Tag: nevin manimala

J Obstet Gynaecol. 2026 Dec;46(1):2721701. doi: 10.1080/01443615.2026.2721701. Epub 2026 Aug 28.

ABSTRACT

BACKGROUND: Cross-sectional associations of high-density lipoprotein-related inflammatory indices (HIRIs) – white-blood-cell-, lymphocyte-, monocyte-, neutrophil-, and platelet-to-high-density lipoprotein cholesterol (HDL-C) ratios (WHR, LHR, MHR, NHR, and PHR) – with self-reported gynaecological cancer (GC) history are unclear.

METHODS: We analysed 12,955 women from six National Health and Nutrition Examination Survey cycles (2007-2008 to 2017-March 2020 pre-pandemic), including 369 with GC history; cervical cancer (CC), 184; uterine cancer (UC), 127; and ovarian cancer (OC), 70. Primary analyses used survey-weighted logistic regression and restricted cubic spline (RCS) models with Benjamini-Hochberg false discovery rate (BH-FDR) correction; component-resolved and sensitivity analyses were supportive, and other secondary analyses were exploratory.

RESULTS: In fully adjusted models, overall GC history was nominally associated with PHR (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.01-1.59; p = 0.045), the highest NHR tertile (OR 1.67, 95% CI 1.12-2.50; p = 0.013), and the highest WHR tertile (OR 1.56, 95% CI 1.04-2.34; p = 0.032). Subtype analyses showed selected nominal patterns, including an NHR tertile gradient for CC and WHR/LHR/PHR associations for UC; OC estimates were less stable. No primary logistic or RCS result survived BH-FDR correction. In supportive component-resolved analyses, the OC WHR white-blood-cell component met the BH-FDR threshold within the prespecified WHR-specific eight-test family (OR 2.40, 95% CI 1.35-4.25; p = 0.003; q = 0.025).

CONCLUSIONS: HIRIs showed modest, heterogeneous cross-sectional associations with self-reported GC history, but the primary findings were not retained after multiplicity correction. These ratios appear to reflect both shared HDL-C and numerator-cell information and should be interpreted as descriptive, hypothesis-generating phenotypes rather than diagnostic, prognostic, or causal markers.

PMID:42665432 | DOI:10.1080/01443615.2026.2721701

Cutan Ocul Toxicol. 2026 Aug 28:1-8. doi: 10.1080/15569527.2026.2725116. Online ahead of print.

ABSTRACT

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening mucocutaneous reactions. Although SCORTEN remains the most widely used prognostic tool, its performance in real-world settings may vary according to patient population and clinical context. This study evaluated clinical variables associated with in-hospital mortality in SJS/TEN.

MATERIALS AND METHODS: We conducted a single-center retrospective cohort study including 20 patients diagnosed with SJS, SJS/TEN overlap, or TEN between January 2010 and December 2024. Clinical and demographic data were extracted, including SCORTEN, mucosal involvement, etiology, comorbidities, treatment modalities, need for intensive care unit (ICU) admission, organ failure, ICU and ward length of stay. Due to the small sample size, statistical comparisons were exploratory and were performed using appropriate exact and non-parametric tests.

RESULTS: The in-hospital mortality rate was 40.0% (8/20; exact 95% CI, 19.1%-63.9%). ICU admission occurred in 8/8 non-survivors and 4/12 survivors (absolute difference, 66.7 percentage points; 95% CI, 24.1 to 86.2; p = 0.005). Respiratory failure, dialysis-requiring renal failure, and malignancy each occurred in 4/8 non-survivors and 0/12 survivors (absolute difference for each, 50.0 percentage points; 95% CI, 12.6 to 78.5; p = 0.014 for each), although these outcomes partly overlapped. Among ICU-admitted patients, the median ICU length of stay was 8.5 days in both outcome groups (Hodges-Lehmann difference, 0 days; 95% CI, -9 to 11; p = 0.958). Neither SCORTEN nor TBSA category was significantly associated with mortality.

CONCLUSIONS: In this retrospective single-center cohort, ICU requirement, acute organ failure, and underlying malignancy were more frequent among non-survivors with SJS/TEN. Given the limited sample size and absence of multivariable analysis, these findings should be interpreted cautiously. Larger multicenter studies are needed to clarify prognostic factors and real-world clinical course in SJS/TEN.

PMID:42665431 | DOI:10.1080/15569527.2026.2725116

In Vivo. 2026 Sep-Oct;40(5):3137-3145. doi: 10.21873/invivo.14462.

ABSTRACT

BACKGROUND/AIM: TROP2 has become a therapeutic target in urothelial carcinoma following the approval of TROP2-directed antibody-drug conjugates (ADCs), yet its expression in transurethral resection (TURBT) material remains poorly characterized. This study aimed to evaluate TROP2 protein expression using immunohistochemistry (IHC) in bladder TURBT samples and to investigate its association with histological grade, tumor stage, lymphovascular invasion (LVI), carcinoma in situ (CIS), recurrence, and survival outcomes.

MATERIALS AND METHODS: A total of 79 bladder TURBT specimens were included. Histological grading was performed according to the WHO/ISUP two-tier classification system (low grade / high grade) and pathological staging was based on the AJCC/UICC TNM Classification, 8th edition. TROP2 expression was assessed using IHC and quantified using the H-score method. Statistical analyses were performed using the chi-square test, Fisher’s exact test, Mann-Whitney U and Kruskal-Wallis tests, Spearman’s correlation analysis, receiver operating characteristic analysis, Kaplan-Meier estimates with log-rank tests, and Cox proportional hazards regression.

RESULTS: Mean age was 65.87±11.46 years (91.1% male). Mean TROP2 H-score was 173.99±48.15 (median 160.0; range 30-280). A significant negative correlation was identified between TROP2 and histological grade (rho=-0.410; p=0.0003); median H-scores were 200.0 in low-grade versus 150.0 in high-grade tumors. Receiver operating characteristic analysis yielded an area under the curve (AUC) of 0.736 (sensitivity 92.3%, specificity 45.0%; cut-off 200). No significant association was found with pT stage, LVI, CIS, recurrence, disease-free survival (log-rank p=0.886), or overall survival (log-rank p=0.752). Cox regression confirmed no independent prognostic effect on survival.

CONCLUSION: TROP2 inversely correlates with histological grade in bladder TURBT specimens (AUC=0.736) and may guide pathologists in diagnostically challenging cases – limited tissue, cautery artifact, or incomplete resection – where a low H-score suggests high-grade disease. TROP2 may complement WHO/ISUP grading and serve as a candidate predictive biomarker for TROP2-targeted ADC therapies.

PMID:42665429 | DOI:10.21873/invivo.14462

In Vivo. 2026 Sep-Oct;40(5):2881-2893. doi: 10.21873/invivo.14438.

ABSTRACT

BACKGROUND/AIM: To compare two different devices for computed tomography (CT)-guided preoperative localization of impalpable pulmonary nodules in terms of effectiveness, technical and clinical success and complications rate.

PATIENTS AND METHODS: CT-guided preoperative localization procedures of small or ground glass (i.e., impalpable) pulmonary nodules performed in our center from April 2018 to December 2021 before lung resection with video-assisted thoracic surgery (VATS) were retrospectively analyzed. Two different markers were used: spiral-wire (SpW) and hydrogel plug (HyP). For each nodule the density, size and pleural distance were evaluated. Technical (correct CT-guided positioning of the marker) and clinical (its correct localization in VATS) success were assessed for each device. Complications as displacement, pneumothorax and parenchymal hemorrhage (PH) were registered. Statistical analysis was made by Chi-square, Wilcoxon and Fisher tests.

RESULTS: Eighty-five consecutive patients (46/39 males/female; mean age 42 years, range=4-80 years) with 85 pulmonary nodules (maximum diameter: 8.5±6.4 mm in the SpW group and 17.0±4.2 mm in the HyP group) underwent preoperative CT-guided localization with SpW (65/85, 76.5%) or HyP (20/85, 23.5%) device. Correct CT-guided landmark positioning was obtained in 100% of cases. VATS revealed 4/65 (6.2%) cases of marker displacement in the SpW group and 3/17 (17.6%) cases in the HyP group (p=0.0353). Pneumothorax occurred in 40/65 (61.5%) cases in the SpW group and in 11/20 (55.0%) cases in the HyP group (p=0.602); no drainage tube was needed. PH occurred in 34/65 (52.3%) cases in SpW group and in 14/20 (70.0%) cases in HyP group (p=0.0163).

CONCLUSION: Both markers are effective for the preoperative localization of impalpable pulmonary nodules in VATS. SpW seems to be slightly more stable and safer than HyP lung marker in relation to the displacement and PH rate.

PMID:42665416 | DOI:10.21873/invivo.14438

In Vivo. 2026 Sep-Oct;40(5):2894-2907. doi: 10.21873/invivo.14439.

ABSTRACT

BACKGROUND/AIM: Type II odontoid fractures in elderly patients are associated with high rates of nonunion and substantial morbidity. However, the clinical relevance of radiographic nonunion following anterior odontoid screw fixation remains unclear. This study aimed to evaluate long-term functional outcomes and health-related quality of life, with particular focus on the impact of fracture healing.

PATIENTS AND METHODS: This retrospective single-center study included 82 patients (mean age 75.7 years) treated with anterior odontoid screw fixation between 2011 and 2019. Radiographic union was assessed using postoperative imaging. Patient-reported outcome measures (PROMs), including Visual Analog Scale (VAS), Neck Disability Index (NDI), EQ-5D-5L, and SF-36, were obtained at long-term follow-up. Outcomes were compared between patients with and without radiographic union.

RESULTS: Radiographic nonunion was observed in 44% of patients. A total of 27 patients completed follow-up assessments. Overall outcomes were favorable, with low pain levels (mean VAS score of 2), minimal disability (NDI mean 7), and good quality of life (EQ-5D-5L mean 0.79). Patients with nonunion demonstrated consistently worse PROMs; however, differences did not reach statistical significance. A significant difference was observed in the EQ-5D-5L anxiety/depression domain (p=0.018), indicating increased psychological burden in the nonunion group.

CONCLUSION: Anterior odontoid screw fixation provides satisfactory long-term clinical outcomes in elderly patients with type II odontoid fractures. Despite a high rate of radiographic nonunion, functional outcomes and quality of life were not significantly impaired. These findings suggest that mechanical stability may be more clinically relevant than complete osseous union. Larger prospective studies are required to confirm these results.

PMID:42665394 | DOI:10.21873/invivo.14439

In Vivo. 2026 Sep-Oct;40(5):2947-2959. doi: 10.21873/invivo.14444.

ABSTRACT

BACKGROUND/AIM: Hospital stays are often associated with emotional strain, influenced by environmental, procedural, and communication factors. While supportive interventions hold promise for improving patient well-being, understanding the lived experiences and needs of patients is essential for designing effective, patient-centered solutions. This study seeks to explore these factors to inform future strategies for enhancing emotional support during hospital stays.

PATIENTS AND METHODS: A 2023 cross-sectional survey at the Department of Radiology and Nuclear Medicine at the University Hospital Mannheim was conducted as an exploratory assessment to characterize patient-reported emotional stressors and care experiences during hospitalization. The survey employed a mixed-methods approach. The data was analyzed using descriptive and inferential statistics, with qualitative responses coded for thematic patterns.

RESULTS: The survey revealed that prolonged waiting times (>1 hour, 74% of participants) and communication problems were associated with lower self-reported mental well-being (mean score dropped from 4.45 to 3.57 out of 5, p<0.001). Language barriers and organizational inefficiencies exacerbated distress, while staff empathy and social visits improved well-being. Prior to procedures, the most common stated emotions by participants were apprehension (68% therapeutic procedure and 58% diagnostic procedure) and anxiety (47% therapeutic, 21% diagnostic), with these emotions shifting to confidence (78% therapeutic, 57% diagnostic) and hope (44% therapeutic, 43% diagnostic) post-procedure.

CONCLUSION: Communication delays and procedural anxiety are important contributors to emotional distress during hospitalization. These findings delineate empirically grounded stress domains that may guide structured investigation of supportive intervention strategies. By integrating such innovations alongside the irreplaceable value of human-centered care, future research can build on these insights to create holistic, patient-tailored solutions. Co-design with patients and clinicians, followed by rigorous validation, will be key to unlocking this potential.

PMID:42665371 | DOI:10.21873/invivo.14444

BMJ Glob Health. 2026 Aug 28;11(8):e024344. doi: 10.1136/bmjgh-2026-024344.

ABSTRACT

Cluster randomised trials (CRTs) remain key for evaluating the community-wide impact of interventions against infectious diseases such as malaria. Randomising by cluster prevents contamination and enables both the direct and indirect effects of the intervention to be estimated. Although these trials are extremely informative, they can be logistically demanding and costly to carry out, which means it is important that these trials are well powered. Here, we present a framework for planning CRTs that measure malaria prevalence as the outcome using an established mathematical model of malaria transmission. In this way, we explicitly consider the epidemiology of the individual trial clusters. The framework can be used alongside a baseline prevalence survey to help inform the sample size calculations for the trial. We use a case study to illustrate the framework, where we simulate a CRT in which a next-generation pyrethroid-pyrrole insecticide-treated net (ITN) is compared against a standard pyrethroid-only ITN. We show how the malaria endemicity of the trial location and timing of the follow-up surveys can affect the results obtained. We also highlight how other active interventions against malaria can reduce study power by increasing the amount of between-cluster heterogeneity in malaria prevalence.

PMID:42665358 | DOI:10.1136/bmjgh-2026-024344

BMJ Open. 2026 Aug 28;16(8):e115438. doi: 10.1136/bmjopen-2025-115438.

ABSTRACT

OBJECTIVES: To characterise demographics, comorbidities, co-medications and healthcare resource utilisation (HCRU) in patients newly diagnosed with Alzheimer’s disease (AD) in England using published and validated AD algorithms.

DESIGN: Observational cohort study.

SETTING: Real-world data in England from the Clinical Practice Research Datalink Aurum primary care database linked to the Hospital Episode Statistics secondary care database.

PARTICIPANTS: Two disease-based algorithms (Imfeld et al and Douros et al) and one medication-based algorithm (Schroeder et al) were selected from the literature to identify patients with AD. The index period for patient selection was from 1 January to 31 December 2019. Patients were grouped into three non-mutually exclusive cohorts reflecting these algorithms (cohorts A-C), then patients aged ≥60 years were further grouped into three subcohorts (subcohorts 1-3). Subcohort 1 included 9826 patients, subcohort 2 included 10 265 patients and subcohort 3 included 7355 patients.

PRIMARY OUTCOME MEASURES: Demographics, comorbidities, co-medications and HCRU present up to and including the date of cohort qualification were described.

RESULTS: Across subcohorts 1-3, mean age at index ranged from 81 to 83 years, and most patients were female (59%-63%) and White (93%). Common comorbidities were hypertension (67%-71%), asthma and chronic obstructive pulmonary disease (60%-63%) and arthritis and osteoarthritis (51%-53%). Common co-medications were analgesics (87%-89%), systemic corticosteroids (83%-84%) and anti-inflammatory and anti-rheumatic agents (81%-82%). Up to 34% of patients had a specialist referral or visit, with up to 18% involving a neurologist. In the 12 months prior to and including the index date, up to 46% of patients had an emergency department visit or inpatient visit for any cause.

CONCLUSIONS: In England, most newly diagnosed patients with AD were White females in their early 80s with common comorbidities including hypertension, asthma, chronic obstructive pulmonary disease, arthritis and osteoarthritis. This study addresses a critical evidence gap by quantifying the England-specific burden of comorbidity, polypharmacy, and HCRU among patients with AD using multiple validated and published AD algorithms. Findings were broadly consistent across the three subcohorts identified using disease-based and medication-based algorithms, strengthening internal validity of the study and demonstrating that the findings are robust to the method of AD case definition. This study provides a novel insight into the real-world AD population in England, and findings may help healthcare professionals to identify patients living with AD, understand patients’ needs and tailor treatment strategies.

PMID:42665355 | DOI:10.1136/bmjopen-2025-115438

BMJ Open. 2026 Aug 28;16(8):e121243. doi: 10.1136/bmjopen-2026-121243.

ABSTRACT

OBJECTIVE: To identify the main drivers of low-value medical imaging in Iran and explore potential strategies to reduce its use.

DESIGN: Qualitative study using semistructured interviews.

SETTING: Public and private healthcare settings in Iran.

PARTICIPANTS: 34 physicians, including general practitioners, radiologists and non-radiology specialists, selected using purposive and snowball sampling.

METHODS: Semistructured interviews were conducted between October 2023 and February 2024 through face-to-face, telephone and video calls. Data were analysed using thematic content analysis with a hybrid inductive-deductive approach and organised using the five control knobs framework.

RESULTS: Participants identified multiple drivers of low-value medical imaging across five domains: organisation, financing, payment, behaviour and regulation. Key drivers included weaknesses in the referral system, limited oversight, financial incentives, defensive medical practice, patient demand and misconceptions about diagnostic value. Suggested mitigation strategies included public education, physician training, stronger referral pathways, improved insurance oversight, use of evidence-based guidelines and better regulatory monitoring.

CONCLUSIONS: Low-value medical imaging in Iran is sustained by interacting weaknesses in referral pathways, financial incentives, professional practice and oversight. Efforts to reduce overuse should therefore combine physician and public education with stronger referral systems, insurer monitoring and regulatory action.

PMID:42665351 | DOI:10.1136/bmjopen-2026-121243

BMJ Open. 2026 Aug 28;16(8):e118421. doi: 10.1136/bmjopen-2026-118421.

ABSTRACT

BACKGROUND: The transition from chronic homelessness to being housed is a period of increased mortality risk. Examining the post-housing period is important for improving our understanding of this increased risk.

OBJECTIVES: To investigate, in a retrospective cohort study, the mortality rate of people who had been chronically homeless and who moved into supported housing and to identify risk factors associated with mortality.

DESIGN: Retrospective cohort study with eligible records reviewed from 1 October 2017 until 14 June 2024.

SETTING: Three supported housing units in Ottawa, Ontario, Canada.

PARTICIPANTS: Participants were any individual, alive or deceased, who moved into one of the eligible supported housing units within 6 months of their opening date. 123 participants were included in the study. The mean age was 41.3 (SD 11.9) years, and 76 (62%) were male.

OUTCOMES: The primary outcome was all-cause and cause-specific mortality following transition to supported housing. Differences in demographics and morbidity were also compared between people who were alive as of 14 June 2024 and those who were deceased as of 14 June 2024.

RESULTS: During a mean follow-up of 2.6 years, there were 27 deaths recorded (22% of those who moved into supported housing). Most, 11 (40%), died from ‘other causes’, where the cause of death was unclear or unknown and where they were found dead in their room, seven (26%) died of ‘natural causes’ usually in hospital after a medical event, seven (26%) of an opioid overdose and two (8%) where we have suppressed cause of death for privacy. There were no statistically significant differences in psychiatric diagnoses, substance use, medical diagnoses or opioid agonist therapy between those who died and those still alive at the end of the study period. Survival differed significantly across age groups (log-rank χ²=11.05, p=0.011), with residents aged 31-45 years demonstrating better survival than older age groups. No significant differences in survival were observed by sex.

CONCLUSIONS: There is a high mortality rate in people who are chronically homeless who move into supported housing. As our findings do not identify any clear baseline risk factor, it supports the idea that the transition into housing must be complemented with comprehensive health and well-being services that can meet this population’s complex needs to reduce the mortality risk.

PMID:42665348 | DOI:10.1136/bmjopen-2026-118421