Nevin Manimala

Kathmandu Univ Med J (KUMJ). 2025 Oct-Dec;23(92):413-417.

ABSTRACT

Background Breast-conserving surgery with radiation therapy is the standard approach for early breast cancer. It provides much better cosmetic effects as well as the same level of overall survival as compared to a mastectomy. Despite strong global evidence supporting breast-conserving surgery, it is less preferred in Nepal, and its outcome in the Nepali context is poorly documented. Objective To assess the oncological outcomes of breast-conserving surgery at a tertiary cancer centre in Nepal. Method This hospital-based retrospective cohort study was done in Bhaktapur Cancer Hospital, Nepal, from 2012 to 2018. All the breast cancer patients who underwent breast-conserving surgery were included in the study and were followed up for at least 5 years postoperatively till 2024 with clinical examination and radiological investigations. The statistical analysis was done using SPSS version 22. The measurement data with a normal distribution were expressed as the mean ± standard deviation. Result The study included 100 patients, with a median age of 43 years (range 25-73 years), and a mean tumor size of 26.34 ± 8.6 mm. The mean hospital stay was 3.9 ± 1.08 days, and 94% patients had no complications. Histologically, invasive carcinoma of no special type was the most common. Five-year disease-free survival and five-year overall survival rate were 96% and 97% respectively. Conclusion Our study concluded that Breast Conserving Surgery has a shorter hospital stay, fewer complications, and good oncological outcomes, so it is a simple and feasible technique for patients with early breast cancer.

PMID:42318714

Turk J Anaesthesiol Reanim. 2026 Jun 19. doi: 10.4274/TJAR.2026.252149. Online ahead of print.

ABSTRACT

OBJECTIVE: Over 75% of women who have post-mastectomy reconstruction feel significant pain right away, and about 50% endure chronic pain. Thus, increasing the efficiency of postoperative pain management is crucial. Our study investigated the effects of ultrasound-guided erector spinae plane blocks (ESPB) and rhomboid intercostal blocks (RIB) on perioperative fentanyl use and pain scores in patients undergoing radical mastectomy surgery.

METHODS: This was a double-blind, randomised controlled trial conducted at a tertiary care hospital. Patients with breast cancer aged 18-70 years and American Society of Anaesthesiologists status I-II who were scheduled for unilateral modified radical mastectomy were included. They were randomly assigned to two groups. ESPB was performed in the ESPB group, and RIB was performed in the RIB group, using ultrasound guidance. Total postoperative fentanyl usage in the first 24 hours was the primary outcome indicator of the study. Intraoperative fentanyl requirements and numerical rating scale (NRS) scores at seven distinct time points were used as secondary outcome measures.

RESULTS: The difference between the mean of total postoperative fentanyl consumption in 24 hours in Group ESPB (2.67±0.68 μg kg^-1) and Group RIB (3.68±1.22 μg kg^-1) was statistically significant (t value: -4.183, df:66, P value: < 0.001). There was no difference in intraoperative opioid consumption between the groups (P=0.7). However, NRS scores were not significantly different between the ESPB group and the RIB group.

CONCLUSION: Our study’s outcome demonstrates ultrasound-guided ESPB to be more effective than RIB in terms of lower perioperative fentanyl consumption.

PMID:42318699 | DOI:10.4274/TJAR.2026.252149

J Med Econ. 2026 Dec;29(1):1738-1749. doi: 10.1080/13696998.2026.2682685. Epub 2026 Jun 19.

ABSTRACT

AIM: This study investigated the financial impact of introducing the once-daily single-inhaler triple therapy (SITT) fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) in Saudi Arabia for adult patients with uncontrolled asthma.

METHODS: The expected 5-year budget impact of introducing FF/UMEC/VI for asthma was modeled using an epidemiology-based approach that included both acquisition and efficacy-related costs. Year-on-year costs were estimated for 2026 through 2030. Changes in healthcare resource utilization after FF/UMEC/VI introduction were estimated from the expected change in asthma control reported in the Phase IIIa CAPTAIN trial. The perspective of the model was the Saudi national healthcare payer; only direct medical costs were included. The robustness of the model was tested using sensitivity and scenario analyses.

RESULTS: It was estimated that in 2026, 12,108 patients in Saudi Arabia would receive FF/UMEC/VI, which will likely increase over subsequent years (2027: 29,615 patients; 2028: 31,191 patients; 2029: 32,938 patients; 2030: 34,727 patients), as validated by local expert opinion. The introduction of FF/UMEC/VI was estimated to save a total of United States Dollars (USD) 10,654,389 over 5 years, or USD 16.32 per patient, with savings increasing each year after introduction. Drug acquisition costs contributed to the greatest impact on the budget, and the model was most sensitive to changes in the market uptake of FF/UMEC/VI. Across all sensitivity and scenario analyses, FF/UMEC/VI was consistently cost saving.

LIMITATIONS: Various model inputs could not be derived from published sources, so multiple assumptions were used. Future market share was estimated from current competitor market share data; as FF/UMEC/VI is the first SITT for asthma to be introduced into Saudi Arabia, there is no historical data on which to base these estimates.

CONCLUSION: Introducing FF/UMEC/VI in Saudi Arabia has the potential to deliver meaningful clinical and economic benefits at both the individual patient and healthcare system level.

PMID:42318691 | DOI:10.1080/13696998.2026.2682685

Cleft Palate Craniofac J. 2026 Jun 19:10556656261461128. doi: 10.1177/10556656261461128. Online ahead of print.

ABSTRACT

BackgroundThis study compares clinical and radiographic outcomes in alveolar bone grafting (ABG) using iliac crest bone graft (ICBG) alone, demineralized bone matrix (DBM) with recombinant human bone morphogenetic protein-2 (rhBMP-2), and ICBG with recombinant human bone morphogenetic protein-2 with demineralized bone matrix (rhBMP2/DBM).PurposeWe evaluated differences in clinical success and radiographic bone formation among grafting techniques for secondary alveolar cleft repair.Study Design, Setting, and SampleRetrospective cohort study of patients undergoing secondary ABG for cleft alveolus between 2017 and 2023 at a tertiary children’s hospital.Independent VariableType of grafting technique: ICBG alone, DBM with rhBMP-2, or ICBG with rhBMP-2.Main Outcome VariablesThe primary outcome was radiographic success (bony bridging on cone-beam computed tomography). Secondary outcomes included vertical bone height and reoperation.CovariatesAge, sex, cleft laterality, and graft type.AnalysesDescriptive statistics and comparative analyses were performed. Statistical significance was set at P < .05.ResultsA total of 432 patients (527 clefts) were included: 196 ICBG, 284 DBM + rhBMP-2, and 47 ICBG + rhBMP-2. Radiographic success was highest in the ICBG + rhBMP-2 group (89.4%) compared with ICBG (65.3%; P = .001) and DBM + rhBMP-2 (61.6%; P < .001). Mean vertical bone height was greater in the ICBG + rhBMP-2 group (7.4 ± 2.6 mm) versus ICBG (4.7 ± 1.9 mm; P < .001) and DBM + rhBMP-2 (4.4 ± 1.2 mm; P < .001).Conclusions and RelevanceICBG combined with rhBMP-2 demonstrates improved radiographic bone formation and vertical height compared with alternative grafting strategies, without increasing reoperation rates.

PMID:42318690 | DOI:10.1177/10556656261461128

J Prosthodont. 2026 Jun 19. doi: 10.1111/jopr.70183. Online ahead of print.

ABSTRACT

PURPOSE: To understand the use of soft liners/reliners in complete dentures to improve mastication, bite force, and patient’s quality of life, and to reduce pain.

METHODS: A systematic search was performed in MEDLINE (PubMed), EMBASE, and CENTRAL until May 2025 to find clinical studies comparing removable prostheses with and without soft liners or relining with soft and/or hard reliners. Case reports, case series, and in vitro studies were excluded. The Risk of Bias Tool 2, ROBINS-I, and the GRADE approach were used for quality and certainty assessment.

RESULTS: Thirty-two articles encompassing 710 patients were included (up to 6 months follow-up). Bite force, quality of life, and masticatory performance were significantly better in the soft liners group [MD: 34.99, CI: 19.98; 50.00], [MD: -2.03, CI: -3.30; -0.76], and [MD: 2.48, CI: 0.13; 4.84], respectively. Pain was compared in two ways, using the visual analog scale (VAS) and a questionnaire. For both methods, studies showed a general trend of less pain in the soft liners group, with a statistical significance in the VAS method [MD: -14.18, CI: -18.92; -9.44] and [MD: -2.15, CI: -5.97; 1.68], respectively. Comparisons of electromyography (EMG) amplitude and duration showed no statistically significant differences between groups [MD: -17.23, CI: -149.76; 115.30] and [MD: -0.39, CI: -2.95; 2.17], respectively.

CONCLUSION: Using soft liners, regardless of type, for lining or relining complete dentures, improves bite force, mastication, and quality of life and is associated with less pain. No effect was observed on the masticatory muscle EMG (amplitude and duration).

PMID:42318679 | DOI:10.1111/jopr.70183

ChemMedChem. 2026 Jun 26;21(12):e202500954. doi: 10.1002/cmdc.202500954.

ABSTRACT

The Trypanosomatidae family, which includes Trypanosoma and Leishmania species, is responsible for several neglected tropical diseases. The limitations of current therapies highlight the urgent need for novel therapeutic strategies. Here, we report the design and synthesis of 43 new hybrid molecules that combine isatin and thiazole scaffolds, which were evaluated for their in vitro anti-Trypanosomatidae activity and subjected to in silico analyses. In the anti-Trypanosoma cruzi assays, 12 compounds displayed EC₅₀ values ranging from 1.30 to 3.14 µM, comparable to that of benznidazole (EC₅₀ = 3.17 µM). In the leishmanicidal assays, against the promastigote form of Leishmania amazonensis, 36 compounds exhibited EC₅₀ values lower than miltefosine (EC₅₀ = 26.74 µM), with compounds 8 and 10 emerging as the most potent (EC₅₀ = 1.40 µM). However, none surpassed miltefosine against the amastigote form of Leishmania infantum or L. amazonensis. The compounds exhibited cytotoxicity toward RAW 264.7 macrophages and L929 fibroblasts. In silico predictions indicated that all synthesized compounds presented favorable bioavailability scores, drug-likeness profiles, and physicochemical stability. Moreover, molecular and electronic structure analyses revealed a moderate, positive, and statistically significant correlation (ρ = 0.50, p < 0.05) with trypanothione reductase, suggesting this enzyme as a potential biological target in T. cruzi.

PMID:42315999 | DOI:10.1002/cmdc.202500954

Ren Fail. 2026 Dec;48(1):2687235. doi: 10.1080/0886022X.2026.2687235. Epub 2026 Jun 18.

ABSTRACT

Acute kidney injury (AKI) is a common and severe complication following renal transplantation, largely driven by ischemia-reperfusion injury (IRI). However, reliable biomarkers for post-transplant AKI remain unavailable. In this study, we analyzed transcriptomic datasets from multiple cohorts to identify robust gene signatures associated with transplant-related AKI. Weighted gene co-expression network and differential expression analyses in the discovery cohort revealed 222 candidate genes altered during early allograft IRI, which were subsequently refined in an integrated training cohort using least absolute shrinkage and selection operator (LASSO) regression and support vector machine-recursive feature elimination (SVM-RFE) to a four-gene signature comprising SOCS3, MYC, TGIF1, and LETM2. This signature showed excellent discriminative performance in the training cohort (10-fold cross-validation AUC = 0.969) and was validated in independent external datasets, including a large cohort (AUC = 0.942). Decision curve analyses indicated potential clinical utility for early AKI identification across a broad threshold-probability range, with favorable performance compared with several established biomarkers such as neutrophil gelatinase-associated lipocalin. Single-cell transcriptomics revealed cell type-specific expression of the four genes across renal compartments. Moreover, their protein levels were elevated at 24 h after IRI in mouse kidneys, and displayed high expression in human AKI biopsies. Additionally, serum protein levels of SOCS3 and LETM2 were elevated in patients with cardiac surgery-associated AKI, whereas TGIF1 and MYC did not reach statistical significance. Collectively, this study identified a four-gene signature with potential utility as an early diagnostic biomarker panel for post-transplant AKI. Further large-scale clinical trials are needed to validate its diagnostic efficacy.

PMID:42315974 | DOI:10.1080/0886022X.2026.2687235

Ren Fail. 2026 Dec;48(1):2687920. doi: 10.1080/0886022X.2026.2687920. Epub 2026 Jun 18.

ABSTRACT

Although multiple risk prediction models have been developed to identify malnutrition in dialysis patients, their quality and performance remain unclear, limiting their practicality in current clinical practice and future research. Therefore, we conducted a systematic review and meta-analysis to evaluate these models. Searches were conducted in PubMed, Embase, Web of Science, The Cochrane Library, CINAHL, SinoMed, CNKI, Wanfang, and VIP Database from inception to January 26, 2026. Two investigators independently screened the literature, extracted data, and assessed quality using the Prediction model Risk of Bias Assessment Tool (PROBAST). Meta-analyses of the prevalence of malnutrition, common predictors and model performance were performed using Stata 18.0 and R 4.5.1. A total of 12 eligible studies conducted in China were included, and the pooled prevalence of malnutrition in dialysis patients was 41%. Meta-analysis identified age, serum calcium, Kt/V, triglycerides, sex, vitamin D, NT-proBNP, and comorbid diabetes as statistically significant predictors. The pooled effect of the nine internal validated models was 0.83, indicating good discriminatory performance. However, all included models were rated at high risk of bias, primarily due to inappropriate data sources and poor reporting of the analysis. The current analysis reveals a high prevalence of malnutrition among dialysis patients. Eight significant predictors were identified, guiding future selection for constructing predictive models of malnutrition risk in this population. Although existing models demonstrate adequate discriminatory performance, their methodological limitations constrain clinical applicability. Future studies should prioritize the development of standardized, externally validated models to enable early identification and intervention, thereby improving outcomes in this vulnerable group.

PMID:42315969 | DOI:10.1080/0886022X.2026.2687920

J Am Med Inform Assoc. 2026 Jun 19:ocag091. doi: 10.1093/jamia/ocag091. Online ahead of print.

ABSTRACT

OBJECTIVES: To leverage the evaluation of the environmental impact of the Direct AP-HP/Lorah e-referral service offered in Paris (France) hospitals to create recommendations for evaluating the impact of digital health services.

MATERIALS AND METHODS: We review the tools and methods currently available to measure the carbon footprint and electricity consumption of digital services in the context of Life Cycle Assessment (LCA) for a comprehensive evaluation. We use the recent deployment of a telemedicine communication service at a major French hospital as a case study to understand the practical implications of conducting an impact study. Three-deployment scenarii are considered: current usage, double usage and maximum capacity.

RESULTS: The bulk of the carbon footprint of the Direct AP-HP/Lorah service is due to servers vs network and user terminals in all scenarios considered. Computing hardware production impacts was instrumental in the overall impact assessment, as embodied impact represent 45% of Carbon footprint and the most of Metallic resource depletion. Recommendations for further studies notably include adequate anticipation of service usage and data collection.

DISCUSSION: The environmental impact of the new telemedicine service could be assessed in sufficient level of details to provide decision makers with an adequate comparison of the service with alternative email communication.

CONCLUSION: The recommendations derived from this use case should facilitate adequate impact data collection for future studies.

PMID:42315963 | DOI:10.1093/jamia/ocag091

Sci Rep. 2026 Jun 18. doi: 10.1038/s41598-026-58784-5. Online ahead of print.

ABSTRACT

Rockfalls are a destructive geo-hazard in Romania’s steep environments that pose significant material damage and loss of life, even when involving small rock volumes, owing to their high mobility and unpredictability. This study presents the first national-scale assessment of rockfall potential occurrence in Romania, applying a multi-criteria statistical and geospatial analysis based on the Weight of Evidence method. By integrating 1,743 historical rockfall sites and 19 environmental variables as driving factors, we mapped and statistically assessed the potential rockfall distribution of their occurrence across the Carpathian and Subcarpathian regions. Findings reveal that over 18,000 km² of Romanian territory is suitable for rockfall assessment, while approximately 1,500 km² face high rockfall occurrence potential. The Southern Carpathians emerged as the most vulnerable area, and all over the Carpathians and Subcarpathians statistical analysis highlighted that topographical and environmental factors are the primary drivers of rockfall distribution. Our model achieved 94% predictive accuracy, confirming the reliability of the resulting potential rockfall occurrence map, as well as its utility as a decision-support tool. These findings provide a robust scientific reference for national and local authorities to mitigate rockfall geohazards, manage rockfall risks and improve infrastructure resilience in Romania.

PMID:42315949 | DOI:10.1038/s41598-026-58784-5