Tag: nevin manimala

Australas J Dermatol. 2026 Feb 24. doi: 10.1111/ajd.70076. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: The Royal Brisbane & Women’s Hospital (RBWH) in Queensland, Australia provides definitive care for all diagnosed adult patients with SJS/TEN within its catchment. In this retrospective cohort study, we identified all SJS/TEN cases at RBWH over a 10-year period. We assessed disease incidence and the relationship of 3 variables (disease severity, time taken to admission to the definitive tertiary centre and systemic immunosuppressive treatment) to the outcome of mortality.

METHODS: Patients were identified via ICU MetaVision dermatology entries, discharge coding and manual admission recording. Age, gender, culprit drug, time to definitive tertiary centre admission, total body surface area (TBSA), SCORTEN, complications, systemic therapy utilisation and mortality were recorded. Relationships between variables were analysed using Spearman’s Rank correlations and logistic regression.

RESULTS: Fifty-two cases over 10 years met inclusion criteria (37 TEN, 8 SJS/TEN and 7 SJS). Mortality (9.6%; 5 deaths) was low compared to published rates. Multivariate regression analysis revealed a significant relationship between increased SCORTEN and mortality as expected. There was no significant relationship between systemic treatment and mortality or between ‘days to definitive care’ and mortality. Modelling accounted for 44% of variance in mortality.

CONCLUSIONS: SJS/TEN incidence matched published rates. Severity of SJS/TEN and mortality were correlated. Neither systemic immune suppression nor time taken to be admitted to the definitive tertiary centre correlated with mortality. Expert multidisciplinary care in the RBWH ICU and Burns Unit is likely to contribute to the excellent mortality outcomes found. Limitations of the study included its retrospective cohort design, that it was performed in a single centre, and the relatively small sample size leading to statistically insignificant findings. Our results should bolster growing data to improve understanding of this rare but serious condition.

PMID:41736175 | DOI:10.1111/ajd.70076

Diabetol Metab Syndr. 2026 Feb 24. doi: 10.1186/s13098-026-02107-1. Online ahead of print.

ABSTRACT

OBJECTIVE: This study evaluated the effects of intensive lifestyle modification (ILM) incorporating calorie-carbohydrate restriction (CCR) with or without time-restricted feeding (IFCCR) on psychological health in adults with type 2 diabetes (T2D).

RESEARCH DESIGN AND METHODS: In a 24-week randomized controlled trial, 120 adults with T2D were allocated to CCR (n = 40), IFCCR (n = 40), or a control group (n = 40). Both intervention arms followed an energy-restricted diet (1000-1200 kcal/day), received behavioral support, and performed ≥ 150 min/week of physical activity. The IFCCR group additionally restricted eating to an 8-hour daily window. Primary and secondary outcomes were eating disorder psychopathology (EDE-Q scale) and diabetes-related distress (PAID scale), respectively.

RESULTS: Both CCR and IFCCR significantly reduced diabetes-related distress compared to the control (CCR: β = -1.80, p = 0.007; IFCCR: β = -1.78, p = 0.01). EDE-Q scores also improved significantly. Improvements were observed across EDE-Q subscales, particularly in weight and shape concern. After adjustment for changes in weight and HbA1c, reductions in PAID became non-significant, while improvements in several EDE-Q domains, particularly in the IFCCR group, remained significant. IFCCR showed numerically greater reductions than CCR, though differences were not statistically significant. The control group demonstrated minimal changes.

CONCLUSIONS: Intensive lifestyle modification incorporating CCR or IFCCR improved eating disorder psychopathology, whereas reductions in diabetes-related distress appear largely related to metabolic changes. These findings support the integration of structured dietary and behavioral interventions into diabetes care.

TRIAL REGISTRATION: This trial was registered in Iranian Registry of Clinical Trials (IRCT), IRCT20230917059447N1 (https//irct.behdasht.gov.ir/trial/72666).

PMID:41736129 | DOI:10.1186/s13098-026-02107-1

J Anesth Analg Crit Care. 2026 Feb 25. doi: 10.1186/s44158-026-00362-2. Online ahead of print.

ABSTRACT

INTRODUCTION: Blood purification techniques are being investigated as adjunctive options in critically ill patients not only to treat severe inflammation but also to remove harmful substances such as myoglobin in rhabdomyolysis. Yet, the available evidence is limited, and further research is needed to clarify their clinical benefits.

METHODS: The international prospective COSMOS Registry (NCT05146336, 23 Nov 2021) tracks CytoSorb® (CS) utilization patterns and outcomes in critical care settings. Clinical assessment was performed before, during, and after CS treatment, with a 90-day follow-up. Device-related adverse effects were reported by investigators as the safety evaluation. Data were analyzed according to a pre-specified statistical plan using descriptive statistics and paired tests to compare pre- and post-treatment values, with subgroup and safety analyses performed.

RESULTS: A total of 300 adult patients (30.3% female, mean age 59 ± 15 years) from 22 sites were included in this analysis. The most common indications for CS therapy (multiple indications possible per patient) were septic shock (48.3%), rhabdomyolysis (12.8%), cardiogenic shock (11.5%), liver failure (11.5%), and acute respiratory distress syndrome (ARDS; 5.0%). On average, each patient received 3.3 ± 3.3 adsorbers, with 27.9% of patients receiving 4 or more adsorbers. CS was integrated in conjunction with kidney replacement therapy (75.6%), standalone hemoperfusion (7.1%), intermittent hemodialysis (IHD; 10.6%), extracorporeal membrane oxygenation (ECMO; 3.9%), and sustained low-efficiency daily dialysis (SLEDD; 4.9%). At baseline, median (interquartile range, IQR) APACHE II and SOFA scores were 24 [18, 30] and 12 [9, 15], respectively. Fluid balance improved from +1675 [141, 3348] mL pre-CS to +115 [-1100, 1495] mL post-CS, and norepinephrine requirements decreased from 0.21 [0.09, 0.40] µg/kg/min to 0.08 [0.02, 0.22] µg/kg/min (p < 0.0001 for both). Ratio of partial pressure of oxygen in arterial blood to the fraction of inspiratory oxygen concentration (P/F ratio) improved from 120 [72, 208] to 176 [115, 255] (p < 0.0001). Platelet counts decreased from 123 [76, 185] to 72 [42, 118] × 10⁹/L (p < 0.0001), while albumin levels remained stable from 2.6 [2.3, 3.1] to 2.5 [2.3, 3.0] g/dL (p = 0.112). ICU mortality was 33.1%, which was lower than mortality estimates historically associated with comparable APACHE II and SOFA scores. No serious adverse effects related to the device or device deficiencies were reported.

CONCLUSIONS: Real-world CytoSorb® use as part of standard care in critically ill patients was associated with improvements in several clinical and laboratory parameters; however, these findings should be interpreted cautiously given the observational design and absence of a control group. Observed mortality was lower than mortality estimates historically associated with established severity scores.

PMID:41736101 | DOI:10.1186/s44158-026-00362-2

Genome Biol. 2026 Feb 25. doi: 10.1186/s13059-026-04006-0. Online ahead of print.

ABSTRACT

BACKGROUND: Machine learning models in biomedical research are often hindered by demographic imbalances in clinical datasets, leading to biased predictions that disadvantage minority populations. Existing bias-correction methods face limitations in handling the heterogeneity of biomedical data and the complexity of demographic influences.

RESULTS: We present DeBias, a computational framework for mitigating demographic biases in high-dimensional biomedical datasets. DeBias identifies and removes bias-associated subspaces from the feature space using control samples, enabling global correction of demographic distortions while preserving disease-specific signals. To evaluate its effectiveness, we apply DeBias to cell-free DNA methylation data for cancer detection. DeBias achieves a significant reduction in the number of features exhibiting demographic bias and outperforms existing methods in improving cancer detection performance for minority populations. Performance gains are validated in independent cohorts, highlighting the robustness of the approach.

CONCLUSIONS: DeBias offers an effective and generalizable strategy for correcting demographic biases in biomedical machine learning. It represents a step toward more equitable machine learning models that can deliver reliable and unbiased predictions across diverse patient populations.

PMID:41736096 | DOI:10.1186/s13059-026-04006-0

Int J Behav Nutr Phys Act. 2026 Feb 25. doi: 10.1186/s12966-026-01898-w. Online ahead of print.

NO ABSTRACT

PMID:41736085 | DOI:10.1186/s12966-026-01898-w

Chiropr Man Therap. 2026 Feb 24;34(1):5. doi: 10.1186/s12998-026-00627-1.

ABSTRACT

BACKGROUND: Injuries sustained during healthcare consultations are a significant concern, and compensation claims relating to injuries in health systems are increasing. Extensive research has addressed injuries in the secondary sector, whereas knowledge about injuries sustained in primary care remains sparse. This retrospective register-based study aimed to describe compensation claims involving chiropractors in Denmark between 2013 and 2022.

METHODS: All claims related to chiropractors from 2013 to 2022 were accessed in the Danish Patient Compensation Association Register and analyzed using the Healthcare Complaints Analysis Tool. Data on patient characteristics, injuries, processing time, decisions, appeals, and financial compensation were collected. Claims were categorized as relating to clinical, management, or patient-clinician relationship, alongside nine symptom-based injury classifications. Data relating to cervical artery dissection were examined separately and in greater detail, including information on presenting symptoms, International Classification of Primary Care, Second Edition code recorded by the chiropractor, treatment modalities used, time from treatment to onset of symptoms, and type of vascular injury subsequently diagnosed. Descriptive statistics summarized findings.

RESULTS: A total of 535 chiropractor-related claims were identified, with 519 included for analysis. The number of claims per 100,000 consultations increased from 1.03 in 2013 to 3.57 in 2022. Most claims (84%) concerned treatment outcomes and side effects, primarily worsening of symptoms (23%) or delayed referral (23%). Of the 519 claims, only 32 (6%) were approved for compensation. Cervical artery dissection-related claims had the highest approval rate within category (29%; ~ 0.7 approved claims per million consultations) and accounted for 94% of total financial compensation (14 approved claims, 3,025,000 €).

CONCLUSION: Compensation claims related to chiropractic care in Denmark increased between 2013 and 2022, but approval rates remained low. Most claims concerned dissatisfaction with treatment outcome or worsening of symptoms. Cervical artery dissection-related claims had the highest approval rate and accounted for the highest compensation. When approved, they were compensated based on the fairness rule stating that the outcome could neither have been predicted nor expected from patients’ individual cases. Better communication between patients and chiropractors about expectations for treatment, natural course of conditions, and expected reactions to treatment will likely reduce the number of claims.

PMID:41736054 | DOI:10.1186/s12998-026-00627-1

Ital J Pediatr. 2026 Feb 24. doi: 10.1186/s13052-026-02216-7. Online ahead of print.

NO ABSTRACT

PMID:41736052 | DOI:10.1186/s13052-026-02216-7

Perioper Med (Lond). 2026 Feb 24. doi: 10.1186/s13741-026-00659-4. Online ahead of print.

ABSTRACT

Bayesian methods offer an intuitive and coherent statistical framework for updating probabilistic beliefs by integrating prior knowledge-whether from existing data or expert consensus-with new evidence via likelihood functions to generate posterior probability distributions. This approach yields clinically meaningful outputs, such as credible intervals and probabilities of treatment benefit, and can incorporate thresholds relevant to practice, like the region of practical equivalence (ROPE). Recent advances in computation-including Markov chain Monte Carlo (MCMC) sampling, Hamiltonian Monte Carlo algorithms, and probabilistic programming languages like Stan and JAGS- have made Bayesian approaches feasible even for complex hierarchical models. In perioperative medicine, these methods are particularly valuable for (1) complementing trial results by quantifying clinically important effects in the context of statistically nonsignificant findings or modest probabilities of benefit despite statistical significance, (2) enhancing meta-analyses through coherent integration of heterogeneous studies and sparse data, and (3) enabling adaptive and platform trial designs through continuous evidence synthesis. The ability to incorporate informative priors can complement existing knowledge, especially in small-sample studies, which are common in perioperative medicine, where traditional approaches provide insufficient precision. Although concerns remain regarding subjectivity in prior specification, these are increasingly addressed through structured guidelines, benchmark priors, and comprehensive sensitivity analyses. Altogether, Bayesian methods provide a flexible and powerful alternative for generating actionable insights in complex clinical settings, including in perioperative care.

PMID:41736024 | DOI:10.1186/s13741-026-00659-4

BMC Med Educ. 2026 Feb 24. doi: 10.1186/s12909-026-08821-8. Online ahead of print.

ABSTRACT

BACKGROUND: In undergraduate medical education, the ability to manage clinical-cases is a core competency expected of future physicians. Traditionally, this skill is developed through repeated exposure to real patient encounters in clinical settings. However, increasing patient safety concerns, limited clinical opportunities, and faculty workload constraints have made it increasingly difficult for students to access sufficient clinical practice. As a result, innovative solutions such as AI-based simulations are being explored to supplement clinical training. Among these, large language models (LLMs) offer promising potential for generating diverse, interactive, and context-specific clinical scenarios that can support competency-based education. This study aims to evaluate and compare the effectiveness and educational utility of four widely used and accessible LLMs; ChatGPT-4o, Claude 3.7 Sonnet, Gemini 1.5, and DeepSeek (Chat), in generating clinical scenarios for Turkish undergraduate medical education, and to identify the model that produces the most accurate, understandable, and pedagogically appropriate content aligned with national medical education standards.

METHODS: A convergent parallel mixed methods design was employed. Using standardized prompts based on Türkiye’s National Core Undergraduate Medical Education Program-2020, scenarios on three common infectious diseases were generated by each LLM. Twenty-five senior medical students and five expert clinicians evaluated the Turkish-language scenarios using structured rating forms and open ended feedback. Quantitative data were analyzed with Friedman and Wilcoxon tests; qualitative data underwent thematic analysis.

RESULTS: Claude received the highest ratings for clarity, realism, and support for clinical reasoning. Statistically significant differences favored Claude over Gemini and DeepSeek (p < 0.05). Qualitative feedback supported these results, highlighting Claude’s educational value and linguistic precision. ChatGPTperformed moderately, while Gemini and DeepSeek exhibited issues with realism and coherence.

CONCLUSIONS: In this study, Claude was rated highest for generating Turkish-language scenarios perceived as clinically appropriate and pedagogically useful for undergraduate medical education in Türkiye. Overall, the findings provide preliminary evidence on perceived scenario quality across models and support further multicenter and outcomes-focused studies to evaluate feasibility, implementation, and educational impact in diverse settings. Future research should also examine how LLM-generated scenarios can be used as supplementary materials in simulation-based learning.

PMID:41736016 | DOI:10.1186/s12909-026-08821-8

BMC Endocr Disord. 2026 Feb 24. doi: 10.1186/s12902-026-02205-1. Online ahead of print.

ABSTRACT

BACKGROUND: Negative perceptions of insulin therapy are common in diabetes mellitus (DM) patients and may delay treatment. Insulin perception has been studied in type 2 diabetics but not type 1 or prediabetics. The aim of this study was to determine the differences in perceptions of insulin use between diabetes types.

METHODS: This cross-sectional study was conducted at a tertiary care hospital between December 2023 and April 2024. Participants were adult diabetes outpatient clinic patients with T1DM, T2DM, or prediabetes. The validated Insulin Therapy Appraisal Scale (ITAS) quantified patients’ insulin therapy perceptions. Patients who did not use insulin and were in the prediabetes category answered the questions based on their current knowledge about insulin treatment. Higher scores on the positive sub-dimension indicate more favorable perceptions of insulin therapy, whereas higher scores on the negative sub-dimension and total ITAS reflect more negative perceptions. p-value < 0.05 was considered statistically significant.

RESULTS: A total of 160 adult patients were included in the study. Patients with T1DM demonstrated significantly higher ITAS positive sub-dimension scores and lower negative sub-dimension and total ITAS scores compared with patients with T2DM and prediabetes (p < 0.05). No significant differences in ITAS scores were observed between the T2DM and prediabetes groups. Correlation analyses showed that the ITAS positive sub-dimension score was inversely associated with age and C-peptide levels. In contrast, negative sub-dimension and total ITAS scores were positively correlated with age and C-peptide levels but negatively correlated with diabetes duration. Marital status, highest education level, and regular blood glucose monitoring were found to significantly influence insulin perception (p < 0.05). Female patients exhibited more positive perceptions, whereas insulin users, patients without diabetes-related complications, and those who exercised regularly demonstrated less negative attitudes toward insulin therapy.

CONCLUSION: Patients with T1DM have significantly more positive perceptions of insulin therapy compared with patients with T2DM and prediabetes. Identifying factors influencing insulin-related perceptions may help improve acceptance of insulin therapy and enhance treatment adherence in patients with diabetes.

CLINICAL TRIAL NUMBER: N/A.

PMID:41736002 | DOI:10.1186/s12902-026-02205-1