Tag: pubmed

Drug Saf. 2026 Jan 19. doi: 10.1007/s40264-025-01645-3. Online ahead of print.

ABSTRACT

BACKGROUND: Previous evidence suggests a potential protective effect of warfarin against cancer, compared to non-users. However, it may be prone to immortal time bias and residual confounding.

OBJECTIVE: We aimed to examine the association between cancer and warfarin, compared with active comparator (direct oral anticoagulants).

METHODS: We conducted studies using population-based databases from England and Hong Kong to investigate the association between warfarin and hazard of cancer using a new-user active-comparator cohort design. People with atrial fibrillation aged ≥ 18 years who had first received anticoagulant treatment during 01/01/2011-31/12/2019 were involved.

RESULTS: No evidence supported the association between warfarin and hazard of overall cancer, compared with direct oral anticoagulants in both settings (England: hazard ratio [HR] = 1.03, 95% confidence interval [CI] 0.94-1.13; Hong Kong: HR = 0.89, 95% CI 0.79-1.01). A lower hazard of female breast (HR = 0.49, 95% CI 0.30-0.79), ovarian (HR = 0.07, 95% CI 0.01-0.58), and pancreatic (HR = 0.46, 95% CI 0.22-0.96) cancers and a higher hazard of kidney cancer (HR = 3.57, 95% CI 1.64-7.76) were found in Hong Kong, comparing warfarin with direct oral anticoagulants, but these were not replicated in England.

CONCLUSIONS: This study does not find a protective effect of warfarin against cancer versus direct oral anticoagulants. The risks of site-specific cancers including pancreatic, kidney, and sex-specific cancers between oral anticoagulants shown in the Hong Kong setting only may require further investigation in other independent datasets.

PMID:41553598 | DOI:10.1007/s40264-025-01645-3

Metabolomics. 2026 Jan 19;22(1):19. doi: 10.1007/s11306-025-02389-y.

ABSTRACT

INTRODUCTION: Tuberculosis (TB) and type 2 diabetes mellitus (T2DM) are highly prevalent diseases resulting in high mortality rates globally. Furthermore, T2DM increases susceptibility to TB and vice versa, worsening disease outcomes. This comorbidity is, however, not well described nor understood, despite its rising prevalence globally.

OBJECTIVES: This investigation aimed to better characterize the urinary metabolic profiles of patients with the TB and T2DM comorbidity in a South African cohort, to better understand its metabolic basis and associated clinical implications.

METHODS: Using untargeted GCxGC-TOFMS metabolomics, urine samples from 17 patients with TB and T2DM and 34 healthy controls were analyzed and statistically compared to identify significantly altered urinary metabolites.

RESULTS: TB-T2DM comorbid patients were characterized by altered metabolism of: (1) tryptophan and kynurenine (reduced kynurenic acid, anthranilic acid, picolinic acid) associated with changes to NAD⁺ synthesis and a redox imbalance, (2) nucleotides (reduced 3-aminoisobutyric acid, orotic acid, thymine, β-alanine, adenine, hypoxanthine), (3) tyrosine (reduced 3,4-dihydroxyphenylglycol, 4-hydroxy-3-methoxyphenylglycol, hydroxyphenylpyruvate), (4) lipids (reduced dec-2-enedioate, adipic acid, methylmalonic acid), (5) reduced concentrations of various glycine conjugates associated with glycine depletion, and (6) reduced urinary concentrations of various gut microbial metabolites indicative of microbial dysbiosis.

CONCLUSION: These results indicate several metabolic disruptions to amino acids, nucleotides, lipids, NAD⁺ homeostasis and the host microbiome, in TB-T2DM patients, mainly driven by inflammation and oxidative stress. Overall, the findings indicate synergistic amplification of metabolic stress, associated with immune suppression and TB-T2DM disease progression, and subsequently suggests how TB increases T2DM susceptibility and vice versa, as foundation for further investigations.

PMID:41553570 | DOI:10.1007/s11306-025-02389-y

Cir Pediatr. 2026 Jan 15;39(1):32-36. doi: 10.54847/cp.2026.01.15.

ABSTRACT

OBJECTIVE: To analyze the experience in the management of myeloid sarcomas at a pediatric oncology referral center.

MATERIAL AND METHODS: A descriptive, retrospective study of patients under 18 years of age diagnosed with myeloid sarcoma between 2010 and 2024. Demographic variables, underlying disease, tumor location, tumor size, treatment, and clinical outcome were collected. The analysis was performed using IBM® SPSS Statistics 30.0.

RESULTS: Seventeen myeloid sarcomas were identified in 14 patients, 13 (76.5%) of whom were male. The median age at diagnosis was 4.33 years (range: 1 month-14.5 years). In 10 cases (58.8%), the sarcoma was the first manifestation of an underlying hematologic malignancy. Biopsy was performed in 12 cases (70.6%). The most frequent locations were soft tissues (47.1%) and bone (23.5%). The mean tumor volume was 45.2 cm3. Acute myeloid leukemia was the most common underlying neoplasm (n= 14), followed by B-cell acute lymphoblastic leukemia (n= 3). Eight myeloid sarcomas (47.1%) resolved after a first cycle of chemotherapy, 6 (35.3%) required additional cycles, 2 (11.8%) received local treatment, and in 1 case (5.9%) resolution was not achieved.

CONCLUSIONS: Myeloid sarcoma represents an uncommon extramedullary manifestation. Early diagnosis, based on a high index of suspicion and appropriate clinical and radiological characterization, is crucial to establish an effective therapeutic approach and improve prognosis.

PMID:41550052 | DOI:10.54847/cp.2026.01.15

Cir Pediatr. 2026 Jan 15;39(1):22-31. doi: 10.54847/cp.2026.01.14.

ABSTRACT

INTRODUCTION: The treatment of choice in pediatrics for solid organ injuries resulting from blunt abdominal trauma is conservative management. However, in Spain, said management has proven to be heterogeneous and inconsistent with recent evidence. The Spanish Society of Pediatric Surgery (SECP) sponsored the development of this consensus document in the year 2024.

MATERIAL AND METHODS: After recruiting a group of experts, a bibliographic review was conducted using the systematic reviews from APSA, the ATOMAC group, and contributions from the experts themselves, to draft a series of initial suggestions. The experts, using the Delphi method, scored these (Likert scale) in different voting rounds until statistical stability in the responses was determined (Wilcoxon Test). Consensus was defined as agreement (scores 4-5) exceeding 70%.

RESULTS: Twelve experts from 11 centers were recruited, achieving gender parity. Seventeen suggestions were developed, organized into four key areas: PICU admission, discharge criteria and strict bed rest, analytical/radiological controls, and physical activity restriction. Statistical stability was reached after 2 scoring rounds, achieving consensus on 15 of the 17 suggestions, while it was not achieved regarding hospital discharge criteria and duration of strict bed rest.

CONCLUSIONS: Through Delphi methodology, a consensus document on the conservative management of solid organ injuries was developed. Although consensus was not reached on key aspects such as discharge criteria and strict bed rest, this document aims to help homogenize clinical practice.

PMID:41550051 | DOI:10.54847/cp.2026.01.14

Cir Pediatr. 2026 Jan 15;39(1):15-21. doi: 10.54847/cp.2026.01.13.

ABSTRACT

INTRODUCTION: Surgical necrotizing enterocolitis (NEC) is associated with high mortality. Bell’s criteria may indicate surgery in late stages, leading to worse outcomes. Early identification of surgical candidates is necessary. Objective: To evaluate surgical decision-making strategies in neonates with NEC, comparing Bell’s criteria versus the combined use of metabolic disorder components (MD7) and paracentesis.

MATERIAL AND METHODS: A randomized controlled clinical trial was conducted in perinatal hospitals (2022-2023), ClinicalTrials.gov identifier: NCT06035848. Preterm neonates with NEC were divided into a control group (CG): surgery determined by Bell’s criteria, and an intervention group (IG): surgery indicated by MD7 and positive paracentesis. The primary outcome was mortality. Descriptive and inferential statistics, relative risk (RR), with 95% confidence interval (CI), and a p-value < 0.05 indicating statistical significance were used.

RESULTS: 117 patients participated (CG n = 56, IG n = 61). In surgical NEC, mortality was 32.1% in IG and 64.7% in CG (p = 0.034; RR = 2, 95% CI: 1.1-4.8). In the IG, surgery was performed early, with better outcomes for perforation, intestinal necrosis, and reoperation (p < 0.05). There were no complications derived from paracentesis, and there were 3 non-therapeutic laparotomies in the IG.

CONCLUSIONS: The strategy based on MD7 and paracentesis was superior to Bell’s criteria for guiding surgical decisions in preterm neonates with NEC, reducing mortality. The main limitation was a small number of non-therapeutic laparotomies, expected due to the greater sensitivity of the strategy.

PMID:41550050 | DOI:10.54847/cp.2026.01.13

Cir Pediatr. 2026 Jan 15;39(1):4-8. doi: 10.54847/cp.2026.01.11.

ABSTRACT

INTRODUCTION: Extraction of bars during Minimally Invasive Repair for Pectus Excavatum (MIRPE) is susceptible to complications ranging from mild to severe. Objective: to compare the outcomes following the implementation of a Bar Extraction Safety Protocol (BESP) to determine its effectiveness in reducing complications.

MATERIAL AND METHODS: Retrospective comparative cohort study. Inclusion criteria: Patients who underwent bar removal from November 2013 to March 2024, in whom BESP was implemented, compared with a historical cohort operated on previously. Protocol includes: a) Preoperative measures: during implantation, use of smooth bars, a minimum of two bars with lateral stabilizers, sternal elevation; pre-removal: chest X-rays. b) Intraoperative measures: bilateral incisions, bar straightening, and “safety string” maneuver. c) Postoperative measures: 24-hour admission to the pediatric intensive care unit (PICU) and post-removal chest X-ray. Complications were classified using the Clavien-Dindo (C-D) system, focusing on clinically relevant ones (C-D ≥ II). Statistical analysis was performed using the chi-squared test (Stata v16).

RESULTS: Sixty-seven patients were included; 62 were male. Mean age at surgery: 17 years (range 14-24). Thirty patients (43 bars) operated on pre-BESP, 37 (81 bars) post-BESP. Pre-BESP bars were serrated; post-BESP bars were smooth. Bar dwell time was 27 months (IQR 23-33) pre-BESP and 24 months (IQR 23-25) post-BESP. Hospital stay was 1 day in both groups (maximum: 16 vs. 4 days). Clinically relevant complications occurred in 20% of pre-BESP patients and 0% post-BESP (p=0.048).

CONCLUSIONS: Implementation of BESP significantly reduced complications after bar removal, improving safety during bar removal in the MIRPE.

PMID:41550048 | DOI:10.54847/cp.2026.01.11

J Sleep Res. 2026 Jan 19:e70285. doi: 10.1111/jsr.70285. Online ahead of print.

ABSTRACT

K-complexes (KCs) are hallmark waveforms of non-rapid eye movement stage 2 (NREM2) sleep, associated with sleep maintenance and memory consolidation. KC density and amplitude decline with ageing and are further altered in amnestic mild cognitive impairment (aMCI). Manual scoring, while considered the gold standard, is labour intensive and subjective. Existing automated KC detectors, often trained on small public datasets of young healthy subjects using single-channel electroencephalography (EEG), may underperform in elderly aMCI individuals whose KC morphology is more variable. Hence, the goal of this study is to develop and validate AdaPatchFormer, an automated multi-channel Transformer-based KC detection algorithm optimised for elderly individuals with aMCI. AdaPatchFormer integrates a period embedding module, which adaptively identifies physiologically relevant rhythms across multiple frequency bands, with a multi-granularity encoder that progressively fuses temporal features across channels. The model was trained on full-night polysomnography (PSG) recordings from 268 elderly aMCI patients and evaluated against expert-labelled gold standards on four independent test datasets: private aMCI and cognitively normal cohorts, plus two public elderly cohorts. Across all datasets, AdaPatchFormer outperformed the two open-access detectors by Chambon et al. and Lechat et al., achieving higher recall, precision, specificity, accuracy, F1 score, Matthews correlation coefficient (MCC) and a well-balanced recall-precision profile. Moreover, the KC density and amplitude detected by AdaPatchFormer closely mirrored expert annotations. These results suggest that AdaPatchFormer is a robust, accurate, and objective algorithm for KC detection in elderly individuals, with the potential for supporting early and cost-effective identification of aMCI in real-world settings.

PMID:41550042 | DOI:10.1111/jsr.70285

Scand J Prim Health Care. 2026 Dec;44(1):2617522. doi: 10.1080/02813432.2026.2617522. Epub 2026 Jan 19.

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, the use of macrolides, specifically azithromycin, for respiratory tract infections (RTIs) in primary care increased in several countries. In Norway, antibiotic treatment of COVID-19 was never recommended.

OBJECTIVES: To investigate the antibiotic treatment for RTIs in Norwegian primary care, comparing pre-pandemic and pandemic periods.

METHODS: We defined RTI episodes and antibiotic treatment using several national registries including demographic and residency data from Statistics Norway, reimbursement claims from the Norwegian Registry for Primary Health Care, antibiotic dispensing from the Norwegian Prescription Database, and deaths from the Norwegian Cause of Death Registry, for the years 2018-2021.

RESULTS: Approximately 80% of the 4 904 376 total RTI episodes during the study period were handled exclusively in daytime general practice (DGP). Use of electronic consultations for RTI episodes increased from less than 1% to more than 50%. Throughout the study period, most RTI episodes were handled without antibiotic use. The antibiotic treatment rate for RTI episodes dropped during the pandemic, relative risk (RR) 0.52, 95% confidence interval (CI) 0.52-0.52, compared to pre-pandemic. Over half of all antibiotic treatments for RTIs were phenoxymethylpenicillin, and the distribution of antibiotic types was relatively stable during the study period, except for some temporary changes in the initial months of the pandemic. DGP handled most of the influx of RTIs during the first month of the COVID-19 pandemic in primary care, without increasing antibiotic use.

CONCLUSIONS: DGP handled most of the influx of RTIs during the initial phase of the COVID-19 pandemic in primary care. During the pandemic antibiotic treatment for RTIs was reduced, and the distribution of antibiotic types barely changed.

PMID:41550016 | DOI:10.1080/02813432.2026.2617522

J Bronchology Interv Pulmonol. 2026 Jan 19;33(2):e1054. doi: 10.1097/LBR.0000000000001054. eCollection 2026 Apr 1.

ABSTRACT

BACKGROUND: Bronchoscopy frequently precipitates intraprocedural hypoxemia. Although several recent randomized controlled trials suggest that high-flow nasal cannula oxygen (HFNO) reduces intraprocedural hypoxemia during bronchoscopy, the overall certainty of this evidence remains insufficient. Hence, we performed a systematic review and meta-analysis to compare the efficacy of HFNO with that of conventional low-flow oxygen therapy (COT) during adult bronchoscopy.

METHODS: MEDLINE, Embase, and trial registries were searched for randomized controlled trials (RCTs) involving adults (18 y or older) undergoing bronchoscopy that compared HFNO with COT. The primary outcome was the incidence of hypoxemia during the procedure. The key secondary outcomes were total procedure time, bronchoscopy interruption, and lowest intraprocedural peripheral oxygen saturation. The pooled risk ratios (RRs) or mean differences (MDs) were calculated, and the certainty of evidence was assessed. The protocol was registered with PROSPERO (CRD420251071548).

RESULTS: Eleven RCTs (12 study arms) comprising 1714 participants met the inclusion criteria. HFNO was found to significantly reduce the incidence of hypoxemic events compared with COT (RR: 0.39, 95% CI: 0.26-0.59) and lowered the likelihood of procedure interruption (RR: 0.39, 95% CI: 0.27-0.55). HFNO also maintained a higher nadir SpO2 (MD=4.5%, 95% CI: 3.02-5.99). No statistically significant difference was observed in the total procedure time (MD: -0.87 min, 95% CI: -1.99 to 0.25).

CONCLUSION: This meta-analysis showed HFNO reduces the incidence of intraprocedural hypoxemia and interruptions during bronchoscopy. Our findings support a selective approach, suggesting the benefits of HFNO are greater in high-risk patients.

PMID:41550007 | DOI:10.1097/LBR.0000000000001054

J Bronchology Interv Pulmonol. 2026 Jan 19;33(2):e1056. doi: 10.1097/LBR.0000000000001056. eCollection 2026 Apr 1.

ABSTRACT

BACKGROUND: Incidental pulmonary nodules (IPN) are nodules identified on imaging performed for a reason unrelated to the diagnosis of cancer. This study analyzes improvement in time-to-diagnosis for patients first presenting with an IPN that was later diagnosed as lung cancer through a formal IPN program.

METHODS: This is a 5-year retrospective, single-center analysis of outcomes for IPN patients diagnosed with lung cancer who presented through a formal IPN program (FIP) pathway compared with a matched group of patients diagnosed with lung cancer presenting through traditional IPN referral (TIR) pathway. The primary endpoint was time-to-diagnosis of lung cancer. A chart review was performed to determine the date of the initial CT scan identifying the IPN to the date of the procedure to diagnose lung cancer in the FIP group and the TIR group. The number of days from identification of the IPN to diagnosis was compared between the 2 groups.

RESULTS: Between May 2019 and May 2024, a total of 9303 patients were identified with IPNs through the formal IPN program. Ninety-six of these patients (1%) were diagnosed with cancer following nodule biopsy. Eighty-one of the patients (84%), making up the FIP group, were diagnosed with primary lung cancer. Twenty-one of the 81 primary lung cancer patients in the FIP group (27%) were diagnosed with early-stage disease and underwent curative resection. The average time from identification of an IPN to diagnosis of lung cancer in the FIP cohort was 43 days. The average time from identification of the IPN to diagnosis of lung cancer in the TIR cohort was 177 days. There was a 134-day difference between the 2 groups from identification of an IPN to diagnosis of lung cancer.

CONCLUSION: Implementation of a formal IPN program can reduce time-to-diagnosis of lung cancer in patients presenting with an IPN by 134 days compared with traditional referral patterns. Formal IPN programs can result in a shift towards an earlier stage of diagnosis for lung cancer.

PMID:41549999 | DOI:10.1097/LBR.0000000000001056