Tag: nevin manimala

Clin Transl Allergy. 2026 Apr;16(4):e70166. doi: 10.1002/clt2.70166.

ABSTRACT

BACKGROUND: In the United States, beta-lactam allergy labels (BLAL) are documented in 9%-16% of hospitalized patients and associated with worse clinical outcomes such as increased mortality, length of hospital stay (LOS), intensive care unit (ICU) admission, and use of alternative antibiotics, providing an incentive for broad delabeling protocols. In Europe, BLAL prevalences are lower (0.6%-5%) and the association with clinical outcomes insufficiently explored. Therefore, we assessed the association between BLAL and penicillin allergy label (PenAL) and clinical outcomes and antibiotic use in hospitalized patients in Belgium.

METHODS: Retrospective population-based cohort study of all patients admitted to the University Hospitals Leuven between 2010 and 2018 for pneumonia, pyelonephritis (therapeutic indications), or appendectomy, coronary artery bypass grafting, total knee or hip replacement (prophylactic indications) or heart, kidney, liver, or lung transplantation (mixed indications). Multivariable regression analysis was performed, using BLAL or PenAL as independent variable, and age, gender, Charlson Comorbidity Index, and diagnosis as a priori hypothesized confounders.

RESULTS: We included 21,999 patients accounting for 23,842 admissions. A BLAL was recorded in 1394 (6.3%) patients, with 1113 (5.1%) having an unspecified PenAL. An increased use of next-line antibiotics was observed among patients with BLAL or PenAL. However, BLAL or PenAL were not associated with altered in-hospital or 3-month post-hospitalization mortality, LOS or ICU admission.

CONCLUSION: Despite altered antibiotic use, we observed no association of BLAL or PenAL with clinical outcome parameters, highlighting regional differences and limiting transferability of non-EU findings to guide EU delabeling protocols.

PMID:41896181 | DOI:10.1002/clt2.70166

Mil Med. 2026 Mar 27:usag138. doi: 10.1093/milmed/usag138. Online ahead of print.

ABSTRACT

INTRODUCTION: Periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome (PFAPA) is a rare, self-resolving, under-recognized autoinflammatory condition impacting young children. There is limited management and outcome data on PFAPA. Our study aims to describe the diagnostic and treatment approach, family impact, and outcomes of children with PFAPA from the perspective of their parents.

MATERIALS AND METHODS: We performed a survey-based case series study targeted toward parents of children diagnosed with PFAPA. Department of Defense beneficiaries diagnosed with PFAPA between ages 0 and 18 years and cared for by a Military Pediatric Infectious Disease physician at Naval Medical Center Portsmouth or Walter Reed National Capital Consortium between 2012 and 2023 were included. Parents of these patients were contacted via telephone and invited to participate in the online anonymous survey covering PFAPA diagnostic timeline, management strategies, clinical outcomes, and the impact on the patient’s family. Quantitative data from the survey was analyzed using descriptive statistics, and qualitative data from free text responses underwent manual thematic analysis.

RESULTS: Twenty-two children were identified with PFAPA, and 17 parents were successfully contacted and invited to participate. Of these, 10 parents completed the survey. For eight (80%) patients, a PFAPA diagnosis required more than four healthcare visits and took greater than a year from symptom onset. Seven parents reported use of abortive corticosteroids for PFAPA treatment, and four (40%) underwent tonsillectomy, resulting in immediate cessation of fever episodes for three of the four patients. At the time of the survey, 70% of children with PFAPA had experienced resolution of their fever episodes. Nearly every parent stated that PFAPA led to missed school and workdays. Half of respondents stated that PFAPA negatively impacted their child’s mental health and/or family well-being. More than half (60%) of respondents expressed feeling dismissed in their concerns and wished more providers were knowledgeable about PFAPA.

CONCLUSIONS: For most children with PFAPA, diagnosis requires more than four healthcare visits and over a year of time. PFAPA is a self-limited condition but poorly impacts families through missed school, missed workdays, and other family life disruptions. Parents of children with PFAPA want to be heard when they express concerns about frequent fever episodes and want providers to be better informed about PFAPA and available treatment options.

PMID:41896172 | DOI:10.1093/milmed/usag138

Pediatr Neonatol. 2026 Mar 7:S1875-9572(26)00036-7. doi: 10.1016/j.pedneo.2025.11.013. Online ahead of print.

ABSTRACT

BACKGROUND: Torsades de Pointes (TdP) is a life-threatening polymorphic ventricular tachycardia often associated with corrected QT prolongation (QTc). In infants, the risk factors and drug associations remain poorly characterized, despite their vulnerability to adverse drug reactions. This study aimed to identify drugs associated with TdP and QT prolongation in infants using data from the USFDA Adverse Event Reporting System (AERS).

METHODS: We conducted a disproportionality analysis utilizing data from the USFDA AERS database, applying the Standardized MedDRA Narrow Query (SMQ) for TdP/QT prolongation. Reports were filtered for infants aged ≤1 year, and duplicate cases were excluded. We employed both frequentist and Bayesian statistical methods for signal detection, focusing on the reporting odds ratio and proportional reporting ratio for frequentist analysis, and the Information Component for Bayesian analysis.

RESULTS: A total of 224 unique reports were identified. Significant signals for drugs associated with TdP and QT prolongation were detected, including anesthetics (fentanyl, propofol), systemic antibacterials (erythromycin, azithromycin), and various cardiac medications (propranolol, amiodarone, flecainide). Notably, midazolam was strongly associated with long QT syndrome, while a range of drugs showed links to ventricular tachycardia. Overall, 19 (8.5%) reports resulted in death, 117 (52.2%) involved hospitalization, and 51 (22.8%) were life-threatening events.

CONCLUSION: This study highlights critical drug safety signals for TdP and QT prolongation in infants, emphasizing the need for vigilant monitoring and cautious drug use in this vulnerable population. Further research is essential to elucidate risk factors and improve pharmacovigilance strategies in pediatric care.

PMID:41896159 | DOI:10.1016/j.pedneo.2025.11.013

Surg Obes Relat Dis. 2026 Mar 4:S1550-7289(26)00090-0. doi: 10.1016/j.soard.2026.02.017. Online ahead of print.

ABSTRACT

Up to 22% of bariatric and metabolic surgery (BMS) candidates experience trauma or stressor-related symptoms and/or diagnoses (trauma-related distress), such as post-traumatic stress disorder (PTSD), yet research assessing their impact on surgical outcomes remains limited. To our knowledge, this is the first systematic review examining how presurgical trauma-related distress affects postsurgical BMS outcomes. Five electronic databases and five grey literature sources were searched from inception to April 2025 for quantitative studies of adults undergoing BMS with current symptoms or diagnoses of trauma-related distress. Studies had to report associations between presurgical trauma-related distress and postsurgical outcomes. The Newcastle-Ottawa Scale was used to assess study quality. Narrative synthesis and vote counting by direction of effect was utilized. Nine observational studies (n = 5457) met inclusion criteria, ranging from poor to fair quality. PTSD was not statistically associated with postoperative weight loss in any study (n = 4). In one study, PTSD was associated with other mental health disorders, including major depressive disorder. Another study showed that people presenting with PTSD had worse mental health-related quality of life (QoL) than controls. Adjustment disorders showed no significant effect on postoperative weight loss (n = 1). Despite the high prevalence of trauma in this population, high-quality research on its impact on BMS outcomes is scarce, with methodological heterogeneity further limiting robust conclusions. The limited available evidence suggests PTSD and adjustment disorders do not significantly affect post-surgical weight loss, but QoL may be reduced in this population. Future research should employ standardized trauma measures, larger samples, and long-term follow-up to clarify how active trauma-related distress impacts BMS outcomes.

PMID:41896145 | DOI:10.1016/j.soard.2026.02.017

Pain Manag Nurs. 2026 Mar 26:S1524-9042(26)00100-1. doi: 10.1016/j.pmn.2026.03.006. Online ahead of print.

ABSTRACT

OBJECTIVE: There are no randomized controlled trial (RCT) in the current literature comparing live, robotic, and visual animal-based therapies. This single-blind randomized controlled trial was conducted to comparatively evaluate the effectiveness of live parrot, robotic parrot, and parrot picture therapies on pain during venipuncture in adults with chronic illness.

METHODS: The study included 240 patients randomized into four groups. Groups interacted with live parrots, robotic parrots, or parrot pictures during venipuncture. The control group received no intervention. Pain levels were assessed before and after the procedure using the “Visual Analog Scale (VAS).” Analysis was performed using Chi-Square test, One-way ANOVA and paired samples t-test.

RESULTS: There was no difference in pre-procedure pain scores between the groups (p > .05). After the procedure, the VAS score for the live parrot group was 2.01 ± 1.35, for the robotic parrot group 2.03 ± 1.46, for the parrot picture group 2.08 ± 1.62, and for the control group 4.91 ± 1.88. Again, after the procedure, pain scores in all experimental groups were found to be significantly lower than in the control group (p < .001). Live parrot therapy was found to be the most effective pet therapy, followed by robotic parrot and parrot picture therapy. The reduction in pain in the live parrot group was statistically more significant than in the picture group.

CONCLUSION: The research findings revealed that pet therapy applied during venipuncture, especially live animal interaction, may be a potentially effective, safe, and non-pharmacological method for reducing pain. Robotic animals, on the other hand, can be considered a promising alternative when the use of live animals is not possible. It is recommended that these distraction strategies be considered and integration into routine nursing practices be developed as part of patient-centered care.

PMID:41896141 | DOI:10.1016/j.pmn.2026.03.006

Pain Manag Nurs. 2026 Mar 26:S1524-9042(26)00095-0. doi: 10.1016/j.pmn.2026.03.001. Online ahead of print.

ABSTRACT

INTRODUCTION: Children in the hospital experience fear, anxiety, and pain due to needle-related procedures. Non-pharmacological distraction techniques are effective in alleviating these negative experiences.

AIM: To evaluate the effects of virtual reality and bubble play on pain, fear, anxiety, procedure, and crying time during peripheral intravenous catheterization in children aged 6-12 years.

METHODS: This randomized controlled trial was conducted with children aged 6-12 years (n: 105) who were treated in a children’s hospital and underwent peripheral intravenous catheterization. Participants were divided into three groups as virtual reality, bubble play and control group. The study data were collected using the Children’s Anxiety Scale, Children’s Fear Scale and Visual Analogue Scales. Data were analyzed using number, percentage, chi-square and correlation test. Bonferroni correction was used in the analysis of anxiety, pain and fear scores of the groups.

RESULTS: It was determined that children in the bubble play group and virtual reality group had less fear after the procedure and virtual reality was the most effective method that significantly reduced the pain (p = .019) and anxiety (p = .000) levels of children. Statistically significant differences were found between the groups in terms of total catheterization (p = .000) and total crying time (p = .000).

IMPLICATIONS FOR PRACTICE: The non-pharmacological management of pain, fear, and anxiety during painful experiences in pediatric patients is an effective nursing practice. Virtual reality or bubble play interventions are initiatives that can be easily integrated into nursing practices. It is important to raise nurses’ awareness regarding the use of these beneficial interventions.

CONCLUSION: Virtual reality is an effective method to reduce procedural pain, fear and anxiety during peripheral intravenous catheterization procedure in children aged 6-12 years.

PMID:41896139 | DOI:10.1016/j.pmn.2026.03.001

Surgery. 2026 Mar 26:110152. doi: 10.1016/j.surg.2026.110152. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to rigorously evaluate the early clinical outcomes following implementation of Versius CMR Surgical Robotic System in thoracic surgery and to compare these results with those achieved using a uniportal video-assisted thoracic surgery approach.

METHODS: This study encompassed a cohort of 124 patients who underwent robotic-assisted thoracic surgery, including 92 anatomical lung resections and 32 thymectomies performed by 3 lead surgeons without prior robotic experience. This group was compared with a control group of 229 patients who underwent the same procedures using a uniportal video-assisted thoracic surgery approach in which these 3 surgeons have extensive experience. The study spans the period since implementation of Versius in April 2023 until mid-August 2024 in addition to a group of subxiphoid video-assisted thoracic surgery thymectomies for comparison going back to May 2022. Propensity score-matched analysis was performed to create comparable groups of patients, and patients were matched using the nearest-neighbor matching method without replacement applying a multivariable model including gender, age, smoking, forced expiratory volume in 1 second, chronic obstructive pulmonary disease, diabetes mellitus, chronic kidney disease, hypertension, and tumor size. This resulted in a total of 168 matched patients, 84 of which underwent robotic-assisted thoracic surgery matched to 84 patients who underwent uniportal video-assisted thoracic surgery.

RESULTS: The robotic approach showed comparable results to uniportal video-assisted thoracic surgery in terms of complete resection and nodal upstaging. Uniportal video-assisted thoracic surgery showed an advantage in the number of stations on lymph node dissection (P < .001); however, this disappeared following propensity matching. The robotic group required increased conversion rate, which was mostly made electively to ensure safety or facilitate progression. Thirty-day mortality was less than 1% in each group. The average hospital stay in the robotic group was more than 1 day shorter, but with no statistical significance, whereas this stay remained comparable between the matched groups. Operating robotic times demonstrated noticeable improvement in the learning curve following about 7 months and 66 cases.

CONCLUSIONS: Versius robotic surgical system provides smooth adoption and safe implementation in thoracic surgery with satisfactory early clinical results in both thymectomy and anatomical lung resection, even in the lack of prior robotic surgical experience. Extensive experience in alternative approaches is essential to allow for conversion and ensure safe practice.

PMID:41896109 | DOI:10.1016/j.surg.2026.110152

Rev Neurol (Paris). 2026 Mar 26:S0035-3787(26)00452-2. doi: 10.1016/j.neurol.2026.02.150. Online ahead of print.

ABSTRACT

INTRODUCTION: Neurological semiology is often considered to be difficult to learn. The “Neurological hat game (NHG)” and the “Neurospeed game (NSG)” are two educational games that have both proven their effectiveness as a teaching method. The aim of this study was to compare the effectiveness of these two games.

METHODS: We performed a prospective study, during which we randomly assigned either the NHG or the NSG to third-year medical students at the Sorbonne Paris Nord University in November 2021. In both groups, students answered 20 multiple choice questions (MCQ) before and after the game. We compared the progression of average MCQ scores before and after the games, between the two groups of students. At the end of the games, the students were asked to complete a satisfaction survey.

RESULTS: A total of 156 students were included, 76 for the NSG and 80 for the NHG. In both groups, the average MCQ score improved after the game, compared with the average MCQ score before the game. The difference in the progression of MCQ averages between the two games was not statistically significant (P=0.65). Among the 156 students, 140 answered the satisfaction survey (63 NSG and 77 NHG). Responses to the questionnaire were mostly positive, with no difference between the two groups.

CONCLUSIONS: This study showed that the NSG and the NHG are two playful tools for teaching neurological semiology. Both are equally effective and popular with students. Further studies are needed to confirm the effectiveness of these teaching methods on long-term learning.

PMID:41896099 | DOI:10.1016/j.neurol.2026.02.150

Trends Plant Sci. 2026 Mar 26:S1360-1385(26)00029-4. doi: 10.1016/j.tplants.2026.02.005. Online ahead of print.

ABSTRACT

Plant roots form a microbiome that interacts at the cell wall extracellular matrix before entering the cell. The root primary and accessory walls present a dynamic, cell-type-dependent scaffold that microbes must navigate, using shared cellulose or contrasting chitin motifs and influencing plant gene responses that encode enzymes for cell wall biosynthesis and degradation. We propose that an interface evolves as microbes reach the root tip and interact with host polymers, potentially driving concurrent degradation of root and microbial cells. Knowledge gaps span diffusion, fluid flow, nutrient exchange, and the physics of microbial motion within the wall boundary. Advances in in situ imaging and mathematical modelling can help understand the dynamics of cell walls to design root microbiomes to function in agroecosystems.

PMID:41896075 | DOI:10.1016/j.tplants.2026.02.005

Acad Radiol. 2026 Mar 26:S1076-6332(26)00174-1. doi: 10.1016/j.acra.2026.03.009. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: To develop and externally validate ultrasound nomograms combining BI-RADS features and quantitative morphometric characteristics, and to compare their performance with expert radiologists and large language models in biopsy recommendation and malignancy prediction for breast lesions.

METHODS: In this multi-center, multi-national study, 1747 women with breast lesions underwent ultrasound across three centers in Iran and Turkey. A total of 10 BIRADS and 26 morphological features were extracted from each lesion. Three nomograms based on BI-RADS, morphometric, and both feature sets were constructed. Three radiologists (one senior, two general) and two ChatGPTs including ChatGPT-o3 and o4-mini-high interpreted de-identified breast lesion images. Diagnostic performance for biopsy recommendation and malignancy prediction was assessed across all cohorts.

RESULTS: According to the pooled results, although the difference between the fused nomogram and the BI-RADS version was not statistically significant, the fused version consistently outperformed all models in biopsy recommendation and malignancy prediction (AUCs of 0.901 and 0.853, respectively) compared to BI-RADS nomogram (AUCs of 0.898 and 0.834), morphometric nomogram (AUCs of 0.825 and 0.708), radiologist1 (AUCs of 0.820 and 0.729), radiologist2 (AUCs of 0.605 and 0.719), radiologist3 (AUCs of 0.728 and 0.699), ChatGPT-o3 (AUCs of 0.729 and 0.689), and o4-mini-high (AUCs of 0.713 and 0.695).

CONCLUSIONS: The proposed BI-RADS-morphometric nomogram outperforms standalone nomogram models, LLMs, and radiologists in guiding biopsy decisions and predicting malignancy. The proposed novel fused nomogram has the potential to reduce unnecessary biopsies and enhance personalized decision-making in breast imaging.

PMID:41896057 | DOI:10.1016/j.acra.2026.03.009