Nevin Manimala

Asia Pac J Clin Oncol. 2026 Jan 9. doi: 10.1111/ajco.70062. Online ahead of print.

ABSTRACT

BACKGROUND: Sentinel lymph node biopsy (SLNB) reduces morbidity in breast cancer (BC) surgery compared to axillary lymph node dissection. Standard tracers such as vital blue dye (VBD), methylene blue (MB), and radioisotopes (RIs) are effective but costly and logistically challenging. Gentian violet (GV), a low-cost alternative, offers a potential solution for resource-constrained settings.

METHODS: We conducted a single-center retrospective study at Cancer Foundation Hospital, analyzing 40 BC patients who underwent SLNB using GV and RI (January-December 2024). Sentinel lymph node (SLN) detection rates, concordance between GV and RI, and safety profiles were assessed. Detection was compared across tumor grade, histopathology, receptors, and chemotherapy status.

RESULTS: The median patient age was 52 years, with most patients having a BMI between 21 and 30 (72.5%). T2 tumors were the most common (60%), followed by T3 (17.5%). Stage II disease predominated (75%), and invasive ductal carcinoma (IDC) was the most frequent histological subtype (70%). Among the cohort, 60% were estrogen/progesterone receptor-positive, 22.5% were triple-positive, and 10% were triple-negative. GV dye successfully identified SLNs in 97.5% of cases, with GV detecting more nodes than RI in 32.5% of patients, while both methods identified the same number in 50% of cases. The false-negative rate for GV was 2.5%. Detection rates were consistent across tumor subtypes, grades, and receptor statuses, with no statistically significant differences (p > 0.05). Neoadjuvant chemotherapy (NACT) did not impact SLN detection (p = 0.803). GV dye exhibited a favorable safety profile, with no intraoperative or postoperative complications reported at Days 0, 3-7, and 30. No cases of staining-related reactions, dermatitis, tattooing, or skin necrosis were observed.

CONCLUSIONS: Gentian violet is a safe, effective, and affordable alternative to MB for SLNB in BC. It demonstrates high detection rates and excellent safety, particularly suitable for resource-limited settings. Larger studies are warranted to validate these findings and support broader clinical adoption.

PMID:41510595 | DOI:10.1111/ajco.70062

Nurs Crit Care. 2026 Jan;31(1):e70313. doi: 10.1111/nicc.70313.

ABSTRACT

BACKGROUND: Excessive noise exposure in intensive care units (ICUs) remains a critical issue that adversely affects both healthcare professionals and patients. Prolonged and unnecessary noise contributes to psychological stress, sleep disturbance and physiological alterations, ultimately delaying patient recovery and increasing staff fatigue.

AIM: This Study Aimed to Assess the Effect of Implementing a Structured Noise Reduction Bundle on Critical Care Nurses’ Knowledge and Practice in an Adult ICU in Egypt.

STUDY DESIGN: A quasi-experimental pre-post research design was employed in a single adult ICU characterised by an open-unit layout, which may influence ambient noise levels. Data were collected using four instruments: (1) a questionnaire assessing nurses’ socio-demographic characteristics and knowledge regarding the noise reduction bundle; (2) an observational checklist evaluating adherence to noise reduction bundle practices; and (3) objective noise level measurements within the ICU before and after intervention.

RESULTS: Implementation of the noise reduction bundle significantly improved ICU noise outcomes and enhanced nursing competencies. Post-intervention, mean knowledge scores increased from 20.3 to 25.6 (p < 0.001), with satisfactory knowledge rates rising from 15.6% to 81.3%. Practice scores improved from 42.9 to 60.3 (p < 0.001), with satisfactory practice rates increasing from 14.1% to 82.8%. These improvements were strongly correlated with a statistically significant reduction in average noise levels across all ICU shifts (p < 0.001), reflecting tangible environmental improvements.

CONCLUSION: Effective noise reduction in ICUs requires integrated bundle interventions, workflow modifications and behavioural changes in staff communication, which collectively foster a sustainable and quiet clinical environment conducive to patient recovery and staff well-being.

RECOMMENDATIONS: Future research should involve larger and more diverse populations to validate these findings, develop standardised noise control protocols and assess the long-term impact of continuous staff education programmes and integrate noise management strategies within institutional quality improvement frameworks.

RELEVANCE TO CLINICAL PRACTICE: Noise in intensive care units (ICUs) is a critical environmental stressor that affects both patients and healthcare professionals. Excessive noise disrupts patient sleep, delays recovery, increases stress and contributes to staff fatigue and communication errors. Implementing a structured noise reduction bundle provides a practical and evidence-based approach to minimise unnecessary sound exposure, enhance patient comfort and promote safer, more focused clinical environments. Strengthening ICU nurses’ knowledge and adherence to noise reduction practices fosters a culture of awareness and accountability that supports high-quality, patient-centred care.

PMID:41510571 | DOI:10.1111/nicc.70313

Rev Med Virol. 2026 Jan;36(1):e70104. doi: 10.1002/rmv.70104.

NO ABSTRACT

PMID:41510570 | DOI:10.1002/rmv.70104

Kidney Med. 2025 Nov 7;8(2):101175. doi: 10.1016/j.xkme.2025.101175. eCollection 2026 Feb.

ABSTRACT

RATIONALE & OBJECTIVE: There are substantial racial/ethnic disparities in access to kidney replacement therapies (KRT). Although existing work often focuses on discrete treatment outcomes, a holistic depiction of racial/ethnic groups’ differential experiences requires a longitudinal approach.

STUDY DESIGN: A sequence analysis in national registry data.

SETTING & PARTICIPANTS: Adults aged 18-64 years with incident kidney failure in 2009 in the United States Renal Data System database.

EXPOSURE: Race/ethnicity (non-Hispanic Asian American [Asian-NH], non-Hispanic African American or Black [Black-NH], Hispanic, and non-Hispanic White [White-NH]) and age group (18-44 years and 45-64 years).

OUTCOME: Ten-year KRT modality sequences (in-center dialysis, home dialysis, deceased donor kidney transplant [DDKT], living donor kidney transplant, stopped dialysis, and mortality).

ANALYTICAL APPROACH: Using sequence analysis, longitudinal KRT modalities were characterized using descriptive statistics and visualized with state distribution plots, stratified by race/ethnicity and age.

RESULTS: The study included 50,776 adults with kidney failure (24% 18-44 years old and 76% 45-64 years old; 3.6% Asian-NH, 35.8% Black-NH, 17.7% Hispanic, and 42.9% White-NH). Among those aged 18-44, Hispanic and Asian-NH patients more frequently survived 10 years compared with Black-NH and White-NH patients. Among non-White patients, receipt of DDKT increased in years 4-6. Asian-NH patients had the highest DDKT receipt frequency. Asian-NH and White-NH patients more frequently experienced treatment sequences with 3 or more KRT modalities, and these sequences more commonly included transplant. Among patients initially receiving home dialysis, Asian-NH and White-NH patients more commonly transitioned to transplant compared with Black-NH and Hispanic patients. Compared with patients aged 18-44 years, racial/ethnic differences in KRT treatment sequences were attenuated among those aged 45-64 years.

LIMITATIONS: Descriptive analyses cannot identify causal mechanisms. Excluding patients missing KRT modality may limit generalizability.

CONCLUSIONS: Patterns in the KRT modality sequences offer a more nuanced view of racial/ethnic disparities in access to treatments for incident kidney failure.

PMID:41510562 | PMC:PMC12775809 | DOI:10.1016/j.xkme.2025.101175

Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Oct 20;33(4):517-527. doi: 10.5606/tgkdc.dergisi.2025.27712. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: This study aims to evaluate the diagnosis, surgical outcomes, and prognosis of patients with traumatic diaphragmatic rupture and discuss recent advancements in diagnostic technologies.

METHODS: Between January 2014 and January 2024, a total of 35 patients (27 males, 8 females; mean age: 45.3±14.2 years; range, 13 to 68 years) who underwent diaphragmatic repair for traumatic diaphragmatic rupture in three centers were retrospectively analyzed. Data including demographic characteristics of the patients, medical history, type of trauma, clinical findings, diagnostic methods used preoperatively, preoperative interventions, the establishment of an intraoperative diagnosis, associated organ injuries, side of the diaphragmatic rupture, type of surgical procedure, postoperative complications, and length of hospital stay were recorded.

RESULTS: Among the cases, penetrating trauma was the most common mechanism (62.9%). Among the 25 patients who underwent computed tomography, a preoperative diagnosis of diaphragmatic rupture was established in 14 (56%). The median defect size in the diaphragm was 5.7 cm in blunt trauma cases and 4.04 cm in penetrating trauma cases. The morbidity rate was 40%, and the mortality rate was 5.7%. The length of hospital stays for the surgically treated patients ranged from 4 to 16 days. Comparing the laparotomy and thoracotomy groups, the laparotomy group had a longer hospital stay (p=0.017) and had statistically significant data in terms of participation in multidisciplinary surgery (p=0.001).

CONCLUSION: Diaphragmatic rupture should be considered in cases involving high-energy blunt trauma, particularly when multiple lower rib fractures, liver lacerations, or splenic lacerations are present, or in patients with a history of penetrating trauma to the thoracoabdominal region. As delays in diagnosis and treatment may increase morbidity and mortality, early recognition and prompt management are essential. The choice of surgical procedure should be guided by the presence or absence of concomitant injuries.

PMID:41510551 | PMC:PMC12728965 | DOI:10.5606/tgkdc.dergisi.2025.27712

Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Oct 20;33(4):546-554. doi: 10.5606/tgkdc.dergisi.2025.27813. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: This study aims to emphasize the features that should be considered in the follow-up of patients with solitary fibrous tumors by analyzing the clinical and pathological parameters that are effective in the prognosis.

METHODS: In this study, 53 patients (28 males, 25 females; mean age: 56.2±5 years; range, 24 to 76 years) diagnosed with solitary fibrous tumor and operated on between 2009 and 2023 were retrospectively examined. The patients included in the study were followed for at least one year. Patients with complete clinical and pathological data records were included in the study. Survival and recurrence rates were analyzed in relation to clinical and pathological parameters.

RESULTS: The median follow-up was 44.9 months. Eight (15%) patients underwent anatomic resection, 23 (35.8%) patients underwent wedge resection, five (5.6%) patients underwent total pleurectomy, 26 (41.5%) patients underwent mass excision, and three (1.8%) underwent mass excision and chest wall resection. Survival analyses were conducted using the Kaplan-Meier method. Overall survival and disease-free survival were calculated in months from the date of surgery until the date of death or recurrence, respectively. Low mitotic rate was found to be a significant independent predictor of reduced mortality (odds ratio [OR]=0.46, 95% confidence interval [CI]: 0.243-0.877, p=0.018), indicating better survival outcomes in patients with low mitotic activity. In contrast, low Ki-67 expression was not a statistically significant predictor (OR=0.9, 95% CI: 0.880-1.116, p=0.885). Pleomorphism was strongly associated with increased mortality (OR=10.0, 95% CI: 1.316-76.081, p=0.026), highlighting the importance of pleomorphism as an important prognostic marker. Necrosis, although not statistically significant (OR=6.3, 95% CI: 0.497-79,123, p=0.156), showed a trend indicating worse outcomes. Similarly, CD34 negativity showed a trend in favor of mortality (OR=3.5, 95% CI: 0.429-28.990, p=0.241.

CONCLUSION: Solitary fibrous tumors are generally benign and have low recurrence and high survival rates. However, the recurrence rate is higher in malignant solitary fibrous tumors. According to the results of our study, high mitosis rate and pleomorphism are important independent predictors of increased mortality in solitary fibrous tumors. These findings emphasize the importance of detailed histopathological examination in prognostic evaluation.

PMID:41510546 | PMC:PMC12728960 | DOI:10.5606/tgkdc.dergisi.2025.27813

Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Oct 20;33(4):470-478. doi: 10.5606/tgkdc.dergisi.2025.28290. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: This study aims to evaluate our experience with magnetic resonance lymphangiography in single-ventricle congenital heart disease patients and to examine the association between imaging findings and clinical outcomes and postoperative outcomes.

METHODS: Between November 2022 and May 2025, a total of 33 patients (22 males, 11 females; median age: 44 months; range, 37 to 57.5 months) with single-ventricle congenital heart disease who underwent T2-weighted magnetic resonance lymphangiography at our center were retrospectively analyzed. The T2-weighted sequences were chosen for their high-resolution depiction of lymphatic structures without the need for contrast agents. The imaging findings were analyzed for preoperative risk evaluation or suspected postoperative lymphatic complications.

RESULTS: Lymphatic abnormalities were categorized into types 1 to 3 based on the extent and distribution of T2-hyperintense signals. No patients in this cohort exhibited type 4 abnormalities. Among 33 patients, 11 (33%) were classified as type 1, 18 (55%) as type 2, and four (12%) as type 3. Although not statistically significant, patients with type 3 patterns had the longest median pleural effusion duration (27.5 days) and length of hospital stay (61 days). One patient showed early postoperative progression from type 2 to type 3, which resolved clinically and radiologically after fenestration ballooning. In the late period, two patients developed protein-losing enteropathy, and one had Fontan failure.

CONCLUSION: Magnetic resonance lymphangiography provides critical information about structural lymphatic abnormalities. It also aids risk stratification prior to the Fontan procedure and guides individualized management of postoperative complications, ultimately guiding treatment and improving outcomes.

PMID:41510542 | PMC:PMC12728969 | DOI:10.5606/tgkdc.dergisi.2025.28290

Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Oct 20;33(4):451-459. doi: 10.5606/tgkdc.dergisi.2025.27992. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: This study aims to investigate the effects of deep parasternal intercostal plane block on left internal thoracic artery vasospasm in coronary artery bypass grafting patients.

METHODS: Between March 2024 and August 2024, a total of 29 patients (24 males, 5 females; mean age: 60.1±8.3 years; range, 56 to 66 years) who were scheduled for elective coronary artery bypass grafting were included in this prospective study. An ultrasound-guided bilateral deep parasternal intercostal plane block was performed with 15 mL of 0.25% bupivacaine per side after anesthesia induction. Left internal thoracic artery peak systolic velocity, end-diastolic velocity, and resistive index, along with heart rate and mean arterial pressure, were recorded immediately before the block (T0) and 30 min after (T1). Demographics, body mass index, and comorbidities of the patients were noted.

RESULTS: After deep parasternal intercostal plane block administration, the left internal thoracic artery resistivity index decreased significantly (p=0.041), and the left internal thoracic artery diameter increased significantly (p=0.004). Although the peak systolic velocity increased and the end-diastolic velocity decreased following the block, these changes were not statistically significant (p=0.145 and p=0.135, respectively).

CONCLUSION: Our study findings suggest that deep parasternal intercostal plane block administration may prevent left internal thoracic artery vasospasm by increasing arterial conduit diameter and reducing the resistivity index. Based on these findings, we believe that this method can be safely applied under ultrasound guidance without complications.

PMID:41510541 | PMC:PMC12728966 | DOI:10.5606/tgkdc.dergisi.2025.27992

Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Oct 20;33(4):528-537. doi: 10.5606/tgkdc.dergisi.2025.27905. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: This study aims to encourage the use of percutaneous transthoracic biopsies by thoracic surgeons as a diagnostic method.

METHODS: This retrospective study was conducted between January 1, 2015, and January 31, 2024, with 793 patients (632 males, 160 females; mean age: 65±12 years; range, 11 to 93 years) who underwent lung tru-cut biopsy under computed tomography guidance. Patients whose radiologic and pathology records were accessible via the Hospital Information System and the Picture Archiving and Communication System were included.

RESULTS: A total of 973 tru-cut biopsy procedures were performed. There was no statistically significant difference in age distribution between sexes (p=0.15). Most biopsies were performed on the upper lobes, predominantly the right upper lobe (33.2%). The supine position was the most commonly used during the procedure (49.4%). The mean lesion diameter and distance from the chest wall were 49±17 mm and 51±16 mm, respectively. A definitive diagnosis was obtained on the first attempt in 78.6% of patients, while repeat biopsies were required in 21.4%. Primary lung malignancy was diagnosed in 63% of cases. Postprocedural complications included pneumothorax in 16.1%, intraparenchymal hemorrhage in 0.1%, hemoptysis in 0.1%, and hemothorax in 0.1% of patients. Complications were most frequently observed following biopsies of the left lower lobe (32.4%). Lesions located in the upper lobes were significantly more likely to be malignant (p=0.01). A significant increase in complication rates was observed with greater parenchymal tissue penetration during the procedure (p=0.001).

CONCLUSION: Computed tomography-guided percutaneous lung biopsies can be performed more safely by thoracic surgeons due to their procedural experience. Additionally, in the event of complications, thoracic surgeons are more capable of providing prompt and effective intervention, thereby enhancing patient safety. Thoracic surgeons should be actively involved in all diagnostic stages of pulmonary or mediastinal nodules or masses, including procedures such as tru-cut lung biopsy and endobronchial ultrasonography.

PMID:41510537 | PMC:PMC12728956 | DOI:10.5606/tgkdc.dergisi.2025.27905

Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Oct 20;33(4):432-441. doi: 10.5606/tgkdc.dergisi.2025.27779. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: This study aims to compare the effects of measurements taken with indocyanine green fluorescence imaging (IFI) and transittime flowmeter measurement (TTFM) methods on the surgical outcomes of coronary artery bypass grafting.

METHODS: Between December 2023 and May 2024, a total of 70 patients (53 males, 17 females; mean age: 64.2±9.1 years; range, 43 to 82 years) who underwent on-pump coronary artery bypass grafting via median sternotomy by the same surgical team were included in this prospective study. The control group (TTFM group, n=35) consisted of patients who had intraoperative TTFM, while the remaining patients received both TTFM and IFI measurements during surgery (TTFM+IFI group, n=35). The groups were compared in terms of first-month survival, ejection fraction preservation, intra-aortic balloon pump use, need for extracorporeal membrane oxygenation, postoperative myocardial infarction, and length of intensive care unit and hospital stay.

RESULTS: In our clinic, distal anastomoses were performed in a mean of 3.3±0.7 vessels in the TTFM group and in a mean of 3.7±0.8 vessels in the TTFM+IFI group. The total number of distal anastomoses in the TTFM group and TTFM+IFI group was 115 and 130, respectively. According to the TTFM and IFI measurements taken during the surgery, no revision was required in any of the grafts. There was no statistically significant difference between the two compared groups in terms of early survival, postoperative myocardial infarction, need for intra-aortic balloon pump, need for extracorporeal membrane oxygenation, preservation of ejection fraction, length of stay in the intensive care unit, and time to discharge (p>0.05).

CONCLUSION: The use of IFI yields no significant effect on early-term outcomes and TTFM is solely adequate for assessing graft functionalities in coronary artery bypass grafting.

PMID:41510535 | PMC:PMC12728974 | DOI:10.5606/tgkdc.dergisi.2025.27779