Tag: pubmed

Genet Epidemiol. 2026 Feb;50(1):e70031. doi: 10.1002/gepi.70031.

ABSTRACT

A longstanding aim of developmental psychology and epidemiology is to understand the causal effects of parental phenotypes on offspring outcomes. Traditional approaches often fail to account for confounding and reverse causation. We evaluate the use of Mendelian randomisation with non-inherited variants (MR-NIV) to address these limitations. MR-NIV leverages non-inherited genetic variants to instrument the parental phenotype independent of the offspring’s genotype. We used Directed Acyclic Graphs and simulations to validate MR-NIV and explore robustness to assortative mating. In contrast to an alternative MR method which adjusts the parental genotype for offspring genotype, MR-NIV can be robust to assortative mating when used without trio data. In settings without trio data, MR-NIV outperformed the adjustment method. The adjustment method outperformed MR-NIV in settings with trio data. Applying MR-NIV to the Avon Longitudinal Study of Parents and Children, we assessed the causal effect of parental smoking on offspring smoking initiation at age 16. Results were consistent with observational studies, suggesting a meaningful increase in the risk of offspring smoking due to parental smoking. However, larger sample sizes will be necessary to provide a precise answer. MR-NIV offers a promising extension of Mendelian randomisation for studying the developmental environment.

PMID:41562185 | DOI:10.1002/gepi.70031

Ann Saudi Med. 2026 Jan-Feb;46(1):32-41. doi: 10.5144/0256-4947.2026.32. Epub 2026 Jan 22.

ABSTRACT

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has become the preferred minimally invasive approach for thoracic surgical procedures, with potential advantages over traditional thoracotomy. Perioperative and long-term outcomes between uni-port (U-VATS) versus multi-port (M-VATS) techniques remains under investigation.

OBJECTIVES: To compare U-VATS and M-VATS in terms of operative outcomes, complications, and oncological parameters.

DESIGN: Retrospective cohort study.

SETTING: Single tertiary referral center, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia.

PATIENTS AND METHODS: Adult patients aged 18-75 years who underwent VATS lung resection between January 2015 and September 2024 were included. Pediatric patients and those undergoing open techniques were excluded. Collected data included sociodemographic, preoperative, intraoperative, and postoperative variables. Statistical analysis used t-test, Mann-Whitney U, Chi-square, and multivariate logistic regression.

MAIN OUTCOME MEASURES: Operative time, blood loss, lymph node dissection, postoperative complications, hospital stay, mortality, and recurrence.

SAMPLE SIZE: 194 patients (103 U-VATS, 91 M-VATS).

RESULTS: Baseline characteristics were similar between groups. U-VATS was associated with longer operative time, [mean (SD) 210.0 (110.4) vs. 154.2 (69.9) min, P<.001] and greater blood loss [416.7 (392.2) vs. 150.0 (76.4) ml, P=.034]. Malignant lymph node involvement was higher in U-VATS (39.8% vs. 19.8%, P=.021), with more lymph node stations sampled. Anatomical resections were more common in U-VATS (31.1% vs. 13.2%, P=.005). Complication rates were low, with pneumonia (4.4%) as the most frequent in M-VATS and prolonged air leak (2.9%) in U-VATS. Thirty-day mortality was comparable (17.5% vs. 15.4%). Multivariate analysis showed M-VATS was associated with dissecting more lymph nodes (odds ratio, OR: 1.223; 95% confidence interval, CI: 1.019-1.468; P=.030), while anatomical resections were more likely with U-VATS (OR: 0.40; 95% CI: 0.180-0.740; P=.006).

CONCLUSIONS: Both U-VATS and M-VATS are safe for lung resections. U-VATS is more commonly used for anatomical resections and allows broader lymph node station sampling, supporting its expanding role in thoracic surgery.

LIMITATIONS: Single-center retrospective design, relatively small sample, and incomplete lymph node documentation.

PMID:41562168 | DOI:10.5144/0256-4947.2026.32

Ann Saudi Med. 2026 Jan-Feb;46(1):54-60. doi: 10.5144/0256-4947.2026.54. Epub 2026 Jan 22.

ABSTRACT

BACKGROUND: Fiberoptic bronchoscopy is a crucial diagnostic tool in the evaluation of lung cancer, particularly in tumors with endobronchial involvement. While forceps biopsy, bronchial brushing, and bronchial washing are commonly used, the diagnostic value and optimal timing of bronchial washing remain debatable.

OBJECTIVES: To evaluate the effect of pre- and post-biopsy bronchial washing on cytological diagnostic yield in patients with visible endobronchial lesions.

DESIGN: Prospective diagnostic study.

SETTINGS: Single tertiary university hospital.

MATERIALS AND METHODS: Between April 2018 and April 2021, 55 patients with bronchoscopically visible endobronchial lesions underwent flexible bronchoscopy. Patients with invisible or submucosal tumors were excluded. Bronchial washings were obtained before and after 4-6 forceps biopsies. Cytological analyses were conducted blindly on all specimens. Statistical analysis included Chi-square and McNemar tests, with P<.05 considered significant.

MAIN OUTCOME MEASURES: Cytological diagnostic positivity rates in pre- and post-biopsy bronchial washings.

SAMPLE SIZE: Fifty-five patients.

RESULTS: Forceps biopsy alone achieved a diagnostic yield of 95%, which increased to 96% when combined with bronchial washing. Post-biopsy washing demonstrated a significantly higher cytological positivity rate (47%) than pre-biopsy washing (22%) (P=.002). No complications were observed.

CONCLUSIONS: Bronchial washing after forceps biopsy significantly improves cytological diagnostic yield in endobronchial lung lesions. Its simplicity, low cost, and additional diagnostic yield support its routine use in bronchoscopic evaluation.

LIMITATIONS: Single-center design and relatively small sample size; other cytologic methods such as brushing orendobronchial ultrasound (EBUS) were not evaluated.

PMID:41562167 | DOI:10.5144/0256-4947.2026.54

Ann Saudi Med. 2026 Jan-Feb;46(1):20-31. doi: 10.5144/0256-4947.2026.20. Epub 2026 Jan 22.

ABSTRACT

BACKGROUND: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare and severe autoimmune disease characterized by pauci-immune necrotizing vasculitis.

OBJECTIVES: The study aims to explore the frequency, clinical characteristics, and management of AAV patients in two tertiary centers in the United Arab Emirates (UAE) over 17 years.

DESIGN: A retrospective observational case series.

SETTING: Two tertiary centers in the UAE.

METHODS: Patients diagnosed with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), or eosinophilic granulomatosis with polyangiitis (EGPA) from 2008 to 2024 were included. Demographic, clinical, laboratory, histopathological information, treatment, complications, relapses, and mortality were collected. ANCA testing for anti-proteinase 3 (PR3) and anti-myeloperoxidase (MPO) antibodies was performed using enzyme-linked immunosorbent assays. Descriptive statistical analysis was performed to summarize the data.

MAIN OUTCOME MEASURES: Subtype distribution, organ involvement, ANCA positivity, relapse, and mortality rates.

SAMPLE SIZE: Twenty-six patients.

RESULTS: We identified 26 AAV patients with a median age of 52.5 years. The majority were females (58%, n=15), and half were locals. The most common AAV subtype was microscopic polyangiitis (50%, n=13), followed by granulomatosis with polyangiitis (38%, n=10) and eosinophilic granulomatosis with polyangiitis (12%, n=3). ANCAs tested positive in nearly all of these cases. The most common clinical manifestations of AAV were constitutional symptoms with renal and pulmonary involvement. The induction therapy included corticosteroids, rituximab, cyclophosphamide, mycophenolate mofetil, and plasma exchange. The most prescribed maintenance medications were corticosteroids and azathioprine. The overall relapse rate was 31%, and the overall mortality rate was 19% (n=5).

CONCLUSION: In our cohort, MPA was the most common subtype, being predominantly associated with P-ANCA/MPO-ANCA positivity. Notably, few studies from the Gulf region have addressed this topic. It’s unclear whether this finding reflects low occurrence or potential underdiagnosis and, thus, points to unmet needs and a significant gap in the understanding of AAV. Multicenter studies are needed to validate these results and improve AAV management in Middle Eastern populations.

LIMITATIONS: Retrospective design with small number of participants.

PMID:41562166 | DOI:10.5144/0256-4947.2026.20

Ann Saudi Med. 2026 Jan-Feb;46(1):1-8. doi: 10.5144/0256-4947.2026.1. Epub 2026 Jan 22.

ABSTRACT

BACKGROUND: In pediatric surgical practice, physicians may face malpractice claims leading to substantial compensations and even criminal liability.

OBJECTIVES: To examine the legal processes and responsibilities of physicians by reviewing Supreme Court decisions related to malpractice claims involving pediatric surgeons.

DESIGN AND SETTINGS: A retrospective study based on the online archive of Supreme Court decisions.

PATIENTS AND METHODS: A search was conducted using keywords from the Supreme Court decision search engine. Decisions were reached regarding malpractice claims involving pediatric surgery.

MAIN OUTCOMES MEASURES: The medical procedure that was the subject of the malpractice claim, the resulting damage, the expertise of the physicians, and the reasons for the Supreme Court’s reversal and approval were evaluated.

SAMPLE SIZE: 82 Supreme Court decisions.

RESULTS: Among 82 decisions, circumcision (46%; n=38) was the most common. Appendicitis and testicular torsion followed. Total/subtotal penile amputation was present in 40% (n=15) of circumcisions. Half of the appendicitis cases resulted in death, and all testicular torsion cases resulted in organ loss. General surgeons were the most frequent physicians involved in litigation, accounting for 16% of cases (n=13), followed by pediatric surgeons and general practitioners, each accounting for 15% of cases (n=12). Supreme Courts found physicians at fault in 35% of criminal cases and 38% of civil cases. Deficiencies in expert reports were the reason for reversals in 42% of the decisions.

CONCLUSION: Supreme Courts conduct comprehensive evaluations in malpractice cases, considering factors such as indication, authority, fault status, complication management, and causal link. Physicians’ understanding of these issues will significantly contribute to minimizing malpractice claims.

LIMITATIONS: Retrospective study.

PMID:41562164 | DOI:10.5144/0256-4947.2026.1

Ann Saudi Med. 2026 Jan-Feb;46(1):61-74. doi: 10.5144/0256-4947.2026.61. Epub 2026 Jan 22.

ABSTRACT

BACKGROUND: The comparative effectiveness of intercostal tube drainage (ITD) and less invasive methods in initial pneumothorax management remains uncertain.

OBJECTIVES: To compare ITD with other invasive approaches in adults.

DESIGN: A systematic review and meta-analysis based on PRISMA guidelines, covering twelve studies from nine countries (Iran, UK, Netherlands, USA, Belgium, Kuwait, Norway, Pakistan, Switzerland) published between 1994 and 2021.

MATERIALS AND METHODS: A comprehensive search was conducted in PubMed, and Google Scholar. The study encompassed randomized controlled trials (RCTs), prospective and retrospective analyses with adults presenting pneumothorax. Quality assessment was conducted using the Cochrane risk-of-bias (RoB 2) tool for randomized trials and the MINORS tool for non-randomized studies.

MAIN OUTCOME MEASURES: Immediate success rates, hospital stay durations, complication rates, and recurrence rates at 12 months.

SAMPLE SIZE: A total of 1204 patients were included across 12 studies, ten RCTs (n=932), one prospective (n=60) and one retrospective study (n=212).

RESULTS: Meta-analysis showed no statistically significant differences between the ITD and the less invasive techniques in the immediate success rate (OR: 0.88, 95% CI: 0.47-1.65, P=.69). Also, no difference was noticed in the 1-week success rate (OR: 1.01, 95% CI: 0.6-1.5, P=.96) and recurrence (OR: 1.20, 95% CI: 0.80-1.80, P=.38).

RISK OF BIAS: The RoB was low in 82% of studies assessed by RoB 2 and the study evaluated by MINORS demonstrated a moderate RoB.

HETEROGENEITY: A high statistical heterogeneity was observed (I²=77%).

CONCLUSIONS: ITD and other invasive approaches demonstrated comparable effectiveness, with no significant differences in immediate success, 1-week success, or recurrence rates.

LIMITATIONS: The studies varied widely in design, patient groups, and quality. There were also signs of publication bias and a limited number of high-quality RCTs.

PROSPERO REGISTRATION NUMBER: CRD42024517888.

PMID:41562163 | DOI:10.5144/0256-4947.2026.61

Laryngoscope. 2026 Jan 21. doi: 10.1002/lary.70389. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe the prevalence and morphology of vocal fold contralateral reactive lesions in patients with vocal fold polyps or cysts, and to report disease regression following office-based laryngeal surgery (OBLS).

METHODS: Medical records and video recordings of patients with vocal fold polyps or cysts who underwent OBLS between November 2023 and September 2025 were reviewed. Demographic data included age, gender, history of smoking, history of reflux disease, type of vocal fold pathology, and type of office-based laryngeal procedure. Prevalence, morphology, and disease regression of CRLs were assessed by two otolaryngologists who independently reviewed the video recordings of patients included in this study.

RESULTS: Twenty-six males and 19 females were included in the study. The mean age was 48.9 ± 14.9 years. The prevalence of CRLs was 60%. Most of these lesions were fibrous. Eighteen lesions were treated with ILSI, and 8 lesions were treated with the blue laser and steroid injection. Five patients were lost to follow-up. Analysis of 21 CRLs showed complete disease regression in 52.4% of cases, and partial disease regression in 47.6% of cases. There was no statistically significant difference in disease regression between the two treatment subgroups (p = 0.284). There was a statistically significant difference in total disease regression of the primary lesion between those who had partial vs. complete disease regression of their CRL (p < 0.001).

CONCLUSION: CRLs are common in patients with vocal fold polyps and cysts. All lesions regressed partially or completely following OBLS using the blue laser and/or steroid injection.

PMID:41562156 | DOI:10.1002/lary.70389

Hum Vaccin Immunother. 2026 Dec;22(1):2598691. doi: 10.1080/21645515.2025.2598691. Epub 2026 Jan 21.

ABSTRACT

Prophylactic HPV vaccines are effective against cervical cancer and its precursors, but data on their impact on fertility and pregnancy are limited. This registry-based study examined the association between HPV vaccination and childbirth rates. Study population comprised 6200 HPV- and 1667 hepatitis B-virus (HBV) vaccinated women born in 1992-1993 and an age- and community-aligned cohort of 19,473 unvaccinated women born in 1990-1991. Nearly half of the HPV-vaccinated women participated in a cervical screening trial between ages 22 and 28. Childbirth numbers and rates per 10,000 person-years with 95% confidence interval (CI) were compared across the groups. The mean age at first childbirth ranged between 22.9 and 23.4 years among the vaccinated and unvaccinated women. At the age of 28, the cumulative proportion of all childbirths among HPV-vaccinated and screened cohorts was 2277 (36.7%), among HBV-vaccinated 781 (46.9%) and among unvaccinated reference cohorts 8997 (46.2%). Childbirth rates per 10,000 person years were 306 (95% CI 294-319), 390 (95% CI 364-419) and 385 (95% CI 377-393), respectively. HPV-vaccinated and screened women had lower childbirth rates compared to unvaccinated women at young age, possibly due to sexual counseling that HPV-vaccinated participants got in an overlapping cervical screening trial conducted between ages 22 and 28. This may have postponed their family planning to later ages.

PMID:41562152 | DOI:10.1080/21645515.2025.2598691

Knee Surg Sports Traumatol Arthrosc. 2026 Jan 21. doi: 10.1002/ksa.70275. Online ahead of print.

ABSTRACT

PURPOSE: Dynamic tibiofemoral movements following anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) autografts have not yet been compared to other autografts. We aimed to compare dynamic anterior tibial translation (ATTd) and internal tibial rotation (ITRd) during jump-landing and walking among patients with QT, bone-patellar tendon-bone (BPTB) and hamstrings tendon (HT) autografts at mid-term follow-up. The secondary aim was to compare lower extremity strength among autografts.

METHODS: Patients were included from a previous randomized controlled trial (randomly received primary ACLR with a QT, BPTB or HT autograft), and were prospectively assessed for additional analyses. Primary outcome measures were side-to-side differences in ATTd and ITRd during the side hop, single-leg hop for distance, triple hop for distance, double-leg drop-jump and walking, measured using 3D optoelectronic motion capture, and statistically analyzed using statistical parametric mapping. Moreover, isometric hamstrings and quadriceps strength limb symmetry index (LSI) were assessed using a dynamometer.

RESULTS: Thirty patients were included at 4.7 ± 1.8 years (range: 1.4-7.2) post-ACLR (n = 10 per autograft; age: 31.0 ± 4.8 years). No significant between-group differences were observed for side-to-side difference in ATTd and ITRd during all dynamic tasks (p > 0.05). QT and BPTB autograft groups demonstrated greater isometric hamstrings strength LSI (QT = 98.4% vs. BPTB = 99.3% vs. HT = 79.0%; p = 0.02) and greater hamstrings/quadriceps strength ratio LSI (QT = 102.0% vs. BPTB = 104.6% vs. HT = 79.6%; p = 0.01) compared to the HT autograft, but quadriceps strength was similar among autografts.

CONCLUSIONS: Patients who underwent ACLR with QT autografts demonstrated similar side-to-side differences in ATTd and ITRd compared to patients with BPTB and HT autografts 5 years post-ACLR, without demonstrating graft-harvest-related strength deficits, whereas patients with HT autografts showed persistent hamstrings weakness. Graft selection should consider persistent hamstrings strength deficits in patients with HT autografts, while ATTd and ITRd are not autograft-dependent. These findings support QT autografts as a viable option for ACLR.

LEVEL OF EVIDENCE: Level II.

PMID:41562143 | DOI:10.1002/ksa.70275

Int J Phytoremediation. 2026 Jan 21:1-14. doi: 10.1080/15226514.2026.2617380. Online ahead of print.

ABSTRACT

Significant environmental damage to aquatic ecosystems is caused by heavy metals, and the situation necessitates strategies against the contaminants. The present study was intended to explore Salvinia molesta‘s potential for the phytoremediation of contaminating water to remove three metals: chromium (Cr), nickel (Ni), and cadmium (Cd), with an emphasis on the influence of chemical amendments, ethylene diamine disuccinic acid (EDDS) and sodium dodecyl sulfate (SDS), applied independently. Plants were treated for a period of 60 days with single and combined metal solutions supplemented with EDDS (0.05-0.2%) and SDS (0.5-2%), and responses were measured through morphological factors and biochemical indicators, including bioaccumulation factor (BAF) with translocation factor (TF) used cautiously due to the floating habit of S. molesta. It was observed that S. molesta was capable of substantial heavy metal accumulation, with the highest accumulation recorded under EDDS amended and SDS amended treatments at elevated metal concentrations. EDDS treatments primarily enhanced metal bioavailability and uptake while maintaining plant growth and physiological stability under moderate metal stress, whereas SDS treatments, particularly at higher concentrations, resulted in increased metal accumulation accompanied by reductions in biomass, chlorophyll content and protein levels, indicating stress driven accumulation linked to altered membrane permeability. The application of EDDS or SDS resulted in higher metal uptake compared to untreated controls, with BAF values reaching 3.8 for Cr, 4.2 for Ni, and 3.5 for Cd; however, maximum accumulation under SDS treatments did not consistently correspond to biologically sustainable phytoremediation performance. Statistical analysis showed significant differences (p < 0.05) between treatments and control in metal bioavailability following amendment application, highlighting a dose-dependent tradeoff between metal uptake efficiency and plant health. This study represents the first integrated evaluation of EDDS and SDS under multi-metal (Cr-Ni-Cd) conditions in S. molesta, addressing a major gap in chemical-assisted phytoremediation research. Future work should be aimed at determining the optimum concentrations of these chemical amendments to facilitate the scale-up of phytoremediation projects.

PMID:41562135 | DOI:10.1080/15226514.2026.2617380