Category: Nevin Manimala

Arch Osteoporos. 2025 Jul 15;20(1):93. doi: 10.1007/s11657-025-01560-1.

ABSTRACT

In hip fracture patients with poor medication adherence, DMAB discontinuation significantly increased the risk of subsequent vertebral and rib fractures. Additionally, higher CCI scores were associated with an increased risk of these fractures. These findings underscore the importance of maintaining treatment adherence to minimize fracture risk in this vulnerable population.

PURPOSE: To assess the risk of major osteoporotic fractures and periprosthetic fractures in hip fracture patients who discontinued denosumab (DMAB) or zoledronic acid (ZOL).

METHODS: Data from the South Korean National Health Insurance Review and Assessment Service were analyzed, focusing on patients aged ≥ 60 years who underwent hip fracture surgery and initiated DMAB or ZOL treatment. Among 20,180 patients, 1737 discontinued DMAB, and 3720 discontinued ZOL. After 1:1 propensity score matching, 3240 patients were included in the final analysis. The DMAB group was stratified into three subgroups based on the cumulative DMAB duration after hip fracture surgery: 1-2, 2-3, and > 3 Y. Discontinuation was defined as a 270-day gap for DMAB or 540-day gap for ZOL last injections. Subsequent osteoporotic fractures after discontinuation were evaluated.

RESULTS: DMAB discontinuation significantly increased the risk of subsequent vertebral fractures (hazard ratio [HR] = 1.81; 95% confidence interval [CI], 1.28-2.56, P = 0.01) and rib fractures (HR = 2.04; 95% CI, 1.27-3.23, P = 0.004) compared to ZOL discontinuation. Higher Charlson Comorbidity Index (CCI) scores were also significantly associated with an increased risk of subsequent vertebral (HR 1.05, 95% CI 1.03-1.09, P = 0.02) and rib fractures (HR 1.12, 95% CI 1.06-1.19, P < 0.01). Although the incidence of hip fractures was lower in DMAB discontinuation group (1 case) than in the ZOL discontinuation group (10 cases), this difference did not reach statistical significance. No significant difference was observed in the risk of other nonvertebral fractures (humerus, wrist, ankle) and periprosthetic fracture between the two groups.

CONCLUSION: This nationwide study, the first to use real-world data, highlighted the significant increase in the risk of vertebral and rib fracture associated with DMAB discontinuation in patients with poor adherence and higher comorbidity burden. Optimizing medication adherence is crucial to minimize the fracture risk in this vulnerable population.

LEVEL OF EVIDENCE: Level III, Prognostic.

PMID:40663295 | DOI:10.1007/s11657-025-01560-1

Endocrine. 2025 Jul 15. doi: 10.1007/s12020-025-04354-0. Online ahead of print.

ABSTRACT

PURPOSE: Type 1 diabetes mellitus (T1D) is a chronic autoimmune disease frequently associated with other autoimmune diseases. This study aims to evaluate the prevalence of additional autoimmunity in adults with T1D and its association with glycemic control, chronic complications, and other comorbidities.

METHODS: We performed a cross-sectional study in adult patients with T1D, followed at the Endocrinology Department of a tertiary hospital, between May 2022 and May 2024. Clinical data collected included glycemic control (HbA1c and continuous glucose monitoring [CGM] parameters), diabetes complications, and other comorbidities. These parameters were compared according to the history of autoimmune diseases. Statistical analysis was performed using parametric and non-parametric tests, ANCOVA and logistic regression models, unadjusted and adjusted for age and sex.

RESULTS: Of the 439 participants (48.8% female and mean age 36.8 ± 14.1 years), 33.8% had at least one autoimmune disease, predominantly Hashimoto’s thyroiditis (28.8%) and celiac disease (3.9%), with higher prevalence in women (p < 0.001). HbA1c (7.7 ± 1.3 vs. 7.8 ± 1.4%, p = 0.53) and CGM-derived parameters, such as glucose management indicator (7.4 ± 0.9 vs. 7.4 ± 0.8%, p = 0.44) and time in range (58.7 ± 18.9 vs. 56.6 ± 16.5%, p = 0.84), were similar in patients with and without autoimmune diseases.

CONCLUSIONS: Over one fourth of patients with T1D had a concomitant autoimmune disease. Our results suggest that the presence of other autoimmune diseases may not preclude the attainment of similar glycemic targets. Given the high risk of autoimmunity in T1D, systematic screening and personalized treatment should be considered. Prospective studies are warranted to explore the long-term implications on metabolic control and cardiovascular outcomes.

PMID:40663292 | DOI:10.1007/s12020-025-04354-0

Clin Rheumatol. 2025 Jul 15. doi: 10.1007/s10067-025-07562-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients with idiopathic inflammatory myopathy (IIM) and anti-melanoma differentiation-associated protein 5 (anti-MDA5) antibodies are at significant risk (50-90%) of developing interstitial lung disease (ILD), with a reported mortality rate of 33-60%. Notably, the coexistence of anti-MDA5 and anti-Ro52 antibodies is associated with a more severe ILD prognosis than that of anti-MDA5 antibodies alone. The aim of this study was to investigate the serological characteristics of ILD in patients with IIM who possess anti-MDA5 antibodies, with or without concurrent anti-Ro52 antibodies.

METHODS: We retrospectively collected data from 32 patients diagnosed with anti-MDA5-positive IIM between May 2018 and December 2022. We reviewed these patients’ clinical manifestations, serological parameters, HRCT images and outcomes. We compared the difference between the patients with and without anti-Ro-52 antibodies.

RESULTS: Of the 32 patients with IIM and anti-MDA5 antibodies, 16 tested positive for anti-Ro52 antibodies. Patients positive for both autoantibodies had a higher prevalence of ILD (81.25% vs. 43.75%, p = 0.028), a higher frequency of ground-glass opacity (100% vs. 42.85%, p = 0.002) of HRCT findings, higher C-reactive protein levels (2.9 vs. 1.4 mg/L, p = 0.038), and were older (54.2 vs. 42.1 years, p = 0.021) than those without. Patients who were positive for the coexistence of anti-MDA5 and anti-Ro52 antibodies tended to have a lower survival rate, although this difference was not statistically significant (p = 0.124).

CONCLUSION: Individuals with IIM coexistence of anti-MDA5 and anti-Ro52 antibodies may experience a greater inflammatory response, higher ILD frequency, and poorer prognosis than those without.

KEY POINTS: • The coexistence of anti-MDA5 and anti-Ro52 antibodies in a small cohort of patients with IIM was found to be associated with a higher overall inflammatory features, including the presence of interstitial lung disease. • Coexistence of these antibodies and interstitial lung disease particularly relating to the radiological findings of ground glass opacities can be helpful in providing insights into evaluation and diagnostic pathways for clinicians. • A trend for a lower survival rate was observed for patients with the presence of these two antibodies than anti-MDA5 antibody alone.

PMID:40663261 | DOI:10.1007/s10067-025-07562-1

Langenbecks Arch Surg. 2025 Jul 15;410(1):222. doi: 10.1007/s00423-025-03799-1.

ABSTRACT

BACKGROUND: The impact of anastomotic leakage (AL) on quality of life (QoL) following low anterior resections (LAR) remains a pressing concern, particularly as advancements in surgical techniques and multimodal treatments have resulted in an increasing number of survivors.

METHODS: This study evaluated how AL affected health-related QoL in patients treated at the Department of Surgery, University hospital Mannheim of Heidelberg University from 2010 to 2021, utilizing the LARS score, the EORTC QLQ-C30, and the EORTC QLQ-CR29 questionnaires.

RESULTS: The study included 20 patients in each group, with those having AL matched 1:1 to control subjects without AL, based on criteria such as age, gender, comorbidities, tumor location, and resection degree. Both groups showed impaired QoL in EORTC assessments, with no statistically significant differences except in the abdominal pain scale of EORTC QLQ-CR29, which was higher for AL patients (19.99 ± 22.68 vs. 6.66 ± 17.43; p = 0.03). Comparison of QoL between patients who received neoadjuvant radiotherapy and those who did not, independent of AL, revealed significantly reduced QoL in several scales of both the EORTC QLQ-C30 and QLQ-CR29 assessments. A statistically significant worsening of QoL was observed in the sore skin domain (36.66±34.81 for RT vs. 3.70±11.11 without RT; p = 0.02) of the EORTC QLQ-CR29 among AL patients who received neoadjuvant radiotherapy. AL patients treated with Endoscopic Vacuum Therapy (EVT) showed improved QoL.

CONCLUSIONS: AL alone does not appear to be an independent risk factor for impaired QoL after LAR for rectal cancer. However, the combined effect of AL and neoadjuvant radiotherapy may contribute to worse functional outcomes, significantly impacting QoL. Effective AL management with EVT can help mitigate these effects and improve patient outcomes.

PMID:40663260 | DOI:10.1007/s00423-025-03799-1

Neurosurg Rev. 2025 Jul 15;48(1):567. doi: 10.1007/s10143-025-03686-9.

ABSTRACT

BACKGROUND AND OBJECTIVE: Cerebrospinal fluid leaks or fistulas are a relatively common neurosurgical pathology. Classically, this condition has been managed through an open surgical approach, but endoscopic surgery has emerged as a less invasive alternative with several advantages. Despite this, no meta-analysis has yet directly compared the clinical outcomes of these two management strategies.

METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. The PubMed, Embase, LILACS and Web of Science databases were rigoursly searched. Post-operative repair success rate, risk of recurrence and the risk of presenting any operation-related compilation and the all-cause mortality rate were analyzed. Data were analyzed using a common-effects meta-analysis, and statistical heterogeneity was assessed. The study was registered with PROSPERO (CRD42024606877).

RESULTS: Seven studies comprising 360 patients (140 endoscopic, 220 open) were included. Although the point estimate suggested a higher success rate with endoscopic repair, the difference was not statistically significant OR 1.32 (95% CI 0.55-3.16, I2 = 4.4%). The complication rate was significantly lower in the endoscopic group OR 0.26 (95% CI 0.10-0.67, I2 = 38%) and a leave-one-out analysis excluding the study by Gassner et al. found OR 0.10 (95% CI 0.03-0.32, I2 = 0%). Recurrence of CSF fistulas showed a trend favoring endoscopic repair (OR 0.78, 95% CI 0.42-1.43, I2 = 0%). No mortality was reported.

CONCLUSIONS: Endoscopic CSF fistula repair demonstrates a superior safety profile and is non-inferior in terms of efficacy compared to open surgery. Given the limited number of high-quality studies, further research is needed and larger, well-designed studies are recommended to refine clinical decision-making and optimize patient care.

PMID:40663243 | DOI:10.1007/s10143-025-03686-9

Jpn J Radiol. 2025 Jul 15. doi: 10.1007/s11604-025-01832-3. Online ahead of print.

ABSTRACT

BACKGROUND: Autism spectrum disorder (ASD) affects social interaction, communication, and behavior. Early diagnosis is important as it enables timely intervention that can significantly improve long-term outcomes, but current diagnostic, which rely heavily on behavioral observations and clinical interviews, are often subjective and time-consuming. This study introduces an AI-based approach that uses T1-weighted structural MRI (sMRI) scans, network analysis, and vision transformers to automatically diagnose ASD.

METHODS: sMRI data from 79 ASD patients and 105 healthy controls were obtained from the Autism Brain Imaging Data Exchange (ABIDE) database. Complex network analysis (CNA) features and ViT (Vision Transformer) features were developed for predicting ASD. Five models were developed for each type of features: logistic regression, support vector machine (SVM), gradient boosting (GB), K-nearest neighbors (KNN), and neural network (NN). 25 models were further developed by federating the two sets of 5 models. Model performance was evaluated using accuracy, area under the receiver operating characteristic curve (AUC-ROC), sensitivity, and specificity via fivefold cross-validation.

RESULTS: The federate model CNA(KNN)-ViT(NN) achieved highest performance, with accuracy 0.951 ± 0.067, AUC-ROC 0.980 ± 0.020, sensitivity 0.963 ± 0.050, and specificity 0.943 ± 0.047. The performance of the ViT-based models exceeds that of the complex network-based models on 80% of the performance metrics. By federating CNA models, the ViT models can achieve better performance.

CONCLUSION: This study demonstrates the feasibility of using CNA and ViT models for the automated diagnosis of ASD. The proposed CNA(KNN)-ViT(NN) model achieved better accuracy in ASD classification based solely on T1 sMRI images. The proposed method’s reliance on widely available T1 sMRI scans highlights its potential for integration into routine clinical examinations, facilitating more efficient and accessible ASD screening.

PMID:40663220 | DOI:10.1007/s11604-025-01832-3

Rheumatol Int. 2025 Jul 15;45(8):171. doi: 10.1007/s00296-025-05918-z.

ABSTRACT

BACKGROUND: Serum ferritin has been proposed as biomarker of interstitial lung disease (ILD) in anti-MDA5 dermatomyositis (DM). Nevertheless, no data exist for serum ferritin in other idiopathic inflammatory myopathies (IIM)-ILD nor in IIM without ILD. Aim of this case-control study was to assess whether serum ferritin may be considered a specific and sensitive biomarker for IIM-ILD, as well as to assess whether it correlates with clinical and immunological findings.

PATIENTS AND METHODS: All patients affected by IIM and followed at Siena (Italy), Palermo (Italy), Bari (Italy) and Lucknow, (India) IIM referral centers were retrospectively included. They had diagnosis of DM and ASS, with and without ILD. Myositis specific or myositis associated antibodies were tested through line immunoassay (Euroimmune, Lubeck, Germany). Serum ferritin concentrations at the first assessment (T0) were detected by ChemiLuminescent Enzyme Immunoassay technology.

RESULTS: A total of 139 IIM patients (study cohort n = 51 and validation cohort n = 88; mean age and standard deviation 44.3 ± 17.75) were included. The most common subtype was DM (n = 70, 50.3%), followed by ASS (n = 50, 35.9%). The three most common MSAs were MDA5 (n = 25, 18%), Jo1 (n = 25, 18%) and Mi2 (n = 10, 7%). ILD was assessed in 69 subjects. Ferritin values were higher in DM-MDA5 than DM-non-MDA5 (p = 0.0073) and ASS (p = 0.0006). All 69 patients affected by ILD were subsequently divided showing statistically significant difference for ferritin (p = 0.0013).

CONCLUSION: Our study included a huge number of patients from multicenter datasets, comprising patients of different ethnicities. Ferritin values lower than 303.5 ng/ml evaluated for the first time in a patient with suspected IIM and ILD, waiting for autoimmunity tests, allowed to exclude MDA5-DM. The strength of our findings was corroborated by binomial logistic regression, which proved the independence of ferritin from CPK and CRP to identify DM-MDA5-ILD. Such evidence allows to exclude that ferritin values are influenced by systemic inflammation.

PMID:40663209 | DOI:10.1007/s00296-025-05918-z

Lasers Med Sci. 2025 Jul 15;40(1):317. doi: 10.1007/s10103-025-04509-5.

ABSTRACT

Leprosy, when diagnosed late, often leads to persistent complications, including neuropathic pain due to Mycobacterium leprae infection. This study aimed to apply a physiotherapeutic protocol combined with photobiomodulation as a non-pharmacological resource to reduce neuropathic pain and maintain functional capacity in leprosy patients.

METHODS: A double-blind randomized clinical trial was conducted with 30 leprosy patients. Patients were randomly divided into two groups: physiotherapeutic protocol (PPG) and physiotherapeutic protocol combined with photobiomodulation (PPBMG). They were analyzed for simplified neurological assessment (SNA), pain scale (VAS), screening of activity limitation and safety awareness (SALSA), participation scale, and quality of life survey (SF-36).

RESULTS: In the SALSA, a reduction in the number of patients with severe limitation was observed in PPBMG (effect size, 0.24). In participation scale, there was an increase in the number of patients without restrictions in PPBMG. Regarding VAS, there was improvement in both groups (PPG, P = 0.0061; PPBMG, P = 0.041), with no difference between them. In relation to neurological evaluation by nerve palpation, there was improvement in the ulnar nerve condition (P = 0.0244) in PPG group, and in the fibular nerve (P = 0.0425) in PPBMG group. In the functional assessment, PPBMG patients showed statistical differences with improvement in the median (P = 0.0281) and tibial (P = 0.0267) nerves. In the SF-36, there was an increase in the domains of physical limitations (PPG, P = 0.0273; and PPBMG, P = 0.0078) and pain (PPG, P = 0.0156; and PPBMG, P = 0.0020; effect size, 0.34).

CONCLUSION: This study provides relevant evidence for the efficacy of PPBMG in treating neuropathic pain in leprosy patients.

PMID:40663207 | DOI:10.1007/s10103-025-04509-5

Eur J Pain. 2025 Aug;29(7):e70080. doi: 10.1002/ejp.70080.

ABSTRACT

BACKGROUND: Chronic pain is a prevalent condition that disproportionately affects women, significantly impairing their functioning. Understanding its prevalence and impact is essential for designing effective interventions. This study aimed to determine the prevalence of chronic pain among women and assess its effects on functioning.

METHODS: This cross-sectional analysis utilised data from the National Study on Disability (ENDISC-2022) in Chile, focusing on women aged 18 years and older. Chronic pain was assessed through self-reported data, and functioning was evaluated using performance indicators derived from the Model Disability Survey (MDS). Generalised Linear Models (GLM) were applied to examine associations with sociodemographic and psychosocial variables, and stratified analyses compared women with and without chronic pain.

RESULTS: Among the 30,010 participants in the ENDISC study, 14.8% reported chronic pain, with 67.1% of those affected being women. Women experiencing chronic pain exhibited significantly poorer performance scores across all evaluated domains compared to their counterparts without pain. The GLM regression analysis revealed that women with chronic pain had a significantly higher risk of worse functioning scores compared to those without chronic pain.

CONCLUSIONS: Sociodemographic factors such as age, education level, and employment status further influenced outcomes, underscoring the vulnerability of women with chronic pain. Chronic pain is a significant and pervasive issue among women in Chile, markedly impairing their functioning and well-being. Gender-sensitive approaches and policies are crucial to reducing the burden of chronic pain and improving the quality of life for affected women, particularly those in vulnerable sociodemographic groups.

SIGNIFICANCE: The findings highlight the need for targeted interventions that address the multifaceted nature of chronic pain, including its physical, psychological, and social dimensions in women with pain and a more sensitive look at the difficulties encountered by this population, such as work issues.

PMID:40662308 | DOI:10.1002/ejp.70080

Health Promot Int. 2025 Jul 1;40(4):daaf062. doi: 10.1093/heapro/daaf062.

ABSTRACT

The Active School Flag (ASF) is a multi-stage, multi-component, whole-of-school physical activity (PA) programme. This study explored relationships between Irish adolescents’ health literacy, PA knowledge, beliefs and awareness and their efforts to communicate PA messages. Schools (n = 17) newly enrolled in the ASF programme were invited to participate in a mixed methods study. A questionnaire assessing adolescents’ health literacy, PA knowledge and beliefs about the consequences of behaviour, and ASF programme awareness was completed in five schools. Statistical analysis involved a hierarchical multiple linear regression. Focus groups (n = 11) were conducted with ASF programme implementers in ten schools to understand current practices of communicating PA messages. Data were analysed using a reflexive thematic analysis. Males comprised 62.3% of the sample (N = 483), and 57.1% were junior students (1st-3rd year). The overall model significantly predicted adolescents’ health literacy, F(4, 464) = 56.241, P < .001. Gender (B = -1.09, P = .02), knowledge of PA (B = 0.4, P = .04), and beliefs about the consequences of behaviour (B = 2.3, P < .001) were significant predictors of health literacy, accounting for 33.2% of the variance. Challenges included low awareness of, engagement with, and maximizing support for implementing ASF. The gap identified between the messages communicated and awareness of ASF requires further research to develop an effective, structured, and standardized PA communication plan for schools to facilitate policy and practice. Improving adolescents’ knowledge and beliefs about the consequences of PA could improve overall health literacy levels. Therefore, providing support and guidance to whole-of-school programme implementers for communicating PA messages will help influence practice and policy.

PMID:40662281 | DOI:10.1093/heapro/daaf062