Nevin Manimala

Ann Afr Med. 2026 Jun 5. doi: 10.4103/aam.aam_69_26. Online ahead of print.

ABSTRACT

OBJECTIVES: To analyze the histopathological features and spectrum of lichenoid interface dermatitis with emphasis on epidermal changes and inflammatory patterns. To study the spectrum of lichenoid lesions and estimate the clinical correlation with the histopathological diagnosis of lichenoid interface dermatitis.

MATERIALS AND METHODS: This research was a retrospective observational study conducted in the Department of Pathology, Vinayaka Mission Kirupanandha Variyar Medical College and Hospital, from January 2023 to April 2025. The study included all patients with lichenoid tissue reactions. Biopsies were processed and studied under a microscope for histopathological assessment. The histopathological evaluation focused on key features of the epidermal and dermoepidermal junction.

STATISTICS: Categorical variables were presented as frequencies and percentages to enable comparisons with other studies. Data analysis was performed using SPSS 21.0, and graphs and tables were created using Microsoft Word and Excel.

RESULTS: We had 70 cases of histopathologically diagnosed lichenoid dermatitis. The age ranged from 1 to 70 years, with the most common being 20-29 years. Females were more affected with M: F ratio of 2:3. We encountered more lichen planus and its variants as the common entity of lichenoid dermatitis, which accounts for 65.7%. The epidermal changes, such as vacuolar degeneration, hyperkeratosis, and acanthosis, are the common findings. Band-like inflammatory infiltrate was seen in 87.2% of cases.

CONCLUSION: The histopathological features may vary depending on the specific subtype of lichenoid dermatitis and the disease stage. It provides valuable insights into its diagnosis, and it should be correlated with clinical presentation and other investigative methods for a comprehensive diagnosis.

PMID:42253009 | DOI:10.4103/aam.aam_69_26

Ann Afr Med. 2026 Jun 5. doi: 10.4103/aam.aam_98_26. Online ahead of print.

ABSTRACT

BACKGROUND: Women with systemic lupus erythematosus (SLE) are at increased risk of adverse maternal and fetal outcomes, particularly when pregnancy occurs during periods of active disease. Effective contraception is therefore essential, yet data on sexual activity and contraceptive practices among women with SLE in Nigeria are limited.

METHODS: A cross-sectional survey was conducted between April and July 2025 among women aged 18-48 years with rheumatologist-diagnosed SLE in Nigeria. Participants were recruited through rheumatology clinics and an online survey platform. Information obtained included sociodemographic characteristics, disease duration, disease activity assessed using the Mexican SLE Disease Activity Index, sexual activity, reproductive intentions, contraceptive use, and perceived risk of unintended pregnancy. Descriptive statistics were used, and Kendall’s tau-b assessed the association between sexual activity and disease activity.

RESULTS: Eighty-five women were analyzed. The mean age was 35.0 ± 7.7 years, and the median disease duration was 50 months (interquartile range: 22-108). Fifty-eight participants (68.2%) were sexually active. Among these, 39 (67.2%) reported using contraception, although only 19 (48.7%) used it consistently. Barrier methods, predominantly condoms, were the most commonly used (31.1%). Most contraceptive users (74.4%) did not intend pregnancy within the next 12 months. Sexual activity was inversely associated with disease activity (Kendall’s tau-b = -0.184, P = 0.048). Despite low perceived risk, 23.2% reported at least one episode of unintended pregnancy risk in the preceding year.

CONCLUSION: This study demonstrates that women with SLE in Nigeria remain sexually active and, despite their strong pregnancy avoidance intentions, frequently rely on barrier methods and inconsistently use contraception. These patterns closely mirror global experience and highlight the urgent need to integrate structured, disease-specific contraceptive counseling into routine SLE care in Nigeria to reduce potentially unintended pregnancy and associated maternal-fetal risks.

PMID:42253002 | DOI:10.4103/aam.aam_98_26

Ann Afr Med. 2026 Jun 5. doi: 10.4103/aam.aam_309_26. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Different formulas are being used to determine the internal diameter (ID) of the cuffed endotracheal (ET) tube in pediatric patients. Recently, a new formula was proposed to predict the ET tube size based on middle finger length (MFL). The aim of this study was to determine the accuracy of this new formula in predicting the cuffed ET tube and to compare it with other commonly used formulas.

MATERIALS AND METHODS: This comparative observational study was carried out among 120 samples of children up to 12 years of age undergoing surgery under general anesthesia after taking their consent. All the details regarding the patient’s age, height, weight, and MFL were collected a day before surgery and the ET tube details and the predicted ET tube size by the five formulae were collected on the day of surgery. They were entered into Microsoft Excel sheet and analyzed using STATA software version 17.

RESULTS: Out of 120 study participants, the fraction of patients in whom the exact ID of cuffed ET tube was correctly predicted with the MFL, age-based formulas (ABFs), height-based formula (HBF), weight-based formula (WBF), and Multivariate prediction tool (MPT) formula were 20%, 18.3%, 0%, 3.3%, and 0.8%, respectively. The predicted ID size within 0.5 mm difference excluding the exact fit for MFL formula, ABF, HBF, WBF, and MPT formula was 20.8%, 57.5%, 12.5%, 30.8%, and 22.5%, respectively. The predicted ID size potentially too big >0.5 mm difference for MFL formula, ABF, HBF, WBF, and MPT formulas were 59.2%, 24.2%, 87.5%, 65.8%, and 76.7%, respectively. Pearson correlation coefficient for all the formulas was r > 0.80 and shows a strong positive correlation which was statistically significant (P < 0.001).

CONCLUSION: ABFs were more accurate compared to other formulae in predicting the ET tube size in case of pediatric patients, but in children less than 5 years of age, MFL formula was a better predictor than other formulas.

PMID:42252986 | DOI:10.4103/aam.aam_309_26

J Microbiol. 2026 May;64(5):e2603014. doi: 10.71150/jm.2603014. Epub 2026 May 14.

ABSTRACT

16S rRNA gene amplicon sequencing is the most widely used approach for characterizing microbial communities, yet analyzing such data requires navigating a fragmented landscape of bioinformatics tools with distinct installation requirements, parameter settings, and data formats. Here we present 16S-Pipeline, an open-source, web-based platform that provides a complete workflow from raw FASTQ files to publication-ready statistical analyses. 16S-Pipeline automatically detects sequencing type (paired-end, single-end, long-read), variable region, and sequencing platform (Illumina, PacBio HiFi, Nanopore), then performs quality filtering, primer trimming, amplicon sequence variant (ASV) inference via DADA2, taxonomy assignment against SILVA v138.1, phylogenetic tree construction, and optional functional prediction via PICRUSt2. Downstream analyses include alpha and beta diversity, taxonomic composition visualization, differential abundance testing using five complementary methods (ALDEx2, DESeq2, ANCOM-BC2, LinDA, MaAsLin2) with consensus reporting, and KEGG pathway mapping. Built-in NCBI SRA integration enables downloading public datasets for re-analysis and generates submission metadata spreadsheets for data deposition. The interactive web interface built on FastAPI and Plotly Dash enables researchers to perform complex microbiome analyses without command-line expertise. 16S-Pipeline is freely available at https://github.com/tatsu1207/16S-Pipeline under the MIT License.

PMID:42252976 | DOI:10.71150/jm.2603014

Infect Control Hosp Epidemiol. 2026 Jun 8:1-8. doi: 10.1017/ice.2026.10480. Online ahead of print.

ABSTRACT

OBJECTIVE: Antimicrobial Stewardship Programs (ASPs) need healthcare economic analyses to support and inform ASP strategies. This work aimed to determine whether widely available artificial intelligence (AI) platforms like Microsoft Copilot^TM could facilitate healthcare economics analyses for ASP programs without dedicated healthcare economic supports.

DESIGN: AI (Microsoft Copilot^TM) was prompted to develop a cytomegalovirus prophylaxis protocol for lung transplant recipients using only PubMed-indexed articles. Copilot^TM was then prompted to produce probabilistic samples of simulated patients from aggregate statistics of a 165-patient cohort from Vanderbilt University Medical Center and to analyze cost-effectiveness across four distinct cytomegalovirus prophylaxis protocols, including its own.

SETTING: Tertiary care academic medical center, including outpatient and inpatient environments.

PATIENTS OR PARTICIPANTS: Simulated patient data was developed via random, single-blind, probabilistic selection from pre-defined aggregate cohort statistics.

RESULTS: The AI-generated prophylaxis protocol was evidence-based without hallucination, but this conservative protocol relied on outdated evidence and was associated with significant increases in expected per-patient cost (mean +$4740, P < .01) compared to recent guideline-based and institutional protocols. AI independently identified and executed sensitivity analyses, which revealed that in this simplified model, letermovir use had a large impact on expected per-patient cost.

CONCLUSIONS: The AI-proposed protocol was less cost-effective, but data suggest that careful prompting can provide appropriate PubMed-indexed literature to support ASP protocol development. Additionally, CoPilot^TM provided a thorough cost-effectiveness analysis comparing all potential and existing protocols. With appropriate oversight, AI and Microsoft Copilot^TM can conduct healthcare economic analyses suitable for ASP strategic planning and implementation.

PMID:42252971 | DOI:10.1017/ice.2026.10480

Am J Surg Pathol. 2026 Jun 8. doi: 10.1097/PAS.0000000000002576. Online ahead of print.

ABSTRACT

Giant cell urothelial carcinoma (GCUC) is an exceedingly rare histologic subtype with 50+ reported cases. To date, 3 case series have been reported. Scant chemotherapy and immunotherapy responses were reported with variable results. We report the largest GCUC series, including 27 GCUC and 27 matched control urothelial carcinoma (CoUC) patients, most (>90%) of whom had more than 5 years of follow-up, including neoadjuvant and adjuvant therapy status. We further characterized the nuclear size ratio of giant tumor cells to background tumor cells and analyzed urothelial differentiation markers (GATA3, CK5/6), p53, tumor-infiltrating lymphocytes (CD19 and CD3), and therapeutic targets (TROP2, Nectin4, PDL1, and HER2). Morphometric analysis of giant tumor cells demonstrated that they were, on average, 12 times larger than surrounding nongiant tumor cells. GCUC showed many histologic and immunophenotypic features similar to CoUC. GCUC was enriched for higher stages (T3/4 and metastatic disease) than CoUC and showed a trend toward worse OS than conventional urothelial carcinoma, but was similar to urothelial carcinoma with variant histology. GCUC included 3 low-stage (T1/2) patients, who had significantly worse OS than low-stage CoUC, suggesting early extensive workup and oncologic intervention. Chemotherapy slightly improved OS in both GCUC and CoUC patients without statistical significance. Compared with CoUC, GCUC appeared to have more tumor-infiltrating T cells, but without statistical significance. There were no expression differences in TROP2, Nectin4, PDL1, and HER2. However, a subset of GCUC patients might benefit from target therapies (PDL1, Nectin4), warranting more cohort studies.

PMID:42252958 | DOI:10.1097/PAS.0000000000002576

Brain Behav. 2026 Jun;16(6):e71330. doi: 10.1002/brb3.71330.

ABSTRACT

BACKGROUND: Thirdhand smoke (THS) is a persistent environmental toxin that poses significant health risks, especially to vulnerable populations such as pregnant women and their fetuses. Effective interventions to enhance knowledge, modify beliefs, and improve protective practices are crucial. This study aimed to evaluate the impact of a structured, multi-component educational intervention on knowledge, beliefs, and self-reported practices related to THS among pregnant women.

METHODS: A randomized controlled trial was conducted with 100 pregnant women in their second or third trimester, recruited from comprehensive health centers in Isfahan, Iran. Participants were randomly assigned to an intervention group (n = 50) or a control group (n = 50). The intervention group received a multi-faceted educational program consisting of four face-to-face group sessions, one spousal session, educational pamphlets, and reinforcement messages via a social media group. The control group received routine prenatal care. Data were collected using validated questionnaires assessing knowledge (11 items), beliefs (using the Beliefs About Thirdhand Smoke-BATHS scale, 9 items), and self-reported practices (9 items) at baseline and two months post-intervention. Data were analyzed using paired t-test, Wilcoxon signed-rank test, and Analysis of Covariance (ANCOVA) in SPSS v.23.

RESULTS: The intervention group demonstrated significant improvements in mean scores of knowledge (from 13.30 ± 2.68 to 21.52 ± 5.23, p < 0.001), beliefs (from 25.60 ± 8.12 to 38.46 ± 4.01, p < 0.001), and self-reported practices (from 10.50 ± 1.50 to 13.52 ± 2.10, p < 0.001) after the intervention. No significant changes were observed in the control group. ANCOVA results, while controlling for baseline scores, confirmed a statistically significant effect of the intervention on post-intervention scores for knowledge (F = 179.61, p < 0.001), beliefs (F = 77.52, p < 0.001), and practices (F = 54.14, p < 0.001).

CONCLUSION: A structured, theory-based educational intervention significantly improved knowledge, beliefs, and self-reported protective practices concerning THS among pregnant women. Integrating such comprehensive programs into routine prenatal care is strongly recommended to mitigate THS exposure risks and promote maternal and fetal health.

TRIAL REGISTRATION: This randomized controlled trial was prospectively registered in the Iranian Registry of Clinical Trials (IRCT) on 25/04/2025, prior to participant recruitment (Identifier: IRCT20250105064282N1). https://irct.behdasht.gov.ir/trial/81695.

PMID:42252955 | DOI:10.1002/brb3.71330

Int J Urol. 2026 Jun;33(6):e70536. doi: 10.1111/iju.70536.

ABSTRACT

OBJECTIVES: To evaluate inflammatory biomarkers (neutrophil-to-lymphocyte ratio [NLR], C-reactive protein [CRP]) as continuous variables and assess linearity and the proportional hazards (PH) assumption, including time-varying effects, in metastatic renal cell carcinoma (mRCC) treated with first-line immune checkpoint inhibitor (ICI)-based combinations.

METHODS: This multicenter retrospective study included 151 patients with mRCC. Log-transformed NLR and CRP were tested for linearity (quadratic terms) and PH (Schoenfeld residuals). Multivariable Cox regression was adjusted for International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk factor count and treatment regimen. Time-varying effects were assessed using marker × log(time) interactions and 12-month landmark analyses; incremental discrimination beyond IMDC was evaluated using Harrell’s concordance index.

RESULTS: Log-transformed NLR and CRP showed no statistically significant evidence of nonlinearity (p = 0.211 and p = 0.055, respectively). NLR showed evidence of PH violation for all outcomes, whereas CRP did not. On multivariable analysis, NLR remained associated with overall survival (OS; adjusted hazard ratio [HR] 2.10, 95% confidence interval 1.26-3.49, p = 0.005) and cancer-specific survival (adjusted HR 2.04, 1.20-3.47, p = 0.009). Landmark analysis suggested a stronger OS association during 0-12 months (HR 2.61, 1.49-4.59) than after 12 months (0.93, 0.37-2.34). Adding NLR to IMDC modestly improved OS discrimination (ΔC-index +0.038, bootstrap p = 0.052).

CONCLUSIONS: Log-transformed inflammatory markers showed no statistically significant evidence of nonlinearity. NLR showed exploratory evidence of time-varying prognostic associations, with stronger discrimination during earlier follow-up.

PMID:42252945 | DOI:10.1111/iju.70536

Arch Ital Urol Androl. 2026 Jun 5:15582. doi: 10.4081/aiua.2026.15582. Online ahead of print.

ABSTRACT

INTRODUCTION: Obstructive uropathy is a common complication in advanced cervical cancer, occurring because of ureteral compression by the tumour mass and often leading to hydronephrosis and impaired renal function. Double-J (DJ) stent insertion is frequently used as the first-line decompression method to restore ureteral patency; however, its technical success is influenced by anatomical distortion and severity of obstruction. Understanding the factors associated with successful stent placement is essential to guide appropriate urinary diversion strategies.

MATERIALS AND METHODS: This retrospective cross-sectional study included 275 patients with confirmed advanced cervical cancer and hydronephrosis treated at Dr. Saiful Anwar General Hospital, Malang, from January 2019 to July 2025. Data collected included age, cervical cancer stage, hydronephrosis grade, DJ stent insertion status, histopathology findings, and survival status. Statistical analysis using the Kruskal-Wallis test and Spearman correlation assessed the association between clinical variables and DJ stent insertion.

RESULTS: DJ stent insertion was successfully performed in 56.7% of patients. Hydronephrosis grade (p = 0.027) and cervical cancer stage (p = 0.046) were significantly associated with successful stent insertion in univariate analysis, whereas histopathological subtype was not (p = 0.970). Patients with higher-grade hydronephrosis had significantly lower odds of successful stent insertion. Correlation analysis showed no significant monotonic relationship between hydronephrosis severity and cancer stage (ρ = -0.041, p = 0.503). In multivariate logistic regression analysis, severe hydronephrosis emerged as an independent predictor of DJ stent insertion failure (OR 0.30, 95% CI 0.11-0.83, p = 0.021), while cervical cancer stage and histopathological subtype were not significant after adjustment.

CONCLUSION: Hydronephrosis severity and cervical cancer stage influence the success of DJ stent insertion in advanced cervical cancer; however, hydronephrosis severity appears to be a more direct determinant of stenting feasibility than cancer stage alone, whereas histopathological subtype shows no significant association.

PMID:42252923 | DOI:10.4081/aiua.2026.15582

Arch Ital Urol Androl. 2026 Jun 5:15191. doi: 10.4081/aiua.2026.15191. Online ahead of print.

ABSTRACT

OBJECTIVES: To estimate the learning curve for thulium laser enucleation of the prostate (ThuLEP) performed by the same surgeon, appreciating the sequential progression in skill and proficiency over time.

PATIENTS AND METHODS: The study retrospectively enrolled 60 patients with benign prostatic hyperplasia (BPH) who underwent the ThuLEP procedure performed by a single experienced endourologist. Though not initially skilled with laser enucleation of the prostate, the surgeon had observed numerous cases before. The patients were divided into three groups, each containing 20 cases. The procedure started with inspection, followed by incision and trough creation and plane development, apicolateral dissection, sphincter release, anterior dissection, bladder neck dissection, C-shaped baso-lateral dissection, and adenoma detachment technique called veil-sparing ThuLEP using the ABCD method. Perioperative parameters, enucleation and morcellation time (min), enucleation efficiency (g/min), morcellation efficiency (g/min), enucleated tissue weight (g), hospital stay time, and catheterization time (h) were recorded.

RESULTS: There was a statistically significant decrease in the International Prostate Symptom Score (IPSS) 6 months postoperatively (median = 3) compared with 1-day postoperatively (median = 4) and preoperatively (median = 25). Uroflowmetry parameters, IIEF-5 scores, enucleation and morcellation efficiency, hospitalization period, and catheterization time were evaluated, showing substantial improvements and stabilization over time.

CONCLUSIONS: A highly skilled endourologist in TURP was able to master the learning curve of ThuLEP after completing the initial 40 patients. Upgrading the sequential progression in skill and proficiency over time for treating benign prostatic hyperplasia in addition to its safety, feasibility, efficacy that improve procedure outcome with fewer difficulties.

PMID:42252919 | DOI:10.4081/aiua.2026.15191