Tag: nevin manimala

Infect Control Hosp Epidemiol. 2026 Jun 8:1-8. doi: 10.1017/ice.2026.10480. Online ahead of print.

ABSTRACT

OBJECTIVE: Antimicrobial Stewardship Programs (ASPs) need healthcare economic analyses to support and inform ASP strategies. This work aimed to determine whether widely available artificial intelligence (AI) platforms like Microsoft Copilot^TM could facilitate healthcare economics analyses for ASP programs without dedicated healthcare economic supports.

DESIGN: AI (Microsoft Copilot^TM) was prompted to develop a cytomegalovirus prophylaxis protocol for lung transplant recipients using only PubMed-indexed articles. Copilot^TM was then prompted to produce probabilistic samples of simulated patients from aggregate statistics of a 165-patient cohort from Vanderbilt University Medical Center and to analyze cost-effectiveness across four distinct cytomegalovirus prophylaxis protocols, including its own.

SETTING: Tertiary care academic medical center, including outpatient and inpatient environments.

PATIENTS OR PARTICIPANTS: Simulated patient data was developed via random, single-blind, probabilistic selection from pre-defined aggregate cohort statistics.

RESULTS: The AI-generated prophylaxis protocol was evidence-based without hallucination, but this conservative protocol relied on outdated evidence and was associated with significant increases in expected per-patient cost (mean +$4740, P < .01) compared to recent guideline-based and institutional protocols. AI independently identified and executed sensitivity analyses, which revealed that in this simplified model, letermovir use had a large impact on expected per-patient cost.

CONCLUSIONS: The AI-proposed protocol was less cost-effective, but data suggest that careful prompting can provide appropriate PubMed-indexed literature to support ASP protocol development. Additionally, CoPilot^TM provided a thorough cost-effectiveness analysis comparing all potential and existing protocols. With appropriate oversight, AI and Microsoft Copilot^TM can conduct healthcare economic analyses suitable for ASP strategic planning and implementation.

PMID:42252971 | DOI:10.1017/ice.2026.10480

Am J Surg Pathol. 2026 Jun 8. doi: 10.1097/PAS.0000000000002576. Online ahead of print.

ABSTRACT

Giant cell urothelial carcinoma (GCUC) is an exceedingly rare histologic subtype with 50+ reported cases. To date, 3 case series have been reported. Scant chemotherapy and immunotherapy responses were reported with variable results. We report the largest GCUC series, including 27 GCUC and 27 matched control urothelial carcinoma (CoUC) patients, most (>90%) of whom had more than 5 years of follow-up, including neoadjuvant and adjuvant therapy status. We further characterized the nuclear size ratio of giant tumor cells to background tumor cells and analyzed urothelial differentiation markers (GATA3, CK5/6), p53, tumor-infiltrating lymphocytes (CD19 and CD3), and therapeutic targets (TROP2, Nectin4, PDL1, and HER2). Morphometric analysis of giant tumor cells demonstrated that they were, on average, 12 times larger than surrounding nongiant tumor cells. GCUC showed many histologic and immunophenotypic features similar to CoUC. GCUC was enriched for higher stages (T3/4 and metastatic disease) than CoUC and showed a trend toward worse OS than conventional urothelial carcinoma, but was similar to urothelial carcinoma with variant histology. GCUC included 3 low-stage (T1/2) patients, who had significantly worse OS than low-stage CoUC, suggesting early extensive workup and oncologic intervention. Chemotherapy slightly improved OS in both GCUC and CoUC patients without statistical significance. Compared with CoUC, GCUC appeared to have more tumor-infiltrating T cells, but without statistical significance. There were no expression differences in TROP2, Nectin4, PDL1, and HER2. However, a subset of GCUC patients might benefit from target therapies (PDL1, Nectin4), warranting more cohort studies.

PMID:42252958 | DOI:10.1097/PAS.0000000000002576

Brain Behav. 2026 Jun;16(6):e71330. doi: 10.1002/brb3.71330.

ABSTRACT

BACKGROUND: Thirdhand smoke (THS) is a persistent environmental toxin that poses significant health risks, especially to vulnerable populations such as pregnant women and their fetuses. Effective interventions to enhance knowledge, modify beliefs, and improve protective practices are crucial. This study aimed to evaluate the impact of a structured, multi-component educational intervention on knowledge, beliefs, and self-reported practices related to THS among pregnant women.

METHODS: A randomized controlled trial was conducted with 100 pregnant women in their second or third trimester, recruited from comprehensive health centers in Isfahan, Iran. Participants were randomly assigned to an intervention group (n = 50) or a control group (n = 50). The intervention group received a multi-faceted educational program consisting of four face-to-face group sessions, one spousal session, educational pamphlets, and reinforcement messages via a social media group. The control group received routine prenatal care. Data were collected using validated questionnaires assessing knowledge (11 items), beliefs (using the Beliefs About Thirdhand Smoke-BATHS scale, 9 items), and self-reported practices (9 items) at baseline and two months post-intervention. Data were analyzed using paired t-test, Wilcoxon signed-rank test, and Analysis of Covariance (ANCOVA) in SPSS v.23.

RESULTS: The intervention group demonstrated significant improvements in mean scores of knowledge (from 13.30 ± 2.68 to 21.52 ± 5.23, p < 0.001), beliefs (from 25.60 ± 8.12 to 38.46 ± 4.01, p < 0.001), and self-reported practices (from 10.50 ± 1.50 to 13.52 ± 2.10, p < 0.001) after the intervention. No significant changes were observed in the control group. ANCOVA results, while controlling for baseline scores, confirmed a statistically significant effect of the intervention on post-intervention scores for knowledge (F = 179.61, p < 0.001), beliefs (F = 77.52, p < 0.001), and practices (F = 54.14, p < 0.001).

CONCLUSION: A structured, theory-based educational intervention significantly improved knowledge, beliefs, and self-reported protective practices concerning THS among pregnant women. Integrating such comprehensive programs into routine prenatal care is strongly recommended to mitigate THS exposure risks and promote maternal and fetal health.

TRIAL REGISTRATION: This randomized controlled trial was prospectively registered in the Iranian Registry of Clinical Trials (IRCT) on 25/04/2025, prior to participant recruitment (Identifier: IRCT20250105064282N1). https://irct.behdasht.gov.ir/trial/81695.

PMID:42252955 | DOI:10.1002/brb3.71330

Int J Urol. 2026 Jun;33(6):e70536. doi: 10.1111/iju.70536.

ABSTRACT

OBJECTIVES: To evaluate inflammatory biomarkers (neutrophil-to-lymphocyte ratio [NLR], C-reactive protein [CRP]) as continuous variables and assess linearity and the proportional hazards (PH) assumption, including time-varying effects, in metastatic renal cell carcinoma (mRCC) treated with first-line immune checkpoint inhibitor (ICI)-based combinations.

METHODS: This multicenter retrospective study included 151 patients with mRCC. Log-transformed NLR and CRP were tested for linearity (quadratic terms) and PH (Schoenfeld residuals). Multivariable Cox regression was adjusted for International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk factor count and treatment regimen. Time-varying effects were assessed using marker × log(time) interactions and 12-month landmark analyses; incremental discrimination beyond IMDC was evaluated using Harrell’s concordance index.

RESULTS: Log-transformed NLR and CRP showed no statistically significant evidence of nonlinearity (p = 0.211 and p = 0.055, respectively). NLR showed evidence of PH violation for all outcomes, whereas CRP did not. On multivariable analysis, NLR remained associated with overall survival (OS; adjusted hazard ratio [HR] 2.10, 95% confidence interval 1.26-3.49, p = 0.005) and cancer-specific survival (adjusted HR 2.04, 1.20-3.47, p = 0.009). Landmark analysis suggested a stronger OS association during 0-12 months (HR 2.61, 1.49-4.59) than after 12 months (0.93, 0.37-2.34). Adding NLR to IMDC modestly improved OS discrimination (ΔC-index +0.038, bootstrap p = 0.052).

CONCLUSIONS: Log-transformed inflammatory markers showed no statistically significant evidence of nonlinearity. NLR showed exploratory evidence of time-varying prognostic associations, with stronger discrimination during earlier follow-up.

PMID:42252945 | DOI:10.1111/iju.70536

Arch Ital Urol Androl. 2026 Jun 5:15582. doi: 10.4081/aiua.2026.15582. Online ahead of print.

ABSTRACT

INTRODUCTION: Obstructive uropathy is a common complication in advanced cervical cancer, occurring because of ureteral compression by the tumour mass and often leading to hydronephrosis and impaired renal function. Double-J (DJ) stent insertion is frequently used as the first-line decompression method to restore ureteral patency; however, its technical success is influenced by anatomical distortion and severity of obstruction. Understanding the factors associated with successful stent placement is essential to guide appropriate urinary diversion strategies.

MATERIALS AND METHODS: This retrospective cross-sectional study included 275 patients with confirmed advanced cervical cancer and hydronephrosis treated at Dr. Saiful Anwar General Hospital, Malang, from January 2019 to July 2025. Data collected included age, cervical cancer stage, hydronephrosis grade, DJ stent insertion status, histopathology findings, and survival status. Statistical analysis using the Kruskal-Wallis test and Spearman correlation assessed the association between clinical variables and DJ stent insertion.

RESULTS: DJ stent insertion was successfully performed in 56.7% of patients. Hydronephrosis grade (p = 0.027) and cervical cancer stage (p = 0.046) were significantly associated with successful stent insertion in univariate analysis, whereas histopathological subtype was not (p = 0.970). Patients with higher-grade hydronephrosis had significantly lower odds of successful stent insertion. Correlation analysis showed no significant monotonic relationship between hydronephrosis severity and cancer stage (ρ = -0.041, p = 0.503). In multivariate logistic regression analysis, severe hydronephrosis emerged as an independent predictor of DJ stent insertion failure (OR 0.30, 95% CI 0.11-0.83, p = 0.021), while cervical cancer stage and histopathological subtype were not significant after adjustment.

CONCLUSION: Hydronephrosis severity and cervical cancer stage influence the success of DJ stent insertion in advanced cervical cancer; however, hydronephrosis severity appears to be a more direct determinant of stenting feasibility than cancer stage alone, whereas histopathological subtype shows no significant association.

PMID:42252923 | DOI:10.4081/aiua.2026.15582

Arch Ital Urol Androl. 2026 Jun 5:15191. doi: 10.4081/aiua.2026.15191. Online ahead of print.

ABSTRACT

OBJECTIVES: To estimate the learning curve for thulium laser enucleation of the prostate (ThuLEP) performed by the same surgeon, appreciating the sequential progression in skill and proficiency over time.

PATIENTS AND METHODS: The study retrospectively enrolled 60 patients with benign prostatic hyperplasia (BPH) who underwent the ThuLEP procedure performed by a single experienced endourologist. Though not initially skilled with laser enucleation of the prostate, the surgeon had observed numerous cases before. The patients were divided into three groups, each containing 20 cases. The procedure started with inspection, followed by incision and trough creation and plane development, apicolateral dissection, sphincter release, anterior dissection, bladder neck dissection, C-shaped baso-lateral dissection, and adenoma detachment technique called veil-sparing ThuLEP using the ABCD method. Perioperative parameters, enucleation and morcellation time (min), enucleation efficiency (g/min), morcellation efficiency (g/min), enucleated tissue weight (g), hospital stay time, and catheterization time (h) were recorded.

RESULTS: There was a statistically significant decrease in the International Prostate Symptom Score (IPSS) 6 months postoperatively (median = 3) compared with 1-day postoperatively (median = 4) and preoperatively (median = 25). Uroflowmetry parameters, IIEF-5 scores, enucleation and morcellation efficiency, hospitalization period, and catheterization time were evaluated, showing substantial improvements and stabilization over time.

CONCLUSIONS: A highly skilled endourologist in TURP was able to master the learning curve of ThuLEP after completing the initial 40 patients. Upgrading the sequential progression in skill and proficiency over time for treating benign prostatic hyperplasia in addition to its safety, feasibility, efficacy that improve procedure outcome with fewer difficulties.

PMID:42252919 | DOI:10.4081/aiua.2026.15191

J Health Popul Nutr. 2026 Jun 7. doi: 10.1186/s41043-026-01349-z. Online ahead of print.

ABSTRACT

BACKGROUND: In this study, weemployed classical test theory (CTT) to develop and validate a concise, abbreviated version of the Tuberculosis Medication Adherence Scale (TBMAS-SF). This shortened version aims to provide a more efficient measurement tool for tuberculosis patients while maintaining acceptable psychometric properties.

METHODS: A survey of tuberculosis patients undergoing treatment at the Heilongjiang Provincial Institute of Infectious Disease Control and Prevention was conducted using convenient sampling and the TBMAS. Data analysis was performed using SPSS 26.0 and Amos 24.0. A total of 496 questionnaires were distributed in this study, with 404 valid responses collected, resulting in a valid response rate of 81.45%.

RESULTS: The analysis revealed that the TBMAS-SF demonstrated acceptable reliability, with a Cronbach’s α coefficient of 0.931 and a split-half reliability of 0.739. Confirmatory factor analysis indicated that the TBMAS-SF demonstrated acceptable comparative fit but suboptimal absolute fit, with a chi-square degrees of freedom ratio of 4.981, RMSEA = 0.141, RMR = 0.014 (which is less than 0.05), CFI and IFI values exceeding 0.9, and NFI and TLI values approaching 0.9. There was a statistically significant but modest positive correlation between the TBMAS-SF score and medication literacy score (r = 0.228, p < 0.01), suggesting limited but acceptable empirical validity.

CONCLUSION: The TBMAS-SF demonstrates acceptable internal consistency and promising construct validity, though suboptimal absolute fit indices warrant further refinement and cross-validation.

PMID:42252479 | DOI:10.1186/s41043-026-01349-z

J Ethnobiol Ethnomed. 2026 Jun 7. doi: 10.1186/s13002-026-00913-5. Online ahead of print.

ABSTRACT

BACKGROUND: Agricultural production continues to face critical problems, including persistent pest invasion, a lack of modern farm inputs, and climate change. Non-chemical pest control practices are vital, as they signify both cultural and practically embedded assets for sustainable agricultural practices in resource-limited environments. Therefore, this study aimed to assess the utilization of non-chemical pest control practices among agro-pastoralist farmers in the Gambella region of Ethiopia.

METHODS: A mixed research design was used to assess the utilization of non-chemical pest control practices among farmers from a total sample size (n = 274). The purposive sampling technique was used to select kebelles, and the systematic random sampling technique was used to select the target households. Primary data were collected from the sample respondents using structured questionnaires, key informant interviews, focus group discussions, and direct observations. Secondary data were collected from the documented sources. Frequency, percentage, chi-square, H-test, and ordinal logit model were used for quantitative data analysis, while thematic analysis was employed for qualitative data.

RESULTS: The common non-chemical pest control practices used by farmers were the application of ash (49.6%), crop rotation and intercropping (16.4%), use of neem extract (13.5%), physical removal of pests (10.2%), timing of planting based on the pest cycle (6.6%), and the use of chili or tobacco spray (3.7%). The ordinal logit model showed that farmers level of education negatively and significantly influenced the utilization of such practices (p < 0.01), and farmland ownership was positively and statistically associated with farmers non-chemical pest management systems (p < 0.01). The crops cultivated also showed a positive and statistically significant association with farmers’ utilization of the practices (p < 0.05).

CONCLUSIONS: This study concludes that the implementation of non-chemical pest control practices is shaped by socioeconomic and farmland-level factors rather than being regularly practiced across all households. Therefore, improving the application of locally available pest management systems with appropriate agricultural support should strengthen sustainable pest control and enhance farmland resilience in the Gambella region.

PMID:42252462 | DOI:10.1186/s13002-026-00913-5

Harm Reduct J. 2026 Jun 7. doi: 10.1186/s12954-026-01481-3. Online ahead of print.

ABSTRACT

OBJECTIVES: The ongoing toxic drug crisis in Canada, driven largely by fentanyl proliferation, has led to ever-escalating overdose rates. The Safer Alternatives for Emergency Response (SAFER) program was launched in Vancouver, British Columbia (BC) in 2021 to reduce overdose risk by offering prescribed pharmaceutical alternatives, including fentanyl medications. This study aimed to evaluate satisfaction and the program’s perceived impact on health and social outcomes among SAFER participants.

METHODS: Data were collected from 78 SAFER participants through baseline interviewer-administered questionnaires. The primary outcome was self-reported changes in drug use, health status and social outcomes. Descriptive statistics summarized participant characteristics and outcomes.

RESULTS: Among 78 participants, with 22 (28%) identifying as women or gender diverse, 76% reported reduced drug use, while 71% experienced reductions in drug cravings/withdrawal and overdose risk, respectively. Safer drug-use behaviours were also reported: 56% reported that they were more likely to use sterile equipment, 37% said they were more likely to check their drugs, and 35% said they were more likely to carry naloxone. Improvements in overall physical health (58%), mental health (63%), financial stability (55%), and social connections (49%) were also noted. High satisfaction with services was reported (78%), although 71% suggested improvements, including extended hours, easier access to carry doses, and expanded medication options.

DISCUSSION: These findings indicate that the SAFER program is perceived as effective in reducing overdose risk and improving health and social outcomes. However, barriers such as service accessibility and limited medication options remain. Addressing these concerns could enhance program outcomes. Further large-scale research is recommended to confirm these results and explore long-term impacts.

PMID:42252457 | DOI:10.1186/s12954-026-01481-3

BMC Psychol. 2026 Jun 8. doi: 10.1186/s40359-026-04956-x. Online ahead of print.

ABSTRACT

BACKGROUND: This study examined the relationship between work-family conflict and professional identity among young faculty in Chinese higher education institutions. It also tested the indirect role of mindful teaching and the moderating role of work-family support. The study further explored the different gender patterns of indirect and moderating effects.

METHODS: Data were collected from 505 young university faculty using the Work-Family Conflict Scale, Mindfulness in Teaching Scale, Teacher Professional Identity Scale, and Work-Family Support Scale. Statistical analyses included descriptive statistics, correlation analysis, and hierarchical regression.

RESULTS: (1) Work-family conflict exhibited a significant negative association with young faculty’s professional identity. (2) Mindfulness in teaching (intrapersonal and interpersonal mindfulness) played an indirect role in the relationship between work-family conflict and professional identity. (3) Work-family support moderated the relationships between work-family conflict and mindfulness in teaching/professional identity. When the level of work-family support was higher, the negative association between work-family conflict and mindfulness in teaching/professional identity was weaker. (4) Indirect and moderating effects exhibited distinct gender patterns. For indirect effects, subgroup analyses by gender revealed that, in the male teacher sample, the indirect pathway via interpersonal mindfulness was significant. In contrast, in the female teacher sample, the indirect pathway via intrapersonal mindfulness was significant. For moderating effects, descriptive comparisons between gender subgroups showed that the moderating effect of work-family support had a larger coefficient in the female sample than in the male sample. However, this difference was not formally tested for statistical significance.

CONCLUSIONS: This study offers a new perspective for understanding the occupational psychological well-being of university faculty. Based on these correlational findings, cautious exploration is warranted regarding possible intervention entry points, such as enhancing teachers’ mindfulness levels and building supportive environments, with potential differential emphases for male and female teachers. Nevertheless, further effectiveness testing is required.

PMID:42252452 | DOI:10.1186/s40359-026-04956-x