Nevin Manimala

Eur J Orthop Surg Traumatol. 2025 Jul 20;35(1):310. doi: 10.1007/s00590-025-04436-9.

ABSTRACT

OBJECTIVES: To examine hemoglobin trends following isolated femoral shaft fractures (FSF) and characterize patient profiles associated with transfusion needs for optimized patient management.

METHODS: Design: Retrospective cohort study.

SETTING: Level 1 trauma center. Patient Selection Criteria: Patients aged > 18 years undergoing isolated femur fracture fixation (ICD-10 and CPT 27506). Outcome Measures and Comparisons: Hemoglobin (Hgb) was recorded at the ER, pre-operatively, and daily post-operatively and compared to baseline Hgb (pre-injury or ≥ 3 months post-injury). Total Hgb loss was calculated, correcting for transfusions. Demographics, injury mechanism (high/low energy), number of transfusions, and length of stay were collected. SPSS was used for analysis.

RESULTS: 540 patients were included. Baseline Hgb was 14.6 g/dL for males and 13.1 g/dL for females. Post-injury Hgb decreased to 13.8 g/dL and 11.9 g/dL, respectively. 48.5% of patients required transfusion (40.7% males, 61% females, p = 0.001). The age threshold for increased risk of receiving a transfusion was 60 years old. Patients between the ages of 60-80 had a higher rate of transfusions (65.94%) when compared to patients between the ages of 40-60 (38.38%). 80.49% of patients above the age of 80 received a transfusion and were 6.2 times more likely to receive a transfusion compared to patients under 40. The median length of stay (LOS) of a patient receiving a transfusion was 4 days, while the median LOS for a patient not receiving a transfusion was 2 days.

CONCLUSIONS: Hemoglobin (Hgb) progressively declines after femoral shaft fractures (FSFs), with the most significant drop occurring post-operatively. Older age and female sex were associated with increased transfusion needs. Transfusion is associated with an increase in the LOS. These findings emphasize the importance of monitoring Hgb trends and considering age and injury mechanisms when assessing transfusion risk in FSF patients.

LEVEL OF EVIDENCE: Prognostic Level III.

PMID:40684417 | DOI:10.1007/s00590-025-04436-9

J Robot Surg. 2025 Jul 20;19(1):405. doi: 10.1007/s11701-025-02489-w.

ABSTRACT

Robotic-assisted surgery has transformed hernia repair by improving precision, minimizing postoperative complications, and accelerating recovery. This study evaluates three robotic techniques-robotic transabdominal preperitoneal (rTAPP), robotic Rives (rRives), and robotic transabdominal retromuscular umbilical prosthetic (rTARUP)-for treating primary ventral and incisional hernias. Following PRISMA guidelines, a systematic review and meta-analysis were conducted. Databases such as PubMed, Embase, Cochrane Library, and Web of Science were searched for studies comparing rTAPP, rRives, and rTARUP. Key outcomes included recurrence rates, surgical duration, and postoperative complications, with secondary outcomes assessing hospital stay and cost-effectiveness. Statistical analyses were performed using RevMan 5.4 and STATA 16, calculating pooled odds ratios (OR) and mean differences (MD). Heterogeneity was measured via I² statistics, and publication bias was evaluated using the Egger test. The analysis included 18 studies encompassing 1,500 patients. rTAPP showed shorter operative times (MD: – 25.3 min, 95% CI: – 30.1 to – 20.5, *p* < 0.05) and reduced recurrence rates (OR: 0.45, 95% CI: 0.30-0.68, *p* < 0.01) compared to rRives and rTARUP. However, rTARUP was linked to fewer postoperative complications (OR: 0.65, 95% CI: 0.50-0.85, *p* < 0.05). No significant publication bias was detected (Egger test, *p* = 0.12). Robotic hernia repair techniques offer unique benefits: rTAPP is more efficient, while rTARUP reduces complications. These results emphasize the need for personalized surgical approaches.

PMID:40684413 | DOI:10.1007/s11701-025-02489-w

Cardiovasc Toxicol. 2025 Jul 20. doi: 10.1007/s12012-025-10044-0. Online ahead of print.

ABSTRACT

There have been concerns about potential adverse cardiovascular (CV) events associated with prokinetics that enhance gastrointestinal (GI) motility. To evaluate whether prokinetics use was associated with increased CV risk. We conducted a self-controlled case series (SCCS) study using the National Health Claims Database in South Korea. Age-adjusted incidence rate ratios (IRR) for the development of CV events (composite of myocardial infarction and stroke) were estimated by comparing the incidence during the risk period with prokinetics and the control period without prokinetics. This SCCS study included 15,621 participants who experienced CV events and exposure to prokinetics between 2004 and 2019. The risk period with prokinetics had a significantly increased risk for CV events compared to the control period (IRR 1.56, 95% CI 1.48-1.66). When the risk period was categorized according to the time from initiation of prokinetics, CV risk was highest in the first 7 days (IRR 2.29, 95% CI 2.13-2.47), and declined to non-significance in ≥ 15 days (IRR 1.03, 95% CI 0.94-1.13). In the analysis according to the class of prokinetics, CV risk was highest in the order of central dopamine type 2 (D2) receptor antagonist (IRR 2.14, 95% CI 1.95-2.34), peripheral D2 receptor antagonist (IRR 1.37, 95% CI 1.24-1.51), and selective 5-hydroxytryptamine 4 receptor agonist (IRR 1.29, 95% CI 1.17-1.42). The use of prokinetics was associated with an increased risk of CV adverse events, particularly in the early period following initiation of central D2 receptor antagonists.

PMID:40684411 | DOI:10.1007/s12012-025-10044-0

Pediatr Cardiol. 2025 Jul 20. doi: 10.1007/s00246-025-03955-w. Online ahead of print.

ABSTRACT

Pulmonary vein stenosis (PVS) in pediatric patients is associated with significant morbidity and requires repeated transcatheter interventions to maintain pulmonary vein patency. While these procedures can improve clinical outcomes, they come with inherent risks, and data on safety and post-procedural outcomes are limited. This single-center, retrospective study included pediatric patients who underwent transcatheter interventions for PVS between 2015 and 2024. Data were collected on patient demographics, procedural details, post-procedure disposition, adverse events (AEs), and hospital length of stay. Statistical analysis was performed to identify predictors of AEs. A total of 224 catheterization procedures were performed on 67 children with PVS. The overall AE rate was 11%, with the most common events including puncture site bleeding (5 cases), followed by pulse loss (4 cases), pulmonary hemorrhage (3 cases), stent embolization (3 cases), cerebrovascular accident (2 cases), contained vascular tear of pulmonary veins (2 cases), heart block (2 cases), supraventricular tachycardia (SVT, 2 cases), intra-abdominal hemorrhage associated with transhepatic access (1 case), and ST-segment changes (1 case). Despite these risks, most patients, particularly those treated on an outpatient basis, experienced short hospital stays. Operator experience and multidisciplinary care were critical in optimizing safety and outcomes. No statistically significant predictors of AEs were identified. Percutaneous interventions for PVS can be performed safely with strict adherence to standardized protocols, allowing for a controlled rate of complications despite increasing case volumes. While serious AEs such as cerebrovascular events and pulmonary hemorrhage remain a concern, targeted strategies may contribute to improved safety outcomes.

PMID:40684406 | DOI:10.1007/s00246-025-03955-w

Eur J Orthop Surg Traumatol. 2025 Jul 20;35(1):311. doi: 10.1007/s00590-025-04421-2.

ABSTRACT

BACKGROUND: There is growing but so far inconclusive evidence about the value of three-dimensional (3D) fluoroscopy in calcaneal fracture care. The aim of this study was to retrospectively review our own cohort of calcaneus fractures before and after the implementation of 3D fluoroscopy and compare their outcome in terms of quality of reduction and amendments made based on the additional information gained by 3D imaging.

METHODS: Between March 2012 and October 2022, we operated on 28 calcaneal fractures in 25 patients of whom eight were treated with the aid of 3D fluoroscopy (= hybrid group). In all cases, a sinus tarsi approach (STA) and an angular stable plate were used. Intra- and postoperative scans were analyzed based on the Delphi Consensus criteria evaluating quality of reduction and radiographic outcome. Statistical analyses were performed to check for statistical significance and inter-rater reliability.

RESULTS: We found no difference between the two groups (one group treated with conventional fluoroscopy and the other with 3D fluoroscopy) in terms of quality of reduction and radiographic outcome. Nevertheless, in more than half of our patients in the hybrid group, amendments were made based on the information gained through 3D fluoroscopy. Median radiation dose and surgical time was prolonged in the hybrid group but not leading to an increased infection rate.

CONCLUSION: We found satisfactory outcomes in osteosynthesis of calcaneus fractures using the STA, regardless of whether conventional or 3D fluoroscopy was used intraoperatively. However, no significant improvement due to usage of intraoperative 3D fluoroscopy imaging in terms of restoration of the anatomy and quality of reduction could be found. Nevertheless, 3D fluoroscopy helps to avoid revision surgeries due to intra-articular placed screws and does not seem to lead to more cases of infection despite slightly prolonged operation times.

PMID:40684401 | DOI:10.1007/s00590-025-04421-2

Disabil Rehabil. 2025 Jul 20:1-14. doi: 10.1080/09638288.2025.2534090. Online ahead of print.

ABSTRACT

PURPOSE: Early rehabilitation can support functional recovery and prevent deconditioning in hospital, though practice remains variable. This study aimed to evaluate an emerging model for delivering early, multidisciplinary rehabilitation parallel to acute specialist medical care; in-reach rehabilitation.

METHODS: Consecutive in-reach rehabilitation episodes delivered as part of standard care at a tertiary hospital between 2015-2023 were included in a retrospective evaluation. Routine data including case characteristics, rehabilitation goals and functional independence before and after in-reach rehabilitation were extracted from records and analyzed via descriptive statistics and mixed-effects linear modeling.

RESULTS: 967 participants were included (64% male, mean age 58.4 ± 15.4 years). In-reach episodes were delivered over a median 11 [7-18] days for heterogenous diagnoses, most commonly reconditioning (31.3%), cardiopulmonary transplant (22.1%), and neurological impairments (20.1%). Functional Independence Measure scores increased with in-reach rehabilitation (mean gain 24.0 points [95% CI 22.9-25.1]); with younger age, earlier in-reach commencement and certain diagnoses associated with larger gains in multivariable modeling. In-reach goals prioritized activities and participation, with high observed goal attainment (90.5%).

CONCLUSIONS: In-reach rehabilitation is feasible in an acute general hospital setting for patients with heterogenous diagnoses. In-reach rehabilitation was associated with functional improvements and high rates of goal attainment in routine care.

PMID:40684378 | DOI:10.1080/09638288.2025.2534090

Equine Vet J. 2025 Jul 20. doi: 10.1111/evj.14558. Online ahead of print.

ABSTRACT

BACKGROUND: Strangles (Streptococcus equi infection) remains endemic in the UK, with ~300 laboratory diagnoses annually. Sub-clinically infected long-term carriers are considered a key driver of endemicity. Analysing genomes of circulating strains could provide valuable transmission insights of this pathogen.

OBJECTIVES: To determine the population structure and diversity of UK S. equi isolates and to model transmission using epidemiological and whole genome sequencing data.

STUDY DESIGN: Retrospective cross-sectional epidemiological and genomic surveillance.

METHODS: A dated phylogenetic tree derived from 511 S. equi isolates collected from UK horses between 2015 and 2022 was reconstructed. Bayesian Analysis of Population Structure (BAPS) identified clusters of related genomes, while iGRAPH identified clusters of sequences appropriate for transmission analysis, performed using Transphylo.

RESULTS: BAPS identified nine groups, with 82% of strains clustering into two (McG-BAPS3, McG-BAPS5). A statistically significant association (p < 0.001) was found between the year of recovery and trends in the frequency of McG-BAPS groups, with McG-BAPS3 increasing and McG-BAPS5 decreasing in prevalence over the study period. Eight transmission clusters encompassing 64% of total sequences (n = 286/447) underwent analysis. Sixteen direct transmission pairs were identified; 10 were between horses from different UK regions. A transmission chain extending over a 6-month period was inferred from isolates from nine horses.

MAIN LIMITATIONS: Bacterial strains from sub-clinically infected carrier horses may be underrepresented due to data collection via positive laboratory diagnoses. Furthermore, a low sampling proportion relative to overall UK cases provided only a snapshot of broader, unsampled transmission events.

CONCLUSIONS: The rapid change in S. equi population structure indicates acutely infected/recently convalesced short-term carrier horses play a more influential role in transmission than long-term carriers. Our work provides novel insights to our understanding of S. equi transmission dynamics. Transmission of genetically related strains across diverse regions suggests a real-time sequence-based surveillance system could inform interventions to minimise transmission.

PMID:40684376 | DOI:10.1111/evj.14558

Equine Vet J. 2025 Jul 20. doi: 10.1111/evj.70000. Online ahead of print.

ABSTRACT

BACKGROUND: Early and specific diagnosis of bronchopneumonia in foals is important to prevent severe disease. In human medicine, C-reactive protein (CRP) and interleukin-6 (IL-6) are important diagnostic and prognostic biomarkers in neonatal pneumonia in other species. Evaluation of these markers in foals with naturally occurring respiratory diseases is lacking.

OBJECTIVES: To determine if CRP and IL-6 were useful predictors of respiratory disease in foals from birth to weaning.

STUDY DESIGN: Prospective cohort study.

METHODS: Periodic blood samples from 200 initially healthy foals were collected from birth to weaning on a farm with endemic Rhodococcus equi and Streptococcus equi pneumonia. The foals were examined weekly by physical examination and trans-thoracic ultrasonography to determine the presence or absence of pulmonary consolidation and were divided into three groups after weaning: (1) foals that remained healthy; (2) foals that developed subclinical, mild, self-limiting pulmonary lesions; and (3) foals that developed severe pulmonary lesions and clinical pneumonia that required antimicrobial treatment. Thirty foals from each health group (N = 90 total foals) were randomly selected from the 200 initially enrolled for assessment of associations between CRP and IL-6 concentrations and health status. Data were analysed using linear mixed models, with p-values < 0.05 considered statistically significant.

RESULTS: Age-related changes were found in both plasma CRP and IL-6 concentrations. Circulating concentrations of CRP were increased through weaning, while plasma IL-6 concentrations decreased through weaning. Respiratory disease did not significantly impact concentrations of CRP or IL-6 at any age.

MAIN LIMITATIONS: Timing of sample collection, small sample size.

CONCLUSIONS: Neither IL-6 nor CRP concentrations were suitable predictors of subclinical or clinical bronchopneumonia in foals in this study. Further studies are needed to determine if more frequent measurement of these markers in foals at the time of pneumonia diagnosis provides helpful diagnostic or prognostic information.

PMID:40684375 | DOI:10.1111/evj.70000

Foot Ankle Int. 2025 Jul 20:10711007251351317. doi: 10.1177/10711007251351317. Online ahead of print.

ABSTRACT

BACKGROUND: Isolated gastrocnemius tightness is associated with several foot conditions. The Silfverskiöld test examines for such tightness, and when assessing passive ankle dorsiflexion it is important to perform the examination with the proper technique. Several studies have reported reproducible examination techniques, yet none, to our knowledge, have evaluated whether measurement side-medial or lateral-affects dorsiflexion values. Understanding measurement consistency is crucial for clinical practice and research standardization. We have undertaken a study investigating whether this is of importance and assessed the repeatability of ankle dorsiflexion measurements.

METHODS: We performed an exploratory cross-sectional examination of 145 pediatric patients (290 feet) with a 2-person 2-hand Silfverskiöld test. Masked, repeated goniometric measurements were undertaken along both the medial and lateral axis of the leg and foot.

RESULTS: There was a small systematic difference between medial and lateral measurements where lateral measurements were on average almost 2 degrees more in equinus. The repeatability coefficient for all repeated measurements ranged from 5.1 to 5.5 degrees. The intraclass correlation coefficient between medial and lateral measurements was excellent (ICC = 0.97).

CONCLUSION: We found a small systematic difference of 2 degrees between medial and lateral measurements that was less than the repeatability coefficient. The repeatability coefficient was 5 degrees, meaning that for ankle dorsiflexion measurements it is unlikely that a second measurement will differ more than 5 degrees. We do not believe that the statistically significant small difference between medial and lateral measurements is clinically relevant; however, it makes sense to consistently measure ankle dorsiflexion on either the medial or lateral side.

PMID:40684368 | DOI:10.1177/10711007251351317

Egypt J Immunol. 2025 Jul;32(3):66-80. doi: 10.55133/eji.320308.

ABSTRACT

Inflammatory bowel disease (IBD) is a class of chronic inflammatory disorders including, Crohn’s disease (CD) and ulcerative colitis (UC). The PTPN22 gene is thought to be a T-cell negative regulator, regulates immune cell activation, and an important risk factor for human autoimmunity. This study aimed to investigate the potential association of PTPN22 gene single nucleotide polymorphisms (SNPs) with inflammatory bowel disease in Egyptian patients and their relation to clinical disease characteristics. Three SNPs in the PTPN22 gene (-1123G/C, +788G/A, and +1858C/T) were investigated in 90 IBD patients (19 with CD and 71 with UC) and 81 apparently healthy controls. These 3 polymorphisms were genotyped by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Allele and genotype frequencies were correlated with disease association and with clinical disease characteristics. No statistically significant differences in the genotype and allele frequencies of the PTPN22 gene SNPs (-1123G/C, +788G/A, and +1858C/T) were found between IBD patients and control subjects. In conclusion although the PTPN22 gene is involved in autoimmune diseases, it does not appear to be associated with IBD predisposition or its clinical characteristics in Egyptians.

PMID:40684363 | DOI:10.55133/eji.320308