Category: Nevin Manimala

Transfusion. 2025 Mar 10. doi: 10.1111/trf.18177. Online ahead of print.

ABSTRACT

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) and emergency department thoracotomy (EDT) are effective methods of aortic occlusion (AO) for life-threatening bleeding; however, complete AO can lead to visceral ischemia. Partial REBOA (P-REBOA) has been proposed as an alternative to the completely occlusive REBOA (C-REBOA) to balance hemorrhage control and perfusion. Using the Aortic Occlusion for Resuscitation in Trauma (AORTA) multicenter, observational registry, we tested the hypothesis that P-REBOA resulted in better outcomes compared to EDT and C-REBOA.

STUDY DESIGN AND METHODS: We queried the 2017-2023 AORTA registry for adults who underwent EDT, C-REBOA, or P-REBOA in the emergency department (ED). Patients with chest penetrating injuries were excluded. We compared mortality, ventilator-free-days (VFD), and ICU-free-days (ICUFD) using survival analysis or generalized linear models to adjust for confounders.

RESULTS: Overall, 921 patients underwent EDT (n = 613, 66.6%), C-REBOA (n = 224, 24.3%), or P-REBOA (n = 84, 9.1%); 83.1% died. After confounder adjustment, compared to P-REBOA, both C-REBOA and EDT were associated with a lower likelihood of attaining hemodynamic improvement and stability as well as with higher mortality (adjusted hazard ratio, aHR = 1.84; 95% CI: 1.01-1.60 and aHR = 3.32; 95% CI: 1.96-2.78, respectively). EDT patients had less VFD and ICUFD than those undergoing C-REBOA and P-REBOA, but there were no differences between the two endovascular procedures. Among patients who survived >48 h, EDT was more likely to be associated with complications compared to the other two procedures.

DISCUSSION: P-REBOA was more likely to be associated with improved hemodynamic stability and reduced mortality compared to C-REBOA and EDT, suggesting this modality may be a better AO procedure for patients with no penetrating thoracic injuries.

PMID:40059692 | DOI:10.1111/trf.18177

Orthop Surg. 2025 Mar 10. doi: 10.1111/os.70016. Online ahead of print.

ABSTRACT

OBJECTIVES: Different alignment strategies (kinematic alignment [KA] versus mechanical alignment [MA]) during total knee arthroplasty (TKA) significantly influence postoperative patellar tracking. This study aimed to compare radiological parameters of patellar tracking and clinical outcomes between KA-TKA and MA-TKA via the mini-subvastus approach.

METHODS: This prospective randomized controlled study included 234 patients who underwent KA-TKA and MA-TKA from January 2022 to October 2023. The preoperative and postoperative patellar tilt, lateral patellar shift, knee society score (KSS), oxford knee score (OKS), and intraoperative patellar lateral retinacular release (LRR) rate were measured. In addition, radiological parameters and clinical outcomes were compared between the LRR and non-LRR groups. Independent samples t test and chi-square test were used to compare the differences between groups.

RESULTS: Two-hundred and thirty-four patients were followed up for 12 months post-TKA. No significant differences were observed between the two groups in terms of the demographics and pre- or post-operative radiological parameters of patellar tracking (p > 0.05). The postoperative KSS and OKS were significantly higher in the KA group than in the MA group (p < 0.05). The LRR rate was 6.7% (8/120) in the KA group and 25.4% (29/114) in the MA group, and the difference was statistically significant (x² = 15.476, p < 0.001). The preoperative patella tilt and lateral patellar shift were greater in the LRR group (p < 0.001) and the postoperative OKS was lower (p < 0.05).

CONCLUSIONS: KA-TKA via the mini-subvastus approach can achieve both good patellar tracking and clinical outcomes. Avoiding muscle damage and refraining from excessive soft tissue release are crucial to improving postoperative patient comfort. In our opinion, KA-TKA via the mini-subvastus approach may be a more suitable surgical option.

PMID:40059658 | DOI:10.1111/os.70016

J Ocul Pharmacol Ther. 2025 Mar 10. doi: 10.1089/jop.2024.0110. Online ahead of print.

ABSTRACT

Corticosteroid use as an anti-inflammatory agent in infective conjunctivitis has been met with concerns about prolonged infection. This systematic review aims to evaluate the safety and efficacy of corticosteroids as a treatment for infective conjunctivitis. A comprehensive search was conducted on PubMed, Cochrane, Scopus, ScienceDirect, Embase, and ProQuest for clinical trials of topical corticosteroids with or without combination with other medications in bacterial or viral conjunctivitis up to November 2023. The studies were screened, and data on safety and efficacy were extracted. The quality of studies was assessed using the Jadad Scale. Meta-analysis was performed using the random-effects model, with heterogeneity assessed with the I² statistic. We found ten clinical trials that met the inclusion criteria. Overall meta-analysis revealed significant clinical resolution in dexamethasone-containing therapy compared to non-corticosteroid treatment (OR 1.51; 95% CI 1.19-1.92), with several studies reporting significantly reduced clinical symptoms severity. Two of the six studies assessing viral and bacterial eradication reported significantly improved viral clearance rates. Meta-analysis indicated no difference in ocular adverse effects compared to nonsteroid therapy (OR 1.33; 95% CI 0.82-2.16). In conclusion, corticosteroid use in infective conjunctivitis is relatively safe and may help improve clinical resolution and reduce symptom severity, especially when combined with antibiotics and antiseptics.

PMID:40059644 | DOI:10.1089/jop.2024.0110

Child Obes. 2025 Mar 10. doi: 10.1089/chi.2024.0361. Online ahead of print.

ABSTRACT

Background: Enhancing the quality of Family Child Care Home (FCCH) meals is an opportunity to impact children’s diet and health. The purpose of this study is to assess Happy Healthy Homes (HHH) randomized controlled trial impact on health-related foods and nutrients served to and consumed by young children and achievement of Child and Adult Care Food Program (CACFP) requirements and best practices. Methods: Forty-five CACFP participating FCCHs in a moderately sized midwestern city were recruited in 2017-2018 and randomized to nutrition intervention (NUT n = 24) or control (CON n = 21). Participants received two in-home, individual 90-minute education sessions, one 3-hour small group class, and a 15-minute check-in phone call over 3 months. Outcomes include 3- and 12-month served and consumed fiber, sugar, grains, vegetables, and fruit and achievement of CACFP Best Practices. Primary analyses at 12 months used a mixed model under an intent-to-treat paradigm to account for repeated measures on participants with 3-month outcomes. Sensitivity analyses were completed on those with complete 12-month measures. Results: There were no statistically significant group-by-time effects for foods served, consumed, or CACFP Best Practices score in the primary analysis. However, in sensitivity analysis, the CACFP Best Practice score (out of 18) increased in NUT +0.5 from 8.9 ± 1.5 at baseline at 12 months and decreased -0.9 in CON from 9.9 ± 1.7 at baseline, group by time p = 0.05. Conclusions: The HHH intervention did improve the CACFP Best Practices score for lunches served. The study’s effect may have been limited due to sample size and attrition. Trial Registration: Clinicaltrials.gov, NCT03560050. Retrospectively registered on 23 May 2018. First participant enrolled October 2017.

PMID:40059639 | DOI:10.1089/chi.2024.0361

Metab Syndr Relat Disord. 2025 Mar 10. doi: 10.1089/met.2024.0194. Online ahead of print.

ABSTRACT

Background: Household food insecurity (HFI) refers to the lack of access to safe and nutritious food, and this condition may be associated with the occurrence of metabolic syndrome (MetS). Thus, this study aimed to conduct a quantitative synthesis (meta-analysis) to summarize the evidence from epidemiological studies on the association between HFI and MetS. Methods: A systematic search was conducted in the PubMed, Embase, Web of Science, and Latin American and Caribbean Health Sciences Information Center databases to retrieve epidemiological studies published until October 2023. The entire process of selection, data extraction, and assessment of article quality was independently performed by two reviewers. The quality of the studies was evaluated using the criteria proposed by the National Institutes of Health instrument. The random-effects model was used to report the quantitative synthesis of combined data. The Q-test and I² index were used to assess heterogeneity. Egger’s and Begg’s tests were employed to evaluate publication bias. Results: A total of 10 articles meeting the eligibility criteria were selected and included in this meta-analysis. High heterogeneity was observed among the studies (I² > 70), along with a low risk of publication bias. Considering all ten included studies, no statistically significant association was found between HFI and MetS (odds ratio = 1.17; 95% confidence interval: 0.89-1.55; I² = 79.9%). Conclusions: The findings of this meta-analysis did not reveal a statistically significant association between HFI and MetS, indicating the need for further studies aimed at exploring and expanding the scientific evidence on this relationship.

PMID:40059634 | DOI:10.1089/met.2024.0194

Neuromodulation. 2025 Mar 6:S1094-7159(25)00029-7. doi: 10.1016/j.neurom.2025.01.016. Online ahead of print.

ABSTRACT

BACKGROUND: Diabetes mellitus affects more than half a billion people globally, often leading to painful diabetic neuropathy (PDN). Spinal cord stimulation (SCS) has emerged as a promising treatment for PDN.

OBJECTIVE: This meta-analysis evaluated the efficacy of SCS compared with the best medical therapy (BMT) for PDN.

MATERIALS AND METHODS: Following the Preferred Reporting Items of Systematic reviews and Meta-Analyses guidelines, a systematic search of the PubMed, Scopus, Web of Science, Embase, and Cochrane CENTRAL data bases was conducted up to December 1, 2023 and updated on January 2, 2025. Data extraction was performed using Microsoft Excel, and quality assessment was conducted using Cochrane’s Risk of Bias 2.0 and ROBINS-1 tools. Statistical analysis and heterogeneity assessment were performed using Review Manager (RevMan) software (The Cochrane Collaboration, London, UK).

RESULTS: Nine clinical trials involving 407 patients were included. The analysis revealed significant pain reduction in the SCS group (mean difference [MD]: -5.46, 95% CI: [-6.09, -4.83], p < 0.00001). Subgroup analysis indicated pain relief benefits in both conventional SCS (MD: -4.176, 95% CI: [-4.865, -3.486], p < 0.001) and 10-kHz SCS (MD: -4.581, 95% CI: [-6.376, -2.785], p < 0.001). SCS also achieved higher treatment success rates (≥50% pain relief) than did BMT (risk difference: 0.59, 95% CI: [0.33, 0.85], p < 0.00001). Moreover, SCS significantly improved the EuroQol-5 Dimension utility index (MD: 0.16, 95% CI: [0.10, 0.23], p < 0.00001) and self-reported health (MD: 15.29, 95% CI: [4.51, 26.07], p = 0.005).

CONCLUSION: This meta-analysis provides robust evidence supporting SCS as an effective intervention for managing chronic pain and enhancing the quality of life in patients with PDN, highlighting its superiority to conventional medical therapy.

PMID:40057880 | DOI:10.1016/j.neurom.2025.01.016

Int J Radiat Oncol Biol Phys. 2025 Mar 6:S0360-3016(25)00087-2. doi: 10.1016/j.ijrobp.2025.01.023. Online ahead of print.

ABSTRACT

PURPOSE/OBJECTIVES: To characterize the effects of prostate radiation therapy on sexual health outcomes in sexual minority men (SMM), particularly those engaging in receptive anal intercourse (RAI), and compare them with heterosexual men (HET).

METHODS AND MATERIALS: This retrospective cohort study included patients with intact prostates, ≥6 months after radiation therapy and androgen deprivation therapy (ADT), seen between June 2022 and August 2023, and sexually active with a partner in the prior 30 days. Patients self-reported sexual orientation, gender identity, sexual behaviors, and health outcomes using select items from Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction, Sexual Health Inventory for Men, and American Urological Association questionnaires. P values <.05 were considered statistically significant; mean differences (MD) ≥3 were considered clinically meaningful.

RESULTS: Of eligible participants, 39% HET (n = 57/145) and 68% SMM (n = 21/31) were sexually active with a partner in the last 30 days (P = .005); including 15 (71%) SMM engaging in RAI. Overall, 9% received brachytherapy, 46% external beam radiation therapy, 45% both; 14% received ADT. The cohort reported worse orgasm ability (3.3, P < .01), orgasm pleasure (MD: 7.2, P < .001), and sexual satisfaction (MD: 3.4, P < .001) compared with US general population normative scores for sexually active adult men. SMM were more likely to be single (72% vs 33%, P < .001) and have higher prostate-specific antigen at diagnosis than HET (P = .031). SMM engaging in RAI reported worse orgasm ability (MD: 3.5), orgasm pleasure (MD: 6.3, P < .05), and anal discomfort (MD: 9.0) compared with norms. For SMM engaging in RAI, brachytherapy with/without external beam radiation therapy was associated with worse orgasm pleasure (MD: 3.1), yet less anal pain (MD: 5.2) compared with external beam radiation therapy alone; the addition of ADT was associated with worse orgasm ability (MD: 14.1, P < .05), orgasm pleasure (MD: 10.7, P < .05), anal pain (MD: 6.8), and sexual satisfaction (MD: 6.1).

CONCLUSIONS: Prostate cancer treatments uniquely affect sexual health in SMM, particularly those engaging in RAI. Clinicians should inquire about sexual orientation, gender identity, and sexual behaviors when discussing treatments to align care with individual preferences.

PMID:40057858 | DOI:10.1016/j.ijrobp.2025.01.023

J Am Dent Assoc. 2025 Mar 7:S0002-8177(25)00091-1. doi: 10.1016/j.adaj.2025.01.007. Online ahead of print.

ABSTRACT

BACKGROUND: The authors investigated, via a web-based survey, the perceptions of general dentists in the United States regarding endodontists restoring endodontically treated teeth (ETT).

METHODS: A 15-question survey was distributed to American Dental Association members. Participants were asked to rate their comfort with various scenarios. In the control scenario, an endodontist placed restorations without prior discussion with the general dentist. In the experimental scenario, an endodontist trained in endorestorative procedures, having previously discussed their intentions, placed the restorations. Data were analyzed using descriptive statistics, Fisher exact test, McNemar test, and false discovery rate adjustment (P_adj).

RESULTS: The response rate was 48% (N = 544). General dentists were significantly more likely to accept the experimental scenario than the control scenario for post space creation (88.1% vs 84.2%; P_adj = .026), post placement (66.7% vs 52.2%; P_adj = 3.35e-13), and core placement (68.2% vs 55.1%; P_adj = 2.28e-12). Overall, 69% (374) supported endodontists placing restorations after discussion with referring general dentists, 12.9% (70) disagreed, and 18.4% (100) were undecided. Opponents (67) cited lack of trust (64%) and billing preferences (18%). Undecided general dentists (83) identified residency training (28%), case portfolios (16%), and individualized discussions (13%) as factors likely to increase acceptance. More recent graduates, female practitioners, those practicing at community clinics, in rural or urban areas, and in the South or West were significantly more comfortable with endodontists placing restorations (P_adj < .05).

CONCLUSIONS: General dentists broadly supported endodontists restoring ETT if they were trained in endorestorative procedures and after prior discussion.

PRACTICAL IMPLICATIONS: Endodontists should communicate their intent to restore ETT with general dentists to facilitate interdisciplinary collaboration.

PMID:40057857 | DOI:10.1016/j.adaj.2025.01.007

J Am Dent Assoc. 2025 Mar 6:S0002-8177(25)00088-1. doi: 10.1016/j.adaj.2025.01.006. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to assess the feasibility of screening at-risk adult dental patients for abnormal blood glucose levels by means of using a chairside finger-stick test that measures glycated hemoglobin (HbA_1c) levels.

METHODS: A total of 260 high-risk adult patients, as classified by the American Diabetes Association and Centers for Disease Control and Prevention Prediabetes Risk Test, with no history of diabetes received a chairside HbA_1c finger-stick test. Descriptive statistics and χ² and Fisher exact tests were used to examine associations of HbA_1c levels with risk scores and study participants’ characteristics.

RESULTS: Results of chairside testing indicated that 34.2% had undiagnosed prediabetes and 6.6% had undiagnosed diabetes. Results of the postprocedure questionnaire showed high levels of acceptance and satisfaction with the testing. At 6 months after testing, 64.6% of patients with dysglycemia had consulted their primary care provider for follow-up.

CONCLUSIONS: Dental care professionals are in a unique position to collaborate with physicians and other health care providers in the identification of undiagnosed prediabetes and diabetes. Targeted chairside diabetes testing in the oral health care setting for high-risk patients is a viable public health primary preventive measure.

PRACTICAL IMPLICATIONS: Screening is pivotal for the early detection, prevention, and management of diabetes, and the dental care setting, where chairside testing is a viable strategy, may be an important venue in confronting the diabetes epidemic.

PMID:40057856 | DOI:10.1016/j.adaj.2025.01.006

Orv Hetil. 2025 Mar 9;166(10):377-384. doi: 10.1556/650.2025.33243. Print 2025 Mar 9.

ABSTRACT

Bevezetés: A COVID–19-világjárvány előtt a digitális egészségügyi megoldások elterjedését szabályozási és stratégiai hiányosságok is akadályozták, a pandémia idején azonban a digitális eszközök gyors bevezetése szükségszerűvé vált. Ezen időszak után már rendelkezésre állnak a szabályozási feltételek Magyarországon is, amelyek a digitális egészségügyi megoldások használatát támogatják, ugyanakkor az alkalmazásuk iránti kényszer csökkent. Célkitűzés: Két országos reprezentatív lakossági kutatásunkban arra kerestük a választ, hogy a COVID–19-járvány milyen hatással volt a lakosság digitális egészségügyi megoldásokkal kapcsolatos használati szokásaira, attitűdjeire és igényeire. Módszerek: Két országos reprezentatív lakossági felmérés eredményeit hasonlítjuk össze. Az első felmérést 2021 októberében, a COVID–19-járvány idején végeztük 1500 fő telefonon történő megkérdezésével, míg a második felmérést 2024 februárjában 1000 fő online kérdőíves megkeresésével. Mind a két minta nem, kor, iskolai végzettség és településtípus szerint reprezentálja a magyar felnőtt lakosságot. Az adatgyűjtést mindkét felmérés esetében az Ipsos Zrt. végezte. Eredmények: A két lakossági felmérés eredményei alapján az internetes egészségügyi információkeresés gyakorisága és módja jelentős változásokon ment keresztül. Azok aránya, akik egyáltalán nem keresnek információt az interneten, tovább csökkent. Az egészségügyi célú internethasználat során a weboldalak népszerűsége nőtt, míg a blogok, a podcastok és a közösségi platformok iránti érdeklődés csökkent. A digitális egészséggel kapcsolatos lehetőségek ismertsége és használata szintén növekedett, különösen az online időpontfoglalás, az egészségügyi adatok megosztása és a közösségi média használata terén. Az ellátás hatékonyságával kapcsolatos pozitív vélemények enyhén csökkentek, míg a technológiai frusztrációval kapcsolatos aggodalmak enyhültek. Következtetés: A COVID–19-járvány elmúltával megjelentek a digitális egészségüggyel kapcsolatos szabályozások, a lakosság körében pedig megszokottá vált a digitális egészségügyi technológiák használata. A digitális technológiák ismertsége és használata szignifikánsan növekedett, különösen az online időpontfoglalás, az e-recept és a viselhető eszközök esetében. A digitális eszközök használatának potenciális hátrányai iránti aggodalmak mérséklődtek, míg az előnyök iránti elvárások nem változtak jelentősen, ami reálisabb megítélést jelez. A páciensek digitalizációs igénye mára az ellátás szerves részévé vált, támogatva a tudatosabb, aktívabb szerepvállalást a gyógyulási folyamatban. Orv Hetil. 2025; 166(10): 377–384.

PMID:40057836 | DOI:10.1556/650.2025.33243