Nevin Manimala

BMC Anesthesiol. 2026 Jun 22. doi: 10.1186/s12871-026-04022-4. Online ahead of print.

ABSTRACT

BACKGROUND: Inadvertent perioperative hypothermia remains one of the most common yet undertreated complications in anesthesia practice. Although evidence-based guidelines for its prevention have long been available, a significant gap persists between existing knowledge and clinical implementation. This study reports an eight-year institutional experience in which perioperative hypothermia was adopted as a quality indicator and managed through a collaborative framework between the anesthesiology department and the hospital quality management unit.

METHODS: A single-center, retrospective quality improvement study was conducted between May 2014 and September 2022. Adult patients who underwent surgery lasting more than four hours under general anesthesia were included. Postoperative body temperature was measured by tympanic infrared thermometry upon admission to the recovery unit; values below 36 °C were recorded as hypothermia. A Plan, Do, Check, Act (PDCA) cycle was employed in four phases: problem identification and baseline data collection (2014), awareness and education interventions (2014-2015), structural and technical improvements including provision of tympanic thermometers to all operating rooms and standardization of forced-air warming protocols (2015-2016), and continuous monitoring with periodic reinforcement (2016-2022). Data were collected monthly during 2014-2016 and through a sampled audit of one representative month per quarter from 2017 onward. Trends were analyzed using a Cochran, Armitage test and grouped binomial logistic regression, and process stability with a statistical process control chart.

RESULTS: A total of 1,902 patients were evaluated over the study period, of whom 348 (18.3%) were found to be hypothermic postoperatively. The annual hypothermia rate was 32.5% in 2014, falling to 25.9% in 2015 and 15.2% in 2016 following the educational and structural interventions. From 2017 to 2022, rates stabilized between 9.7% and 15.1%, representing an approximate 3.2-fold reduction from baseline. The decreasing trend was statistically significant (Cochran, Armitage p < 0.001; odds ratio 0.806 per year, 95% CI 0.762, 0.852). Intermittent spikes were observed in isolated quarters (e.g., 32.4% in the third quarter of 2019), but targeted re-education sessions led to prompt correction. The lowest annual rate recorded was 9.7% in 2021.

CONCLUSION: Systematic identification and monitoring of perioperative hypothermia as a quality indicator, coupled with relatively straightforward interventions (education, equipment provision, and ongoing surveillance), was associated with a substantial and sustained reduction in hypothermia rates over eight years. Active collaboration between the quality management unit and the anesthesiology department, with a designated physician serving as quality representative, appeared central to sustaining these gains. These findings suggest that a structured, PDCA-based quality improvement approach may help bridge the gap between established guidelines and day-to-day clinical practice, even without large-scale resource investment; as a single-center experience, this should be regarded as a working hypothesis requiring multi-site confirmation.

PMID:42324460 | DOI:10.1186/s12871-026-04022-4

BMC Public Health. 2026 Jun 22. doi: 10.1186/s12889-026-28251-x. Online ahead of print.

ABSTRACT

BACKGROUND: Out-of-home food consumption has become an integral component of contemporary dietary patterns, particularly in urban contexts. Evidence suggests that eating outside the home is associated with diet quality, nutritional intake, and broader public health outcomes. However, Brazil lacks validated multidimensional instruments capable of comprehensively assessing the economic, behavioral, and experiential determinants underlying this behavior. This study aimed to develop and validate the Scale of Determinant Factors in Out-of-Home Food Consumption (SDF-OHFC) and to examine the structural relationships among its dimensions.

METHODS: A cross-sectional study was conducted with 426 Brazilian adults who reported consuming food outside the home at least once per week. Data were collected through an online survey and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The measurement model was assessed for reliability, convergent and discriminant validity. Structural relationships were tested using bootstrapping procedures (5,000 resamples), and predictive performance was evaluated through R², Q², RMSE, and MAE. Measurement invariance was examined across sex, marital status, and geographic regions.

RESULTS: The SDF-OHFC comprises five dimensions: economic aspects, convenience, habits and personal preferences, social and experiential aspects, and perceived food quality. The scale demonstrated satisfactory internal consistency (Cronbach’s α = 0.705-0.762), composite reliability (> 0.70), and convergent validity (AVE > 0.50). All hypothesized structural relationships were statistically significant (p < 0.05). Economic aspects played a central antecedent role, positively influencing convenience and habits, and negatively influencing social and experiential aspects. Convenience and social and experiential dimensions were positively associated with perceived food quality. Structural invariance was confirmed across all tested demographic groups.

CONCLUSIONS: The SDF-OHFC is a valid and reliable multidimensional instrument for assessing determinants of out-of-home food consumption in Brazil. By integrating economic, behavioral, and experiential factors within a single framework, the scale supports public health research and policy development aimed at improving urban food environments, promoting healthier eating practices, and addressing structural determinants of dietary behavior.

PMID:42324459 | DOI:10.1186/s12889-026-28251-x

Genet Med. 2026 Jun 19:102632. doi: 10.1016/j.gim.2026.102632. Online ahead of print.

ABSTRACT

PURPOSE: Biallelic variants in the minor spliceosomal gene RNU4ATAC were successively identified in Taybi-Linder/MOPD1 (Microcephalic osteodysplastic primordial dwarfism type I), Roifman, and Lowry-Wood syndromes, characterized by variable microcephaly, short stature, neurodevelopmental impairment, skeletal dysplasia, and immunodeficiency. Two-thirds of the reported individuals present with Taybi-Linder syndrome, the first described and most severe form.

METHODS: We collected clinical and molecular data from individuals with biallelic RNU4ATAC variants through various French and European networks and clinics, to refine the phenotypic spectrum of RNU4ATAC-opathies.

RESULTS: We enrolled 69 participants and identified 18 new pathogenic variants. We report a significant proportion of attenuated/atypical presentations, novel rare symptoms, and, unexpectedly, a broad spectrum of autoimmune/inflammatory manifestations, affecting nearly half of the participants. Integrating our data with the 109 published cases, we propose a novel classification based on the main manifestations, immunodeficiency and microcephalic primordial dwarfism. Using computer-assisted facial analysis, we also demonstrated the existence of a specific dysmorphic pattern in RNU4ATAC-opathies, distinct between some sub-syndromes.

CONCLUSION: We present a large cohort of individuals with RNU4ATAC-opathies and expand the phenotypic spectrum to pauci-symptomatic forms, indicating that these diseases are likely to remain underdiagnosed.

PMID:42322192 | DOI:10.1016/j.gim.2026.102632

Genet Med. 2026 Jun 19:102637. doi: 10.1016/j.gim.2026.102637. Online ahead of print.

ABSTRACT

PURPOSE: SET is a member of the inhibitor of histone acetyltransferases (INHAT) complex, involved in transcriptional silencing and gene regulation. Pathogenic variants in SET are postulated to cause neurodevelopmental disorder (NDD) phenotypes, but as only few individuals are described, detailed clinical information is scarce. Hence, currently counseling on phenotype and prognosis of this condition remains challenging.

METHODS: Here we describe the clinical phenotype and mutational spectrum of 23 unreported individuals harboring (likely) pathogenic variants in SET.

RESULTS: Phenotypes include global developmental delay with often pronounced hypotonia, delayed motor development and speech and language delay, ultimately evolving into (mild) intellectual disability. Comorbidities include behavioral concerns, sleeping disturbance and variable unspecific ocular problems. Next generation computer-assisted phenotyping using GestaltMatcher showed limited overlapping facial features between affected individuals and differences compared to disorders caused by related chromatin modifying genes. In addition, we generated a DNA methylation signature, able to distinguish individuals carrying pathogenic variants in SET from individuals with other NDDs and healthy controls. We used this DNA methylation signature to assess pathogenicity of two variants of uncertain significance in SET found in two additional individuals.

CONCLUSION: Together, this expands the knowledge on the SET-related disorder and provides novel approaches for its diagnosis.

PMID:42322191 | DOI:10.1016/j.gim.2026.102637

ScientificWorldJournal. 2026;2026(1):e3077222. doi: 10.1155/tswj/3077222.

ABSTRACT

BACKGROUND: Diabetic foot ulcers are a major complication of diabetes and contribute significantly to morbidity and healthcare burden in India. Physiotherapists play a vital role in prevention and management; however, their knowledge, attitude, and clinical practices in the Indian context remain unexplored.

OBJECTIVE: The study is aimed at assessing the knowledge, attitudes, and practices (KAP) of physiotherapists practicing across India regarding diabetic foot care through a national online cross-sectional survey.

METHOD: A cross-sectional national online survey was conducted from January 2024 to March 2025 among physiotherapists practicing across India. A total of 249 participants were included using a convenience sampling technique. Data were collected using a self-developed, content-validated questionnaire consisting of 20 questions across knowledge, attitude, and clinical practice domains. Descriptive statistical analysis was performed using Jamovi (2.6.23).

RESULTS: A total of 249 respondents from 28 Indian states were included. While 94.8% acknowledged their role in diabetic care, only 41% had received formal training in diabetic foot management. Although most participants identified clinical signs of complications, inconsistencies were observed in interpreting ABI and HbA1c values. Although 98.8% reported providing patient education practices, only 47.4% performed routine foot assessments. Greater clinical experience was associated with better application of knowledge in practice.

CONCLUSION: Indian physiotherapists demonstrate positive attitudes toward diabetic foot care; however, gaps remain in formal training and consistent clinical practice persist. Strengthening structured education and developing standardized clinical guidelines are essential to improve practice.

PMID:42322180 | DOI:10.1155/tswj/3077222

Histopathology. 2026 Jun 20. doi: 10.1111/his.70205. Online ahead of print.

ABSTRACT

AIMS: Appendiceal goblet cell adenocarcinoma (GCA) is an uncommon malignancy that has been described under various names and grading schemes. The 5th Edition of the World Health Organization (WHO) Classification of Digestive System Tumours provides a three-tiered system for grading these neoplasms, but the reproducibility of this classification scheme has not been studied.

METHODS AND RESULTS: We scanned 58 H&E-stained slides from 20 GCA and circulated the whole-slide images among seven pathologists with interest in appendiceal pathology. They evaluated each slide for the presence of 15 histological patterns defined by the WHO as criteria for low-grade (n = 5) and high-grade (n = 10) GCA. Cases were also evaluated for the presence of extracellular mucin. Participants also reported the percentage of high-grade features in each whole slide image and each case. Interobserver variability was assessed statistically. All seven observers agreed on the WHO grade for four of the 20 cases (20%; one grade 1, three grade 3). Using Fleiss’s kappa statistic, overall agreement for cases was fair at 0.29 (95% confidence interval [CI]: 0.14-0.44), and pairwise agreement between observers ranged from 0.00 to 0.82 (median = 0.13). Gwet’s agreement coefficient ranged from 0.10 to 0.87 (median = 0.28), while overall agreement was 0.36 (95% CI: 0.17-0.54). There was significant variability with respect to assessing the presence of individual features. The best agreement was seen for extracellular mucin (neutral feature, κ = 0.43) and tumour sheets (high-grade feature, κ = 0.41), whereas the worst agreement was seen for mild architectural disarray/tubular fusion (low-grade feature, κ = 0.05) and necrosis (high-grade feature, κ = 0.07).

CONCLUSIONS: We conclude that interobserver agreement for grading GCA using the three-tiered WHO 5th Edition classification system is fair at best. A validated two-tiered system (i.e. low- versus high-grade) may be more reproducible.

PMID:42322148 | DOI:10.1111/his.70205

Phys Occup Ther Pediatr. 2026 Jun 20:1-14. doi: 10.1080/01942638.2026.2689068. Online ahead of print.

ABSTRACT

AIMS: To evaluate cognitive and executive function (EF) in children with obstetric brachial plexus injury (OBPI), and the potential effects of injury severity and surgical intervention.

METHODS: Fifty-two children aged 6-12 years were assessed: 30 with OBPI (Type IIa: n = 10, Type IIb: n = 11, Type III-IV: n = 9) and 22 children with typical development. Cognitive function was measured using the Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA-Ch), and EF was assessed via parent-reported Childhood Executive Functioning Inventory (CHEXI). Non-parametric tests and subgroup analyses were conducted, with false discovery rate (FDR) correction applied for multiple comparisons.

RESULTS: Children with OBPI scored significantly lower on total and domain-specific DOTCA-Ch measures (median [IQR]: 85 [72-95] vs. 125 [115-135]; q = 0.002), with large effect sizes (Cliff’s δ = -0.82 to -0.90). No significant differences were found in CHEXI EF composites. Subgroup analyses showed no statistically significant effects of surgery or Narakas classification, although trends indicated potentially poorer cognitive outcomes in children with Narakas type III-IV.

CONCLUSION: Children with OBPI had lower cognitive function than children with typical development but there was no difference in EF. Findings support integrating cognitive assessments into management of children with OBPI.

PMID:42322142 | DOI:10.1080/01942638.2026.2689068

Lymphat Res Biol. 2026 Jun 20:15578585261461974. doi: 10.1177/15578585261461974. Online ahead of print.

ABSTRACT

PURPOSE: In times when health and physical activity are gaining in value, the search for effective methods to support fitness and improve quality of life is becoming a priority. One of the therapies that is gaining increasing popularity is pressotherapy, which supports the regeneration of the body on many levels.

METHODS: The study was conducted on a group of 15 healthy, young women. The participants underwent 10 pneumatic compression therapy treatments using the CarePump Expert8 device. The participants were examined 4 times: a week before the first treatment, immediately before the first treatment, after the 10th treatment and a week after the 10th treatment.

RESULTS: Statistical analysis of mean changes in the range of motion values showed significant decrease in: right (p < 0.05) and left (p < 0.05) hip joint extension; right (p < 0.05) hip joint horizontal abduction; horizontal adduction of the right (p < 0.05) and left (p < 0.05) hip joint; dorsiflexion of the right (p < 0.05) and left (p < 0.05) ankle joint, and also an increase in: right (p < 0.05) and left (p < 0.05) hip external rotation. Statistical analysis of changes in mean values of circumferences showed significant decrease at all tested levels: P1 right (p < 0.05) and left (p < 0.05); U1 right (p < 0.05) and left (p < 0.05); U2 right (p < 0.05) and left (p < 0.05); K right (p < 0.05) and left (p < 0.05); G1 right (p < 0.05); and left (p < 0.05); G2 right (p < 0.05) and left (p < 0.05).

CONCLUSIONS: A series of pressotherapy sessions did not improve lower limb range of motion or body composition indices; however, it did reduce circumferences at all levels of the lower limbs. Long-term use of pressotherapy can help maintain healthy fluid levels, improve circulation, and improve overall physical fitness.

PMID:42322135 | DOI:10.1177/15578585261461974

Am J Phys Med Rehabil. 2026 Jun 22. doi: 10.1097/PHM.0000000000003068. Online ahead of print.

ABSTRACT

Clinically meaningful outcomes require more than statistical significance; they must also represent an actual benefit to patients. The minimum clinically important difference (MCID) is the smallest change in a patient-reported outcome measure (PROM) that is clinically significant to the patient. Despite the growing use of PROMs in clinical research, considerable variability exists in how MCID is defined, calculated, and interpreted across populations and clinical contexts. The objective of this review is to provide a comprehensive summary of the various methods for estimating and interpreting MCID, including distribution-based, anchor-based, and Delphi approaches, and to discuss their relationship with statistical significance in clinical practice. A literature search was conducted using Web of Science, MEDLINE, Embase, PubMed, and Google Scholar. MCID values may vary depending on the patient population, clinical context, and the PROM administered. Each calculation methodology has its strengths and limitations in evaluating clinically meaningful change from baseline to post-treatment. It is recommended to report both a statistically significant difference, defined as P < 0.05, or equivalently a 95% confidence interval (CI) that excludes the null value (i.e., does not include 0 for mean differences or 1 for odds ratios), and a clinically meaningful difference, defined as an effect size meeting or exceeding the established MCID for the outcome measure. Reporting the effect estimate alongside its 95% CI is encouraged as the primary approach, as this conveys both the magnitude and precision of the finding.

PMID:42322131 | DOI:10.1097/PHM.0000000000003068

Clin Adv Periodontics. 2026 Jun 20. doi: 10.1002/cap.70075. Online ahead of print.

ABSTRACT

BACKGROUND: Soft tissue grafts are commonly used in periodontal surgery around teeth and implants. However, few studies have examined donor-site pain through patient-reported outcomes following soft tissue grafting. This study aimed to minimize donor-site pain during autologous gingival grafting using a three-dimensionally (3D)-printed stent and evaluate its effectiveness from a patient-centered perspective.

METHODS: In this randomized controlled trial, 32 patients requiring autogenous gingival grafts were equally allocated to the control group (Omnivac stent) or the test group (3D-printed stent). Patient-reported outcomes were assessed using a visual analog scale (VAS) and the Oral Health Impact Profile-14 (OHIP-14) questionnaire on the day of surgery and at 1, 7, and 14 days postoperatively.

RESULTS: Data from 16 control and 14 test patients were analyzed (two patients were lost to follow-up). The test group reported significantly lower VAS scores than the control group. Despite a lack of statistically significant temporal differences, marked reduction was observed on the day of surgery and on postoperative day 7. OHIP-14 scores were significantly lower in the test group than in the control group across all time points. Analysis of the individual OHIP-14 items at different intervals revealed significant reductions in discomfort-specifically in pronunciation, taste, mastication, and daily activities-when using 3D-printed stents.

CONCLUSIONS: This study applied 3D-printed stents to reduce donor-site discomfort after autogenous soft tissue grafting and evaluated their effectiveness using patient-reported outcomes. Although 3D-printed stents may not directly reduce postoperative pain, they help alleviate discomfort during routine oral functions and daily activities.

KEY POINTS: This study focuses on the free gingival graft, one of the most frequently employed soft tissue grafts in periodontal practice. While autogenous gingival grafting on the palatal side is currently considered the gold standard, it causes additional pain and discomfort in patients. This study demonstrates that three-dimensional technology can be used to improve stent design to reduce patient pain and discomfort.

PLAIN LANGUAGE SUMMARY: This randomized controlled trial demonstrates that compared with a conventional stent, a customized 3D-printed palatal stent significantly improves patient-reported comfort and oral function after autologous gingival grafting, thereby enhancing postoperative quality of life.

PMID:42322120 | DOI:10.1002/cap.70075