Tag: nevin manimala

Asian Pac J Cancer Prev. 2026 Mar 1;27(3):999-1005. doi: 10.31557/APJCP.2026.27.3.999.

ABSTRACT

OBJECTIVE: Significant gaps exist between hospital-incurred medical costs and national health insurance reimbursement rates, challenging the sustainability and equity of breast cancer care in Indonesia. Fixed tariffs often fail to capture the complexities and financial burdens associated with chemotherapy. This study compares hospital-incurred medical costs with both INA-CBG and non-INA-CBG reimbursement rates for breast cancer chemotherapy, identifies the key cost components, and evaluates the appropriateness of current tariffs under the National Health Insurance (JKN) scheme.

METHODS: A retrospective cross-sectional study was conducted at a tertiary hospital in Surabaya, Indonesia, using data from breast cancer patients who underwent chemotherapy in 2021. Clinical and cost data were obtained from hospital billing records, electronic medical records, and BPJS Kesehatan claims. The Wilcoxon signed-rank test was used to compare hospital-incurred medical costs with reimbursement rates. Subgroup analyses by INA-CBG code and chemotherapy regimen were performed to assess variability in coverage.

RESULTS: A total of 80 patients were included, predominantly female (97.5%) and diagnosed with stage IV disease (64.1%). Most were categorized under INA-CBG code C-3-13-0 (93.75%). Overall, the median hospital-incurred medical costs significantly exceeded reimbursement rates: IDR 3,657,290 vs. IDR 1,161,000 for C-3-13-0 (p < 0.001) and IDR 3,964,189 vs. IDR 2,151,900 for C-4-13-I (p = 0.031). Key cost drivers were chemotherapy administration (57.93%), nursing care (14.04%), and handling of cytotoxic drugs (7.88%). Specific regimens, such as vinorelbine, showed significantly higher costs that were not adequately reimbursed.

CONCLUSION: JKN tariffs for breast cancer chemotherapy substantially underestimate actual treatment costs. To improve financial sustainability and access, periodic tariff adjustments, adoption of activity-based costing, and consideration of hybrid payment models should be implemented to ensure equitable financing of oncology care in Indonesia.

PMID:41793678 | DOI:10.31557/APJCP.2026.27.3.999

Asian Pac J Cancer Prev. 2026 Mar 1;27(3):989-997. doi: 10.31557/APJCP.2026.27.3.989.

ABSTRACT

BACKGROUND: The Enhanced Recovery After Surgery (ERAS) protocol aims to achieve early recovery. However, its effects on the quality of recovery (QoR), as measured by patient-reported outcomes, still require further evaluation. This study aims to assess the QoR in patients undergoing lobectomy under ERAS protocol and identify the factors influencing QoR.

METHODS: A cross-sectional study was conducted using the QoR-15 score to measure QoR. The implementation of its twenty-seven components measured ERAS protocol adherence. Descriptive statistics were applied to describe the characteristics of QoR. Correlation and multivariable regression analyses assessed associations between ERAS adherence and QoR-15. Structural equation modeling (SEM) was used to evaluate whether potential factors mediated the ERAS adherence and QoR relationship via the average causal mediation effect (ACME).

RESULTS: This study included 98 patients. Their median QoR-15 score was 133, with an interquartile range of 130 to 134. QoR was excellent in 9.2%, good in 85.7%, and moderate in 5.1% of patients. The QoR-15 score moderately correlated with pain severity within the first 24 hours postoperatively (at POD0; ρ=-0.43, p<0.001) and ERAS adherence levels (ρ=0.31, p=0.002). Multivariable linear regression showed that pain at POD0 independently affected QoR-15 scores (β=-0.296, 95% confidence interval [CI] -0.407 to -0.184, p<0.001), while overall ERAS adherence did not (β=0.288, 95% CI -0.293 to 0.868, p=0.327). SEM analysis confirmed that higher ERAS adherence significantly reduced pain severity at POD0 (β = -0.47 per additional factor adhered to, p < 0.001), which in turn improved QoR-15 scores via a significant indirect effect (ACME = 0.381, p = 0.016).

CONCLUSIONS: Patients undergoing lobectomy under the ERAS protocol generally report positive QoR experiences. Adherence to the ERAS protocol may indirectly enhance QoR by reducing early postoperative pain. The study shows favorable QoR outcomes with ERAS implementation and highlights the importance of protocol adherence.

PMID:41793677 | DOI:10.31557/APJCP.2026.27.3.989

Asian Pac J Cancer Prev. 2026 Mar 1;27(3):941-946. doi: 10.31557/APJCP.2026.27.3.941.

ABSTRACT

OBJECTIVE: Assessment of treatment efficacy in neuro-oncology is measured by radiographic criteria. This can be misleading, as imaging findings may not translate into clinical benefit. The NANO scale, constructed by multidisciplinary experts, is an objective and measurable metric of neurological function that can be evaluated during routine examinations in brain tumor patients, so that patients receive an overall assessment of progression, along with radiological findings. This study aims to determine the validity and reliability of the Indonesian version of the NANO scale (NANO-Ina).

METHODS: The study was performed at Cipto Mangunkusumo National Referral Hospital, Jakarta. The validity and reliability process incorporated forward and backward translation to ensure cross-cultural equivalence, and an initial trial was conducted with 10 physicians to identify potential issues and refine item clarity. Subsequently, the 9 domains of the NANO-INA version were tested on 30 pathologically confirmed brain tumor patients by 2 distinct physicians separately. Inter-rater reliability was analyzed using the Kappa statistics.

RESULT: A total of 30 subjects were enrolled from January to August 2023, which included subjects mostly diagnosed with brain metastasis (30%), and the rest were equally distributed among meningioma, glioblastoma, and other primary brain tumors (23.3%). Among these, the majority had not received any treatment (77%), and the remaining were on chemoradiation (10%), chemotherapy (10%), and radiation (3.3%). Our inter-observer variability study demonstrated that the NANO-INA scale exhibits substantial to almost perfect agreement (kappa statistic ranging from 0.629-0.935) for all domains (p<0.05), with the highest agreement observed in strength, facial strength, and language.

CONCLUSION: The NANO-INA scale shows a high level of inter-observer agreement and serves as a reliable tool for assessing neurological function in patients with brain tumors in clinical settings in Indonesia.

PMID:41793672 | DOI:10.31557/APJCP.2026.27.3.941

Asian Pac J Cancer Prev. 2026 Mar 1;27(3):921-929. doi: 10.31557/APJCP.2026.27.3.921.

ABSTRACT

PURPOSE: Acute Myeloid Leukemia (AML) is a heterogeneous hematologic malignancy characterized by a wide range of cytogenetic abnormalities that have critical diagnostic and prognostic implications. South Indian populations are underrepresented in global AML research, warranting region-specific cytogenetic profiling.

METHODS: We performed a cytogenetic analysis of 400 newly diagnosed adult AML patients at a tertiary care center in South India. Conventional karyotyping and fluorescence in situ hybridization (FISH) were performed, and findings were correlated with clinical parameters according to the 2016 WHO and FAB classifications.

RESULTS: Abnormal karyotypes were observed in 49.5% of cases, while 50.5% showed normal karyotypes. The most frequent abnormalities were t(15;17) (16.2%), t(8;21) (6.7%), and inv(16) (3.7%). Other notable findings included trisomy 8 (1.7%), trisomy 21 (1%), and complex karyotypes (6.5%). AML-M4 (33.5%) was the most common FAB subtype. Significant associations were noted between cytogenetic risk groups and variables such as age, gender, and white blood cell count. The distribution of cytogenetic aberrations revealed both similarities and distinct differences when compared with global data, reflecting ethnic and geographical influences.

CONCLUSION: This study highlights the cytogenetic diversity of AML in a South Indian cohort and confirms the importance of cytogenetic analysis in disease classification, risk stratification, and therapeutic decision-making. The findings underscore the need for regional data to refine AML diagnosis and optimize management strategies across different populations.

PMID:41793670 | DOI:10.31557/APJCP.2026.27.3.921

J Oral Rehabil. 2026 Mar 7. doi: 10.1111/joor.70178. Online ahead of print.

ABSTRACT

BACKGROUND: Taste sensitivity declines with age, adversely affecting dietary intake and quality of life. However, the effects of oral health and function on gustatory ability in older adults remain unclear.

OBJECTIVE: To evaluate the relationship between oral health characteristics and taste sensitivity in older adults using solution and strip-based gustatory tests.

METHODS: One hundred older adult participants (age: ≥ 65) were assessed for dental status, denture use, salivary flow, swallowing function, and subjective taste impairment. Taste sensitivity for five modalities was measured using solution and taste strip tests. Statistical analyses included group comparisons and correlation coefficients.

RESULTS: Participants reporting subjective hypogeusia exhibited significantly lower total taste scores in solution and strip tests than those without (p < 0.01). Those with < 20 remaining teeth and users of mandibular dentures had lower umami scores than those with more teeth and no mandibular dentures (p < 0.05). Hyposalivation did not affect solution-based scores but was associated with lower total strip test scores (p < 0.05). Swallowing impairment was correlated with lower solution test scores, particularly for salty and umami (p < 0.01). Women had higher salivary flow and umami sensitivity, but overall gustatory function did not differ by sex. Solution and strip test scores were moderately correlated.

CONCLUSION: Taste perception in older adults is differentially influenced by salivary and swallowing functions, and the concordance between solution- and strip-based tests varies according to oral functional status and taste modality. Our results suggest that these methods capture complementary aspects of gustatory function and should be interpreted based on oral function in this population.

PMID:41793219 | DOI:10.1111/joor.70178

J Magn Reson Imaging. 2026 Mar 7. doi: 10.1002/jmri.70286. Online ahead of print.

ABSTRACT

BACKGROUND: Although deep learning reconstruction (DLR) has been shown to improve image quality in MRI, its impact on quantitative physiologic parameters derived from diffusion-weighted imaging (DWI) and dynamic susceptibility contrast (DSC) perfusion in brain tumor imaging remains unclear.

PURPOSE: To evaluate the impact of DLR on quantitative parameters derived from DWI and DSC in patients with brain tumors.

STUDY TYPE: Retrospective.

SUBJECTS: Sixty-two patients (33 male) with post-radiation brain metastasis.

FIELD STRENGTH/SEQUENCE: 3.0 T; T2, FLAIR, T1WI, DWI, DSC perfusion, and contrast-enhanced T1WI.

ASSESSMENT: DWI and DSC images were reconstructed at three DLR levels (high, medium, and low). Agreement between original and DLR images for apparent diffusion coefficient (ADC), cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time to peak (TTP) was assessed using the coefficient of variation, repeatability coefficient (RC), and concordance correlation coefficient. For DSC time-series, signal-to-noise ratio, root mean square error (RMSE), and mean absolute error (MAE) were computed within tumor masks. DWI comparisons used mean signal intensity at b = 0 and b = 1000.

STATISTICAL TESTS: Paired t-tests compared ADC, relative CBV, and DWI signals. RMSE and MAE were compared using repeated-measures analysis of variance. Significance was set at p < 0.05.

RESULTS: ADC (p = 0.955-0.979) and CBV (p = 0.341-0.708), CBF (p = 0.684-0.983), and MTT (p = 0.403-0.971) values showed no significant differences between original and DLR images, while high-level DLR showed significantly higher TTP than original images. RCs demonstrated high reproducibility across DLR levels for ADC (21.78-22.20), CBV (0.88-0.96), CBF (27.98-34.18), MTT (1.26-1.50), and TTP (3.40-3.99). DSC analysis showed the best noise reduction with high-level DLR (lowest RMSE, 254.62 and MAE, 253.18 of DSC) without compromising CBV quantification.

DATA CONCLUSION: DLR effectively reduced noise in DWI and DSC while preserving quantitative accuracy of ADC, CBV, CBF, and MTT. DLR may enable robust physiological MRI when applied in brain tumor imaging.

TECHNICAL EFFICACY: Stage 3.

PMID:41793218 | DOI:10.1002/jmri.70286

Acta Obstet Gynecol Scand. 2026 Mar 7. doi: 10.1111/aogs.70145. Online ahead of print.

ABSTRACT

INTRODUCTION: In women with a history of one extremely preterm birth, the current literature suggests that ultrasound cervical length screening offers a more favorable risk-benefit ratio than history-indicated cerclage. However, some of the women included in previous studies were at a low risk of cervical insufficiency. Therefore, the efficacy of history-indicated cerclage may have been underestimated. Our objective was to compare history-indicated cerclage with ultrasound cervical length screening in women with a history of one second-trimester loss or extremely preterm birth suggestive of cervical insufficiency.

MATERIAL AND METHODS: We conducted a retrospective cohort study comparing two centers with different management strategies for women with a history of one second-trimester loss or extremely preterm birth suggestive of cervical insufficiency. This study was conducted from January 1, 2015 to December 31, 2022 in two French tertiary care maternity units. In the first center, women were offered a cerclage in the first trimester (cerclage center). In the second center, women were offered an ultrasound screening with cerclage only for women with cervical shortening (ultrasound center). To target a population at high risk for cervical insufficiency, we included women with a history of one second-trimester loss or spontaneous preterm birth before 28 weeks of gestation. We excluded women who had any of the following complications in their previous pregnancy: bleeding from placenta previa or placental abruption, intrauterine fetal death, or delivery after invasive prenatal testing. We also excluded women with a history of more than one preterm delivery. Our primary outcome was delivery before 34 weeks. A multivariable analysis was performed.

RESULTS: The rate of delivery before 34 weeks was significantly lower in the cerclage center compared with that in the ultrasound center (26/165 (15.8%) vs. 38/149 (25.5%), p = 0.032). After adjusting for confounding factors, history-indicated cerclage was associated with a twofold decreased risk of delivery before 34 weeks compared with ultrasound cervical length screening (aOR 0.46, 95% CI 0.23-0.95).

CONCLUSIONS: In women with a history of one second-trimester loss or extremely preterm birth suggestive of cervical insufficiency, history-indicated cerclage is associated with a lower risk of delivery before 34 weeks compared with ultrasound cervical length screening.

PMID:41793210 | DOI:10.1111/aogs.70145

Public Health Rep. 2026 Mar 7:333549261421896. doi: 10.1177/00333549261421896. Online ahead of print.

ABSTRACT

OBJECTIVE: Some refugee children in the United States have an elevated blood lead level (EBLL), which can result in neurologic disease and developmental delays. Little has been published on EBLLs in immigrant infants and children whose families are seeking humanitarian protections outside the refugee program. We evaluated lead testing and anemia in this population.

METHODS: We performed a cross-sectional analysis of lead testing and anemia in infants and children whose families were seeking humanitarian protection (eg, asylum) and treated in clinics in Chelsea, Massachusetts (September 30, 2022-June 30, 2024) and New York City (January 1-November 30, 2023). We extracted demographic and clinical data from the medical records of clinics serving families who received emergency assistance with sheltering. We evaluated the proportion who completed lead testing and the prevalence of EBLL (≥3.5 µg/dL). We used Pearson χ² and Kruskal-Wallis tests to determine factors significantly associated with EBLL.

RESULTS: Among 882 children (most from Venezuela [29.5%], Ecuador [22.0%], Colombia [16.2%], and Peru [6.7%]), 693 (78.6%) completed testing for lead. Lead testing was more common among children aged <5 years than among older children (P < .001). Nine of 693 children (1.3%; 95% CI, 0.6%-2.5%) had EBLL; the mean blood lead level was 5.31 µg/dL. Eight of the 9 children with EBLL were boys (P = .06). Of 882 children, 146 (16.6%) had anemia; 2 children with EBLL had anemia. We did not find a statistically significant association between country of origin and EBLL (P = .23).

CONCLUSION: Clinicians and public health professionals serving newcomer populations should enhance efforts to prevent and screen for EBLL and anemia.

PMID:41793175 | DOI:10.1177/00333549261421896

Ecology. 2026 Mar;107(3):e70300. doi: 10.1002/ecy.70300.

ABSTRACT

Quantifying animal movements is necessary for answering a wide array of research questions in ecology and conservation biology. Consequently, ecologists have made considerable efforts to identify the best way to estimate an animal’s home range, and many methods of estimating home ranges have arisen over the past half a century. Most of these methods fall into two distinct categories of estimators that have only recently been described in statistical detail: those that measure range distributions (methods such as kernel density estimation that quantify the long-run behavior of a movement process that features restricted space use) and those that measure occurrence distributions (methods such as Brownian bridge movement models and the Correlated Random Walk Library that quantify uncertainty in an animal movement path during a specific period of observation). In this paper, we use theory, simulations, and empirical analysis to demonstrate the importance of appropriately using these two categories of distributions and their estimators. Conflating range and occurrence distributions can have serious consequences for ecological inference and conservation practice. For example, in most situations, home ranges estimated using estimators of occurrence distributions are too small, and this problem is exacerbated by ongoing improvements in tracking technology that enable more frequent and more accurate data on animal movements. We encourage researchers to use estimators of range distributions to quantify home ranges and estimators of occurrence distributions to answer other questions in movement ecology, such as when and where an animal crossed a linear feature, visited a location of interest, or interacted with other animals.

PMID:41793168 | DOI:10.1002/ecy.70300

Rev Med Virol. 2026 Mar;36(2):e70125. doi: 10.1002/rmv.70125.

ABSTRACT

Small randomized controlled trials (RCTs) in COVID-19 meta-analyses have been associated with more favourable treatment effects and reduced result stability. This study assessed how trial size impacts effect estimates, statistical stability, and risk of bias. Following PRISMA guidelines, we identified meta-analyses of COVID-19 treatments included in WHO, NIH, and the LIVING Project. Trials were classified by log-scale sample size, and separate pooled meta-analyses were conducted for large-only, small-only, and combined trials. Comparative metrics included the Ratio of Odds Ratios (ROR), Kappa statistics, Fragility Index (FI), Reverse Fragility Index (RFI), and Cochrane Risk of Bias assessments. Sensitivity analyses applied alternative size thresholds (≥ 1000 participants and median-based cutoffs) and stratified results by treatment and outcome type. Across 25 meta-analyses including 221 RCTs (46 large, 175 small), small trials produced more extreme estimates in 19 analyses and wider confidence intervals in 23. The pooled ROR was 0.85 (95% CI: 0.76-0.95; P = 0.004), decreasing to 0.81 (95% CI: 0.68-0.95; P = 0.011) when limited to small trials published before the first large trial. RORs remained below 1 across treatment and outcome types. Agreement between small and large trials was minimal, while large trials showed substantial agreement with overall estimates. Stability and bias profiles favoured large trials (FI: 14.0 vs. 4.0; RFI: 10.0 vs. 5.0). In conclusion, small RCTs tend to overestimate treatment effects and yield less precise, less stable results. Meta-analyses should prioritise large, high-quality trials and interpret small-study findings with caution, particularly in rapidly evolving research contexts.

PMID:41793162 | DOI:10.1002/rmv.70125