaged the valuation network, and task versus baseline and choice difficulty contrasts reliably engaged regions in the frontoparietal and salience networks. We strongly recommend that future neuroimaging studies of delay discounting use these analytic approaches shown to reliably identify specific networks. In addition, we provide all cluster maps from our meta-analysis for use as a priori regions of interest for future experiments.

PMID:41884866 | PMC:PMC13010365 | DOI:10.1162/IMAG.a.1170

Adv Med Educ Pract. 2026 Feb 6;17:576834. doi: 10.2147/AMEP.S576834. eCollection 2026.

ABSTRACT

BACKGROUND: Sleep is an essential occupation that supports cognitive, emotional, and physical well-being functioning, all of which are critical for academic performance. Although research on students has demonstrated relationships between sleep quality and academic performance, evidence from Rwandan students from health sciences programs remains limited. This study addressed this gap by examining the relationship between sleep quality, conceptualized as an occupation, academic performance scores, and related predictors among undergraduate students at the University of Rwanda.

METHODS: A cross-sectional study was conducted among 251 undergraduate health sciences students (mean age= 23.28 ± 1.99 years; 59% male). Participants completed a sociodemographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and an academic performance assessment. Data were analyzed using descriptive statistics and inferential methods, including Pearson correlation, and multiple linear regression to identify predictors of academic performance scores.

RESULTS: Nearly half of the participants (49.8%) reported poor sleep quality, indicating disrupted engagement in the sleep occupation. Students with good sleep quality showed higher academic performance scores (Mean score=169.53) than those with poor sleep quality (Mean score=82.12), U=2390.5, Z=-9.56, p<0.001. Regression analyses showed that poorer overall sleep quality was strongly correlated with lower academic performance [β=-0.70, 95% CI (-1.76 to -1.36), p<0.001]. Specific components of the sleep occupation including subjective sleep quality [β=-0.18, 95% CI (-0.25 to -0.11), p<0.001] and sleep duration [β=-0.12, 95% CI (-0.18 to -0.06), p<0.001] were significantly correlated with reduced academic performance scores. Male gender was correlated with higher academic scores [β=0.10, 95% CI (0.01 to 0.19), p=0.038] than females.

CONCLUSION: This research revealed significant correlations between sleep quality, gender, and academic performance among health sciences students. Considering these correlations, university should consider integrating sleep hygiene education and occupational balance strategies into wellness efforts to enhance academic success. Besides, longitudinal studies are needed to further assess the direction and nature of these relationships.

PMID:41884862 | PMC:PMC13012283 | DOI:10.2147/AMEP.S576834

Adv Med Educ Pract. 2026 Jan 29;17:580674. doi: 10.2147/AMEP.S580674. eCollection 2026.

ABSTRACT

BACKGROUND: Artificial Intelligence is rapidly transforming the education of healthcare professionals. Despite this progress, many healthcare educators lack the necessary knowledge and confidence to integrate AI effectively. Structured faculty development initiatives may address this gap by enhancing educators’ capacity to incorporate AI. This study investigated participants’ perceptions of a series of AI-focused capacity-building workshops conducted in Pakistan and explored the sustained effect of these workshops on educators’ attitudes, confidence, and application of AI tools in educational settings.

METHODS: A Prospective observational follow-up study was conducted across five workshops: AI in Research (n = 18), AI in Simulation (n = 6), AI in Gamification (n = 15), AI in Assessment (n = 23), and AI in Prompt Engineering (n = 27). Immediate post-workshop surveys measured perceived significance, satisfaction, and knowledge gains. A follow-up survey three months later evaluated sustained use, behavioral change, and institutional dissemination. The follow-up survey questionnaire included the application of workshop learning, changes in attitude, skills, and confidence, institutional support, reflection, and future directions. Quantitative data were analyzed using descriptive statistics, while qualitative responses were subjected to thematic analysis.

RESULTS: Participants reported high satisfaction across all workshops, with over 85% rating the sessions as “Excellent” or “Satisfactory” in terms of achieving learning objectives, knowledge gain, and applicability. Follow-up data (n = 56) demonstrated sustained impact: 85% of participants reported using at least one AI tool in teaching or research, 90% expressed increased openness to AI use, and 77% shared their learning with colleagues. Commonly cited challenges included inadequate infrastructure, institutional resistance, and ethical concerns.

CONCLUSION: AI-focused faculty development workshops significantly enhanced educators’ knowledge, skills, confidence, and motivation to incorporate AI into health professions education. The study uniquely contributes follow-up evidence on early capacity building and educators’ application of AI tools after AI-focused faculty development workshops in health professions education.

PMID:41884861 | PMC:PMC13012173 | DOI:10.2147/AMEP.S580674

Front Immunol. 2026 Mar 10;17:1771609. doi: 10.3389/fimmu.2026.1771609. eCollection 2026.

ABSTRACT

INTRODUCTION: The role of antineuronal antibody titres in the acute and long-term diagnostic and therapeutic management of autoimmune encephalitis (AE) remains unclear. In this retrospective monocentric cohort study, we aimed to (I) identify specific characteristics in antibody testing distinguishing AE from non-AE patients, (II) evaluate the prognostic significance of antineuronal antibody findings and (III) assess outcomes and long-term immunotherapy in patients with AE.

METHODS: Patients with suspected autoimmune-associated neuropsychiatric conditions underwent antineuronal antibody testing between 01/2017 and 03/2023. Patients with positive antibody tests were stratified into AE and non-AE groups based on the clinical criteria proposed by Graus and colleagues. Long-term outcomes, antibody titres, and therapeutic strategies were analysed in AE patients over a three-year follow-up period. Among 2,466 patients tested, 53 met the diagnostic criteria for AE.

RESULTS: In AE patients with paired serum and CSF samples (n = 44), antibodies were detectable in both serum and CSF in 55% of cases (n = 24), in serum only in 36% (n = 16), and in CSF only in 9% (n = 4). AE patients with poor outcomes (n=5) showed a trend toward higher median CSF titres in the acute phase and at four months post-onset compared to patients with good outcomes (n=14); however, differences were not statistically significant. Regarding long-term immunotherapy, rituximab-treated patients experienced fewer relapses than those receiving intravenous-immunoglobulins (IVIG; p-value = 0.02).

DISCUSSION: These exploratory results from a small, heterogeneous cohort require confirmation in larger, prospective studies. Based on our data regarding serum and CSF antibodies, in a resource- limited setting we propose a stepwise diagnostic approach starting with serum screening; in suspected anti-NMDAR-AE, initial paired serum/CSF testing remains essential. If antibodies are detected in serum, additional CSF antibody testing may provide diagnostic confirmation and help guide treatment decisions, as high acute-phase CSF titres may suggest poorer long-term outcomes; however, this potential prognostic value requires confirmation in larger, antibody-specific studies.

PMID:41884821 | PMC:PMC13008692 | DOI:10.3389/fimmu.2026.1771609

Front Immunol. 2026 Mar 10;17:1757477. doi: 10.3389/fimmu.2026.1757477. eCollection 2026.

ABSTRACT

INTRODUCTION: Autoimmune hepatitis is a chronic inflammatory liver disease in which the immune system attacks liver tissue. While genetic predisposition plays a role, environmental factors are increasingly recognized as contributors to disease onset and progression. This study aimed to examine the association between environmental exposures and autoimmune hepatitis in a Yemeni population.

METHODOLOGY: A case-control study was conducted, including 93 patients with clinically diagnosed autoimmune hepatitis and 280 age- and sex-matched healthy controls. Data was collected through structured interviews and laboratory analyses. Environmental exposures assessed included residence in different temperature zones, history of viral infections, medication use, pesticide exposure, and the habit of chewing Khat. Liver biopsy findings and vitamin D levels were evaluated to assess disease severity. Statistical comparisons were performed using odds ratios and confidence intervals to determine associations.

RESULTS: Khat chewing was significantly more common in autoimmune hepatitis patients than in controls (65.6% versus 42.1%, OR: 2.6; 95% CI: 1.6-4.3, p < 0.001). Exposure to medications known to induce autoimmune reactions, such as nitrofurantoin and minocycline, was also higher among patients (27.9% versus 1.8%, OR: 21.3; 95% CI: 7.9-57.7, p < 0.001). Living in warm temperature zones and exposure to pesticides (OR: 13.1; 95% CI: 2.7-62.8, p < 0.001) were both significantly associated with increased disease risk. Patients with these exposures also demonstrated higher liver enzyme levels and more advanced fibrosis on biopsy. Vitamin D deficiency was associated with greater disease severity.

CONCLUSIONS: These findings highlight the important role of environmental factors, particularly Khat chewing and pesticide exposure, in the development and progression of autoimmune hepatitis in Yemen. Public health interventions addressing these exposures may help reduce disease burden.

PMID:41884811 | PMC:PMC13008630 | DOI:10.3389/fimmu.2026.1757477

SAGE Open Nurs. 2026 Mar 14;12:23779608261435041. doi: 10.1177/23779608261435041. eCollection 2026 Jan-Dec.

ABSTRACT

BACKGROUND: Healthcare-acquired infections (HAIs) remain a significant cause of preventable morbidity and mortality in pediatric care, particularly in low-resource and conflict-affected settings such as Palestine. Pediatric nurses play a critical role in infection prevention and control (IPC); however, deficiencies in knowledge, attitudes, practices (KAP), and perceived institutional support may undermine effective HAI prevention.

OBJECTIVE: This study aimed to evaluate the effectiveness of a structured educational workshop in improving pediatric nurses’ KAP, and perceptions of institutional support related to HAI prevention.

METHODS: A one-group pre-post quasi-experimental design was conducted in 2024 at a specialized pediatric hospital in Palestine. A total of 54 pediatric nurses participated in a two-week educational workshop comprising four interactive sessions focused on core IPC principles. Data were collected using a validated self-administered questionnaire assessing KAP and perceived institutional support. Paired-sample t tests were performed to compare pre- and postintervention scores.

RESULTS: Statistically significant improvements were observed across all outcome domains following the intervention (p ≤ .001). Mean knowledge scores increased from 52.9 ± 3.3 to 61.9 ± 4.1, attitude scores from 44.1 ± 4.1 to 52.6 ± 3.4, and practice scores from 42.1 ± 5.7 to 53.3 ± 3.1. The proportion of nurses reporting good perceived institutional support increased from 40.7% pre-intervention to 98.1% postintervention.

CONCLUSION: The structured, context-specific educational workshop significantly improved pediatric nurses’ IPC-related competencies and perceptions of institutional support. Integrating continuous professional education with organizational engagement is essential for strengthening HAI prevention in pediatric settings within resource-constrained healthcare systems.

PMID:41884808 | PMC:PMC13009566 | DOI:10.1177/23779608261435041