Category: Nevin Manimala

Eur J Orthop Surg Traumatol. 2025 Feb 25;35(1):76. doi: 10.1007/s00590-025-04183-x.

ABSTRACT

OBJECTIVE: The purpose of this study was to determine the association of hypoalbuminemia with adverse outcomes in patients undergoing surgical repair of nonunions or malunions of upper and lower extremity long bones.

METHODS: DESIGN: Retrospective.

SETTING: Hospitals participating in American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2005 to 2019.

PATIENTS: Patients in the ACS-NSQIP database with upper extremity and lower extremity fractures who underwent nonunion or malunion repairs and had preoperative serum albumin levels. Outcome Measures and Comparisons: Demographic variables, comorbidities and postoperative complications were collected and compared using t tests and chi squared tests. Multivariate linear regression models were used to assess complications, adjusting for variables such as age, sex, BMI, hospital length of stay, and operation time.

RESULTS: Univariate analysis of 1640 total patients (338 [20.6%] with hypoalbuminemia and 1302 [79.4%] with normal albumin) showed patients with hypoalbuminemia had significantly increased 30-day mortality rates, increased lengths of stay, and returns to the operating room. Multivariate analysis showed patients with hypoalbuminemia had significantly greater odds for any complication (OR: 2.62; 95% CI [1.77, 3.84]; p < 0.001), surgical site infections (OR: 2.62; 95% CI [1.34, 4.99]; p = 0.004) and transfusions (OR: 2.77; 95% CI: [1.62, 4.69]; p < 0.001) compared to the normal albumin group.

CONCLUSIONS: There was a significant difference in 30-day postoperative complications between patients with normal albumin levels and those who were hypoalbuminemic after surgical repairs of nonunions or malunions. Albumin level is a risk factor that should be monitored and counseled upon prior to surgical intervention for nonunion or malunion correction.

LEVEL OF EVIDENCE: Level III Retrospective Comparative Study.

PMID:39998685 | DOI:10.1007/s00590-025-04183-x

World J Urol. 2025 Feb 25;43(1):139. doi: 10.1007/s00345-025-05517-4.

ABSTRACT

AIM: This study aims to evaluate the success rate of Shock Wave Lithotripsy (SWL) in treating kidney stones using the Modulith SLK Inline lithotripter, with a focus on the importance of device efficacy as emphasized in EAU guidelines.

PATIENTS AND METHODS: This retrospective single-center study was conducted between June 2023 and June 2024. Inclusion criteria were adult patients (> 18 years) with radiologically confirmed renal stones smaller than 15 mm in diameter. Exclusion criteria included patients with solitary kidneys, significant renal functional deterioration, skeletal deformities, active urinary tract infections, pregnancy, or coagulopathies. Treatment outcomes were collected and analyzed in detail, considering patients’ demographic characteristics (age, gender) and stone parameters (size, location, and hardness [Hounsfield Unit, HU]). The SWL procedures were performed using the Modulith SLK Inline lithotripter (Storz Medical, Switzerland). The success of SWL was defined as achieving complete stone clearance or the presence of clinically insignificant residual fragments (CIRF) (< 4 mm). This study seeks to provide detailed insights into the optimal use cases of SWL as a non-invasive yet effective treatment option for smaller, more manageable stones.

RESULTS: The mean age of the 208 patients included in the study was 42.2 ± 12.7 years (18-75), with a male-to-female ratio of 1.9:1. The mean stone size across all patients was 10.3 mm, and the average HU value was 874.0 ± 283.2. Patients who achieved a completely stone-free status had significantly lower HU values (p = 0.049). The overall success rate of SWL was 78.8%, with 164 patients achieving complete stone clearance. When cases with clinically insignificant residual fragments (CIRF, < 4 mm) were included as successful outcomes, the overall success rate increased to 92.3%. This distinction highlights the inclusion of patients with small residual fragments that are deemed clinically irrelevant in the adjusted success rate. In cases with successful outcomes, the mean stone size was 10.3 mm, whereas it was 12.5 mm in patients with residual fragments or treatment failure. A statistically significant relationship was identified between stone size and treatment success rates (p < 0.001). In contrast, stone localization did not have a significant impact on SWL success rates (p = 0.377).

CONCLUSIONS: SWL has demonstrated its effectiveness in kidney stone treatment with a 78.8% complete stone-free rate using the Modulith SLK Inline lithotripter. Higher success rates were achieved with smaller stones (< 15 mm) and lower HU values. These findings support the significance of advanced lithotripter technology in establishing SWL as a valuable non-invasive option for stones under 15 mm.

PMID:39998683 | DOI:10.1007/s00345-025-05517-4

Prostate. 2025 Feb 25:e24863. doi: 10.1002/pros.24863. Online ahead of print.

ABSTRACT

BACKGROUND: Whole-gland (WG) prostate-specific antigen (PSA) density (PSAD) has proven useful in diagnosing to be beneficial in localized prostate cancer (PCa). This study aimed to evaluate the predictive performance of WG and zonal (transition zone [TZ] and peripheral zone [PZ]) PSAD in predicting PCa and clinically significant PCa (csPCa) in prostate MRI.

METHODS: A retrospective analysis was conducted on consecutive patients who underwent multiparametric MRI and MRI/US fusion-guided biopsy between March 2019 and July 2024. TZ-PSAD, PZ-PSAD, and WG-PSAD were calculated using in-house AI models. Optimal thresholds for TZ-PSAD and PZ-PSAD were determined using the Youden index from receiver operating characteristic (ROC) curve analyses with five-fold cross-validation, whereas 0.15 ng/mL² was applied as the threshold for WG-PSAD. Statistical comparisons were performed using Wilcoxon rank-sum, χ², and Fisher’s exact tests. Logistic regression (LR) and area under the ROC curve (AUC) analyses with DeLong’s test were conducted to evaluate diagnostic performance.

RESULTS: The study cohort included 774 consecutive patients (median age = 67 years [interquartile range {IQR}: 61-71], median WG-PSAD = 0.11 ng/mL² [IQR: 0.07-0.17], median TZ-PSAD = 0.22 ng/mL² [IQR: 0.12-0.41], median PZ-PSAD = 0.13 ng/mL² [IQR: 0.16-0.34]). Among these patients, 475 had PCa and 341 had csPCa. The mean optimal thresholds for TZ-PSAD and PZ-PSAD were 0.20 ng/mL² and 0.21 ng/mL², respectively, for PCa, whereas they were 0.26 and 0.23, respectively, for csPCa. Multivariable LR identified TZ-PSAD (OR = 2.00, p = 0.03) and WG-PSAD (OR = 2.40, p = 0.02) as significant predictors of PCa. For csPCa, TZ-PSAD was the only independent predictor (OR = 2.13, p = 0.02) among PSAD measurements. TZ-PSAD showed a superior AUC for both PCa (0.79 ± 0.05) and csPCa (0.77 ± 0.02) compared to WG-PSAD (0.77 ± 0.06 for PCa, 0.76 ± 0.03 for csPCa) and PZ-PSAD (0.69 ± 0.06 for PCa, 0.70 ± 0.04 for csPCa; p < 0.001).

CONCLUSIONS: Both TZ-PSAD and WG-PSAD are strong predictors of PCa, but TZ-PSAD is a superior predictor of csPCa compared to WG-PSAD and PZ-PSAD. Further prospective studies are warranted to validate these findings.

TRIAL REGISTRATION: NCT03354416.

PMID:39996409 | DOI:10.1002/pros.24863

Clin Cardiol. 2025 Mar;48(3):e70081. doi: 10.1002/clc.70081.

ABSTRACT

BACKGROUND: Disparities in invasive cardiovascular care and outcomes in rural and urban hospitals across the United States have been reported. However, studies investigating disparities regarding leadless pacemaker outcomes and complications based on hospital location are lacking.

OBJECTIVE: To evaluate differences in outcomes and complications related to leadless pacemaker implantations among rural and urban hospitals.

METHODS: The National Inpatient Sample was used to identify patients who underwent leadless pacemaker implantations in the United States from 2016 to 2020. Study endpoints assessed included procedural complications and inpatient outcomes of leadless pacemaker implantations among rural and urban hospitals.

RESULTS: From 2016 to 2020, there were a total of 28 340 and 665 leadless pacemaker implantations in urban and rural hospitals, respectively. Baseline characteristics were similar among both groups, with notable exceptions of higher rates of coagulopathies (13.2% vs. 6.8%, p < 0.001) and peripheral vascular disorders (10.4% vs. 4.5%, p < 0.001) among urban patients. After multivariable adjustment for confounding variables, leadless pacemaker placements occurring in rural hospitals had lower odds of major complications (aOR 0.59, 95% CI 0.41-0.86), but increased odds of inpatient mortality (aOR 1.70, 95% CI 1.21-2.40). Overall, rural leadless pacemaker recipients experienced lower rates of discharge to home, as well as lower costs and length of stay.

CONCLUSIONS: A majority of leadless pacemaker implantations occurred in urban hospitals in the United States. Important differences in outcomes were described based on urban and rural hospital location. Further investigation and policy changes are encouraged to promote improved cardiovascular care and outcomes in rural residents.

PMID:39996401 | DOI:10.1002/clc.70081

BJOG. 2025 Feb 25. doi: 10.1111/1471-0528.18108. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyse global prevalence data for infertility due to endometriosis from 1990 to 2021, emphasising health inequalities.

DESIGN: Population-based study.

SETTING: Data from the Global Burden of Disease (GBD) database.

POPULATION: Individuals diagnosed with infertility due to endometriosis.

METHODS: A statistical method was employed to evaluate changes in disease prevalence over time. We also analysed how disease prevalence varies by age, time period and birth cohort. A model was used to predict future trends. Additionally, we examined the relationship between prevalence and the socio-demographic index (SDI) levels across countries. Finally, we conducted a decomposition analysis to identify key factors driving changes and assessed health inequality.

MAIN OUTCOME MEASURES: The burden of infertility due to endometriosis.

RESULTS: The global burden of infertility due to endometriosis in 2021 showed a downward trend, and the low SDI region had a notably higher burden. High risk was observed in the 25-29 age group in the age effects analysis. Period risks almost kept decreasing over these years, and for cohort effects, the later born individuals showed an overall lower risk than the earlier born individuals. Cross-country inequality analysis revealed significant disparities, with countries in lower SDI categories bearing a higher burden.

CONCLUSIONS: The global burden of infertility due to endometriosis has become a significant public health concern over recent decades. Governments should adapt prevention strategies to fit their specific national contexts.

PMID:39996398 | DOI:10.1111/1471-0528.18108

J Adv Nurs. 2025 Feb 25. doi: 10.1111/jan.16839. Online ahead of print.

ABSTRACT

BACKGROUND: In Australia, aligned to safety and quality standards, the health system implements standardised practices that include patient involvement in nursing bedside handover. Despite this mandate, it remains unclear whether patients are genuinely participating in nursing bedside handovers and whether their perspectives are being considered.

AIM: To explore patient perceptions of their involvement in nursing bedside handovers.

METHODS: A cross-sectional survey study was conducted in two acute metropolitan hospitals in Western Australia from July 2021 to March 2022. The survey administered to patients, comprised three sections: demographic information; involvement in bedside handover; and perceptions of bedside handovers; utilising close-ended and Likert scale questions. Open-ended questions further explored participation in bedside handovers. Descriptive statistics and comparative analyses were performed and responses to open-ended questions underwent summative deductive content analysis.

RESULTS: Of the 390 participants, over half reported five or more bedside handovers (n = 197, 50.7%). Most perceived the importance of (n = 334, 79.0%), and expressed their satisfaction with (n = 327, 89.6%), involvement in bedside handover. Perceptions of handover were mostly positive. There were a few significant differences throughout based on type of hospital, gender and age-group. Open ended responses shared perceptions on the perceived benefits, challenges and barriers and ways to enhance involvement in bedside handover. Patients expressed several challenges, including lack of awareness of their right to participate, the approach of nurses and the timing of handovers as hindering their participation in bedside handovers.

CONCLUSION: Patients perceived the importance of, were mostly satisfied with, and had positive perceptions of bedside handover. However, several challenges hindered effective patient participation. Further research is needed into bedside handover as it is essential to enhance patient-centred quality care that aligns with national safety and quality healthcare standards.

IMPACTS: Understanding the significance of patient involvement in bedside handovers motivates patients to actively share information about their care, leading to increased patient satisfaction and the promotion of patient-centred care. Addressing challenges through targeted strategies can enhance patient participation, communication, increased patient satisfaction and foster a more patient-centred approach to care.

PATIENT OR PUBLIC CONTRIBUTION: The conduct of this study was supported by the consumer advisory group in the participating hospitals who also reviewed the survey questionnaires and conducted face validity of the survey.

PMID:39996386 | DOI:10.1111/jan.16839

Int J Low Extrem Wounds. 2025 Mar;24(1):192-197. doi: 10.1177/15347346231158858. Epub 2023 Feb 21.

ABSTRACT

INTRODUCTION: Because of its rarity compared to dry and wet gangrene of the lower limb, the gaseous form has often been considered as the most severe form of gangrenous disease. We aimed to report clinical, paraclinical, and therapeutic features, and to identify mortality risk factors of gas gangrene of the lower limb.

PATIENTS AND METHODS: We conducted a one-center case series retrospective study over a period of 13 years from January 2006 to December 2018.

RESULTS: A total of 19 patients were included: 12 men, 7 women. Mean age was 59.3 ± 11.3 years. There were 17 diabetic patients and one patient was on radio-chemotherapy for lower rectal cancer. Septic shock was initially present in 4 cases. Hyperleukocytosis was noted in 17 patients. C-reactive protein was elevated in 11 patients. All patients were put on antibiotics then operated on. A total of 8 patients died postoperatively (42%) in an average time of 9.6 days after surgery. On univariate analysis, factors associated with mortality were: Septic shock on admission (p = 0.02); local signs limited to foot (p = 0.05) or extended above the knee (p = 0.02); leukocytosis (p = 0.005); glycemia level (p = 0.02); antibiotic therapy duration (p = 0.04); antibiotic association of Penicillin G, metronidazole, and gentamicin (p = 0.02); amputation procedure solely (p = 0.04) or debridement procedure without amputation (p = 0.05); intraoperative transfusion (p = 0.006); and hospital stay (p = 0.01).

CONCLUSION: Identifying gas gangrene mortality factors is fundamental to standardize management. Our study was able to build on the small size of our series, but further prospective and large-scale studies are required.

PMID:39996358 | DOI:10.1177/15347346231158858

J Res Health Sci. 2025 Jan 1;25(1):e00640. doi: 10.34172/jrhs.2025.175. Epub 2024 Dec 25.

ABSTRACT

BACKGROUND: Integrated trauma systems (ITS) have shown potential in reducing traffic crash-related injuries and mortality, although their structure and impact can vary. This study assessed the effectiveness of ITS in Guilan, Iran. Study Design: A retrospective observational study.

METHODS: Utilizing a cross-sectional analysis, this descriptive-analytical study was conducted in Northern Iran from 2015 to 2019 to compare road traffic crash (RTC) data in Guilan (with ITS) against Mazandaran (without ITS), considering weather as a confounder. The study involved pre- and post-ITS intervention analyses to evaluate changes in RTC, injury, and mortality rates.

RESULTS: Before ITS implementation, Guilan’s daily RTC mean was 38.4 (SD=16.7), which significantly decreased to 30.8 (SD=13.7) after the intervention. Conversely, in the control province of Mazandaran, the daily average number of RTCs increased from 37.29 (SD=14.1) to 42.55 (SD=16.4) post-ITS implementation in Guilan. Furthermore, the mortality rate in Guilan showed a marginal decline from 27.74 (SD=12.6) pre-ITS to 26.60 (SD=11.9) post-ITS, indicating the positive impact of the ITS. In contrast, Mazandaran demonstrated a significant increase in mortality from 32.16 (SD=14.5) to 51.75 (SD=15.7). The statistical analysis confirmed a significant reduction in mortality and injury incidence in Guilan at the time of the intervention, with a marked decrease observed post-intervention (P<0.001).

CONCLUSION: The findings revealed that RTC prevention is feasible in Iran, with ITS in Guilan significantly reducing RTCs, injuries, and mortalities, underscoring the importance of ongoing efforts to expand ITS components nationally.

PMID:39996349 | DOI:10.34172/jrhs.2025.175

J Res Health Sci. 2025 Jan 1;25(1):e00639. doi: 10.34172/jrhs.2025.174. Epub 2024 Dec 25.

ABSTRACT

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic disorder diagnosed by elevated blood sugar. Key risk factors for T2DM include obesity, a sedentary lifestyle, and poor dietary habits. The proportion of macronutrients and the dietary inflammatory index (DII) seem to be associated with the risk of T2DM. This study aimed to assess and compare the macronutrient intake, DII, and BMI of newly diagnosed T2DM patients with healthy individuals in Kermanshah, Iran. Study design: This study employed a case-control design.

METHODS: A total of 105 newly diagnosed T2DM patients were selected as the case group, while an equal number of control participants were selected from their non-diabetic friends or neighbors. Dietary intake was assessed using a validated food frequency questionnaire. Energy, macronutrients, fatty acids intake, and DII were estimated using ShaFA software. Statistical significance was set at P values below 0.05.

RESULTS: The study included 105 newly diagnosed T2DM and 105 healthy individuals. Diabetic patients had significantly lower intake of protein, total fat, polyunsaturated fatty acids (PUFA), and monounsaturated fatty acids (MUFA), while their body mass index (BMI) and DII were higher. Multiple logistic regression indicated that protein, PUFA, and MUFA are protective factors for T2DM, while BMI, carbohydrates, and saturated fat intake are risk factors. A higher DII was correlated with an increased risk of T2DM risk, even after adjusting for BMI.

CONCLUSION: Lower BMI and DII, balanced macronutrient intake, and consumption of MUFA and omega-3 fatty acids may be beneficial in preventing or delaying the onset of T2DM. Further research is needed to explore these associations in greater depth.

PMID:39996348 | DOI:10.34172/jrhs.2025.174

J Res Health Sci. 2025 Jan 1;25(1):e00637. doi: 10.34172/jrhs.2025.172. Epub 2024 Dec 25.

ABSTRACT

BACKGROUND: Hypertension (HTN) elevates blood pressure (BP) in the arteries. It is defined as systolic BP (SBP)>140 mm Hg and/or diastolic BP (DBP)>90 mm Hg. This study aimed to identify determinant risk factors of longitudinal change of SBP and DBP with time to first remission of hypertensive patients. Study Design: A retrospective cohort study.

METHODS: A descriptive and inferential analysis was employed to explore the determinant risk factors, and a multivariate joint model was applied to test the significant association of the possible risk factors.

RESULTS: Of all 369 patients, 235 (63.7%) had first remission with a median survival time of five months. The patients demonstrated shorter first remission time when they had no history of comorbidity, resided in urban areas, took a combination of drugs, and were younger. Similarly, residence, age, treatment, history of diabetes mellitus (DM), history of stroke, and observation time were determinant risk factors of SBP. On the other hand, age, treatment, history of DM, chronic kidney diseases, and observation time were identified as determinant risk factors of DBP. The result revealed a strong positive association between changes in SBP and DBP (P=0.9923). In addition, a significant association was observed between the value of SBP and time to first remission (γ_1=-0.0693, HR=0.993).

CONCLUSION: Having good follow-ups, receiving control of comorbidity, and taking a combination of drugs show several opportunities for decreasing BP. Consequently, this compels patients to experience the first remission early.

PMID:39996346 | DOI:10.34172/jrhs.2025.172