Tag: nevin manimala

Infection. 2026 Apr 13. doi: 10.1007/s15010-026-02790-2. Online ahead of print.

ABSTRACT

PURPOSE: Clinical assessment of brain dysfunction in critically ill patients is frequently limited by impaired consciousness and poor compliance. Blood-based biomarkers may facilitate detection of neurocognitive impairment, quantify structural brain injury, and improve prognostication. This study evaluated the potential diagnostic role of validated brain injury biomarkers compared with routine diagnostics in critically ill patients.

METHODS: We performed a single-center post hoc analysis of a prospective observational sepsis study conducted in two perioperative ICUs. Critically ill patients with and without sepsis were included. Delirium was assessed using validated tools and structural brain injury was evaluated from radiology reports. Biomarkers-neurofilament light chain (NfL), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), glial fibrillary acidic protein (GFAP) and Tau-were measured at two time points (enrollment and day 7). Neurological outcome was assessed using the modified Rankin Scale (mRS). 90-day mortality was recorded.

RESULTS: 90 patients were analyzed (60 with, 30 without sepsis). Delirium occurred in 54.4% and structural brain injury in 42.2%. At ICU discharge, 23.3% had favorable neurological outcomes. NfL levels were higher in septic patients with delirium (p = 0.038). GFAP was significantly elevated in patients with structural brain injury (p < 0.001). All biomarkers showed prognostic potential; GFAP demonstrated the strongest association with unfavorable outcome (aOR 5.11, 95% CI 1.57-22.33). GFAP and UCH-L1 improved AUC in reference model 1 (age + SOFA), while all four biomarkers improved AUC in models 2 (age + GCS) and 3 (APACHE-II) for predicting poor outcome and 90-day mortality.

CONCLUSION: Brain injury biomarkers correlate with delirium and structural injury and may enhance outcome prediction in heterogeneous critically ill patients.

TRIAL REGISTRATION: ClinicalTrials.gov. NCT06749483. Study Registration Date: 23 December 2024.

PMID:41973367 | DOI:10.1007/s15010-026-02790-2

Saudi Dent J. 2026 Apr 13;38(4):48. doi: 10.1007/s44445-026-00150-2.

ABSTRACT

Polyetheretherketone (PEEK) is a high-performance thermoplastic polymer that is currently being utilized in the dental field due to its desirable mechanical characteristics, biocompatibility, and ease of integration into digital CAD-CAM processes. Despite the esthetic and esthetic benefits of composite resins in Class II inlays, mechanical performance in high-stress posterior restorations continues to be a clinical issue with the material. Although other research has been conducted to utilize PEEK in different dental treatment procedures, there are no direct comparative studies dealing specifically with the compressive strength of Class II dental restorations using CAD-CAM developed PEEK inlays as compared to indirect composite inlays. This study aimed to compare the compressive strength of PEEK and composite resin when used as Class II inlays and evaluate PEEK’s suitability as an alternative restorative material. Thirty-four human premolars extracted for orthodontic reasons and randomly allocated to two groups (n = 17). Group A was provided with CAD-CAM-produced PEEK inlays, and Group B was restored with inlays made of an indirect composite. Fracture load testing of all specimens was done through a universal testing machine. An independent t -test was used to statistically analyze the compressive strength values. The PEEK group showed a mean compressive strength value of 381.88 N compared to 266.67 N in the composite group, and the p-value was below 0.001, which was a statistically significant difference. PEEK inlays proved to have better compressive strength than composite resin inlays, which implies that PEEK is a prospective Class II restorative material in stress-bearing posterior areas. Its clinical performance over the long term and in more applications should be the subject of future research.

PMID:41973331 | DOI:10.1007/s44445-026-00150-2

Eur Radiol Exp. 2026 Apr 13;10(1):45. doi: 10.1186/s41747-026-00709-y.

ABSTRACT

OBJECTIVE: Recently, deep learning (DL)-based reconstruction methods have been introduced into clinical magnetic resonance imaging (MRI) systems to enhance image quality and reduce acquisition time. However, their effects on apparent diffusion coefficient (ADC) maps remain unclear. We investigated whether DL-based image reconstruction influences ADC quantification and histogram-based ADC metrics using a calibrated diffusion-weighted imaging (DWI) phantom.

MATERIALS AND METHODS: A phantom containing vials with known ADC values was scanned on a 3-T system using full (fFOV) and reduced (rFOV) field-of-view DWI sequences. Each acquisition was performed using conventional (DL-OFF) and three DL-based strength levels (low, medium, high). Median ADC values were analyzed for repeatability (coefficient of variation (CV)) and accuracy. Histogram changes and first-order radiomic features were assessed using the Wasserstein distance, Friedman, and Wilcoxon tests.

RESULTS: ADC estimates showed high repeatability (CV 0.1-1.2%) and good accuracy (deviation -2 to 7%) across all DL levels and sequences. DL reconstruction progressively reduced histogram dispersion, particularly in high-ADC vials. Wasserstein distances increased with DL strength, confirming a progressive effect on ADC value distributions, while median ADC values remained unchanged. Entropy and interquartile range decreased significantly (p < 0.001), whereas kurtosis and skewness increased, with differences showing less stable and sequence-dependent statistical significance.

CONCLUSION: DL-based reconstruction maintained accurate and repeatable ADC quantification while reducing the dispersion of ADC values. The effect was more evident for high-ADC regions and the rFOV sequence, resulting in narrower distributions of ADC values. Further investigations comparing different DL-based solutions are warranted to assess the generalizability of these findings in clinical settings.

RELEVANCE STATEMENT: Over the past decade, ADC histogram analysis has proven valuable for quantifying tumor heterogeneity, differentiating tumor grade, and evaluating early treatment response. Deep learning reconstruction narrows ADC distributions and reduces dispersion, supporting its potential in oncologic DWI, while highlighting the need for patient-based validation studies.

KEY POINTS: DL reconstruction preserved ADC accuracy in both full FOV and reduced FOV DWI. ADC repeatability remained high across DL levels for both DWI sequences. Histogram dispersion progressively reduced across DL levels, particularly in high-ADC vials. Entropy and interquartile ranges decreased progressively with increasing DL strength.

PMID:41973320 | DOI:10.1186/s41747-026-00709-y

Indian J Gastroenterol. 2026 Apr 13. doi: 10.1007/s12664-026-01977-7. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: To evaluate the efficacy of trans-jugular intrahepatic portosystemic shunt (TIPS) in patients with liver cirrhosis with hepatorenal syndrome non-acute kidney injury (HRS-NAKI) and refractory ascites who are not candidates for liver transplantation.

METHODS: We retrospectively analyzed cirrhotic patients with refractory ascites and HRS-NAKI treated with TIPS (n = 35) and those receiving standard medical therapy alone (n = 134). Propensity score matching (1:1) was performed using age, sex, model for end-stage liver disease (MELD) score, Child-Turcotte-Pugh (CTP) score, serum bilirubin, serum creatinine, serum sodium and ascites severity, yielding 35 matched controls. Laboratory and clinical parameters at one, three and six months were recorded and comparisons were made between both groups using appropriate statistical tests.

RESULTS: At six months, TIPS patients demonstrated improvement in serum creatinine (1.72 ± 0.31 to 1.41 ± 0.28 mg/dL) and urea (78.6 ± 21.4 to 52.3 ± 18.9 mg/dL), while controls showed deterioration. Urinary sodium increased significantly after TIPS (14.0 ± 6.9 to 55.5 ± 25.0 mmol/L at three months, p = 0.001). Mean large-volume paracentesis frequency was lower in TIPS patients (0.52 vs. 1.16 per month, p = 0.002). Plasma renin activity declined after TIPS (13.9 ± 1.5 to 4.8 ± 1.2 ng/mL/h at six months). Hepatic encephalopathy occurred in 35.1%, liver failure in 5.7% and heart failure in 5.7%. Six-month mortality was 11.4% in the TIPS group and 20% in the control.

CONCLUSION: TIPS improves renal function, neuro-hormonal activation and ascites control in patients with HRS-NAKI and refractory ascites who are not transplant candidates. However, it is associated with significant adverse events including hepatic encephalopathy, liver failure and cardiac decompensation. Larger prospective studies are required to identify patients who derive maximal benefit.

PMID:41973304 | DOI:10.1007/s12664-026-01977-7

Ann Surg Oncol. 2026 Apr 13. doi: 10.1245/s10434-026-19559-4. Online ahead of print.

ABSTRACT

BACKGROUND: Lymphedema is a common and burdensome complication after groin dissection for metastatic melanoma. This study evaluated whether a 6-month program of compression garments combined with simple lymphatic drainage (CG-SLD) reduces the rate of lymphedema presentation compared with standard care (SC).

PATIENTS AND METHODS: Participants were randomized 1:1 to SC or CG-SLD for 6 months postoperatively. Lymphedema was assessed preoperatively and every 3 months for 24 months using interlimb volume difference and bioimpedance spectroscopy. The primary end point was the incidence of lymphedema at 24 months. Secondary outcomes included time to lymphedema development, lymphedema severity, and quality of life (QoL). The study was powered to detect a reduction in 24 month incidence from 45 to 18% (α = 0.05, 80% power), requiring 88 participants.

RESULTS: A total of 38 participants were randomized (SC n = 20; CG-SLD n = 18), below the planned sample size. At 24 months, lymphedema incidence was numerically higher but nonsignificant for SC compared with CG-SLD; 55% (31.5-76.9) versus 38.9% (17.3-64.3). All new lymphedema events occurred within 12 months. Early lymphedema severity at 3 months favored CG-SLD; however, no persistent between-group differences were observed at later time points. There was no statistical evidence to support a difference in QoL scores at any time point.

CONCLUSIONS: CG-SLD did not reduce lymphedema incidence compared with SC at 24 months. Although early reductions in lymphedema incidence and severity were observed for CG-SLD, these were not maintained beyond 6 months when interventions ceased. The study was underpowered, and larger trials are required to determine whether early prophylactic strategies provide durable benefit.

PMID:41973292 | DOI:10.1245/s10434-026-19559-4

Diabetes Obes Metab. 2026 Apr 13. doi: 10.1111/dom.70748. Online ahead of print.

ABSTRACT

AIMS: Although pregabalin is a first-line therapy for painful diabetic polyneuropathy (PDPN), its optimal dose-response relationship remains unclear. We conducted a network meta-analysis to evaluate the efficacy and safety of fixed pregabalin dosages in PDPN patients.

MATERIALS AND METHODS: We systematically searched major databases through October 2025 comparing various doses of pregabalin (75, 150, 300, and 600 mg/day) with placebo in adults with PDPN. The outcomes were short- and long-term changes in the average daily pain score, patient/clinician global impression of change, and adverse events (AEs) including dizziness, somnolence, headache, and peripheral oedema.

RESULTS: Twelve RCTs were eligible. In the short term, pregabalin 300 (Standardised Mean Difference [SMD], 1.09; 95% CI, 0.69-1.50) and pregabalin 600 mg/day (SMD, 0.90; 95% CI, 0.24-1.55) produced significant pain reduction compared with placebo. In the long term, both pregabalin 300 (SMD, 0.12; 95% CI, 0.06-0.17) and 600 mg/day (SMD, 0.31; 95% CI, 0.23-0.38) remained effective, whereas pregabalin 75 and 150 mg/day did not demonstrate superiority over placebo. Regarding safety, both pregabalin 300 and 600 mg/day were associated with greater risks of dizziness, somnolence, and peripheral oedema compared with pregabalin 75 mg/day, pregabalin 150 mg/day, and placebo.

CONCLUSION: Pregabalin doses ≤ 150 mg/day demonstrated no clinical benefit over placebo. Conversely, both pregabalin 300 and 600 mg/day showed a pain reduction effect at short- and long-term follow-up. Given that pregabalin 600 mg/day was associated with a higher incidence of AEs, pregabalin 300 mg/day appears to offer a more favourable balance, aligning potent efficacy with a manageable safety profile.

PMID:41969185 | DOI:10.1111/dom.70748

Diabetes Obes Metab. 2026 Apr 13. doi: 10.1111/dom.70747. Online ahead of print.

ABSTRACT

AIMS: To evaluate the accuracy of four general-purpose artificial intelligence (AI) models-ChatGPT (OpenAI), Gemini (Google), Claude (Anthropic) and DeepSeek (DeepSeek AI)-in calculating the carbohydrate content of meals compared with clinicians-calculated reference values.

MATERIALS AND METHODS: The primary endpoint was equivalence between clinicians and AI-generated calculations within an error margin of ±5%. One-hundred twenty-four meals were analysed, equally distributed among breakfast, lunch, dinner and snacks. Carbohydrate contents were jointly determined by two paediatric diabetologists and one clinical nutritionist using the USDA FoodData Central and CREA Italian Food Composition Tables. Each AI model received identical, standardized prompts in English describing the meals. Statistical analyses included the Two One-Sided Tests procedure, the Bland-Altman plots, the Wilcoxon signed-rank and the Spearman correlations.

RESULTS: The clinicians’ median carbohydrate content was 30.32 g. Model medians were 30.75 g (ChatGPT), 30.40 g (Gemini), 29.75 g (DeepSeek) and 29.25 g (Claude). ChatGPT showed the smallest bias, the narrowest limits of agreement, and the highest correlation with clinicians’ calculation. Only ChatGPT met the predefined ±5% equivalence criterion, whereas Gemini and DeepSeek achieved equivalence within a ±10% margin. Claude displayed the largest negative bias and the widest dispersion.

CONCLUSIONS: ChatGPT most accurately approximated clinicians’ carbohydrate calculation among the tested AI models and fulfilled strict clinical equivalence criteria. Although the other models tended to underestimate carbohydrate content, their mean deviations remained within clinically acceptable limits. These findings suggest that AI tools, particularly ChatGPT, may serve as useful adjuncts for carbohydrate counting for people with type 1 diabetes, supporting self-management.

PMID:41969183 | DOI:10.1111/dom.70747

Can J Gastroenterol Hepatol. 2026;2026(1):e1577589. doi: 10.1155/cjgh/1577589.

ABSTRACT

BACKGROUND: Esophageal variceal bleeding (EVB) is a serious complication of cirrhosis and a major cause of upper gastrointestinal hemorrhage, carrying substantial risks of mortality and treatment failure. Prognostic scores are essential for guiding management. This study evaluated and compared the predictive accuracy of the ABC and MAP(ASH) scores with established models in cirrhotic patients with EVB.

METHODS: We retrospectively analyzed 278 cirrhotic patients admitted for EVB at Da Nang Hospital, Vietnam, between January 2022 and January 2025 who underwent endoscopic variceal ligation. Data were collected for ABC, MAP(ASH), AIMS65, and Glasgow-Blatchford scores. Primary outcomes were in-hospital mortality and 5-day treatment failure. Predictive performance was assessed using AUROCs and statistical comparisons.

RESULTS: The ABC score achieved the highest AUROC for predicting in-hospital mortality (0.88), significantly surpassing the MAP(ASH), GBS, and AIMS65 scores (p < 0.001 for all pairwise comparisons). A similar trend was observed for predicting 5-day treatment failure, where the ABC score again demonstrated the highest AUROC (0.79), outperforming both the GBS and AIMS65 scores; however, it showed comparable performance to MAP(ASH) (p = 0.19). In addition, the ABC score’s risk stratification (low, medium, and high) accurately differentiated patients with varying mortality and treatment failure rates.

CONCLUSION: The ABC score is a highly effective and reliable tool for predicting in-hospital mortality and early treatment failure in cirrhotic patients with EVB. While the MAP(ASH) score remains valuable for predicting early treatment failure, the ABC score offers superior overall prognostic accuracy. These findings suggest that the ABC score can guide clinical decisions, particularly in resource-limited settings.

PMID:41969181 | DOI:10.1155/cjgh/1577589

J Ultrasound Med. 2026 Apr 13. doi: 10.1002/jum.70262. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the relationship between intrauterine device (IUD) malposition and patient-reported symptoms, identify risk factors associated with malposition, and assess the reliability of string checks compared with ultrasound findings.

METHODS: A retrospective chart review was conducted at West Virginia University between January 2021 and December 2023. Patients with malpositioned IUDs identified by pelvic ultrasound were included. Data collected included demographics, body mass index (BMI), IUD type, provider type, anatomical abnormalities, symptom profiles, and string check findings. Descriptive statistics were used to summarize the data, and associations with types of IUD malposition were assessed in the statistical analysis.

RESULTS: A total of 175 patients with malpositioned IUDs were identified. Approximately half of the patients were symptomatic (53.1%), most commonly reporting pelvic pain or abnormal uterine bleeding, while 46.9% were asymptomatic. Low intrauterine placement was the most frequent malposition pattern. String visualization was common but did not reliably exclude malposition. No demographic, device, or provider characteristics were significantly associated with specific malposition types.

CONCLUSIONS: Nearly half of patients with malpositioned IUDs were asymptomatic, and visible strings were frequently present, highlighting the limitations of symptom assessment and string checks. Ultrasound plays a central role in evaluating IUD position when clinical concern exists.

PMID:41969178 | DOI:10.1002/jum.70262

J Eur Acad Dermatol Venereol. 2026 Apr 13. doi: 10.1111/jdv.70442. Online ahead of print.

ABSTRACT

BACKGROUND: Dupilumab and tralokinumab for atopic dermatitis (AD) target the type 2 axis through different mechanisms of action, which may lead to variation in effectiveness and safety. Head-to-head trials, however, are lacking.

OBJECTIVES: To compare the real-world effectiveness and safety of dupilumab and tralokinumab in AD.

METHODS: This prospective cohort study enrolled biologic-/Janus kinase inhibitor-naïve AD patients (≥12 years) from the BioDay registry who initiated dupilumab or tralokinumab between November 2021 and September 2024. Visits were scheduled at baseline, 4 weeks and every 3 months up to 52 weeks. Effectiveness outcomes included Eczema Area and Severity Index (EASI), weekly mean pruritus Numeric Rating Scale (NRS), treat-to-target thresholds (EASI ≤ 7; NRS-pruritus ≤ 4, with patients discontinuing treatment considered non-responders) and drug survival. Adverse events (AEs) were assessed at each visit. Inverse probability of treatment weighting (IPTW) was used to balance treatment groups.

RESULTS: In total, 750 patients were included (643 dupilumab; 107 tralokinumab). After IPTW, baseline characteristics were well balanced. During follow-up, dupilumab patients had lower EASI scores than tralokinumab patients, although differences were not consistently statistically significant (p = 0.10). NRS-pruritus scores were significantly lower with dupilumab at all visits (p < 0.0001), mean differences did not exceed the 2-point clinical relevance threshold. The probability of achieving EASI ≤ 7 and NRS-pruritus ≤ 4 was higher with dupilumab (both p < 0.0001), with risk differences of 34.7% and 40.2% at 52 weeks, respectively. After 52 weeks, dupilumab drug survival was 92.6% vs. 70.6% for tralokinumab. Ocular surface disease incidence was similar (HR 1.0, 95% CI 0.6-1.6, p = 0.94) between treatments, leading to discontinuation of dupilumab in n = 23 (3.4/100 PY) and tralokinumab in n = 5 (5.4/100 PY).

CONCLUSIONS: In this real-world comparison, dupilumab provided superior effectiveness compared with tralokinumab. In responders continuing treatment, EASI and NRS-pruritus differences were small. More substantial differences were observed when treatment targets EASI ≤ 7 and NRS-pruritus ≤ 4, and discontinuation rates were taken into account.

PMID:41969170 | DOI:10.1111/jdv.70442