Nevin Manimala

Updates Surg. 2026 Mar 6. doi: 10.1007/s13304-026-02592-z. Online ahead of print.

ABSTRACT

The management of descending necrotizing mediastinitis (DNM) is challenging due to diagnostic delays and a lack of consensus on optimal therapeutic. While the Endo classification describes anatomical extent, its link to patient outcomes remains unclear. This study aimed to evaluate the prognostic utility of the Endo classification and identify key factors predictive 90-day mortality and prolonged hospitalization. We performed a retrospective, single-center cohort study spanning 2015-2025 that included 52 consecutive patients with descending necrotizing mediastinitis who were managed surgically. Demographic characteristics, clinical features, Endo classification, operative approaches, and postoperative outcomes were systematically evaluated. Univariable regression and correlation analyses were applied to determine factors associated with 90-day mortality and length of postoperative hospital stay. The cohort (median age 54 years, 65.4% male) had an 11.5% 90-day mortality rate. The Endo classification guided surgical approach but was not significantly associated with mortality or hospital stay. Instead, preoperative hypoalbuminemia (odds ratio (OR) 1.29 per 1 g/L decrease, p = 0.032), postoperative white blood cell count (OR 1.40 per × 10⁹ decrease, p = 0.046) and odontogenic of infection (OR 0.122, p = 0.026) were significant risk factors for mortality. A shorter symptom-to-diagnosis interval (r = – 0.386, p = 0.008) and the presence of empyema (median stay 34.5 vs. 25.5 days, p = 0.020) were independently associated with a longer postoperative hospital stay. In lower mediastinitis (Types IIA-C), a thoracic approach was associated with a lower incidence of the composite outcome (reoperation/death) compared to a transcervical approach (9.1% vs. 33.3%), though this difference was not statistically significant (p = 0.227). In DNM, physiological reserve and disease tempo are more powerful prognostic indicators than anatomical extent alone. A fulminant presentation and nutritional status are key prognostic indicators. These findings support a management paradigm that integrates early physiological optimization with tailored surgical intervention and postoperative care based on disease extent.

PMID:41790373 | DOI:10.1007/s13304-026-02592-z

Drug Saf. 2026 Mar 6. doi: 10.1007/s40264-026-01661-x. Online ahead of print.

NO ABSTRACT

PMID:41790353 | DOI:10.1007/s40264-026-01661-x

Environ Sci Pollut Res Int. 2026 Mar 6. doi: 10.1007/s11356-026-37566-6. Online ahead of print.

ABSTRACT

Autism spectrum disorder (ASD) is a neurodevelopmental condition with increasing rates of diagnosis and potential links to environmental exposures. Metals are known neurotoxicants that may exacerbate ASD symptom presentation. Our study focused on children aged 3-10 years clinically diagnosed with ASD who have lived in Alabama since birth. Spatial analysis assessed metal distribution and clustering patterns, and Spearman correlation was used to evaluate associations between air toxic metals and ASD symptom presentation. Spatial analysis of airborne metals across Alabama showed considerable spatial variability and hot spots, mostly in central Alabama and surrounding counties. ASD symptom presentation showed moderate positive correlation with cadmium, chromium, and lead, weak positive correlation with manganese, and weak negative correlation with mercury. Proximity and statistical analysis showed 73% of the participants lived within 5 km of an industrial site; those living more than 10 km away had much lower ASD scores, and proximity was a strong predictor of ASD symptoms. Our findings show that children in Alabama may be exposed to multiple air toxic metals at different exposure windows, and industrial emissions and residential proximity to pollution sources are potential environmental contributors to increased ASD symptom presentation.

PMID:41790349 | DOI:10.1007/s11356-026-37566-6

Environ Sci Pollut Res Int. 2026 Mar 6. doi: 10.1007/s11356-026-37536-y. Online ahead of print.

ABSTRACT

Soil contamination with heavy metals remains a major environmental concern in post-conflict Mosul City, posing risks to agriculture, ecosystems, and human health. This study investigated seasonal and interannual variations in cadmium (Cd), lead (Pb), zinc (Zn), chromium (Cr), and nickel (Ni), along with key soil properties (pH, electrical conductivity, and salinity), across urban soils during 2022-2023 by applying multivariate statistics and ArcGIS-based spatial analysis. Severe contamination was identified in 39.47% of the study area (S3, S4, and S7), while high contamination affected an additional 40.09% (S6 and S8); the remaining 20.43% (S1, S2, and S5) showed moderate contamination. Soil pH remained relatively stable, whereas electrical conductivity, salinity, and heavy metals particularly Pb, Zn, Cr, and Ni exhibited higher variability. Strong inter-metal correlations and principal component analysis indicated dominant anthropogenic influences, with heavy metals forming one principal component and EC-salinity another. Seasonal variations were evident in 2022, most likely associated with rainfall-driven leaching, but were negligible in 2023 under drier conditions. Spatial patterns reflected the combined influence of soil properties, climatic conditions, and human activities. These findings highlight the persistence of soil contamination in post-conflict Mosul and underscore the need for immediate remediation in high-risk zones, continued monitoring in moderately contaminated areas, and adaptive land management practices to reduce environmental and health risks. The integrated multivariate-spatial framework offers a transferable approach for assessing soil contamination in conflict-affected urban environments.

PMID:41790348 | DOI:10.1007/s11356-026-37536-y

J Thromb Thrombolysis. 2026 Mar 6. doi: 10.1007/s11239-026-03239-x. Online ahead of print.

ABSTRACT

The purpose of this study is to describe the safety and efficacy of direct oral anticoagulants (DOACs) and low molecular weight heparin (LMWH) for the treatment of cancer-associated thrombosis in patients with extreme bodyweights. This was a single center, retrospective cohort study of adult patients on therapy for at least 6 months. The primary efficacy outcome of this study was to describe the time to first recurrent venous thromboembolism (VTE) within 6 months, compared between treatment and across weight cohorts. The primary safety objective was to describe the time to first major bleeding (MB) event within 6 months of starting therapy, between treatment types and among the weight groups. Secondary outcomes included incidence of recurrent VTE, MB, clinically relevant non-major bleeding (CRNMB) and the rate of VTE- or bleeding-related mortality. The time to recurrent VTE was comparable between all groups. In the BMI cohort, the time to first MB was 19.5 times longer for DOACs compared to LMWH in the overweight population (p = 0.007) and to first MB or CRNMB was 11.98 times longer (p = < 0.0001). In the weight cohort, the time to first MB or CRNMB was 14.63 times longer for DOACs compared to LMWH in the overweight population (p = 0.011) and 6.41 times longer in the normal weight population (p = 0.0009). There was an insufficient number of patients in the underweight group to perform statistical analysis. The results suggest that in overweight patients, DOACs have similar efficacy and fewer bleeding complications than LMWHs.

PMID:41790331 | DOI:10.1007/s11239-026-03239-x

Metabolomics. 2026 Mar 6;22(2):32. doi: 10.1007/s11306-026-02414-8.

ABSTRACT

INTRODUCTION: Gliomas represent the tumors of the central nervous system that originate from glial cells. Overall survival predictions and treatment regimen selection are based on accurate tumor diagnosis and grading. However, the diagnosis of glioma remains critically dependent on either invasive biopsies or advanced imaging.

OBJECTIVE: This exploratory study aims to assess the diagnostic potential of urine specimens for discriminating gliomas from controls and identify the dysregulated pathways in a North Indian cohort. Urine is an ideal non-invasive candidate, requires no prior preparation, and considerably increases patient compliance.

METHOD: Urine samples from 50 glioma patients were analysed with ¹H NMR (Nuclear Magnetic Resonance) spectroscopy and compared with those of healthy controls. Statistical analysis was performed in MetaboAnalyst 6.0 to identify significantly perturbed metabolites. Diagnostic performance was assessed using the Receiver Operating Characteristic (ROC) curve, and the Random Forest model was used to evaluate classification accuracy. Pathway enrichment and topology analysis based on the KEGG (Kyoto Encyclopedia of Genes and Genomes) database were performed to identify dysregulated pathways.

RESULTS: ¹H NMR metabolic analysis of urine samples revealed seven statistically significant (p < 0.05) metabolites namely acetate, pyruvate, creatinine, dimethylamine, glutamine, alanine and carnitine. This panel of metabolites displayed excellent diagnostic capability with an Area Under the Curve of 0.90 as measured by a multivariate ROC curve. The random forest model efficiently differentiated glioma from control samples using significant metabolites. Disruption in the primary energy pathways of the body and in the metabolism of major amino acids was observed in the pathway analysis.

CONCLUSION: Integration of these urinary signatures into current clinical practice can serve as an additional diagnostic tool and a non-invasive screening method for populations at risk. They can also be monitored in real time, thus aiding in adaptive treatment strategies and therapy assessment.

PMID:41790324 | DOI:10.1007/s11306-026-02414-8

Int Ophthalmol. 2026 Mar 6;46(1):146. doi: 10.1007/s10792-026-04029-3.

ABSTRACT

PURPOSE: This study aimed to evaluate pre-treatment optical coherence tomography (OCT) biomarkers in patients with diabetic macular edema (DME) and to assess changes in these parameters and their impact on visual prognosis one year after intravitreal (IV) anti-VEGF and steroid treatment.

METHODS: This retrospective study included 250 eyes of 250 patients with DME. Best-corrected visual acuity (BCVA) and routine ophthalmologic examinations were evaluated at baseline and at 4, 6, and 12 months after treatment. Spectral-domain OCT biomarkers assessed were central macular thickness (CMT), serous retinal detachment (SRD), disorganization of retinal inner layers (DRIL), hyperreflective dots (HRD), integrity of the ellipsoid zone (EZ) and external limiting membrane (ELM), intraretinal cyst (IRC) size, vitreomacular adhesion (VMA), epiretinal membrane (ERM), and macular cube volume (MCV). Patients were classified according to letter gain as good (> 10 letters), moderate (5-10 letters), or poor (< 5 letters) responders. Statistical analyses included one-way ANOVA and Kruskal-Wallis tests with post-hoc multiple comparisons.

RESULTS: BCVA improved significantly at 4, 6, and 12 months after treatment (p < 0.001). Mean CMT, IRC, HRD, and MCV values showed significant reductions at all follow-up visits (p < 0.001). The good responder group had significantly lower baseline BCVA and higher baseline CMT, IRC, and HRD values (p < 0.001). In contrast, the poor responder group showed a significantly higher baseline presence of DRIL (p < 0.001).

CONCLUSION: IV anti-VEGF and dexamethasone treatments provide significant anatomical and functional improvement in DME. High baseline CMT, HRD, and IRC values may indicate a favorable visual prognosis, whereas the presence of DRIL at baseline is associated with limited visual gain. Providing accurate prognostic information at treatment initiation may improve patient compliance.

PMID:41790319 | DOI:10.1007/s10792-026-04029-3

Otolaryngol Pol. 2026 Mar 5;80(1):1-8. doi: 10.5604/01.3001.0055.5832.

ABSTRACT

&lt;b&gt;Introduction:&lt;/b&gt; Subglottic stenosis (SGS) is a rare, recurring fibroinflammatory disease that causes upper airway narrowing and severe dyspnea. Patients often require multiple surgeries due to chronic restenosis. The unpredictable nature of SGS may significantly affect psychological well-being. &lt;br&gt;&lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The aim of this study is to determine the prevalence of depression and anxiety in SGS patients and identify associated risk factors. &lt;br&gt;&lt;br&gt;&lt;b&gt;Materials and methods:&lt;/b&gt; A retrospective chart review was conducted of patients diagnosed with SGS at a tertiary care center from 2012 to 2022. Data collected included demographics, SGS etiology, number/type of surgeries, tracheostomy history, pulmonary function tests, medications, and psychiatric history. Statistical analyses included t-tests, chi-square, and ANOVA with Bonferroni correction. &lt;br&gt;&lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; Of 246 patients (mean age 54, body mass index [BMI] 32 8.7), 16% had a clinical diagnosis of depression, and 49% reported a history of anxiety or depression. Patients with psychiatric comorbidities were older (57.7 vs 52.1 years, p&lt;0.05). Intubation was the leading cause of SGS (41.9%) and significantly associated with depression (p = 0.03). Patients with depression had higher rates of hospital admission within a year (p = 0.00). Interestingly, those with mental health hospitalizations were significantly younger (p = 0.01). &lt;br&gt;&lt;br&gt;&lt;b&gt;Discussion:&lt;/b&gt; Depression and anxiety are more prevalent in SGS patients than in the general population. Contributing factors include age, etiology (particularly intubationrelated SGS), and surgical burden. &lt;br&gt;&lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Mental health should be an integral part of SGS management. Future prospective studies using standardized symptom surveys may better capture the psychological impact of SGS and inform holistic patient care.

PMID:41789544 | DOI:10.5604/01.3001.0055.5832

Hemodial Int. 2026 Mar 6. doi: 10.1111/hdi.70064. Online ahead of print.

ABSTRACT

INTRODUCTION: The relationship between serum calcium levels at the initiation of hemodialysis and coronary artery calcium score (CACS) remains unclear. This study examined whether albumin-corrected calcium (correctedCa; Payne’s formula) and ionized calcium (ionizedCa) measured at dialysis initiation are associated with CACS assessed by screening coronary computed tomography.

METHODS: This single-center cross-sectional study included 176 adults who initiated hemodialysis between 2015 and 2023 and underwent coronary computed tomography with CACS measurement within ±30 days. Restricted cubic spline (RCS) logistic regression was used to evaluate the associations of correctedCa and ionizedCa with CACS ≥ 400, adjusting for clinical covariates. Subgroup analyses were performed according to the median serum albumin level. For models in which nonlinearity was not significant, logistic models treating the variable as a linear term were fitted to calculate odds ratios (OR) per 1-standard deviation (SD) increase.

FINDINGS: The mean age was 70.9 years, 32.9% were women, 54.3% had diabetes, and the mean eGFR was 5.45 mL/min/1.73 m². Higher calcium levels were associated with higher CACS. ionizedCa showed a linear association with CACS ≥ 400 (OR per 1-SD, 1.51; 95% CI, 1.08-2.11). correctedCa also showed a statistically linear association (OR per 1-SD, 1.53; 95% CI, 1.09-2.13), although the RCS curve visually plateaued at higher correctedCa levels. Subgroup analyses revealed that this convex pattern was driven by the low-albumin group.

DISCUSSION: Higher calcium at hemodialysis initiation was associated with increased coronary calcification. ionizedCa tended to show a more stable linear relationship with CACS than correctedCa, as correctedCa may overestimate ionizedCa in patients with low albumin. Measurement of ionizedCa at dialysis initiation may help refine vascular calcification risk stratification as patients enter the dialysis period.

PMID:41789532 | DOI:10.1111/hdi.70064

J Atten Disord. 2026 Mar 6:10870547261419589. doi: 10.1177/10870547261419589. Online ahead of print.

ABSTRACT

OBJECTIVE: ADHD and internalising symptoms such as anxiety and depression are known to be associated in adolescence and understanding the mechanisms linking them is important for improving mental health outcomes for adolescents with ADHD symptoms. Our objective was to examine these mechanisms.

METHOD: In this study, we leverage a high-quality longitudinal dataset, the Millennium Cohort Study (n = 2,607 male, n = 2,791 female) to simultaneously evaluate a range of hypothesised mediating mechanisms. These include indirect effects via peer problems, conduct problems, self-esteem, injuries and accidents, relationships with parents, academic performance, risky decision-making, parental mental health, educational motivation, and general health. We used exploratory longitudinal mediation analysis with regularised structural equation modelling (regSEM) to examine 14 candidate mediators of the ADHD-internalising association across ages 11, 14 and 17.

RESULTS: Regularisation with lasso did not result in the de-selection of any of these mediators; however, only two were statistically significant.

CONCLUSION: Results suggest there may be many mediators of small effect involved in the relation between ADHD symptoms and later internalising problems but point to self-esteem and parental mental health as priority mechanisms for further study in future causal and interventional research.

PMID:41789525 | DOI:10.1177/10870547261419589