Tag: nevin manimala

Nutrition. 2026 May 19;150:113294. doi: 10.1016/j.nut.2026.113294. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients hospitalized with respiratory diseases are at high risk of nutritional deterioration due to increased metabolic demands and systemic inflammation. When enteral nutrition is not feasible, parenteral nutrition (PN) becomes necessary; however, evidence in respiratory referral centers remains limited. This study aimed to characterize the indications, timing, and clinical outcomes of PN, with emphasis on metabolic complications.

METHODS: A retrospective analysis of prospectively collected data was conducted in a tertiary respiratory referral hospital between September 2023 and December 2024. Adults (≥18 y) receiving PN for >2 d were included. Clinical characteristics, indications, timing of PN initiation, nutritional delivery, and metabolic complications were evaluated. PN-associated liver dysfunction and electrolyte disturbances were defined using standardized criteria. Descriptive statistics were applied.

RESULTS: Eighty-two patients were included (54.9% male; mean age 55.6 ± 15.8 y); 79.3% were at nutritional risk on admission. PN was initiated at a median of 4 (1-13) d, mainly due to gastrointestinal dysfunction and hemodynamic instability (31.7% each). Total PN predominated (82.9%), and 57.3% received combined enteral and parenteral nutrition. Nutritional delivery increased stepwise, reaching 31.9 kcal/kg/d and 1.5 g/kg/d of protein by day 7. Glycemic control remained stable, and triglycerides did not exceed critical thresholds. Hypokalemia was the most frequent electrolyte disturbance (36.1% at day 7), while phosphorus and magnesium remained stable. Liver enzyme elevations appeared more related to disease severity than PN.

CONCLUSION: PN was frequently initiated in the context of gastrointestinal dysfunction and hemodynamic instability, often with delayed timing. A structured approach based on gradual nutrient delivery and close monitoring was associated with a low incidence of severe metabolic complications, underscoring the importance of individualized nutritional management.

PMID:42284623 | DOI:10.1016/j.nut.2026.113294

Hum Immunol. 2026 Jun 12;87(8):111783. doi: 10.1016/j.humimm.2026.111783. Online ahead of print.

ABSTRACT

BACKGROUND: In addition to well-established immune checkpoints (ICs), such as CTLA-4, PD-1, PD-L1, increasing attention is being directed toward next-generation ICs, including TIM-3, Gal-9, LAG-3, BTLA, HVEM, and CD160. Single nucleotide polymorphisms (SNPs) within IC-related genes may contribute to dysregulation of inhibitory pathways and impair anti-tumor immune responses. This study aimed to evaluate the association between selected IC gene variants and susceptibility to bladder cancer (BC).

PATIENTS AND METHODS: A total of twelve SNPs located in TIM-3, LGALS9, BTLA, HVEM, and CD160 genes were genotyped using TaqMan assays in 314 BC patients and over 520 healthy controls (HC). Genotype distributions were analyzed under multiple genetic models, and associations with clinicopathological parameters were assessed using multivariate logistic regression.

RESULTS: Genotype distributions of BTLA polymorphisms (rs2705511, rs1982809, rs9288953) differed between BC patients and HC, suggesting potential associations with BC risk. Stratified analyses revealed sex-specific effects, with variants in BTLA (rs1982809), HVEM (rs1886730, rs2234167, rs8725), and CD160 (rs231375) showing potential associations with susceptibility among women. Additionally, SNPs in BTLA and HVEM were nominally associated with recurrence and high-grade tumors, while CD160 and LGALS9 variants were potentially linked to primary tumor occurrence. However, these associations lost statistical significance after correction for multiple comparisons.

CONCLUSIONS: Although the observed associations did not remain significant after multiple testing correction, the results suggest that genetic variation within BTLA, HVEM, and CD160 genes may still play a biologically relevant role in BC susceptibility and disease progression. These findings underscore the potential importance of IC pathways in BC pathogenesis and warrant further investigation in larger, well-powered studies.

PMID:42284619 | DOI:10.1016/j.humimm.2026.111783

Anesth Analg. 2026 Jun 12. doi: 10.1213/ANE.0000000000008158. Online ahead of print.

ABSTRACT

BACKGROUND: Anesthetic agents or some pathophysiological conditions can affect transcranial motor evoked potentials (TcMEP) monitoring. However, the influence of depth of anesthesia on TcMEP reproducibility in youth remains unclear due to limited data. We tested the hypothesis that a deeper level of total intravenous anesthesia (TIVA) can affect surgeon-directed TcMEP reproducibility and the surgical team’s interpretation of TcMEP.

METHODS: We conducted a single-center, prospective before-and-after study in 150 youths undergoing TIVA for scoliosis surgery with surgeon-directed TcMEP. A combination of propofol and remifentanil was administered to all patients. TIVA was initially maintained at a set bispectral index (BIS) level: mean (range) 60 (55-65) (BIS60). We deepened the anesthesia to a set BIS level: mean (range) of 40 (55-65) (BIS40) before the skin incision. The surgical team recorded and interpreted TcMEP at both BIS levels. The primary outcome was the effect of anesthesia depth (BIS60 vs BIS40) on TcMEP reproducibility and the surgical team’s interpretation. The secondary outcome was to compare changes in relativized TcMEP parameters (amplitude and latency) as a percentage at different levels of anesthesia (BIS60 vs BIS40).

RESULTS: Surgeons successfully recorded and interpreted TcMEP in all patients on both levels of depth of anesthesia. The mean ± standard deviation TcMEP amplitudes and latencies at BIS40 were statistically significantly different from the initial TcMEP parameters at BIS60 78.7% ± 15.0 (P < .001) for amplitudes, and 102.7% ± 2.9 (P < .001) for latencies. However, these alterations did not affect the surgical team’s interpretation of TcMEP and were therefore not clinically significant.

CONCLUSIONS: Keeping TIVA within the recommended BIS mean (range) of 40 to 60 (35-65) did not affect TcMEP reproducibility or surgeons’ interpretation of TcMEP. Surgeon-directed TcMEP, along with appropriate depth of anesthesia, may represent a promising alternative when neurophysiologists are unavailable.

PMID:42284616 | DOI:10.1213/ANE.0000000000008158

J Neurosurg Pediatr. 2026 Jun 12:1-9. doi: 10.3171/2026.2.PEDS25625. Online ahead of print.

ABSTRACT

OBJECTIVE: Clinical features of shunt malfunction are often nonspecific and neuroimaging is a well-established aid in diagnosis. In practice, qualitative assessment of overall ventricular change guides management; however, change in third ventricular diameter (TVD) alone has been proposed as a low-complexity quantitative index of overall ventricular change. This study aimed to evaluate the diagnostic utility of change in TVD compared with global assessment of ventricular caliber change by a neurosurgeon in detecting shunt malfunction.

METHODS: A retrospective review of all pediatric ventricular shunt revisions performed at a single center (November 2014-September 2024) was conducted. TVDs were measured when the patient was last known well and on preoperative imaging. Quantitative change was compared to the overall impression of change in ventricular caliber by neurosurgeons for detecting shunt malfunction. Shunt malfunction was defined as the need to replace one or more shunt components at the time of surgery (diagnostic gold standard). Diagnostic performance was assessed using comparison of areas under the receiver operating characteristic (ROC) curve.

RESULTS: A total of 422 shunt revisions were performed during the study period, of which 315 (75%) were found to have shunt malfunction. ROC analysis utilizing a cutoff of ≥ 2-mm TVD increase detected shunt malfunction with 63% sensitivity and 58% specificity (area under the curve [AUC] 0.62, 95% CI 0.55-0.69; p < 0.001). Pragmatic refinement by restricting the cohort to the subset of 136 patients known to have a change in ventricular caliber at the time of previous shunt failure and selecting a ≥ 1-mm cutoff increased the discriminative power of change in TVD to 92% sensitivity and 21% specificity. In this restricted cohort, the overall assessment of ventricular change by neurosurgeons yielded 81% sensitivity and 62% specificity (AUC 0.72, 95% CI 0.59-0.84) and the AUC difference between the two techniques was not statistically significant (AUC difference 0.08, 95% CI -0.03 to 0.20; p = 0.16).

CONCLUSIONS: In a pragmatically selected cohort, an increase ≥ 1 mm from baseline TVD alone provides sensitivity comparable to that of overall assessment of ventricular change by a neurosurgeon identifying shunt malfunction in a cohort undergoing shunt revision. This simple linear measurement could be integrated as a screening test in clinical, imaging, and/or AI algorithms to facilitate rapid recognition of pediatric shunt failure.

PMID:42284612 | DOI:10.3171/2026.2.PEDS25625

J Neurosurg Pediatr. 2026 Jun 12:1-10. doi: 10.3171/2025.12.PEDS2553. Online ahead of print.

ABSTRACT

OBJECTIVE: Approximately one-third of patients with epilepsy develop drug-resistant epilepsy (DRE). Extratemporal lobe epilepsy (ETLE) represents 30%-40% of focal epilepsy cases. ETLE poses significant challenges in localization and treatment because these patients often have diffuse and complex epileptogenic networks. Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive alternative for localizable DRE, yet data for its use in the pediatric ETLE population remain limited. This study aimed to evaluate the safety and efficacy of LITT in pediatric ETLE and identify predictive factors for favorable seizure outcomes.

METHODS: This retrospective study reviewed pediatric patients who underwent LITT for ETLE at a single National Association of Epilepsy Centers level 4 epilepsy center from 2015 to 2023. Patients with prior LITT for temporal lobe epilepsy, hypothalamic hamartomas, or corpus callosotomies were excluded. Preoperative evaluations included noninvasive testing (e.g., video-EEG, MRI, PET, magnetoencephalography) and invasive monitoring with stereo-EEG. The primary study endpoints were 1) International League Against Epilepsy (ILAE) classification at 12 months after the index LITT or additional surgical intervention for the treatment of seizures, and 2) procedure-related complications. Secondary analyses examined imaging concordance with the final ablation location, total ablation volume, and perioperative metrics.

RESULTS: Twenty-nine patients underwent an index LITT procedure for ETLE. At 12 months, 14 patients (48.3%) achieved a good outcome (ILAE class 1-3), and 12 (41.4%) were seizure free (ILAE class 1). There were 6 patients (20.7%) who required additional surgery within 12 months. Concordant PET with the final LITT ablation volume independently predicted seizure outcome (p = 0.04). The total ablation volume ranged from 0.66 to 8.45 cm3, and was not statistically different between groups. In the perioperative period, 3 patients developed transient steroid-responsive LITT-related edema, while no permanent neurological deficits, hematomas, surgical site infections, or deaths occurred.

CONCLUSIONS: This study demonstrated that LITT is a safe and effective treatment option for pediatric ETLE and may achieve acceptable rates of seizure freedom with a minimally invasive approach. Concordance between noninvasive imaging (particularly PET) with LITT targets was associated with favorable outcomes, underscoring the importance of thorough preoperative evaluations to determine appropriate ablation candidates. Future multicenter prospective studies are warranted to further refine patient selection criteria and optimize treatment paradigms.

PMID:42284607 | DOI:10.3171/2025.12.PEDS2553

JMIR Mhealth Uhealth. 2026 Jun 12;14:e71241. doi: 10.2196/71241.

ABSTRACT

BACKGROUND: Digital health interventions show promise for promoting behavior change, but how they incorporate action planning strategies is underreported. This oversight limits understanding of how to implement behavior change techniques. iSIPsmarter is a digital health intervention aimed at reducing sugar-sweetened beverage (SSB) consumption among Appalachian adults.

OBJECTIVE: This study aimed to examine the digital action planning process in the iSIPsmarter intervention, specifically by (1) assessing the frequency of action plan engagement, (2) evaluating participants’ perceived difficulty implementing their action plans and examining progress toward achieving SSB reduction and weight goals, and (3) exploring the selection of barriers and strategies.

METHODS: The digital action planning process is embedded within 5 of iSIPsmarter’s 6 behavioral content modules (Cores) and paired with self-monitoring of SSB intake via SMS text messaging and weight via a cellular-enabled scale. Participants first self-select program goals for SSB intake (in ounces) and weight (loss or maintenance). Then, in Cores 2-6, they complete action plans using personalized tracking feedback, recommendations, and goal progress updates. Participants identify barriers and strategies using preprogrammed or write-in responses. Summary statistics described the aims.

RESULTS: Participants (n=119) were predominately White (Caucasian), female, aged between 18 and 44 years, college-educated, and from rural counties. On average, participants completed 4.5 (SD 1.1) of 5 possible SSB action plans, with 80% (95/119) completing all 5. Across all Cores, perceived difficulty implementing action plans and achieving goals remained relatively stable, with an average of 48% rating the tasks as impossible or hard, 29% as neither hard nor easy, and 24% as easy or very easy. Nearly half achieved their self-selected weekly SSB goals, and one-third made progress toward them. At Core 6, 57% (54/95) of participants met their self-selected SSB program goal, while 46% (44/95) met the recommended SSB intake of less than 8 ounces per day. Of 119 participants, 53 (45%) modified their SSB barriers, and 63 (53%) selected new strategies during action planning. Top reported SSB barriers included (1) caffeine, (2) taste, and (3) habit. Among those with a program weight loss goal (n=94), the average weight loss was -1.3% (SD 2.6) at the 9-week follow-up, with 61% (57/94) achieving their goal. By 6 months, weight loss increased to -2.1% (SD 5.6), with 54% (49/90) achieving their goal. Of those completing weight action plans, 62% (69/112) modified their barriers. Top weight barriers included (1) sweets, (2) portion sizes, and (3) eating healthy foods.

CONCLUSIONS: Findings underscore the value of digital action planning as a central behavior change technique within a nutrition-focused digital intervention. High action plan completion and consistent strategy adaptation suggest that structured, digitally personalized goal setting and action planning processes can effectively support behavior change, particularly among underserved populations with limited access to preventative care.

PMID:42284600 | DOI:10.2196/71241

Surg Laparosc Endosc Percutan Tech. 2026 Jun 5. doi: 10.1097/SLE.0000000000001479. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the clinical application value of the combined use of 3 endoscopes (laparoscope, choledochoscope, gastroscope) with antegrade nasobiliary drainage in the treatment of common bile duct stones.

MATERIALS AND METHODS: A retrospective analysis was conducted on 80 patients diagnosed with cholecystolithiasis and choledocholithiasis admitted to Dongshan Hospital from January 2024 to August 2025. According to the bile drainage method, patients were divided into the endoscopic nasobiliary drainage tube group (ENBD group, n = 40), who underwent concurrent 3-endoscope combination with antegrade nasobiliary tube placement, and the T-tube group (n = 40), who underwent 2-endoscope (laparoscope, choledochoscope) combination with T-tube placement. Intraoperative, postoperative, and complication conditions were compared between the two groups.

RESULTS: All patients in both groups underwent surgery and had drainage tubes successfully placed, with no fatalities reported. There were no statistically significant differences between the two groups in intraoperative blood loss or postoperative complications (bile leakage, pancreatitis) (P > 0.05). The operation time in the ENBD group was longer than that in the T-tube group (P < 0.05). However, the duration of tube retention in the ENBD group was significantly shorter than that in the T-tube group, with a statistically significant difference (Z = -7.698, P < 0.05). The postoperative hospital stay in the ENBD group was significantly shorter than that in the T-tube group, with statistically significant differences (P < 0.05).

CONCLUSION: The concurrent combined use of 3 endoscopes with antegrade nasobiliary drainage is a safe and effective surgical option for the treatment of selected cases of common bile duct stones.

PMID:42284571 | DOI:10.1097/SLE.0000000000001479

JMIR Med Educ. 2026 Jun 12;12:e79027. doi: 10.2196/79027.

ABSTRACT

BACKGROUND: According to the World Health Organization, education and awareness are essential components of public health promotion strategies. In the context of rare diseases (RDs), these actions are particularly critical because of persistent stigma, fragmented knowledge, and the frequent absence of consolidated clinical and organizational protocols. These gaps often result in inappropriate referrals, inefficient care pathways, unnecessary procedures, and delays in diagnosis, negatively affecting health outcomes and quality of life.

OBJECTIVE: This study aimed to identify and systematize the main recommendations for health education and awareness in the field of RDs, supporting the development of health care programs, public policies, and strategic initiatives.

METHODS: We formulated the research question using the Population, Concept, and Context framework. This scoping review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines to ensure methodological transparency. Eligible records included peer-reviewed research articles of any design and official documents published in Portuguese, English, or Spanish, with no time restrictions. Records that did not address the research question, lacked sufficient rigor, or focused exclusively on specific subgroups of RDs were excluded. Searches were performed in PubMed/MEDLINE, Scopus, Embase, Web of Science, as well as gray literature. Study selection and data extraction were conducted by the research team, with disagreements resolved and the included sources reviewed by an RDs expert. Data were thematically categorized by consensus, and descriptive statistics were used to summarize findings.

RESULTS: A total of 58 sources of evidence were included. Among the identified recommendations related to education and awareness, most sources focused on professional education and training (49/58, 84.4%), followed by public policies and intersectoral integration (36/58, 62%), education and awareness for the general population (28/58, 48.2%), digital technologies (27/58, 46.5%), emotional support and experience sharing (20/58, 34.4%), and awareness events and dates (8/58, 13.7%). Percentages exceed 100% because individual sources could report multiple recommendations. Overall, the literature emphasizes integrating RDs content into educational initiatives and strengthening professional competencies, intersectoral collaboration, digital technologies, and broader awareness strategies.

CONCLUSIONS: This scoping review systematically mapped and organized recommendations from diverse sources of evidence on strategies for health education and awareness related to RDs. It synthesizes heterogeneous evidence using a structured approach to provide a comprehensive overview of strategies in this field, consolidating dispersed knowledge into a coherent body of evidence. The findings may inform improvements in health services, as well as professional and managerial practices, and initiatives aimed at supporting patients, families, and advocacy groups involved in RDs, with potential implications for strengthening diagnostic processes, referral coordination, and more equitable access to information and care.

PMID:42284567 | DOI:10.2196/79027

Prim Care Companion CNS Disord. 2026 Jun 9;28(3):25m04168. doi: 10.4088/PCC.25m04168.

ABSTRACT

Objective: To determine the prevalence of generalized anxiety disorder (GAD) in patients (aged 18-86 years, not under treatment, and with no prior diagnosis of GAD) attending an underserved primary care outpatient clinic in Higuerote, Venezuela, between October and December 2023.

Methods: A descriptive, cross-sectional, quantitative, population-based study was conducted. Data were collected via a 49-item closed-question survey that included the Hamilton Anxiety Rating Scale, Perceived Stress Scale, and 16 author-designed yes/no questions on GAD-related risk factors. Statistical analysis was performed using SPSS V26; P < .01 was considered statistically significant.

Results: The study included 440 patients (mean age of 33.8± 15.3 years; 70.2% female); 50.0% of participants presented with mild anxiety, 6.0% with mild-to-moderate anxiety, and 44.0% with moderate-to-severe anxiety. Psychosocial stress, reported by 299 patients (67.9%), was strongly associated with anxiety severity (odds ratio [OR] =124.6; 99% CI, 29.3-529.6; P<.001). Among those with moderate-to-severe anxiety, 85.7% (n=192; OR= 641.0; 99% CI, 138.5-2,966.8; P<.001) reported anxiety episodes, and 90.0% (n= 180; OR= 74.9; 99% CI, 30.2-185.7; P<.001) reported panic attacks. Alcohol consumption (71.8%, n=316) was significantly associated with anxiety severity (P<.001). Family history of anxiety (60.0%, n=264) and depression (51.8%, n=228) were also significantly associated with anxiety severity (P<.01). While SARS-CoV-2 was infection was significantly associated with anxiety severity (OR=1.9; 99% CI, 1.2-3.1; P<.001), history of traumatic brain injury was not (P = .12).

Conclusions: This study revealed a statistically significant high prevalence of GAD in the underserved population of Higuerote, Venezuela. These results show the need for updated mental health epidemiologic data, surveillance, and individualized community-based strategies in disadvantaged/marginalized populations, by empowering local psychiatric workforces through data-driven, context-specific care initiatives.

Prim Care Companion CNS Disord 2026;28(3):25m04168.

Author affiliations are listed at the end of this article.

PMID:42284562 | DOI:10.4088/PCC.25m04168

Ig Sanita Pubbl. 2026 Mar-Apr;99(2):94-109.

ABSTRACT

BACKGROUND: The increasing clinical complexity of pediatric patients, combined with global nursing workforce shortages, requires reliable tools to measure nursing care complexity and support evidence-based staffing decisions. In highly specialized settings such as pediatric cardiovascular units, patient acuity and cognitive nursing workload are particularly demanding. However, data on validated tools for assessing care complexity in pediatric contexts remain limited.

OBJECTIVE: To measure nursing care complexity in pediatric cardiovascular patients and to identify clinical and organizational factors associated with higher complexity levels using validated pediatric acuity tools.

MATERIAL AND METHODS: A retrospective cross-sectional observational study was conducted on 313 patient records from the Pediatric and Congenital Cardiac Surgery and Cardiology Unit and the Pediatric Intensive Care Unit of a tertiary university hospital in Italy (January-December 2022). Nursing care complexity was assessed using the CAMEO II tool for intensive care and the Inpatient CAMEO tool for ward settings. Descriptive statistics were performed. Associations between complexity and categorical variables were analyzed using chi-square tests. Simple and multiple linear regression analyses were conducted to identify predictors of baseline complexity (T0). Statistical significance was set at p 0.05.

RESULTS: All patients admitted to the intensive care unit showed medium nursing care complexity. In the inpatient cardiac unit, 27% of patients had low complexity and 73% had medium complexity; no high-complexity cases were observed. Younger age was significantly associated with higher complexity (B = -0.29, p 0.001). Urgent admission (B = 6.73, p 0.001) and longer hospital stay (B = 0.37, p 0.001) were also significant predictors. Organizational variables, including day of the week and work shift, were not significantly associated with complexity. The regression model explained 46% of the variance in baseline complexity scores (adjusted R² = 0.451).

DISCUSSION AND CONCLUSIONS: In pediatric cardiovascular settings, nursing care complexity is primarily driven by patient-related clinical factors rather than organizational variables. Younger and urgently admitted patients with longer hospital stays require higher cognitive nursing workload. The systematic implementation of validated acuity tools such as CAMEO II and Inpatient CAMEO may support evidence-based workforce planning, optimize nurse-to-patient ratios according to patient acuity, and enhance quality and safety of care. These findings are particularly relevant in the context of healthcare resource constraints and contribute to improving organizational decision-making in specialized pediatric settings.

PMID:42284558