Tag: nevin manimala

Perfusion. 2026 Jan 21:2676591261416084. doi: 10.1177/02676591261416084. Online ahead of print.

ABSTRACT

IntroductionIn children undergoing Extracorporeal Membrane Oxygenation (ECMO), anticoagulation is given to counterbalance the risk of thrombosis. Several laboratory tests are available to monitor heparin, but the ideal method still needs to be determined.MethodsThis retrospective cohort study included all patients under 18 years on ECMO support between 2010 and 2021. At our institution, the test used to monitor unfractionated heparin changed over time, dividing patients into three periods, using either activated clotting time (ACT) (2010-2014), activated partial thromboplastin time (aPTT) (2014-2018) or anti-Xa (2018-2021). The primary objective was to compare the occurrence of hemorrhagic complications. Secondary objectives included thrombotic complications, neurological complications, and survival.ResultsWe included 118 ECMO runs of which 30 ACT-guided, 40 aPTT-guided, and 48 anti-Xa-guided. No statistically significant differences were found in hemorrhagic complications [respectively 46.7% vs. 52.5% vs. 60.4%; p = 0.48], thrombotic complications (p = 0.15), neurological complications (p = 0.13), or 30-days survival (p = 0.84). Duration of ECMO and length of hospital stay were both the shortest in the anti-Xa-guided group (respectively p = 0.02; p = 0.02). During ECMO, the anti-Xa-guided group received a higher unfractionated heparin dose compared to the aPTT- and ACT-guided group [respectively 839 [651-981] vs. 543 [407-692] vs. 330 [223-489] IU/kg d^-1, p < 0.001].ConclusionIn our study, the test or titration method used to guide heparin-dosing in children on ECMO, was not associated with hemorrhagic complications and death. Of note, the dose of unfractionated heparin was significantly higher in the anti-Xa-guided group. Combined testing may be more effective than a single method, more studies are needed to establish the optimal strategy.

PMID:41564429 | DOI:10.1177/02676591261416084

Neurology. 2026 Feb 24;106(4):e214619. doi: 10.1212/WNL.0000000000214619. Epub 2026 Jan 21.

ABSTRACT

BACKGROUND AND OBJECTIVES: The long-term prognosis after maternal ischemic stroke (IS) remains understudied. The objectives were to examine if mortality and long-term morbidity are more frequent in women with prior maternal IS compared with women without a pregnancy-related stroke and to assess recovery in maternal IS patients based on functional outcomes and vocational status.

METHODS: In this retrospective nationwide cohort study, maternal IS patients in Finland during years 1987-2016 were identified from national healthcare registers and verified from patient records. Three pregnant controls without a pregnancy-related stroke were selected for each case and matched by delivery year, age, parity, and geographical area. Deaths were acquired from the Causes-Of-Death Register until 2022. Morbidities (cardiovascular diseases and depression) were collected from Hospital Discharge Register and vocational status from Statistics Finland until 2016 for those who survived ≥1 year after stroke. Functional outcomes by modified Rankin scale (mRS) were estimated from patient records.

RESULTS: There were 97 women with maternal IS, of whom 92 survived ≥1 year after stroke, and 265 matched controls (median age 30.6 years at index delivery in both groups). The median follow-up time was 17.4 years for mortality and 11.6 years for morbidity and vocational status. The overall mortality was higher in maternal IS patients than controls (8.3% vs 1.8%, age-adjusted odds ratio [aOR] 4.96, 95% CI 1.58-15.60) but did not differ significantly after the first year. There were 5 (5.6%) recurrent strokes in maternal IS patients. Patients had more frequently major cardiovascular events (6.7% vs 0%, p < 0.001), cardiac diseases (aOR 8.57, 95% CI 2.22-33.08), and depression (aOR 3.92, 95% CI 1.86-8.24) than controls. Of the patients who survived until the end of follow-up, 92.1% had good functional outcomes (mRS 0-2). Still, employment was rarer (aOR 0.55, 95% CI 0.32-0.94) and retirement (aOR 4.55, 95% CI 2.03-10.17) more common in maternal IS patients than controls.

DISCUSSION: Maternal IS patients had a significant cardiovascular burden and were retired more often than controls at the end of follow-up, although most patients had good functional outcomes. Optimizing long-term prognosis in these young patients necessitates comprehensive management of vascular risk factors and targeted rehabilitation strategies to address residual neurologic deficits.

PMID:41564390 | DOI:10.1212/WNL.0000000000214619

Hepatol Commun. 2026 Jan 21;10(2):e0892. doi: 10.1097/HC9.0000000000000892. eCollection 2026 Feb 1.

ABSTRACT

BACKGROUND: In patients with steatotic liver disease, metabolic dysfunction and alcohol-associated liver disease (MetALD) is a recently defined entity combining metabolic syndrome and moderate-to-high alcohol consumption. Its prognosis and outcomes compared with alcohol-associated liver disease (ALD) remain underexplored. The aim of the study was to assess liver recompensation (LR) between the 2 groups in patients with decompensated liver disease referred for liver transplant (LT) evaluation.

METHODS: We conducted a retrospective cohort study of 194 patients with decompensated liver disease, diagnosed as MetALD or ALD, and referred for LT evaluation between October 2021 and August 2023 at a single U.S. transplant center, and compared the outcomes between the 2 groups. The diagnoses of MetALD and ALD were based on the Delphi consensus definitions.

RESULTS: Of the 194 patients, 135 (70%) had ALD and 59 (30%) had MetALD. Baseline characteristics showed significantly higher BMI (31 vs. 28 kg/m2, p=0.001), chronic kidney disease (32% vs. 17%, p=0.025), and lower Karnofsky scores (51 vs. 62, p=0.014) in the MetALD group. While no statistical difference was found in listing and LT rates between groups, LR occurred significantly less in MetALD compared with ALD (3% vs. 18%, p=0.006). On multivariable analysis, MetALD independently predicted lower LR (HR 0.21, 95% CI: 0.05-0.91). Hypertension (HR 0.38, 95% CI: 0.16-0.89) and increasing BMI (HR 0.91, 95% CI: 0.84-0.99) were also significantly associated with lower LR. While overall mortality was higher in the MetALD group (42% vs. 26%, p=0.029), MetALD was not an independent mortality predictor after adjustment.

CONCLUSIONS: Compared with ALD, MetALD is associated with significantly lower LR in patients with decompensated liver diseases referred for LT evaluation.

PMID:41564363 | DOI:10.1097/HC9.0000000000000892

JMIR Hum Factors. 2026 Jan 21;13:e78457. doi: 10.2196/78457.

ABSTRACT

BACKGROUND: Telemedicine has rapidly expanded worldwide due to its convenience and accessibility. In China, an increasing number of hospitals have begun offering telemedicine services; however, patient utilization remains relatively low. Limited research has examined patients’ behaviors during the process of adopting telemedicine services.

OBJECTIVE: This study aimed to identify barriers to and enablers for patients using telemedicine services and to formulate implementation strategies.

METHODS: We conducted semistructured qualitative interviews based on the Theoretical Domains Framework (TDF) to identify barriers and enablers to telemedicine utilization. Twenty-one patients who had used Peking University Third Hospital’s telemedicine services were included in the interviews. Data were analyzed using NVivo 12.0 with deductive thematic analysis guided by the TDF. Moreover, a group of experts was assembled to devise potential intervention strategies.

RESULTS: A total of 28 themes were identified, including 14 barriers and 14 enablers across 5 of the 14 TDF domains. The most frequently reported barriers were operational challenges, prolonged waiting periods from asynchronous communication, and doubts about therapeutic efficacy, whereas the most frequently mentioned enablers were the convenience of telemedicine, time conservation, and support from hospitals. On the basis of these factors, we devised 6 intervention strategies.

CONCLUSIONS: This study demonstrated that patients’ utilization of telemedicine services was affected by several barriers and enablers, including system architecture and design, patient interactions using telemedicine, and external assistance. To enhance the utilization, these factors must be meticulously considered. This study also suggests strategies to enhance the utilization of telemedicine.

PMID:41564349 | DOI:10.2196/78457

J Pediatr Hematol Oncol. 2026 Jan 20. doi: 10.1097/MPH.0000000000003162. Online ahead of print.

ABSTRACT

OBJECT: Goal of this study was to investigate distribution of 3 aberrant immunophenotypes of T cells in childhood Hemophagocytic lymphohistiocytosis (HLH), and to find their relations with treatment responses and long-time outcomes.

METHODS: Aberrant T cell immunophenotypes presented by patients with HLH at diagnosis during Jan 2018 to Oct 2021 were collected. Distributions of these immunophenotypes among different HLH groups and their relations with first-line therapy responses or lone-time outcomes of patients were studied.

RESULTS: T cell populations with aberrant immunophenotypes were found in 40 patients out of 189 (21.2%). Aberrant immunophenotypic patterns were divided into 3 categories: CD38+HLA-DR+ (N=11, 27.5%), clonal expression of TCRVb (N=17, 42.5%), or down regulation of surface CD5 (N=28, 70.0%). Statistical results showed that T cells from patients with EBV-HLH were prone to present 1 or more of these 3 aberrant immunophenotypes (P<0.001), and that most cases (4/6) with CD4+ T cells with aberrant immunophenotypes were in CAEBV-HLH group. Although plasma levels of IFN-γ were higher in patients with these immunophenotypes (P=0.01), no significant relation was found between these aberrant T cell immunophenotypes and treatment response or long-time outcome. Besides, no hematologic malignancies developed in patients with aberrant T cell immunophenotypes throughout follow up.

CONCLUSION: Patients with HLH frequently show aberrant immunophenotypes of T cells. In most cases, this immunophenotypic patterns have connection to severity, but not outcome of the disease.

PMID:41564346 | DOI:10.1097/MPH.0000000000003162

JMIR Med Educ. 2026 Jan 21;12:e80048. doi: 10.2196/80048.

ABSTRACT

BACKGROUND: Game-based learning has emerged as an effective learning strategy in health care education. However, no games have been specifically designed to support cognitive improvement for diverse learning styles in oral microbiology and immunology.

OBJECTIVE: This study aimed to develop and evaluate an educational card game designed to support diverse learning styles in oral microbiology and immunology, using a duel-style format.

METHODS: An explanatory sequential mixed methods study was conducted with 40 third-year dental students, where half of them were assigned to the first group, starting as the host, while those in the other group began as the microbe. Participants alternated between the microbe and host roles during gameplay. Active engagement through playing as the microbe facilitated knowledge acquisition through observation, supporting inductive learning. On the other hand, the host role aimed to promote the application of knowledge for decision-making, facilitating deductive learning. Quantitative data were collected using pre- and postknowledge assessments and satisfaction questionnaires. Qualitative insights were obtained through semistructured interviews exploring learning experiences when playing as the microbe compared to the host.

RESULTS: Students demonstrated significant improvements in knowledge scores across the 3 assessments (P<.001), with no difference between groups (P=.85). They also perceived the game positively in all 3 aspects (usefulness, ease of use, and enjoyment). Qualitative findings revealed that role variation supported both inductive and deductive learning processes. Participants valued the combination of pedagogical and entertaining components, leading to the game’s motivation and engagement. A conceptual framework demonstrated key emerging themes relevant to the game design and implementation, including learner profile, learning setting, game design, learning process, and learning outcomes.

CONCLUSIONS: The card game demonstrated its potential in enhancing knowledge acquisition and student engagement in oral microbiology and immunology. Role-switching between the host and microbe was perceived by participants to facilitate different learning experiences. Further research is recommended to investigate long-term retention and broader practicality.

PMID:41564344 | DOI:10.2196/80048

JMIR Res Protoc. 2026 Jan 21;15:e80483. doi: 10.2196/80483.

ABSTRACT

BACKGROUND: More than 20 million individuals worldwide, especially in the Vidarbha region of India, are affected by sickle cell anemia (SCA), a hereditary condition that results in aberrant hemoglobin S and red blood cell distortion. The condition leads to anemia, organ complications, and recurrent pain crises, making region-specific data necessary for efficient therapy and public health initiatives.

OBJECTIVE: The goal of the study is to examine the clinical characteristics and unusual manifestations of SCA in the Vidarbha region, with an emphasis on dietary practices, clinical presentations, demographic distribution, and lifestyle factors such as alcohol consumption and smoking.

METHODS: This observational cross-sectional study with random sampling will be conducted at Acharya Vinoba Bhave Rural Hospital in Wardha for 3 months. We will recruit 131 individuals aged 18 to 50 years with dominant hemoglobin S and a positive sickling test. A standardized questionnaire addressing clinical symptoms, nutrition, substance use, inheritance patterns, and demographic information will be used to gather data. SPSS (version 17; IBM Corp) will be used for statistical analysis. Data will be summarized using descriptive statistics. Group differences will be evaluated using inferential tests such as 1-way ANOVA, independent 2-tailed t tests, and chi-square tests. Associations between symptoms and lifestyle variables will be investigated by correlation analysis. Statistical significance is defined as a 2-tailed P value <.05.

RESULTS: The anticipated findings may support the need for targeted regional public health initiatives and underscore the importance of comprehensive screening, detailed patient history, and tailored care strategies for individuals with SCA. As of January 2026, this observational study has not received external funding. Participant recruitment and data collection commenced in January 2026 and are currently ongoing. Data analysis will be undertaken following completion of data collection, and the final results are expected to be submitted for publication in April 2026.

CONCLUSIONS: The findings will support the need for focused regional public health initiatives and emphasize the need for thorough screening, patient history, and customized care techniques for SCA.

PMID:41564337 | DOI:10.2196/80483

JMIR Mhealth Uhealth. 2026 Jan 21;14:e78960. doi: 10.2196/78960.

ABSTRACT

BACKGROUND: Approximately one-third of university students are overweight or obese, and a similar proportion experience anxiety or depression. Despite the interrelated nature of weight and mental health, interventions rarely address these issues simultaneously in young adults. Digital peer support interventions have the potential to promote healthy lifestyle and mental well-being. However, evidence is limited on whether a digital peer-driven approach can concurrently improve weight management and mental health in university populations with preobesity.

OBJECTIVE: This randomized controlled trial (RCT) evaluated the efficacy of a digital peer support program in concurrently improving weight management and mental health outcomes among university students with preobesity.

METHODS: In a single-blind parallel group RCT, 216 students with preobesity were allocated equally among three 6-month arms, which were a peer support intervention, an active wellness control, and a waitlist control. The peer support arm began with an interactive online workshop followed by moderated WeChat (Tencent) group discussions, daily micro tasks, biweekly group challenges, and digital badges to reinforce engagement. The active control group received the same schedule and formats but focused on general wellness topics. The waitlist group completed the same assessments without any intervention during the study period. The primary outcome measured the change in BMI from baseline to 6 months. Secondary outcomes included weekly physical activity measured in metabolic equivalent of task minutes, self-esteem, loneliness, anxiety, and depression assessed at 0, 2, 4, and 6 months. Analyses used linear mixed effects models.

RESULTS: Retention exceeded 90%. At 6 months, the peer-support group achieved a greater BMI reduction than the active control by 0.47 (95% CI -0.89 to -0.04) kg/m² and waitlist by 0.54 (95% CI -0.85 to -0.01) kg/m². Weekly metabolic equivalent of task-minutes was 129.5 higher than active control (95% CI 53.3-205.6) and 152.9 higher than waitlist (95% CI 68.4-237.4). Self-esteem increased by 1.81 points versus active control (95% CI 0.22-3.39) and 1.99 points versus waitlist (95% CI 0.21-3.76). Loneliness scores fell by 3.79 points relative to active control (95% CI -7.03 to -0.56) and by 5.02 points relative to waitlist (95% CI -8.38 to -1.66). No significant differences emerged for anxiety or depression.

CONCLUSIONS: A comprehensive digital peer-support program delivered via WeChat produced modest but clinically meaningful improvements in weight management, physical activity, self-esteem, and social connectedness among undergraduates with preobesity compared with wellness control and no intervention. These findings suggest that integrating peer support into scalable digital platforms can simultaneously address physical and psychosocial health in at-risk university populations.

PMID:41564335 | DOI:10.2196/78960

Surg Innov. 2026 Jan 21:15533506261418202. doi: 10.1177/15533506261418202. Online ahead of print.

ABSTRACT

BackgroundWithin the competencies in education for general surgery residents, the development of Laparoscopic Surgery Skills is of the utmost importance. We evaluated the usefulness of cadavers preserved with a formaldehyde-free solution in the acquisition/development of Skills for Laparoscopic Surgery once basic skills have been developed.MethodsThis is a single-center, single-blind, randomized educational intervention clinical trial. Participants took a theoretical and practical module on the acquisition of skills in laparoscopy and took a pre-test focused on intracorporeal enterorrhaphy. Subsequently, they were randomized by blocks into 3 branches continuing their training in skill acquisition models, silicone models, or Formaldehyde-free solution preserved corpses, and finally they performed a post-test. Two blind experts evaluated participants using the GOALS and OSATS scales for laparoscopic surgery.ResultsN = 37 participants were obtained. No relationship was found between the branch and the results of the GOALS and OSATS tests in pre and post-test, which implies comparability between the training methods. Also, the Pillai’s Trace statistical test for the MANOVA (0.95, F(12, 54) = 4.0988, P < 0.05) and (0.66, F(2, 31) = 30.18, P < 0.05) indicates that the educational level of the participant does have a statistically significant association with the results obtained in the pre- and post-test.ConclusionsEducation and development of laparoscopic surgery skills using cadavers preserved with the presented formaldehyde-free solution is comparable to other simulation models for the acquisition of skills in minimally invasive surgery. Also, this tool improves the learning curve in subjects with no prior experience.

PMID:41564334 | DOI:10.1177/15533506261418202

JMIR Form Res. 2026 Jan 21;10:e79957. doi: 10.2196/79957.

ABSTRACT

BACKGROUND: Smartphone-based ecological momentary assessment (EMA) methods highlight the impact of minority stress and socialization (eg, discrimination and social support) on smoking behaviors in lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) adults; however, studies among LGBTQ+ adolescents are limited. The Puff Break EMA protocol was developed to address this gap.

OBJECTIVE: This study aims to report on the acceptability, feasibility, and appropriateness of the Puff Break EMA protocol.

METHODS: We utilized a multimethod design to evaluate the acceptability, feasibility, and appropriateness of the Puff Break EMA protocol. Participants who reported tobacco/nicotine or cannabis product use within the last 30 days engaged in a 2-week EMA trial, receiving 5 daily assessments measuring tobacco, nicotine, and cannabis use, stress and socialization, and product craving. Posttrial, participants completed a 15-minute exit survey and 60-minute semistructured exit interview. The exit survey used the 12-item Weiner acceptability, appropriateness, and feasibility measures and 6-item Mobile Application Rating Scale, app-specific subscale and also included 7 open-ended responses. The exit interview focused on a review of participants’ data to help understand smoking patterns and experiences with the Puff Break EMA protocol along with questions guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to understand how a future EMA mobile intervention aimed at monitoring and reducing tobacco, nicotine, and cannabis product use could effectively be disseminated to, accessed by, and implemented with LGBTQ+ adolescents. Lastly, lessons learned were obtained through feedback and data collected throughout the study.

RESULTS: All 50 adolescents between the ages of 15-19 (mean 17.82, SD 1.19) were enrolled in the study August 2023 and July 2024. Participants predominantly reported using vaporized tobacco and nicotine products (47/50, 94%), followed by cannabis products (39/50, 78%). The study sample was diverse regarding sexual orientation and gender identities with 32% (16/50) identifying as gay or lesbian, 32% (16/50) bisexual or pansexual, and 14% (7/50) transgender (neither transmasculine nor transfeminine). The median EMA response rate was 75% (~53 of 70 EMA surveys). Results indicated high feasibility (mean 4.43, SD 0.77), acceptability (mean 4.15, SD 0.83), and appropriateness (mean 4.46, SD 0.67) of the Puff Break EMA protocol. The Mobile Application Rating Scale app-specific subscale also indicated high acceptability and feasibility for the EMA method to increase knowledge, awareness, and intentions to monitor tobacco/nicotine use (mean 4.14, SD 1.01). Triangulated results from closed and open-ended survey responses identified 5 key themes related to feasibility, acceptability, and appropriateness. Participants highlighted the ease of the Puff Break EMA protocol, prompt survey reminders, and increased product use awareness. Key feedback from exit interviews included increased flexibility for survey timing, better response-option alignment, and appropriate only for populations interested in monitoring or reducing their product use.

CONCLUSIONS: Findings indicate that using EMA methods to understand the impact of stress and socialization experiences on smoking behaviors in LGBTQ+ adolescents is feasible, appropriate, and acceptable.

PMID:41564333 | DOI:10.2196/79957