Tag: nevin manimala

Orbit. 2026 Apr 30:1-9. doi: 10.1080/01676830.2026.2649276. Online ahead of print.

ABSTRACT

PURPOSE: The study aimed to evaluate international practice patterns among oculofacial plastic surgeons regarding postoperative patching, given evolving evidence and uncertainties surrounding benefits and risks.

METHODS: A web-based survey was distributed to members of nine oculoplastic societies worldwide. The survey included thirty-eight questions about postoperative patching practices for oculofacial procedures. Descriptive statistics, chi-squared tests and logistic regression analyses were performed to assess practice patterns and identify demographic factors associated with patching decisions.

RESULTS: A total of 519 surgeons completed the survey. Patching practices varied substantially by procedure: 29.1% routinely patched after eyelid surgery, 51.1% after orbital surgery, 23.9% after lacrimal surgery, and 80.3% after skin graft surgery. Logistic regression showed that surgeons practicing outside the United States were more likely to patch for eyelid (Odds Ratio (OR) = 5.00, p < 0.001), orbital (OR = 2.94, p < 0.001), and lacrimal (OR = 1.96, p = 0.02) surgeries. Surgeons aged ≥ 40 years were less likely to patch in eyelid (OR = 0.64, p = 0.04) and lacrimal (OR = 0.51, p = 0.002) surgeries.

CONCLUSIONS: Postoperative patching practices among oculofacial plastic surgeons show significant variation, influenced by geographic location, surgeon age, and procedure focus. These findings highlight the need for further research to evaluate the impact of these practices on surgical outcomes and to develop consensus guidelines that optimize patient care.

PMID:42059067 | DOI:10.1080/01676830.2026.2649276

Stroke. 2026 Apr 30. doi: 10.1161/STROKEAHA.125.054194. Online ahead of print.

ABSTRACT

BACKGROUND: As life expectancy rises, identifying causes and risk factors for incident acute ischemic stroke (AIS) among the oldest-old (≥80 years) is increasingly important. We examined whether the effect of age at stroke on AIS subtype is mediated by embolic risk factors and whether these factors improve AIS prediction.

METHODS: Stroke-free participants from the ARIC study (Atherosclerosis Risk in Communities) who developed AIS between visit 5 (2011-2013) and visit 10 (2023) were included for causal analysis; Stroke-free participants at visit 5 were included for prediction analysis. In logistics regression models, the association between age at stroke-onset (≥80 versus <80 years) and adjudicated AIS subtype (embolic ischemic stroke versus thrombotic ischemic stroke) was determined. Bootstrapped mediation analyses (1000-iterations) tested whether atrial fibrillation, myocardial infarction, coronary heart disease, heart failure, and electro/echocardiogram measures mediated the age-AIS subtype relationship. C statistics were calculated for AIS prediction (Predicting Risk of Cardiovascular Disease Events, CHA₂DS₂-VASc) and compared preinclusion and postinclusion of embolic risk factors.

RESULTS: Of 6213 stroke-free participants at visit 5, 277 (4.4%) developed AIS during a median (Q1-Q3) of 5.1 (2.6-7.1) years (median [Q1-Q3] age: 76 [72-80] years; median [Q1-Q3] age at AIS: 81 [77-86] years; 62% female; 99 embolic ischemic stroke and 178 thrombotic ischemic stroke). Individuals with AIS ≥80 years had higher odds of embolic ischemic stroke (versus thrombotic ischemic stroke) compared with those aged <80 years (odds ratio, 1.90 [95% CI, 1.09-3.31]). The effect of age at stroke-onset on embolic ischemic stroke was mediated by atrial fibrillation (44%; P=0.03), an abnormal left atrium volume index (45%; P=0.048), or an abnormal P-wave axis (43%; P=0.04). The predictive performance for AIS ≥80 years using the Predicting Risk of Cardiovascular Disease Events equation (N=5702, C statistic, 0.49 [95% CI, 0.45-0.53]), or CHA₂DS₂-VASc score (N=5739, C statistic, 0.57 [95% CI, 0.55-0.59]) was poor, but inclusion of embolic risk factors improved the performance (Predicting Risk of Cardiovascular Disease Events: C statistics, 0.77 [95% CI, 0.74-0.80]; CHA₂DS₂-VASc: C statistics, 0.63 [95% CI, 0.59-0.67]).

CONCLUSIONS: These findings suggest that identification and control of embolic risk factors are critical to reduce stroke risk as people age, and better stroke-specific prediction tools are needed.

PMID:42059062 | DOI:10.1161/STROKEAHA.125.054194

Int J Geriatr Psychiatry. 2026 May;41(5):e70217. doi: 10.1002/gps.70217.

ABSTRACT

BACKGROUND: Bipolar disorder (BD) in older adults is linked to significant medical comorbidities and hospitalization burden, yet nationwide data remain scarce. This study aims to compare younger versus older BD hospitalization trends, patient characteristics, and the impact of comorbidities on hospitalization outcomes in Portugal (2008-2015).

METHODS: A retrospective observational study was conducted using a Portuguese administrative database, selecting hospitalization episodes of patients aged ≥ 60 years with a primary BD diagnosis. Variables analyzed included demographics, psychiatric comorbidities, Charlson Comorbidity Index (CCI), length of stay (LoS), in-hospital mortality, hospital charges, and readmissions.

RESULTS: From a total of 21,793 BD hospitalizations, there were 4801 (22.0%) BD-related hospitalizations in the older age group, and the annual hospitalization rate was 23.4 per 100,000 inhabitants. The median admission age was 66.0 years, and 67.7% were female. BD type I with a manic episode (32.9%) was the most frequent subtype, and 85.5% of admissions were emergent. The median LoS was 18.0 days, significantly longer than in younger adults (p < 0.001). Readmission occurred in 52.4% of cases, with in-hospital mortality at 0.7%. Comorbidities were present in 23.0% of hospitalizations, with diabetes (13.1%) and dementia (3.2%) being most prevalent.

LIMITATIONS: The study relies on secondary administrative data, subject to coding inaccuracies, and its retrospective design limits causal inferences.

CONCLUSIONS: BD hospitalizations in older adults carry a high medical burden, with comorbidities impacting outcomes. Early screening, multidisciplinary care, and targeted interventions are crucial to improving management and reducing hospitalizations. Further research is needed to explore long-term outcomes and outpatient care strategies.

PMID:42059056 | DOI:10.1002/gps.70217

J Glob Health. 2026 Apr 30;16:04098. doi: 10.7189/jogh.16.04098.

ABSTRACT

BACKGROUND: Lower limb conditions (LLCs) are a major cause of pain, disability, and loss of livelihood globally, yet their prevalence and functional impacts in low- and middle-income countries, including Nepal, remain poorly described.

METHODS: We conducted a cross-sectional, community-based survey in three Nepali districts representing plains, hills, and mountains. Of 2525 screened households, the first 500 adults with self-selected LLCs were interviewed using structured questionnaires adapted from validated tools (Global Alliance for Musculoskeletal Health, COPCORD, Washington Group, WHODAS 2.0). Descriptive statistics summarised condition type, pain location, activity limitations, employment impact, and comorbidities. χ² tests assessed regional differences in condition types.

RESULTS: Of 2525 households, 671 (26.6%, 95% CI = 24.9-28.3) reported a member with an LLC; 11.2% (95% CI = 10.5-12.0) of adults were affected. Among 500 participants surveyed (mean age 57 years; 65% female), pain/discomfort was most common (97%), mainly in the knee (74%) and foot/ankle (48%). Across participants, 628 LLCs were reported; conditions included injury/trauma (19%), deformity (7%), wounds (1%), and amputation (<1%). Prevalence varied by district. Functional limitations were substantial: 82% with pain and all with amputation reported severe activity restriction. Ten percent were unemployed, mostly due to health, and >70% of those doing household work had left other jobs because of their LLC.

CONCLUSIONS: This study offers preliminary, population-based estimates of person-reported LLCs across three ecological zones in Nepal. Musculoskeletal pain was most common, often multi-site and substantially limiting daily activities and employment. While findings highlight the impact of LLCs on well-being and livelihoods, they remain exploratory due to limited geographic scope and self-reporting. Larger, nationally representative studies are needed to confirm these results, differentiate chronic from transient pain, and guide rehabilitation and prevention strategies.

PMID:42059016 | DOI:10.7189/jogh.16.04098

J Hepatocell Carcinoma. 2026 Apr 24;13:586001. doi: 10.2147/JHC.S586001. eCollection 2026.

ABSTRACT

PURPOSE: This study was designed to compare the safety and efficacy of transarterial chemoembolization (TACE) plus hepatic arterial infusion chemotherapy (HAIC) or TACE combined with lenvatinib (LEN) and PD-1 inhibitors (PD-1i) in large intermediate-stage hepatocellular carcinoma (iHCC).

METHODS: This multi-center retrospective study was conducted at four tertiary medical centers. From January 01, 2021, to June 30, 2024, 221 patients with large iHCC undergoing TACE-HAIC-LEN-PD-1i (THLP group, n=103) or TACE-LEN-PD-1i (TLP group, n=118) were enrolled. Local tumor responses, survival, and treatment-related adverse events (TRAEs) were analyzed between the THLP and TLP groups.

RESULTS: Baseline characteristics were well-balanced between the two groups (P>0.05). Objective response rate (70.8% vs. 44.9%, P<0.001) and disease control rate (91.2% vs. 78.8%, P=0.011) in the THLP group were significantly superior over those in the TLP group. Compared to the TLP group, the THLP group achieved significantly better median progression-free survival (11.0 vs. 8.0 months, P<0.001) and median overall survival (29.9 vs. 20.3 months, P<0.001). The incidence of conversion to resection was obviously higher in the THLP group than that in the TLP group (20.4% vs.9.3%, P=0.020). The frequency of any grade or grade 3-4 TRAEs was comparable between the two groups, associating with no statistical differences (P>0.05). No grade 5 TRAEs and treatment-related mortality were observed.

CONCLUSION: TACE-HAIC-LEN-PD-1i was safe and well-tolerated, and achieved better efficacy than TACE-LEN-PD-1i in patients with large iHCC. Further randomized controlled trials are required to validate the benefits of TACE-HAIC-LEN-PD-1i.

PMID:42059012 | PMC:PMC13123561 | DOI:10.2147/JHC.S586001

Afr J Emerg Med. 2026 Jun;16(2):100974. doi: 10.1016/j.afjem.2026.100974. Epub 2026 Apr 22.

ABSTRACT

BACKGROUND: Despite the electrocardiogram (ECG) being a critical bedside diagnostic tool, evidence suggests suboptimal ECG interpretation competence among doctors worldwide. Limited research exists evaluating the ECG interpretation skills of South African junior doctors. This study addresses an important knowledge gap in the literature which assesses the knowledge of “must-know” ECG conditions of junior South African doctors, previously identified through a Delphi study.

METHODS: This cross-sectional survey assessed ECG interpretation competence among 117 junior doctors across four public hospitals in Gauteng Province, South Africa. Data were collected over the period December 2024 to November 2025. Respondents completed a 20-question assessment based on consensus-derived “must-know” ECG diagnoses for medical students adapted from Viljoen’s Delphi study, which identified ECG teaching priorities for medical schools using expert consensus performance was analysed according to professional category, training background, and emergency medicine exposure.

RESULTS: Overall mean score was 10.3/20 (51.5%), with only 34.2% achieving the predefined pass standard of 75%. Community service doctors outperformed interns (57.1% vs 49.1-49.3%) though not significantly (p = 0.194). Formal ECG training significantly improved performance: 62.1% versus 52.9% self-taught and 39.4% untrained (p < 0.001). Critical diagnostic deficiencies included polymorphic ventricular tachycardia; monomorphic ventricular tachycardia; second and third-degree heart blocks. The lowest-scoring ECGs were right ventricular hypertrophy, pericarditis, sinus arrhythmia, and first-degree AV block. Emergency medicine exposure showed dose-response trend (53.7% vs 42.1% vs 36.3%) without statistical significance (p = 0.109) due to sample imbalance (n = 106, 7, 4).

CONCLUSION: Junior doctors in Gauteng demonstrated ECG interpretation deficiencies for life-threatening conditions such as poly and monomorphic ventricular tachycardia, and second and third-degree heart blocks. The lowest-scoring ECGs were those with pericarditis and right ventricular hypertrophy. Despite these findings, this study suggests that formal ECG training improves ECG diagnostic performance which has significant implications for curriculum development.

PMID:42059010 | PMC:PMC13123342 | DOI:10.1016/j.afjem.2026.100974

Afr J Emerg Med. 2026 Jun;16(2):100973. doi: 10.1016/j.afjem.2026.100973. Epub 2026 Apr 22.

ABSTRACT

INTRODUCTION: Emergency medicine (EM) is a global discipline; however, marked inequities in authorship representation persist. Disparities between high-income countries (HICs) and lower-and middle-income countries (LMICs) may influence research visibility, access to funding, and scholarly impact. Using recent data, we examined authorship leadership, funding, and citation patterns across national income groups in high-impact EM journals.

METHODS: We conducted a cross-sectional bibliometric analysis of articles published between 2020 and 2024 in the 20 highest-ranked EM journals according to Google Scholar Metrics. Bibliographic records were retrieved from PubMed and Web of Science, excluding publication types not considered citable scholarly outputs. Country income classification followed the World Bank 2025 schema based on first-author affiliation. Descriptive statistics and χ² tests assessed distributions across income groups. Multivariable logistic regression identified predictors of LMIC first authorship and funding, while linear regression assessed annual citation counts adjusted for study characteristics.

RESULTS: Among 23,379 eligible articles, first authors were predominantly affiliated with HICs (81.6%), followed by upper-middle-income (10.8%), lower-middle-income (7.3%), and low-income (0.3%) countries. LMIC representation did not increase over time. Larger author teams were inversely associated with LMIC first authorship (p < 0.001). In adjusted analyses, LMIC-affiliated first authors accrued fewer annual citations than HIC counterparts (β = -0.79; p < 0.001), whereas funded studies were associated with higher citation rates (p < 0.001). Africa accounted for 0.6% of publications and did not demonstrate lower citation rates once published.

DISCUSSION: High-impact EM research remains dominated by HIC institutions, with persistent inequities in authorship leadership, funding, and citation visibility. These findings suggest that structural barriers to research leadership and publication may contribute to the observed disparities, rather than differences in scholarly relevance once studies are published. Strengthening LMIC research capacity and promoting equitable collaborations and inclusive publishing policies are essential for a more representative global EM research ecosystem.

PMID:42059009 | PMC:PMC13123335 | DOI:10.1016/j.afjem.2026.100973

Clinics (Sao Paulo). 2026 Apr 28;81:100987. doi: 10.1016/j.clinsp.2026.100987. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the application value of fecal Syndecan-2 gene Methylation (mSDC2) detection, combined detection of serum Carcinoembryonic Antigen (CEA) and Carbohydrate Antigen 72-4 (CA72-4) in screening of Colorectal Cancer (CRC) and precancerous lesions.

METHODS: A total of 196 participants were enrolled in this case-control study from March to December 2023, including 65 with CRC, 38 with advanced adenomas, 33 with non-advanced adenomas, and 60 controls. The sensitivity, specificity, and Odds Ratios (OR) for serum CEA, CA72-4, and fecal mSDC2 were evaluated.

RESULTS: The sensitivity of fecal mSDC2 for CRC was 86.2% (56/65), with a specificity of 96.7% (58/60), with an OR of 28.9 (95% CI 8.6-97.2, p < 0.001). The sensitivity in advanced adenomas was 34.2% (13/38). Serum CEA had a sensitivity of 56.9% (37/65) and a specificity of 96.7% (58/60) for CRC, with an OR of 5.7 (95% CI 2.0-16.4, p < 0.001). Combined detection of CEA and CA72-4 had a sensitivity of 69.2% (45/65) and a specificity of 81.6% (49/60). The triple combination (mSDC2 + CEA + CA72-4) achieved a sensitivity of 96.9% (63/65) and a specificity of 78.3% (47/60) in the CRC, and a sensitivity of 50% (19/38) for advanced adenomas. The combined detection had higher sensitivity than single detection, with statistically significant differences compared to serum-based detection (p < 0.001).

CONCLUSION: Combining fecal mSDC2 with serum CEA and CA72-4 increased sensitivity for CRC detection in this single-center study, at the cost of reduced specificity. Validation in larger, screening-intended cohorts with predefined thresholds is warranted.

PMID:42056830 | DOI:10.1016/j.clinsp.2026.100987

J Psychiatr Res. 2026 Apr 24;199:113-121. doi: 10.1016/j.jpsychires.2026.04.030. Online ahead of print.

ABSTRACT

OBJECTIVE: Depression is a leading cause of global disability, motivating the development of objective and scalable diagnostic approaches. Quantitative electroencephalography (QEEG) combined with machine learning (ML) and deep learning (DL) techniques has gained increasing attention for depression detection. This systematic review aimed to critically examine and descriptively compare the methodologies, performance metrics, and limitations of ML- and DL-based models applied to EEG data for depression detection.

METHODS: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Seven electronic databases (PubMed, Scopus, IEEE Xplore, ScienceDirect, Web of Science, SAGE Journals, and MDPI) were searched for peer-reviewed studies published between 2020 and 2024. Eligible studies included human participants, used EEG signals for depression detection, and applied ML or DL algorithms. Extracted information comprised algorithm type, sample size, EEG acquisition parameters, validation strategies, and reported performance metrics, which were synthesized descriptively across studies. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.

RESULTS: A total of 42 studies met the inclusion criteria, including 23 ML-based and 19 DL-based investigations. Reported classification accuracy ranged from approximately 76% to 100%. DL studies showed a higher mean reported accuracy than ML studies (93.92% vs. 90.78%); however, this difference was not statistically significant in the exploratory non-parametric comparison. Near-perfect performance values were frequently observed in studies with small sample sizes and subject-dependent or exclusively internal validation strategies, raising concerns regarding overfitting and limited generalizability. Studies relying on publicly available datasets tended to report more stable performance. QUADAS-2 assessment revealed recurrent risk-of-bias concerns, particularly in the domains of patient selection and index test conduct.

CONCLUSIONS: Both ML and DL approaches demonstrate potential for EEG-based depression detection, but reported performance differences between them should be interpreted cautiously. Although DL studies tended to report higher accuracy values, this pattern was not statistically significant in exploratory analyses and was strongly influenced by sample size, validation strategy, and methodological design. Future research should prioritize larger and more diverse samples, subject-independent or external validation strategies, and standardized reporting frameworks to enhance methodological rigor and clinical applicability.

PMID:42056808 | DOI:10.1016/j.jpsychires.2026.04.030

Asia Pac J Clin Oncol. 2026 Apr 29. doi: 10.1111/ajco.70119. Online ahead of print.

ABSTRACT

AIMS: The prognostic value of clinical complete/near-complete response (cCR/near-cCR) relative to pathologic complete/near-complete response (pCR/near-pCR) after neoadjuvant therapy for locally advanced rectal cancer (LARC) remains incompletely defined.

METHODS: We retrospectively analyzed 180 non-metastatic LARC patients treated with total neoadjuvant therapy (TNT) or standard neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision. Agreement between cCR/near-cCR and pCR/near-pCR was assessed using Cohen’s κ, and associations with survival outcomes were evaluated using Kaplan-Meier and Cox models.

RESULTS: Preoperative cCR/near-cCR was observed in 89 patients (49.4%), whereas pCR/near-pCR occurred in 63 (35.0%), with moderate concordance (κ = 0.53, p < 0.001). Discordance between clinical and pathologic response classification was observed in 42 patients (23.3%). Compared with patients who achieved pCR/near-pCR, those without pCR/near-pCR had inferior 5-year distant metastasis-free survival (DMFS) (66.7% vs. 87.3%; hazard ratio [HR] 2.98, 95% confidence interval [CI] 1.44-6.09; p = 0.003) and locoregional recurrence-free survival (LRFS) (81.0% vs. 95.0%; HR 4.32, 95% CI 1.28-12.23; p = 0.02), while Overall survival (OS) did not differ significantly between groups (63.8% vs. 78.4%; HR 1.42, 95% CI 0.75-3.11; p = 0.06). cCR/near-cCR was associated with improved DMFS on univariable analysis; however, this association was attenuated after multivariable adjustment and did not remain independently significant. Prognostic separation by response was more pronounced in the TNT cohort. Among patients with pCR/near-pCR, baseline biopsy-derived lymphovascular invasion/perineural invasion was associated with numerically poorer outcomes, although these differences were not statistically significant.

CONCLUSION: pCR/near-pCR provides more consistent prognostic discrimination than cCR/near-cCR, and clinically relevant discordance persists in routine practice. Integrating baseline tumor biology with response assessment may refine post-treatment risk stratification, particularly after TNT.

TRIAL REGISTRATION: Not applicable. This study is a retrospective observational study and does not require trial registration.

PMID:42056758 | DOI:10.1111/ajco.70119