Nevin Manimala

Circ Cardiovasc Interv. 2026 Jun 18:e016573. doi: 10.1161/CIRCINTERVENTIONS.126.016573. Online ahead of print.

ABSTRACT

BACKGROUND: Recent observational studies have suggested that early treatment (<12 hours from diagnosis) of intermediate risk pulmonary embolism (PE) with catheter-based therapies may reduce morbidity and mortality. However, the effect of early versus late mechanical thrombectomy on acute pulmonary hemodynamics and right ventricular mechanics is less well defined.

METHODS: Patients enrolled in SYMPHONY-PE were divided into one of 2 groups based on the time from baseline CT pulmonary angiography to mechanical thrombectomy: Early <12 hours versus late ≥12 hours. The primary safety end point was the rate of major adverse events within 48 hours, as adjudicated by an academic independent safety board. The primary efficacy end point was the core-lab assessed mean change in right ventricle-to-left ventricle ratio from baseline to 48 hours.

RESULTS: Early thrombectomy was performed in 44% (48/109) of patients and was associated with a larger reduction, approaching statistical significance, in right ventricle-to-left ventricle ratio (0.52±0.50 versus 0.37±0.34; P=0.071). Mean pulmonary artery pressure decreased significantly more in patients receiving early thrombectomy (8.6±5.2 versus 5.8±5.0 mm Hg; P=0.006). The major adverse events rate was similar (P=0.431) between groups, and there were no mortalities. The differences in efficacy outcomes were greatest in higher-risk patients per the Composite Pulmonary Embolism Shock score.

CONCLUSIONS: Early mechanical thrombectomy was associated with larger reductions in right ventricle-to-left ventricle ratio and mean pulmonary artery pressure, with no significant differences in safety event rates compared with patients who underwent late thrombectomy. Randomized trials are needed to test these associations.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06062329.

PMID:42312382 | DOI:10.1161/CIRCINTERVENTIONS.126.016573

Ren Fail. 2026 Dec;48(1):2685354. doi: 10.1080/0886022X.2026.2685354. Epub 2026 Jun 18.

ABSTRACT

The atherogenic index of plasma (AIP) is a lipid-based marker of cardiovascular risk, yet its prognostic value for severe acute kidney injury (AKI) in critically ill patients with cardiovascular disease (CVD) remains uncertain. This retrospective study analyzed 5,872 patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, with external validation in the eICU Collaborative Research Database (eICU-CRD). The primary outcome was stage 3 AKI, and secondary outcomes included renal replacement therapy (RRT) and length of stay. Stage 3 AKI was observed in 20.7% of patients, with the incidence increasing across AIP quartiles (Q1-Q4: 15.9-26.8%), and 5.3% of patients requiring RRT (Q1-Q4: 2.6-10.9%). High AIP was associated with stage 3 AKI (adjusted OR = 1.35; 95% CI: 1.11-1.64), RRT (OR = 1.95; 95% CI: 1.33-2.87), longer hospital LOS (β = 3.58; p < 0.001) and ICU LOS (β = 1.14; p < 0.001). Restricted cubic splines revealed linear associations between AIP and both renal outcomes (stage 3 AKI and RRT). Mediation analysis indicated that stage 3 AKI mediated 12.6% of the association between the AIP and in-hospital mortality. The predictive models achieved AUCs of 0.916 for RRT and 0.727 for stage 3 AKI. These associations with renal outcomes were robust, as confirmed by entropy balancing and external validation in the eICU-CRD. Elevated AIP is a robust, externally validated predictor of stage 3 AKI and RRT, with substantial predictive accuracy for RRT. Furthermore, it appears to influence in-hospital mortality partially through renal injury, warranting confirmation in future prospective studies.

PMID:42312375 | DOI:10.1080/0886022X.2026.2685354

J Alzheimers Dis. 2026 Jun 18:13872877261457126. doi: 10.1177/13872877261457126. Online ahead of print.

ABSTRACT

BackgroundIn cerebral small vessel disease (CSVD), the burden of white matter hyperintensities (WMH) does not fully account for cognitive impairment, suggesting the involvement of intermediary mechanisms.ObjectiveWe investigated whether a gray matter atrophy network acts as the key mediator linking topologically specific (deep) WMH to multidomain cognitive dysfunction.MethodsIn this retrospective study, 260 patients with CSVD (62 cognitively normal, 125 with mild impairment, 73 with dementia) were included. Cognitive status was assessed neuropsychologically. 3.0 T MRI identified an atrophy network. We then conducted pre-specified mediation analyses and a primary confirmatory analysis using structural equation modeling (SEM) to test whether this atrophy network mediated the effect of deep WMH on cognitive performance.ResultsA 41-region atrophy network was identified, primarily involving the medial temporal lobe and thalamus, that was significantly associated with cognitive status. The final SEM demonstrated excellent fit, showing that higher deep WMH burden was associated with greater network atrophy (β = 0.145, p < 0.05), which in turn was strongly associated with poorer executive function (β = -0.64, p < 0.001) and memory (β = -0.572, p < 0.001). The direct effect of WMH on cognition was not statistically significant in the model.ConclusionsOur findings suggest that in CSVD, a unified network of gray matter atrophy acts as a powerful statistical mediator in the effect of deep white matter injury on cognitive decline. This atrophy pattern may represent a more direct biomarker of the neurodegenerative process underlying cognitive impairment than WMH burden alone.

PMID:42312368 | DOI:10.1177/13872877261457126

J Neurosurg Anesthesiol. 2026 Jun 19. doi: 10.1097/ANA.0000000000001128. Online ahead of print.

ABSTRACT

Hemodynamic stability and timely neurological assessment are critical components of anesthetic management in intracranial neurosurgery. This systematic review and meta-analysis were prospectively registered in PROSPERO (CRD420251274560, registered December 28, 2025) and evaluated the efficacy and hemodynamic stability of remimazolam versus propofol as hypnotic agents in patients undergoing these procedures. PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) comparing remimazolam with propofol in patients undergoing intracranial neurosurgical procedures. The outcomes evaluated were heart rate (HR), mean arterial pressure (MAP), hypotension incidence, recovery characteristics, and adverse events. We computed mean difference (MD) or standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. We included 7 RCTs, comprising 770 patients. Remimazolam was associated with a significantly shorter recovery time compared with propofol (MD: -1.74 min; 95% CI: -3.40 to -0.08; P=0.040; I2=48.7%). There were no significant differences between groups in anesthesia duration (MD: -3.31 min; 95% CI: -9.40 to 2.78; P=0.286; I2=0%), HR (MD: -1.79 bpm; 95% CI: -8.97 to 5.39; P=0.625; I2=97.5%), MAP (MD: -2.54 mm Hg; 95% CI: -6.09 to 1.00; P=0.160; I²=29.5%), and incidence of hypotension (RR: 0.56; 95% CI: 0.26-1.22; P=0.143; I2=72.4%). In conclusion, in patients undergoing intracranial neurosurgery, remimazolam use was associated with shorter recovery time and a hemodynamic profile similar to that of propofol.

PMID:42312365 | DOI:10.1097/ANA.0000000000001128

Trop Doct. 2026 Jun 18:494755261459846. doi: 10.1177/00494755261459846. Online ahead of print.

ABSTRACT

BackgroundAccurate and timely Gram stain interpretation of positively flagged blood culture bottles is crucial for early detection of bloodstream infections and initiation of empirical therapy. However, resin and charcoal particles in culture media may interfere with smear clarity.MethodsA prospective study was conducted on 100 positive blood culture samples. Four smear preparation techniques – conventional, water wash, blood film, and drop and rest – were applied. These were assessed for diagnostic agreement with final culture results and graded for resin/charcoal interference. Kappa (κ) statistics measured concordance.ResultsThe blood film method showed the highest agreement with culture Gram stains (63%, κ = 0.26), followed by conventional (62%, κ = 0.24), drop and rest (61%, κ = 0.22), and water wash (59%, κ = 0.18). It also had the least particle interference and the most deposit-free smears (29/100).ConclusionThe blood film method offers superior diagnostic clarity and is recommended.

PMID:42312347 | DOI:10.1177/00494755261459846

Glob Health Action. 2026 Dec;19(1):2686564. doi: 10.1080/16549716.2026.2686564. Epub 2026 Jun 18.

ABSTRACT

BACKGROUND: Cesarean section is a lifesaving obstetric intervention when medically indicated; however, its utilization remains unequal across sub-Saharan Africa (SSA). Although the World Health Organization recommends cesarean section rates of 10-15%, access remains insufficient in many low-resource settings and excessive in others. Understanding geographic patterns and drivers is essential for maternal health planning.

OBJECTIVE(S): To examine the spatial variation and determinants of cesarean section delivery across SSA.

METHODS: We conducted a cross-sectional analysis using Demographic and Health Survey data (2015-2024) from 201,481 weighted samples across 28 SSA countries. Spatial autocorrelation and hotspot patterns were assessed using Global Moran’s I and Getis-Ord Gi* statistics. Spatial regression models, including ordinary least squares, spatial lag, spatial error, geographically weighted regression, and multiscale geographically weighted regression, were fitted. Model performance was compared using corrected Akaike Information Criterion and adjusted R².

RESULTS: Cesarean section delivery showed significant spatial clustering (Moran’s I = 0.18, z = 43.3, p < 0.01). Hotspot areas were identified in Uganda, Rwanda, Burundi, Kenya, Tanzania, Malawi, South Africa, Lesotho, Gabon, Ghana, and Senegal, while cold spots were observed in Ethiopia, Madagascar, Angola, Nigeria, Guinea, Cote d’Ivoire, Sierra Leone, Liberia, and Mauritania. Previous cesarean delivery, maternal age ≥35 years, pregnancy spacing behavior, and health insurance coverage were significant spatial predictors.

CONCLUSION: Cesarean section utilization in SSA exhibits substantial geographic inequality driven by context-specific determinants. Spatially targeted maternal health policies, improved referral systems, and equitable financing mechanisms are needed to optimize access to medically indicated cesarean delivery while minimizing unnecessary procedures.

PMID:42312320 | DOI:10.1080/16549716.2026.2686564

Int J Chron Obstruct Pulmon Dis. 2026 Jun 12;21:616277. doi: 10.2147/COPD.S616277. eCollection 2026.

ABSTRACT

INTRODUCTION: Patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) often suffer from malnutrition, and traditional assessment methods struggle to fully capture muscle loss. The value of total pectoralis major area (tPMA) measured by CT remains to be determined. This study aimed to investigate the relationship between tPMA and malnutrition in patients with AECOPD and its diagnostic value.

METHODS: A total of 123 patients with AECOPD were enrolled (35 in the malnutrition group and 88 in the non-malnutrition group). Clinical and imaging parameters were compared between the two groups. Logistic regression analysis was used to assess the independent association between tPMA and malnutrition, and ROC curves were employed to evaluate its diagnostic performance when used alone or in combination with albumin (ALB) or total protein (TP). Spearman correlation analysis was used to examine the relationship between tPMA and other nutritional and disease severity indicators.

RESULTS: tPMA levels were significantly lower in the malnourished group than in the non-malnourished group (P < 0.01). tPMA was a protective factor against malnutrition in patients with AECOPD (OR = 0.998, P < 0.001); this association remained statistically significant after adjusting for confounding factors (P < 0.05). The AUC of tPMA for the standalone diagnosis of malnutrition was 0.770; when combined with ALB or TP, the AUC increased to 0.901 and 0.916, respectively (P < 0.05). tPMA was positively correlated with nutritional indicators and negatively correlated with the NRS2002 and CAT (P < 0.05).

DISCUSSION: tPMA is an independent associated factor against malnutrition in patients with AECOPD; when combined with ALB or TP, it significantly improves diagnostic performance and can serve as an objective adjunctive assessment indicator.

PMID:42312314 | PMC:PMC13271148 | DOI:10.2147/COPD.S616277

Front Glob Womens Health. 2026 Jun 2;7:1750182. doi: 10.3389/fgwh.2026.1750182. eCollection 2026.

ABSTRACT

INTRODUCTION: Since Acute Coronary Syndrome (ACS) death rates remain a challenge underscoring the importance of socioeconomic factors, the aim of the study was to explore the trend in incidence, mortality, and mortality-to-incidence ratio (MIR) of ACS and Myocardial Infarction (MI) among women in Serbia, middle income country, from 2006 to 2022, as well possible association with the Human Development Index (HDI), Social Demographic Index (SDI), and Years of Life Lost (YLL).

METHODOLOGY: The research was conducted according to the principles of a descriptive epidemiological study, using data extracted from publicly accessible yearbooks, registry and reports (count, and age-standardized rates). Statistical analysis was performed using Joinpoint Regression analysis with the Joinpoint Regression Program version 5.4.

RESULTS AND DISCUSSION: There were a significant declining trend of MI incidence (APC -2.1, p = 0.005) and mortality rates (APC -7.8, p < 0.001); ACS incidence did not change significantly, while ACS mortality decreased (APC -6.8, p < 0.05). There was significant association between trend of ACS and MI incidence, mortality and MIR at women in Serbia, and increasing trend of HDI and SDI. The constant decline in YLL followed, but the number of lost years remains high (APC -5.9, p < 0.001).

CONCLUSION: Consistently high mortality rates from ACS and MI among women in Serbia may be attributed to the complex phases of socioeconomic transformation the country has experienced, characterised by high exposure to risk factors and insufficient health promotion and prevention strategies. Urgently prioritising cost-effective, multidisciplinary prevention strategies for women, adapted to local contexts and aligned with health and other Sustainable Development Goals, is critical to reducing global disparities in cardiovascular outcomes.

PMID:42312312 | PMC:PMC13269274 | DOI:10.3389/fgwh.2026.1750182

Front Glob Womens Health. 2026 Jun 2;7:1775422. doi: 10.3389/fgwh.2026.1775422. eCollection 2026.

ABSTRACT

OBJECTIVE: To evaluate the influence of partnership status on the perception of menopausal symptoms and quality of life in women undergoing hormone replacement therapy (HRT).

METHODS: The study included 60 menopausal women aged 40-85 years with significant climacteric symptoms. Participants were divided into two groups according to relationship status: women living in a stable partnership (n = 30) and women without a partner for at least one year (n = 30). Menopausal symptoms and quality of life were assessed using the Menopause Rating Scale (MRS) and the Manchester Short Assessment of Quality of Life (MANSA). All participants received combined HRT. Assessments were performed at baseline and after three months of therapy. Changes in symptom severity (ΔMRS) and quality of life (ΔMANSA) were analyzed, and Pearson correlation coefficients with corresponding p-values were used to assess relationships between variables.

RESULTS: HRT was associated with improvement in menopausal symptoms and quality of life in both groups. However, women living in a partnership showed a greater reduction in MRS scores and a greater increase in MANSA scores compared to women without a partner. After three months of HRT, statistically significant correlations (p < 0.05) between hormonal levels (estradiol, FSH), menopausal symptoms, and quality of life were observed exclusively in partnered women.

CONCLUSION: HRT improves menopausal symptoms and quality of life; however, partnership status appears to play a moderating role. A stable partnership may facilitate the integration of psychobiological processes of hormonal changes and contribute to improved subjective adaptation to menopause.

PMID:42312311 | PMC:PMC13269051 | DOI:10.3389/fgwh.2026.1775422

Liver Cancer. 2026 Apr 16. doi: 10.1159/000551935. Online ahead of print.

ABSTRACT

INTRODUCTION: The prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) remains dismal. Although systemic therapy is the standard of care, its effectiveness is limited. This study aimed to compare the efficacy and safety of transarterial chemoembolization (TACE) or hepatic arterial infusion chemotherapy (HAIC) combined with systemic therapy versus systemic therapy alone in patients with HCC and PVTT.

METHODS: We retrospectively analyzed 478 patients newly diagnosed with HCC and PVTT between January 2021 and December 2024. Propensity score matching (PSM) was used to balance baseline characteristics. Outcomes compared between the combination therapy group (TACE/HAIC plus targeted therapy and immunotherapy, n = 374) and the systemic therapy group (n = 104) included overall survival (OS), progression-free survival (PFS), tumor response, and adverse events.

RESULTS: After PSM (184 vs. 102 patients), the combination therapy group showed significantly longer median OS (15.7 vs. 5.9 months; hazard ratio [HR] = 0.524, 95% confidence interval [CI]: 0.391-0.702; p < 0.001) and PFS (7.0 vs. 3.6 months, HR = 0.732, 95% CI: 0.558-0.959; p = 0.024). The disease control rate was also higher in the combination therapy group (43.5% vs. 27.5%, p = 0.007). Subgroup analyses revealed pronounced survival benefits in patients with Vp4 PVTT and those with Child-Pugh B liver function. Although adverse events were more frequent in the combination therapy group, the incidence of grade 3-4 toxicities was generally comparable between the two groups.

CONCLUSION: In HCC patients with PVTT, combining TACE or HAIC with systemic therapy significantly improves survival outcomes compared to systemic therapy alone, with acceptable safety. This multimodal approach offers a promising treatment strategy, particularly for patients with advanced PVTT or impaired liver function.

PMID:42312291 | PMC:PMC13271749 | DOI:10.1159/000551935