Nevin Manimala

Clin Ter. 2026 Mar-Apr;177(2):376-383. doi: 10.7417/CT.2026.2018.

ABSTRACT

BACKGROUND: Cerebral palsy (CP)is an umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development. Play is an occupation of childhood. Through play children improve performance skills. Research shows that play therapy has a positive effect on improving motor skills in children. Games in a way stimulate the nervous system and make the child active, they create vitality and nerve readiness which cause excitement and interaction of sensory and perceptual parts and decision making in children.

OBJECTIVE: The primary objective was to determine adherence to a structured play-therapy program in children with CP. The secondary objective was to explore changes in hand/upper-extremity function following the program.

METHODS: This pilot, single-arm clinical trial recruited 12 children (5-13 years) with hemiplegic or diplegic CP from Sneha Kiran Spastic Society, Mysore. The intervention comprised institution-based play therapy (45 minutes/day, 5 days/week for 6 weeks) with a home component (2 days/week). Adherence was calculated as the percentage of prescribed sessions completed, with ≥75% predefined as adherent. Upper-extremity function was assessed using the Quality of Upper Extremity Skills Test (QUEST) before and after the program.

RESULTS: Institutional adherence ranged from 59% to 96% (mean 86.4%); 11/12 children met the ≥75% adherence threshold. Home adherence was lower (0%-83%). QUEST scores increased from 47.65 ± 14.47 (pre) to 48.51 ± 14.61 (post), with a statistically significant pre-post change on Wilcoxon signed-rank testing (Z = -1.992, p = 0.046).

CONCLUSION: There was good adherence to play therapy (84.6%) in children with hemiplegic and diplegic cerebral palsy with age group of 6 to 12 years. There was significant improvement in hand function after 6 weeks of play therapy. Therefore, play therapy can be implemented in children with cerebral palsy. Larger controlled studies are warranted to confirm effectiveness and to address barriers to home adherence.

PMID:41773379 | DOI:10.7417/CT.2026.2018

Clin Ter. 2026 Mar-Apr;177(2):341-351. doi: 10.7417/CT.2026.2014.

ABSTRACT

BACKGROUND: Post-Operative Delirium (POD) is common post-operative complications that is under-recognized though it is clinically significant. Delirium management can vary according to the local and the policies of the Centre, hospital and countries but it is management is mostly to treat the predisposing and precipitating factors given that it is consider a medical emergency. It is associated risk to post-operative outcomes in cardiac surgery is limited and understanding its effect might help shed the light to more robust screening and management in CCU and ICU center which could improve the survival and morbidity rate post-cardiac surgery operations.

METHODS: We conducted a retrospective cohort study at Al-Azhar University Hospitals including adult patients who underwent cardiovascular surgery. Eligible procedures comprised coronary artery bypass grafting, aortic surgery, valve surgery, or combined procedures. Exclusion criteria were: age <18 years; preoperative history of dementia or cognitive impairment; non-direct vision procedures (including aortic stent implantation and transcatheter aortic valve implantation); cardiovascular surgery combined with other thoracic surgeries; preoperative coma; repeat surgery within 3 days; death within 3 days after surgery; and incomplete clinical data. POD was assessed during the postoperative period using routine Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) screening, with diagnoses aligned to 11th Revision of the International Classification of Diseases (ICD-11) criteria. The primary outcomes were all-cause mortality at 30 days and 1 year. Secondary outcomes included postoperative morbidity indicators: intensive care unit (ICU) readmission, major complications (infection, stroke, and acute kidney injury), and duration of ICU and hospital stay. Associations between delirium and postoperative outcomes were analyzed using multivariable statistical models with adjustment for relevant clinical covariates.

RESULTS: Among records of 152 patients, 37 (24.3%) of them were diagnosed with POD and 115 showed no POD. Patients in POD group were significantly older (69.56±5.85 vs 66.79±5.18 years), more obese (BMI 27.01±1.85 vs 25.63±2.37), had lower educational attainment (2.7% vs 22.6%), and they had a higher CCI (5.67±0.91 vs 4.37±1.55) compared with the NO-POD group respectively. Factors associated with the risk of POD were advancing age (OR=1.002), lower educational level (OR=1.279), CCI (OR=1.587), duration of anesthesia (OR=1.031), volume of blood transfusion (OR=1.001), duration of the bypass (OR=1.037), and duration of the surgery (OR=0.137), while factors associated with a lower one-year survival rate were delirium itself (p<0.001), age (p=0.002), volume of blood transfusion (p<0.001), CCI (p<0.001), duration of the surgery (p0.037), ICU length of stay (p=0.002), and readmission to the ICU (p=0.001).

CONCLUSION: POD is under-recognized postoperative serious complication, it decreases the 30 days and 1 year and increase the post-op morbidities (ICU readmission, major complications, Length of ICU and hospital stay) specially in patients with preoperative co-morbidities.

PMID:41773375 | DOI:10.7417/CT.2026.2014

Clin Ter. 2026 Mar-Apr;177(2):333-340. doi: 10.7417/CT.2026.2013.

ABSTRACT

BACKGROUND: Oxidative balance is known to be disrupted when individuals are exposed to heavy metals especially lead and chromium, which facilitate vascular dysfunction. Smoking adds to this load by producing free radicals which further augment the oxidative stress. A combination of these effects in elderly hypertensive patients can exacerbate cellular damage and degrade the vascular resilience. These outcomes can also be altered by differences in environmental exposure and physical activity of urban and rural populations.

OBJECTIVE: To determine serum levels of lead (Pb), chromium (Cr) and malondialdehyde (MDA) in urban and rural hypertensive elderly smokers, and to determine the effects of physical activity on oxidative stress.

METHODS: A cross-sectional comparative study was conducted on 80 hypertensive smokers aged 50-70 years (40 urban and 40 rural). Serum Pb and Cr concentrations were determined using atomic absorption spectrophotometry, while MDA was measured by the TBARS method. Demographic, lifestyle, and activity data were obtained through structured questionnaires. Statistical analysis included t-test, χ², and Pearson correlation using SPSS version 26.

RESULTS: Urban participants exhibited significantly higher mean serum lead and MDA levels compared with rural participants (p < 0.05), whereas chromium differences were nonsignificant. MDA correlated positively with Pb (r = 0.26, p = 0.020) and negatively with physical activity (r = -0.14, p = 0.227). The standardized beta coefficients disclosed that serum lead was the strongest positive predictor (β = 0.55, t = 5.01, p < 0.001) and serum chromium came in the second position (β = 0.21, t = 2.11, p = 0.038). The physical activity showed a strong negative correlation with oxidative stress (β = -0.36, t = -3.87, p < 0.001), which supports the protective effect of physical activity against lipid peroxidation caused by metals.

CONCLUSION: Exposure to lead is a significant source of oxidative stress among hypertensive smokers as they grow old especially in urban settings. The exercise can contribute to reducing this oxidative load, thus the importance of maintaining an environment, as well as lifestyle change in the prevention of cardiovascular risks.

PMID:41773374 | DOI:10.7417/CT.2026.2013

Clin Ter. 2026 Mar-Apr;177(2):312-319. doi: 10.7417/CT.2026.2010.

ABSTRACT

BACKGROUND: Pseudomonas aeruginosa (P. aeruginosa) remains a major nosocomial pathogen with dynamic and evolving antimicrobial resistance (AMR) profiles, particularly in resource-constrained settings. This study aimed to analyse 15-year trends in antimicrobial susceptibility of P. aeruginosa isolates at a tertiary care centre in South India to inform local empiric therapy and stewardship strategies.

METHODS: A retrospective observational study was conducted between 2010 and 2024, analysing P. aeruginosa isolates from 54,208 clinical specimens. Isolates were identified using standard microbiological protocols, and antibiotic susceptibility was assessed by Kirby-Bauer disc diffusion, interpreted as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Annual susceptibility rates were analysed using descriptive statistics and linear regression to assess temporal trends.

RESULTS: Among 17,517 culture-positive specimens, 2,225 (12.7%) were P. aeruginosa, predominantly from pus (52%) and respiratory samples (34.8%). Aminoglycosides (amikacin, tobramycin) exhibited the highest overall activity, with >70% susceptibility in later years. Significant improvements were observed in meropenem and piperacillin-tazobactam susceptibility over time, while imipenem showed a significant decline. Ceftazidime-avibactam, introduced in 2016, showed a steady increase to 51% in 2024. Conversely, imipenem demonstrated a significant decline (β = -0.83%/year, p = 0.0279). Ceftazidime, although initially low (3.5% in 2015), showed modest recovery by 2024 (32.2%).

CONCLUSION: Over 15 years, P. aeruginosa at this South Indian centre demonstrated both encouraging reversals in resistance to key β-lactam agents and concerning declines in others like imipenem. High and sustained aminoglycoside efficacy supports their selective use in empirical regimens. These findings highlight the critical role of ongoing local surveillance, antimicrobial stewardship, and integration of advanced diagnostics to combat evolving AMR in high-burden settings.

PMID:41773371 | DOI:10.7417/CT.2026.2010

Clin Ter. 2026 Mar-Apr;177(2):285-294. doi: 10.7417/CT.2026.2007.

ABSTRACT

BACKGROUND: Postgraduate medical students face a unique combination of academic, clinical, and personal challenges that expose them to heightened psychological stress. Understanding how stress interacts with coping strategies, self-compassion, emotional regulation, and psychological flexibility is crucial for designing interventions that promote resilience and well-being.

METHODS: A cross-sectional study was conducted among postgraduate medical trainees in a tertiary care institution in India. Participants completed validated tools including the Postgraduate Stressor Questionnaire (PSQ), Self-Compassion Scale (SCS), Brief COPE Inventory, Difficulties in Emotion Regulation Scale (DERS), and the Acceptance and Action Questionnaire-II (AAQ-II). Data were analyzed using descriptive statistics, independent t-tests, and chi-square tests to compare domains across groups. Between‑group differences on AAQ‑II were trivial in magnitude (Cohen’s d ≈ 0.10) with overlapping 95% CIs. Given the sample (N=80), post‑hoc sensitivity suggests limited power to detect effects smaller than d≈0.45; thus, the null may reflect true similarity or insufficient power. Nearly half exceeded the >25 cut‑off, indicating a cohort‑level challenge rather than group‑specific differences.

RESULTS: The majority of participants were below 27 years of age, with balanced gender distribution and a predominance of unmarried students. Performance pressure emerged as the most significant stressor (p=0.003). Group A demonstrated significantly higher self-kindness and overall self-compassion, while Group B showed higher self-judgement and maladaptive coping, including substance use (p=0.004). Emotion regulation difficulties were more pronounced in Group B, particularly in emotional awareness and clarity (p=0.025). Psychological flexibility, as measured by AAQ-II, was comparable between groups with no significant difference.

CONCLUSION: Postgraduate medical students experience high stress levels, predominantly due to performance pressure. Self-compassion appears to be a protective factor, enhancing adaptive coping and emotional regulation, whereas maladaptive coping strategies exacerbate stress-related difficulties. Institutional support combined with self-compassion-based interventions may strengthen resilience and safeguard mental health in this vulnerable group.

PMID:41773368 | DOI:10.7417/CT.2026.2007

Clin Ter. 2026 Mar-Apr;177(2):239-248. doi: 10.7417/CT.2026.2001.

ABSTRACT

BACKGROUND: Endoscopic papillary significant balloon dilatation (EPLBD) has become a convenient method of treating challenging common bile duct (CBD) stones, but predictors of success remain unresolved.

AIM: To analyse clinical, laboratory, radiological, and anatomical effects on a single session of CBD stone clearance with EPLBD.

METHODS: It was a Prospective pilot clinical trial that enrolled 25 adult patients with tough CBD stones who had undergone conventional ERCP procedures in vain. Limited biliary sphincterotomy and EPLBD with 12-18 mm balloons were done on all patients. Clinical, biochemical, radiological, and anatomical parameters were evaluated prior to the procedure. The main result was the total clearance of CBD in one session. The secondary outcomes were complications, biliary stenting necessity, duration of procedures, and length of stay.

RESULTS: The complete clearance of the stone through a single session of complete CBD was reported in 16 out of 25 patients (64%). The complications associated with the procedure were minimal and affected three patients (12%), and were mild in nature; there were no cases of perforation or excessive bleeding. Multi-variable analysis revealed that the independent variables associated with procedural success were larger CBD diameter (OR 1.48 per mm increase, p = 0.012), better distal CBD angulation 135° and above (OR 3.92, p = 0.038), and large balloon size (OR 1.67 per mm increase, p = 0.008). There was no statistically significant correlation between demographic variables and laboratory baseline parameters and EPLBD outcomes.

CONCLUSION: EPLBD is safe and can be highly applied to challenging CBD stones. Some of the main determinants of success are anatomical and procedural factors, and not clinical or laboratory variables.

PMID:41773362 | DOI:10.7417/CT.2026.2001

Clin Ter. 2026 Mar-Apr;177(2):209-217. doi: 10.7417/CT.2026.1997.

ABSTRACT

BACKGROUND: This study aimed to assess the effectiveness of data analysis using a hybrid method in predicting and diagnosing cardiovascular diseases compared to standard methods. Methods. The study involved 200 patients diagnosed with cardiovascular diseases (arterial hypertension, ischemic heart disease, heart failure) in Moscow, Russia. Patients were randomly assigned to two equal groups. Group A underwent analysis of clinical data using random forest, support vector machines, and linear regression methods. Group B was subjected to hybrid method analysis. For Group B, patient survival was higher by 5%, and complication frequency was lower by 3%. The hybrid method demonstrated superior forecasting and treatment efficacy (p < 0.001) compared to similar indicators in Group A.

RESULTS: PCA analysis revealed that principal components explained over 70% of the variability among clinical parameters. Kaplan-Meier survival curves showed a statistically significant influence of cholesterol levels on survival and complication frequency (p < 0.05). Correlation analysis identified an inverse relationship between cholesterol levels and survival (p < 0.05). A hybrid data analysis method proves more effective than standard methods in predicting cardiovascular treatment outcomes and improving patient survival. The use of a hybrid method demonstrates the success of new data processing techniques in clinical practice, enabling the optimization of therapies and improving the quality of care for patients with cardiovascular disease.

CONCLUSION: The use of a hybrid method demonstrates the success of new data processing techniques in clinical practice, enabling the optimization of therapies and improving the quality of care for patients with cardiovascular disease.

PMID:41773358 | DOI:10.7417/CT.2026.1997

Health Soc Care Deliv Res. 2026 Feb;14(5):1-23. doi: 10.3310/GJCC0605.

ABSTRACT

BACKGROUND: Identifying clinical deterioration is a global health priority. Sepsis is a leading cause of deterioration, responsible for around 46,000 deaths annually in the United Kingdom. Early warning scores based on patients’ vital signs can be embedded into electronic patient records to digitally alert clinicians to those at risk. Rapid identification and treatment – particularly with targeted intravenous antibiotics – are critical to improving outcomes in sepsis patients.

RESEARCH QUESTION: This study aimed to evaluate the effectiveness of digital alerts in improving outcomes for patients with sepsis. Using routine electronic patient record data from four United Kingdom National Health Service acute trusts, we investigated how digital alert systems influence patient outcomes and explored mechanisms and mediators of their effectiveness.

OBJECTIVES: Map the types of digital alerts currently in use across United Kingdom hospitals for identifying patients at risk of sepsis (Workstream 1). Evaluate the impact of digital alerts on patient outcomes (Workstream 2). Examine how the implementation process affects alert performance, guided by the consolidated framework for implementation research (Workstream 3). Provide recommendations on alert effectiveness and implementation strategies using systems modelling and mediation analysis (Workstream 4).

METHODS: A mixed-methods approach was employed. A national survey assessed the use of digital sepsis alerts in English National Health Survey hospitals (Workstream 1). Qualitative interviews and focus groups explored the implementation process and its influence on alert performance (Workstream 3). A natural experiment with multilevel interrupted time series analysis examined the impact of sepsis screening tools and digital alerts on outcomes, primarily in-hospital mortality (Workstream 2). Routinely collected clinical data were processed following National Institute for Health Research-Health Information Collaborative standards. Combining quantitative and qualitative data enabled us to link implementation processes with patient outcomes.

RESULTS: All four trusts experienced reduced mortality rates among patients with serious infections following the introduction of digital sepsis screening tools. After adjustment for patient case-mix, admission patterns and pre-existing trends, one trust showed a statistically significant decrease in mortality linked to digital alert implementation. In two trusts, older patients experienced greater mortality reduction than younger ones following alert introduction. Qualitative findings highlighted factors contributing to more effective use of digital alerts: deployment in general wards rather than intensive care units; use by clinicians familiar with similar technologies; availability of 24/7 emergency outreach teams; robust technological infrastructure and alerts that were user-friendly, non-intrusive and not part of multiple competing alert systems.

CONCLUSIONS: The effectiveness of digital sepsis screening tools varies and may depend on patient’s age and care setting. Our findings suggest that digital alerts should leverage a wider range of electronic patient record data and be tailored to specific patient groups. Different trusts and patient populations may require distinct indicators, thresholds and treatment protocols. These findings align with healthcare practitioners’ calls for more sophisticated, patient-centred sepsis screening tools targeted at relevant clinical teams.

FUTURE WORK AND LIMITATIONS: The study involved four National Health Service Trusts with strong data collaboration, but noted limitations include reliance on simple algorithms and varied case-mix and implementation processes. Future research should focus on robust evaluation methods, leveraging granular electronic patient record data and establishing a public registry of digital alert tools.

FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR129082.

PMID:41773349 | DOI:10.3310/GJCC0605

Afr J Reprod Health. 2026 Mar 2;30(4):105-114. doi: 10.29063/ajrh2026/v30i4.10.

ABSTRACT

The study employs descriptive and econometric methods in examining the contribution of women’s participation to the economic growth of Nigeria from 1990 to 2022. Data sources employed were World Bank Development Indicators. Through examination of the data, the study finds that industry remains the largest employer of women in Nigeria, followed by the agricultural sector. Besides, the contribution of female employment in agriculture, services, and manufacturing sectors on Nigerian economic growth was found to be negative although statistically insignificant. Similarly, the female labor participation rate also does not have any significant effect on the economic growth of the nation. In response to these findings, the study recommends that Nigerian policymakers and other stakeholders’ direct investment to the industrial, service, and agricultural sectors in order to promote SDG 8-inclusive economic growth-through increased involvement of women in the working population. Gender balance also must take center stage in recruitment exercises in these sectors as a method of reducing discrimination against women in jobs.

PMID:41773343 | DOI:10.29063/ajrh2026/v30i4.10

Orthop Surg. 2026 Mar 3. doi: 10.1111/os.70279. Online ahead of print.

ABSTRACT

INTRODUCTION: Complex lumbar disc herniation (CLDH), including huge, migrated, and calcified variants, poses surgical challenges due to factors such as deep-seated lesions, irregular morphology, and adhesion to neural structures. This study aimed to compare the clinical outcomes of two minimally invasive endoscopic approaches-percutaneous endoscopic interlaminar discectomy (PEID) and percutaneous endoscopic transforaminal discectomy (PETD)-in the management of CLDH.

METHODS: In this retrospective cohort study, 270 patients with CLDH treated between January 2020 and January 2024 were analyzed. Patients were categorized into three CLDH subtypes and were further divided into PEID and PETD groups based on preoperative imaging findings. Surgical parameters, perioperative data, and complications were recorded. Functional outcomes were evaluated using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. Imaging measurements included the cross-sectional area of facet joints (CSA-FJ) and dural sac (DSCA). Statistical analyses were performed using the chi-square test, Wilcoxon rank-sum test, Shapiro-Wilk test, independent-samples t-test, and two-way repeated-measures ANOVA.

RESULTS: All procedures were successfully completed. PEID showed shorter operative time and significantly fewer fluoroscopy exposures compared to PETD (p < 0.05). PETD was associated with a higher facet joint resection rate (p < 0.05), though DSCA improvements were similar between groups. Both groups demonstrated significant reductions in VAS and ODI scores at all follow-up points (p < 0.05), with no statistically significant differences between approaches. Over 80% of patients achieved excellent or good outcomes according to modified MacNab grading. Complications were uncommon and included dural tears (n = 3), epidural hematoma (n = 1), nerve root injury (n = 1), and recurrent herniation (n = 2).

CONCLUSION: Both PEID and PETD are effective and safe surgical options for treating CLDH. PEID offers reduced operative time and radiation exposure, while PETD requires more extensive facet resection. This study further outlines tailored surgical strategies for different CLDH subtypes, supporting individualized endoscopic treatment selection.

PMID:41773328 | DOI:10.1111/os.70279