Nevin Manimala

J Endocrinol Invest. 2026 May 6. doi: 10.1007/s40618-026-02903-6. Online ahead of print.

ABSTRACT

INTRODUCTION: Primary aldosteronism (PA) can be managed either by unilateral adrenalectomy (ADX) or pharmacologically with mineralocorticoid receptor antagonists (MRA). Several recent meta-analyses have examined how these treatment modalities affect cardiovascular outcomes in patients with PA. However, the impact of treatment on quality of life (QoL) remains largely unexplored.

OBJECTIVE: To synthesize data from previous studies that have investigated QoL in either medically or surgically treated patients with PA.

METHODS: A literature search was conducted in May 2025 in PubMed, Embase and Web of Science. Studies containing data on QoL before and after ADX or MRA were selected.

RESULTS: Fifteen studies evaluated QoL after treatment for PA. Most comparative studies reported greater and faster QoL improvement after ADX than with MRA. QoL consistently improved after ADX, whereas results with MRA were variable and less consistent. Patients treated with MRA were older than patients treated with ADX and frequently received low MRA doses. Five studies (259 ADX-treated and 88 MRA-treated patients) were included in a meta-analysis. Baseline QoL did not differ between treatment groups. At 6 months, QoL improved in both groups, with no statistically significant difference between ADX and MRA.

CONCLUSION: Treatment of PA is associated with improved QoL following both ADX and MRA therapy. Although several studies suggest superior outcomes after adrenalectomy, the meta-analysis did not show a significant difference at 6 months of follow-up. The limited number of patients, short follow-up duration, and potential undertreatment with MRA represent important limitations.

PMID:42090114 | DOI:10.1007/s40618-026-02903-6

J Endocrinol Invest. 2026 May 6. doi: 10.1007/s40618-026-02878-4. Online ahead of print.

ABSTRACT

BACKGROUND: Anti-Müllerian hormone (AMH) is widely used as a marker of ovarian reserve. However, its reliability in functional hypothalamic amenorrhea (FHA) remains debated. FHA is characterized by reduced gonadotropin secretion and impaired folliculogenesis, which may influence AMH expression and lead to an underestimation of reproductive potential.

METHODS: We conducted a case-control study including women diagnosed with FHA and age-matched healthy controls. FHA patients were stratified according to the presence or absence of polycystic ovarian morphology (PCOM). Serum gonadotropins, estradiol, androgens, and AMH were measured and compared between groups. Correlation analyses were performed to explore associations among hormonal parameters.

RESULTS: Overall, AMH concentrations in FHA patients were comparable to those of controls. However, stratification revealed that FHA without PCOM was associated with significantly reduced AMH, whereas FHA with PCOM displayed increased values. FHA patients also showed reduced gonadotropins, estradiol, and androgens compared with controls. In the non-PCOM FHA subgroup, AMH correlated positively with androgens and negatively with estradiol. These findings suggest that suppression of gonadotropins and consequent androgen deficiency may contribute to reduced AMH levels in FHA.

CONCLUSIONS: This pilot study indicates that low AMH in FHA may reflect hypothalamic suppression of gonadotropins rather than true ovarian reserve potentially leading to misinterpretation in fertility counseling. These observations should be interpreted with caution given the small sample size, but they support the hypothesis that AMH levels might recover with restoration of hypothalamic-pituitary activity and menstrual cycles. Larger, longitudinal studies are warranted to confirm the reversibility of AMH and clarify its prognostic value in FHA.

PMID:42090112 | DOI:10.1007/s40618-026-02878-4

Int Urol Nephrol. 2026 May 6. doi: 10.1007/s11255-026-05178-1. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the concordance between treatment recommendations generated by LLMs and decisions made by a multidisciplinary uro-oncology tumor board.

METHODS: Forty-eight consecutive prostate cancer cases previously discussed at a multidisciplinary tumor board were retrospectively analyzed. For each case, treatment recommendations were generated using five LLM platforms (ChatGPT-4o, ChatGPT, Perplexity, Copilot, and DeepSeek) based on standardized clinical summaries. Four independent urology specialists evaluated the concordance between LLM recommendations and tumor board decisions using a 5-point Likert scale. Differences among models were assessed using the Friedman test followed by Bonferroni-corrected Wilcoxon signed-rank tests. Inter-rater agreement was calculated using the intraclass correlation coefficient.

RESULTS: Significant differences in concordance were observed among the evaluated AI platforms (χ² = 32.16, p < 0.001). Perplexity and ChatGPT-4o demonstrated the highest alignment with tumor board decisions, each achieving a median Likert score of 4.75, whereas Copilot showed the lowest concordance (median 3.00). DeepSeek and ChatGPT demonstrated intermediate performance. Post hoc analyses revealed that Perplexity significantly outperformed several lower-performing platforms; however, no statistically significant difference was observed between Perplexity and ChatGPT-4o (p = 0.149). Expert evaluations showed strong inter-rater agreement (ICC = 0.82).

CONCLUSION: Large language models can demonstrate substantial concordance with multidisciplinary tumor board decisions in prostate cancer management. However, variability among models and the risk of hallucinated information indicate that LLMs should function as clinical decision-support tools under expert supervision rather than as autonomous decision-makers.

PMID:42090098 | DOI:10.1007/s11255-026-05178-1

Int Urol Nephrol. 2026 May 6. doi: 10.1007/s11255-026-05183-4. Online ahead of print.

ABSTRACT

BACKGROUND: Laparoendoscopic single-site donor nephrectomy (LESS-DN) has been proposed as a minimally invasive alternative to conventional laparoscopic donor nephrectomy (CLDN), but its perioperative advantages remain controversial. This meta-analysis aimed to compare the outcomes of LESS-DN and CLDN based on randomized controlled trials (RCTs).

METHODS: PubMed, Embase, and the Cochrane Library were searched up to August 20, 2025, for English-language RCTs comparing LESS-DN and CLDN. The risk of bias was assessed using the original Cochrane Risk of Bias tool (RoB 1.0), and pooled analyses were performed using Review Manager 5.4.1 software.

RESULTS: Four randomized controlled trials involving 274 donors (LESS-DN, n = 136; CLDN, n = 138) were included. There were no significant differences between groups in operative time, warm ischemia time, estimated blood loss, length of hospital stay, time to extraction, or overall complication rates.

CONCLUSIONS: Based on the currently available randomized evidence, no statistically significant differences were detected between LESS-DN and CLDN in the perioperative outcomes analyzed in living kidney donors. Further adequately powered, multicenter randomized trials-particularly evaluating postoperative pain, patient-reported recovery, and cosmetic satisfaction-are warranted.

PMID:42090097 | DOI:10.1007/s11255-026-05183-4

Ophthalmic Physiol Opt. 2026 May 6. doi: 10.1007/s44402-026-00102-7. Online ahead of print.

ABSTRACT

PURPOSE: To develop a Scheimpflug-based image analysis technique to quantify tear exchange during scleral lens wear and investigate fluid reservoir tear dynamics during fenestrated lens wear.

METHODS: Nine healthy participants wore a scleral lens (KATT™, Capricornia Contact Lenses) with a single 0.3 mm diameter limbal fenestration in one eye for 90 min. Central (0-2.5 mm from the corneal apex) and peripheral (-1.0 to 0 mm from the scleral spur) stromal cornea oedema was measured using optical coherence tomography. Scheimpflug images were obtained during lens wear at multiple time points following the application of sodium fluorescein to the bulbar conjunctiva. These images were exported and annotated manually to select the region of interest (the fluid reservoir) from which the intensity of each pixel was extracted to provide a measure of fluorescent intensity (in arbitrary units [AU] on a scale of 0-255) throughout lens wear across the central 10 mm.

RESULTS: The coefficient of repeatability for central fluid reservoir intensity measurements was 7 AU (on a scale of 0-255 AU). Fluid reservoir fluorescent intensity varied with measurement location (p < 0.001), being greater towards the periphery (4 and 5 mm from the centre). On average, intensity differences between the peripheral and central fluid reservoir diminished within 10 min of sodium fluorescein application. Two patterns of tear dynamics were observed and were classified as low and high flow. Low flow participants (n = 6) exhibited greater central (3.72× more) and peripheral (2.25× more) corneal oedema, but the difference was not statistically significant.

CONCLUSIONS: The ingress and mixing of sodium fluorescein within the fluid reservoir stabilised between central and peripheral locations after 10 min of fenestrated scleral lens wear. Two patterns of tear dynamics were observed (low and high flow), with low flow participants exhibiting greater corneal oedema. Future research utilising the developed technique may provide further insights into tear exchange during scleral lens wear with different fenestration sizes and configurations.

PMID:42090093 | DOI:10.1007/s44402-026-00102-7

Insights Imaging. 2026 May 6;17(1):124. doi: 10.1186/s13244-026-02281-w.

ABSTRACT

OBJECTIVES: Gender equity in medicine remains a topic of increasing attention. The aim was to investigate if gender influences the radiology profession, with a focus on career progression, leadership roles, work-life balance, research activity and perceived barriers.

MATERIALS AND METHODS: An anonymous online survey consisting of 22 questions was distributed by the European Society of Radiology (ESR) to its members between October and December 2024. The survey covered demographics, work schedules, family responsibilities, career development, leadership roles, research involvement, and perceived personal experiences. Quantitative data were analyzed using descriptive statistics, chi-square test, and rate differences with confidence intervals. Open-ended responses were explored qualitatively using thematic analysis.

RESULTS: Among 830 respondents, 657 completed the questionnaire (63.3% female, 35.3% male, 1.3% others). Women more frequently reported caregiving responsibilities beyond childcare (4.1% vs 3%), longer parental leave (46.2% vs 21.5%), and experiences of harassing behaviors at work. Men held a higher proportion of leadership roles (33.2% vs 25.2%). Respondents involved in research were more likely to work > 30% extra hours (47.2% vs 29.0%). Although research activity rates were similar across genders, women more often reported barriers to attending conferences and a lack of protected research time. Career fulfillment increased with age among men but decreased among women. Gender was considered a career disadvantage by 44.5% of women versus 9.5% of men.

CONCLUSION: The survey reveals perceived gender disparities in radiology, particularly in leadership access, work conditions, and career satisfaction. Addressing structural barriers and promoting supportive workplace policies are essential to achieving true gender equity in the field.

CRITICAL RELEVANCE STATEMENT: Despite improvements in the last few decades, gender inequity remains present in radiology. Variability between geographical regions suggests that key critical areas can be addressed to promote improvement and support a more equitable professional environment.

KEY POINTS: Perceived gender disparities in radiology are present across career progression, leadership roles, and work-life balance. Women were significantly more likely than men to perceive gender as a career disadvantage (44.5% vs 9.5%; p < 0.0001 35.0% [95% CI: 28.9 to 41.1]). They reported slightly higher caregiving responsibilities and longer parental leave. Structural inequalities impact gender equity in radiology, requiring targeted institutional and cultural changes.

PMID:42090088 | DOI:10.1186/s13244-026-02281-w

Neurol Ther. 2026 May 6. doi: 10.1007/s40120-026-00945-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Ofatumumab, an anti-CD20 monoclonal antibody, is a high-efficacy disease-modifying therapy for relapsing multiple sclerosis (RMS). Although pivotal trials demonstrated substantial benefits, real-world data are required to confirm treatment persistence, effectiveness, safety, and biological markers of response in routine clinical settings. This study evaluated the real-world outcomes of ofatumumab in patients treated at a specialised multiple sclerosis (MS) centre in southeastern Spain, including exploratory analyses of B cell kinetics, comorbidity burden using the Charlson Comorbidity Index (CCI), and ethnicity.

METHODS: A retrospective observational study was conducted in adults with MS initiating ofatumumab between December 2022 and December 2025, with ≥ 6 months of continuous therapy. Demographic, clinical, radiological, laboratory, and pharmacological data were extracted from electronic medical records. Statistical analyses encompassed Kaplan-Meier estimates.

RESULTS: Eighty-seven patients were included (mean age 43 years; 75.9% female; 88.5% relapsing-remitting phenotype). Over a median 22-month follow-up, treatment persistence was 95.4%. Annualised relapse rate (ARR) declined from 0.48 pre-treatment to 0.03 on treatment. No evidence of disease activity (NEDA-3) was achieved in 93.1%, with no significant differences between treatment-naïve and previously treated patients. Sustained CD19⁺ B cell depletion was confirmed in all assessments. Immunoglobulin levels remained mostly stable. Ofatumumab was generally well tolerated: systemic injection-related reactions occurred in 29.9% and infections in 6.9%. Exploratory analyses showed no significant differences in relapse or magnetic resonance imaging outcomes by CCI category or ethnicity.

CONCLUSION: In this Spanish real-world single-centre cohort, ofatumumab demonstrated high persistence, substantial suppression of inflammatory activity, and a favourable safety profile in routine clinical practice. Sustained B cell depletion aligned with clinical and radiological stability. These findings support the real-world effectiveness of ofatumumab across diverse patient profiles and complement evidence from pivotal trials. Further prospective studies with broader populations and longer follow-up are warranted to refine understanding of long-term outcomes and determinants of treatment response variability.

PMID:42090082 | DOI:10.1007/s40120-026-00945-9

Ir J Med Sci. 2026 May 6. doi: 10.1007/s11845-026-04418-8. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the relationship between cervical area (CA) measured by two-dimensional (2D) transvaginal ultrasonography (TVUS) and the latency period in pregnancies complicated by preterm premature rupture of membranes (PPROM), and to compare its predictive performance with that of cervical length (CL).

METHODS: This retrospective cohort study included 164 singleton pregnancies with PPROM (24 + 0-32 + 3 weeks). Archived TVUS images obtained within 24 h of admission were reanalyzed in a blinded manner. CA (cm²), CL (mm), and cervical funneling were recorded. The latency period was defined as the time from membrane rupture to delivery and categorized as short (≤ 10 days) or long (> 10 days). Group comparisons, correlation analyses, receiver operating characteristic (ROC) curves, and multivariable logistic regression were performed to identify independent predictors.

RESULTS: Seventy-eight pregnancies had a short latency period. Both CL and CA were significantly lower in the short-latency group. Although the area under the curve (AUC) for CA was higher than that for CL (0.763 vs. 0.678), pairwise comparison using the DeLong test did not show a statistically significant difference (p = 0.064). In the multivariable analysis, cervical funneling (adjusted OR 10.777, 95% CI 4.456-26.063; p < 0.001) and CA (adjusted OR 0.701, 95% CI 0.598-0.822; p < 0.001) remained independent predictors of a short latency, whereas CL lost significance (p = 0.383). CA and CL showed a positive correlation with the latency period (p < 0.001).

CONCLUSIONS: CA measured by 2D-TVUS is an independent predictor of the latency period in PPROM and shows comparable discriminative ability to CL. Incorporating CA assessment may improve risk stratification and aid in timely perinatal management decisions in PPROM pregnancies.

PMID:42090061 | DOI:10.1007/s11845-026-04418-8

Ir J Med Sci. 2026 May 6. doi: 10.1007/s11845-026-04427-7. Online ahead of print.

ABSTRACT

BACKGROUND: Ischemic cardiomyopathy (ICM) and idiopathic dilated cardiomyopathy (DCM) shared common structural alterations with a high mortality from sudden cardiac death (SCD) and pump failure. Implantable cardioverter-defibrillator (ICD) has been confirmed both beneficial and cost-effective for primary prevention of SCD in patients with ischemic or non-ischemic heart diseases. The management of heart failure has improved due to the of implantation of ICD and cardiac resynchronization therapy-defibrillator (CRT-D). It remains unclear whether there is a difference in clinical effectiveness of primary prophylactic ICD implantation between patients with ICM and DCM.

METHODS: We conducted a retrospective, single-center study, which enrolled 53 DCM patients and 25 ICM patients with guideline indications for primary prophylactic ICD or CRT-D treatment. Primary endpoint was all-cause mortality and secondary outcomes included cardiovascular death.

RESULTS: During a median follow-up of 38.5 months, all-cause death occurred in 8 patients (32%) in the ICM group and 5 patients (9.43%) in the DCM group (P = 0.012). Cardiovascular death occurred in 5 patients (20%) in the ICM group and 3 patients (5.66%) in the DCM group (P = 0.052). Multivariable Cox regression analysis showed that cardiogenic mortality in the ICM group is higher than that in the DCM group (hazard ratio [HR] 0.119, 95% confidence interval (CI) 0.016 to 0.860, P = 0.035).

CONCLUSIONS: Among patients who received ICD implantation for the primary prevention of SCD, there is no statistical difference in benefits between DCM and ICM patients. However, compared with DCM patients, ICM patients have a higher cardiovascular mortality, due to more exposure to risk factors.

PMID:42090060 | DOI:10.1007/s11845-026-04427-7

Eur J Nutr. 2026 May 6;65(4):129. doi: 10.1007/s00394-026-03979-9.

ABSTRACT

PURPOSE: Evidence indicates that early-life nutrition may influence later cardiometabolic health, but most studies examine individual outcomes rather than multiple markers. This study assessed the relationship between macronutrient intake at 12 months and cardiometabolic health at ages 5-6 years in preschool children from the EDEN mother-child cohort.

METHODS: Macronutrient intake was derived from 3-day food records, standardized as SD. Body mass index z-scores (z-BMI) were calculated using International Obesity Task Force (IOTF) references. Four sex-specific cardiometabolic phenotypes, based on anthropometric and biological data, were previously identified: “Higher adiposity, blood pressure (BP) and insulin resistance (IR)”, “Higher IR and lower adiposity”, “Higher triglycerides, low-density lipoprotein cholesterol (LDL-c) and lower high-density lipoprotein cholesterol (HDL-c)”, and “Higher BP and lower adiposity”. Multivariable linear regressions examined associations between macronutrients and z-BMI (for 426 boys, 387 girls) and cardiometabolic phenotypes (256 boys, 221 girls).

RESULTS: In girls, higher fat intake at 12 months was linked to higher z-BMI at 5-6 years (β = 0.07 [95%CI 0.00; 0.15]). In boys, greater mono- and disaccharide intake was associated with a higher score on the “Higher triglycerides, LDL-c, and lower HDL-c” pattern (β = 0.22 [0.04; 0.41]), while in girls, it was associated with the “Higher BP and lower adiposity” pattern (β = 0.18 [0.01; 0.35]). Other macronutrients showed no significant associations.

CONCLUSION: In infancy, higher fat intake may contribute to a higher z-BMI in girls in early childhood, and higher sugar intake to less favourable cardiometabolic health.

PMID:42090019 | DOI:10.1007/s00394-026-03979-9