Tag: nevin manimala

Ann Indian Acad Neurol. 2026 Jun 5. doi: 10.4103/aian.aian_1225_25. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Migraine, a disabling neurological disorder, poses a significant global burden, especially among women of reproductive age. In India, inconsistent diagnoses and the underutilization of evidence-based therapies present substantial challenges. This study evaluated the knowledge, attitudes, and practices of general neurologists and headache experts in India regarding migraine diagnosis and treatment, identifying barriers and opportunities for improvement in clinical care.

METHODS: A cross-sectional online survey was conducted among 137 clinicians in India (125 general neurologists and 12 headache experts). The questionnaire assessed diagnostic approaches, preferences for pharmacological and non-pharmacological treatments, utilization of guidelines, and readiness to adopt novel therapies. Data were analyzed using descriptive statistics.

RESULTS: Headache experts reported a higher patient burden, with 9 (75.00%) seeing 25 or more headache patients per week, compared to 39 (31.2%) general neurologists. Migraines comprised over 50% of cases for 7 (58.33%) of the experts. The use of International Classification of Headache Disorders (3 rd edition) criteria was markedly higher among headache experts (91.67% vs. 38.71%), as was the Migraine Disability Assessment (66.67% vs. 24.20%). Nonsteroidal anti-inflammatory drugs and triptans were the most commonly prescribed therapies. Although triptans provided only moderate relief for most patients, newer agents, such as ditans, were rarely used (0-20%). Nonpharmacological interventions were widely adopted, with approximately 90% usage in both groups. Barriers included limited diagnostic standardization, therapeutic inertia, low familiarity with newer agents, and operational challenges such as time constraints.

CONCLUSIONS: Both general neurologists and headache experts acknowledge the burden of migraine and practice holistic management. However, gaps remain in standardized diagnosis, optimal triptan use, and the adoption of novel therapies. Enhancing clinician education, promoting validated diagnostic tools, developing expert consensus, and increasing community awareness are crucial to optimizing outcomes and reducing therapeutic inertia.

PMID:42262822 | DOI:10.4103/aian.aian_1225_25

Saudi J Kidney Dis Transpl. 2026 Jun 3. doi: 10.4103/sjkdt.sjkdt_118_26. Online ahead of print.

ABSTRACT

CONTEXT: Haemodialysis patients are especially vulnerable to blood-borne viral infections because of repeated exposure to invasive procedures and the dialysis care environment.

AIMS: This study aimed to determine the HBV-positive status of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus among haemodialysis patients and to identify factors associated with HBV seropositivity.

SETTINGS AND DESIGN: A cross-sectional analytical study was conducted among haemodialysis patients in Morocco.

METHODS AND MATERIAL: A total of 305 haemodialysis patients were included. Sociodemographic, clinical, and serological data were collected using a structured form. Serological status for HBV, HCV, and HIV was assessed by ELISA and confirmed using specific confirmatory assays. Statistical analysis used: Univariate and multivariable logistic regression analyses were performed to identify factors associated with HBV seropositivity. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated, and statistical significance was set at p < 0.05.

RESULTS: The overall seroprevalence was 2.62% for HBV, 0.33% for HCV, and 0.66% for HIV. Multivariable analysis showed that use of an arteriovenous fistula and complete HBV vaccination (3-4 doses) were significantly associated with lower odds of HBV infection (OR = 0.012, 95% CI: 0.010-0.286, p = 0.007; OR = 0.008, 95% CI: 0.000-0.511, p = 0.023, respectively). In contrast, longer haemodialysis duration was significantly associated with increased HBV seropositivity (OR = 1.036, 95% CI: 1.012-1.061, p = 0.004).

CONCLUSIONS: Despite the low prevalence of HBV, HCV, and HIV, prevention, surveillance, and strengthened vaccination strategies remain necessary in haemodialysis settings.

PMID:42262818 | DOI:10.4103/sjkdt.sjkdt_118_26

J Minim Access Surg. 2026 Jun 5. doi: 10.4103/jmas.jmas_49_26. Online ahead of print.

ABSTRACT

BACKGROUND: Minimally invasive surgery (MIS) has become an essential component of modern surgical practice due to improved patient outcomes. However, these procedures impose significant cognitive and physical demands on surgeons, which remain inadequately quantified. The National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a validated subjective tool used to assess workload during complex tasks, including surgery.

AIM: The aim of this study was to evaluate intra-operative surgeon workload during minimally invasive procedures across multiple surgical departments in a tertiary healthcare centre using NASA-TLX.

PATIENTS AND METHODS: This prospective observational study included surgeons performing elective minimally invasive procedures over a 3-month period at a tertiary care hospital. A total of 200 procedures performed by 27 surgeons across multiple departments were analysed. Emergency procedures, conversions to open surgery, combined procedures and abandoned surgeries were excluded. Surgeons completed the NASA-TLX questionnaire immediately after each procedure, assessing mental demand, physical demand, temporal demand, performance, effort and frustration. Workload scores were compared across procedure types and surgeon experience levels using appropriate statistical analyses, and effect sizes (η²) were calculated.

RESULTS: NASA-TLX scores demonstrated a moderate overall workload, with higher mental and physical demand. Significant differences were observed across procedures in mental demand ( P = 0.013, η² =0.07), physical demand ( P = 0.022, η² =0.06), temporal demand ( P < 0.001, η² =0.11) and frustration ( P < 0.001, η² =0.21). The mean global NASA-TLX score was 5.77 ± 1.3. Laparoscopic gastrointestinal and cholecystectomy procedures demonstrated higher workload scores. Surgeons with < 5 years’ experience reported greater temporal demand, while senior surgeons demonstrated higher mental demand, effort and frustration.

CONCLUSION: Surgeon workload during MIS varies with procedure type and experience level. NASA-TLX is a practical and effective tool for assessing intra-operative workload and may help optimise surgical training, ergonomics and operative planning.

PMID:42262815 | DOI:10.4103/jmas.jmas_49_26

J Minim Access Surg. 2026 Jun 5. doi: 10.4103/jmas.jmas_398_25. Online ahead of print.

ABSTRACT

INTRODUCTION: Recurrent pleural effusions (RPEs) significantly impair the quality of life and remain a therapeutic challenge. Video-assisted thoracoscopic surgery (VATS) pleurodesis is an established treatment, while the role of primary indwelling pleural catheter (IPC) implantation during surgery is not yet clearly defined. This study compared the outcomes of thoracoscopic treatment of RPEs with and without primary IPC implantation.

PATIENTS AND METHODS: In this retrospective bicentric study, 115 adult patients undergoing VATS for RPEs between January 2022 and December 2023 were analysed. Patients were treated at either Knappschaft Kliniken Lünen (KKL), where VATS pleurodesis without IPC was standard, or Helios University Hospital Wuppertal (WUP), where routine primary IPC implantation was performed. Demographic data, operative characteristics, post-operative chest drainage duration and length of hospital stay (LOS) were evaluated. Statistical analysis was performed using unpaired t -tests.

RESULTS: Operative duration did not differ significantly between groups. However, patients in the WUP group demonstrated a significantly shorter duration of post-operative chest drainage (3.4 ± 1.5 vs. 5.2 ± 2.1 days) and reduced LOS (5.8 ± 1.6 vs. 7.4 ± 2.4 days) compared with the KKL group. Post-operative complications were minor and comparable between groups, with no major complications observed.

CONCLUSION: Simultaneous IPC implantation during VATS pleurodesis for RPEs is associated with shorter chest drainage duration and hospital stay without increasing operative time or morbidity. This combined approach represents a safe and effective treatment option for selected patients. Prospective studies are warranted to confirm long-term benefits.

PMID:42262813 | DOI:10.4103/jmas.jmas_398_25

Indian J Pathol Microbiol. 2026 Jun 2. doi: 10.4103/ijpm.ijpm_366_25. Online ahead of print.

ABSTRACT

AIMS: Despite its importance in patient care, public awareness of histopathology and the role of histopathologists remain overshadowed. This study aimed to assess Jordanians’ public awareness of histopathology and identify areas of misconception or lack of understanding.

METHODS: A cross-sectional survey was conducted among adults (>18 years) in Jordan through a web-based questionnaire. The survey evaluated participants’ knowledge and perceptions of histopathology, including the nature of histopathologists’ work, their educational requirements, and their role in patient care. Descriptive statistics, Chi-square tests, and multivariate linear regression were used to analyze the data.

RESULTS: A total of 614 participants completed the survey, of which 41% did not recognize histopathology as a medical specialty. The majority identified pathologists as medical doctors whose main job is diagnosis of diseases among living patients, while some participants have misconceptions about associating histopathologists’ work with performing autopsies or laboratory tests. Underestimation of the duration of training required to become a certified histopathologist and misconceptions regarding the diagnostic decision-making on selected sample procedures were noticed. Female gender, educational level, and medical background were associated with higher knowledge scores.

CONCLUSION: Despite acceptable general knowledge, the observed misconceptions and lack of understanding regarding histopathology among the public necessitate interdisciplinary collaboration between pathologists and other healthcare professionals to increase the public awareness.

PMID:42262808 | DOI:10.4103/ijpm.ijpm_366_25

Saudi J Kidney Dis Transpl. 2026 Jun 3. doi: 10.4103/sjkdt.sjkdt_165_26. Online ahead of print.

ABSTRACT

CONTEXT: Tunneled cuffed catheters (TCCs) are vital haemodialysis access devices in chronic kidney disease (CKD), yet prone to significant dysfunction-related morbidity.

AIMS: To identify bedside patient-related predictors of TCC dysfunction and reduced patency in adult CKD patients undergoing haemodialysis at a single Indonesian center.

SETTINGS AND DESIGN: Single-center retrospective cohort study at Rasyida Kidney Hospital, Medan, Indonesia, covering TCC insertions from 2021 to 2024.

METHODS AND MATERIAL: Primary outcomes were catheter dysfunction and patency. Variables were extracted from medical records.

STATISTICAL ANALYSIS USED: Multivariable logistic regression identified predictors of dysfunction; Cox proportional hazards regression assessed reduced patency.

RESULTS: A total of 102 TCCs in 96 adult patients were included. Mean age was 62.7 ± 14.9 years and 62.7% were female. Dysfunction occurred in 30 catheters (29.4%) over a mean dwell time of 20.1 ± 13.1 months. Independent predictors of dysfunction were femoral insertion site (aOR 3.56, 95% CI 1.08-11.7, p = 0.036) and hypertension (aOR 3.34, 95% CI 1.01-11.1, p = 0.049). Cox regression confirmed femoral site (aHR 3.10, 95% CI 1.29-7.44, p = 0.011), hypertension (aHR 4.45, 95% CI 1.40-14.15, p = 0.011), and age ≥ 60 years (aHR 3.96, 95% CI 1.48-10.64, p = 0.006) as predictors of reduced patency.

CONCLUSIONS: Femoral insertion site and hypertension were strong independent predictors of TCC dysfunction and shortened patency. Age ≥ 60 years additionally predicted reduced patency. These simple bedside factors support practical risk stratification in low-resource haemodialysis settings.

PMID:42262802 | DOI:10.4103/sjkdt.sjkdt_165_26

J Minim Access Surg. 2026 Jun 2. doi: 10.4103/jmas.jmas_498_25. Online ahead of print.

ABSTRACT

INTRODUCTION: While minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS) are applied, the relative impact of surgical approach versus procedure type on outcomes remains controversial in pulmonary hydatid cyst treatment.

PATIENTS AND METHODS: This retrospective study analysed 192 operations performed in 157 patients with pulmonary hydatid cysts between 2010 and 2023. Patients were stratified by surgical approach (VATS, video-assisted mini-thoracotomy and thoracotomy) and by procedure type (cystotomy, cystotomy + capitonnage, cystotomy + wedge and wedge). Demographic data, cyst characteristics, rupture status, concomitant hepatic hydatidosis, post-operative complications, length of stay and recurrence were evaluated. Statistical comparisons were made as appropriate.

RESULTS: The mean patient age was 38.9 ± 20.2 years; 94 were female (59.5%) and 63 were male (40.5%). Cysts treated with VATS were significantly smaller, likely reflecting selection bias towards thoracoscopic suitability, whereas larger cysts were more often managed with cystotomy + capitonnage. Surgical approach did not significantly affect post-operative complication rates or hospital stay ( P > 0.05). In contrast, procedure type strongly influenced outcomes: cystotomy was associated with prolonged air leak and longer hospitalisation, capitonnage reduced complications but slightly extended recovery, and wedge resections achieved the shortest stays with low morbidity. Overall morbidity, recurrence and hospitalisation duration were comparable between paediatric and adult groups.

CONCLUSIONS: In pulmonary hydatid cyst surgery, prognosis depends primarily on the procedure performed rather than the surgical approach. Parenchyma-preserving techniques – particularly capitonnage and appropriately selected wedge resections – reduce morbidity and accelerate recovery. Surgical planning should therefore prioritise the choice of procedure over the approach to optimise outcomes in pulmonary hydatid disease.

PMID:42262782 | DOI:10.4103/jmas.jmas_498_25

JAMA. 2025 Oct 13. doi: 10.1001/jama.2025.16876. Online ahead of print.

ABSTRACT

IMPORTANCE: Functional outcomes in patients with acute ischemic stroke due to large-vessel occlusion who undergo thrombectomy remain suboptimal, and the benefits of intra-arterial alteplase after thrombectomy remain uncertain.

OBJECTIVE: To investigate whether treatment with intra-arterial alteplase after successful endovascular reperfusion improves functional outcomes among patients with acute, anterior-circulation, large-vessel occlusion stroke.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, randomized clinical trial recruited patients with anterior-circulation, large-vessel occlusion stroke within 24 hours of symptom onset who achieved successful reperfusion (expanded Thrombolysis in Cerebral Infarction scale score of ≥2b50) after thrombectomy. Guideline-based intravenous thrombolysis was allowed. Patients were randomized between August 1, 2023, and October 16, 2024, and the trial was conducted at 28 hospitals in China. Final follow-up occurred on January 7, 2025.

INTERVENTIONS: Intra-arterial alteplase treatment (n = 164) with 0.225 mg/kg (maximum dose of 20 mg) vs standard treatment (n = 160).

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of patients with a modified Rankin Scale score of 0 or 1 at 90 days (score range, 0 [no symptoms] to 6 [death]; a score of 0 or 1 indicates an excellent outcome). The safety outcomes included symptomatic intracranial hemorrhage within 36 hours of randomization, all-cause mortality within 90 days, and any intracranial hemorrhage within 36 hours.

RESULTS: Of the 324 patients randomized (median age, 68 years [IQR, 58-75 years]; 99 were female [30.6%]), 1 patient in each group was lost to follow-up. The proportion of patients with a modified Rankin Scale score of 0 or 1 at 90 days was 44.8% (73/163) in the intra-arterial alteplase group vs 30.2% (48/159) in the standard treatment group (adjusted risk ratio [RR], 1.45 [95% CI, 1.08-1.96]; P = .01). The proportion of patients with symptomatic intracranial hemorrhage within 36 hours was 4.3% (7/164) in the intra-arterial alteplase group vs 5.0% (8/160) in the standard treatment group (adjusted RR, 0.85 [95% CI, 0.43-1.69]; P = .67). The proportion of patients with all-cause mortality within 90 days was 17.1% (28/164) in the intra-arterial alteplase group vs 11.3% (18/160) in the standard treatment group (adjusted hazard ratio, 1.60 [95% CI, 0.88-2.89]; P = .12). The proportion of patients with any intracranial hemorrhage within 36 hours was 32.9% (54/164) in the intra-arterial alteplase group vs 26.9% (43/160) in the standard treatment group (adjusted RR, 1.22 [95% CI, 0.92-1.63]; P = .17).

CONCLUSIONS AND RELEVANCE: Among patients with acute, anterior-circulation, large-vessel occlusion stroke who achieved successful endovascular reperfusion by mechanical thrombectomy, intra-arterial alteplase resulted in a higher likelihood of excellent outcomes at 90 days. The incidence of all-cause mortality and any intracranial hemorrhage was higher in patients who received intra-arterial alteplase, although these differences were not statistically significant.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05856851.

PMID:42262770 | DOI:10.1001/jama.2025.16876

JAMA Netw Open. 2026 Jun 1;9(6):e2617459. doi: 10.1001/jamanetworkopen.2026.17459.

ABSTRACT

IMPORTANCE: Endogenous venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism (PE), is considered a rare event in pediatric patients, and its health care implications are largely unstudied. However, its burden on the health care system may be disproportionately higher owing to age-specific risk factors.

OBJECTIVE: To evaluate and characterize the inpatient cohort of children and adolescents with VTE and PE.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide cohort study used data on inpatient cases of VTE in Germany (data source: Federal Bureau of Statistics DESTATIS) from 2020 to 2024. Cases younger than 20 years with VTE as the main or secondary diagnosis, as well as a subcohort with PE as the main diagnosis, were analyzed regarding risk profiles, inpatient care, and outcomes stratified by sex and age.

MAIN OUTCOMES AND MEASURES: Hospital-based incidence of VTE (VTE cases per 10 000 inpatient cases per year) and in-hospital mortality.

RESULTS: This study identified 14 108 pediatric inpatient cases of VTE (mean [SD] age, 9.0 [7.3] years; 7201 male [51.0%]), corresponding to a hospital-based incidence of 15.3 per 10 000 pediatric cases per year. A total of 3311 patients with VTE (23.5%), comprising 1361 of 6907 female patients (19.7%) and 1950 of 7201 male patients (27.1%), were infants younger than 1 year. Risk factors for VTE varied, as rates of infection, chronic organ failure, and congenital diseases decreased with increasing patient age, while cancer was most commonly diagnosed among cases aged 5 to 14 years, and thrombophilia remained a relatively constant risk factor across all age groups. PE occurred in 1564 VTE cases (11.1%); among cases whose main diagnosis was PE, 624 of 888 (70.3%) were female. The in-hospital mortality rate in the VTE cohort was 3.7% (522 of 14 108); mortality risk was significantly increased among infants aged 4 years or younger (OR, 3.52 [95% CI, 2.73-4.57]; P < .001).

CONCLUSIONS AND RELEVANCE: This cohort study found a marked inpatient health care and economic burden for VTE among children and adolescents. Mortality risk was significantly increased among infants younger than 1 year. Studies are needed to provide evidence-based support for the safety and effectiveness of medical interventions for children and adolescents with VTE.

PMID:42262755 | DOI:10.1001/jamanetworkopen.2026.17459

JAMA Netw Open. 2026 Jun 1;9(6):e2617575. doi: 10.1001/jamanetworkopen.2026.17575.

ABSTRACT

IMPORTANCE: The epidemiology of viral respiratory tract infections (RTIs) in children is constantly changing on the basis of transmission, seasonality, immunity, and disruptive events, such as pandemics.

OBJECTIVE: To describe the clinical characteristics and outcomes of children hospitalized with acute RTIs and to examine factors associated with risk of severe disease.

DESIGN, SETTING, AND PARTICIPANTS: This multisite, retrospective cohort study was conducted at 2 Canadian children’s hospitals. Participants included children aged 0 to 18 years who were hospitalized with acute RTIs from July 1, 2022, to June 30, 2023. Follow-up for readmission was performed at 30 days after discharge. Analysis was conducted in June to November 2025.

EXPOSURE: Clinical and demographic factors, signs and symptoms, diagnostic testing, viral testing, management, and interventions.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of patients who developed severe disease, defined as the need for noninvasive or invasive mechanical ventilation, extracorporeal membrane oxygenation therapy, or kidney replacement therapy; cardiac arrest; or death. Demographics and clinical characteristics were also described. Multivariable robust Poisson regression was used to evaluate factors associated with risk of severe outcomes and was reported as adjusted risk ratios (aRRs) with 95% CIs.

RESULTS: There were 2585 children hospitalized with acute RTIs, with a median (IQR) age of 2.5 (0.9-5.0) years. There were 1542 male children (59.7%), and 1307 patients (50.6%) had at least 1 chronic condition, with neurologic, developmental, or genetic conditions being the most common. More than one-third (879 children [34.0%]) were transferred from a referring institution. Viral testing was performed for 2332 patients (90.2%), with a viral pathogen identified in 1828 (70.7%) of those tested. Viral coinfections were detected in 338 children. The most common viruses were respiratory syncytial virus (709 children) and enterovirus-rhinovirus (598 children). The median (IQR) length of hospital stay was 3 (2-6) days. Nearly one-quarter of children (551 children [21.3%]) developed severe disease. Those with 2 or more comorbidities (aRR, 1.62; 95% CI, 1.36-1.93) or who were transferred from a referring hospital (aRR, 4.73; 95% CI, 4.01-5.59) were at increased risk of severe disease.

CONCLUSIONS AND RELEVANCE: This cohort study found that hospitalized children with acute RTIs frequently have underlying chronic conditions and often require intensive intervention. Understanding the epidemiologic profile and factors associated with risk of severe disease in this population can inform resource allocation to optimize outcomes for pediatric patients.

PMID:42262751 | DOI:10.1001/jamanetworkopen.2026.17575