Category: Nevin Manimala

Probl Endokrinol (Mosk). 2025 Sep 14;71(4):57-70. doi: 10.14341/probl13574.

ABSTRACT

BACKGROUND: The main treatment for primary hyperparathyroidism (PHPT) is parathyroidectomy (PTE), conservative therapy, including bisphosphonates, can be used for preoperative correction of hypercalcemia, as well as to improve bone tissue condition among individuals for whom surgery should be postponed or cannot be performed due to high perioperative risks. The question of the effect of bisphosphonates on bone tissue after surgery remains open.

AIM: To study the effect of preoperative bisphosphonate therapy on BMD parameters assessed in DXA and 3D-DXA in patients with PHPT one year after radical PTE.

MATERIALS AND METHODS: The study was conducted on the basis of the Department of pathology of the parathyroid glands and disorders of mineral metabolism of “Endocrinology Research Center” state-funded research facility of the Ministry of Health of the Russian Federation. The study included 50 patients (2 men, 48 women), divided into two groups depending on the presence or absence of preoperative bisphosphonate (BF) therapy. The methods of DXA and 3D-DXA using 3D-Shaper Medical software were used to evaluate BMD and bone microarchitectonics. The statistical analysis was performed using the R language and the Statistica v.13 package.

RESULTS: At the time of the disease’s manifestation, both groups were comparable in terms of the main indicators of calcium phosphorus metabolism, with the exception of the level of beta-crosslapse, which was higher in the group without preoperative BPh therapy (p<0,001). There were also no differences in the parameters of DXA and 3D-DXA. After surgery, both groups showed a comparable increase in BMD based on the results of DXA in the main parts of the skeleton and 3D-DXA in the femur. Changes at the level of the statistical trend were obtained for the 3D-DXA parameters, the final absolute values of which were slightly higher in the second group, including the thickness of the cortical layer in the femur as a whole and in the neck. When comparing the results of DXA before and after PTE in patients receiving BPh, statistically significant differences in absolute BMD values were obtained only in the lumbar spine (p<0,001).According to 3D-DXA data, statistically significant differences were found only in the volume of mineral density of the trabecular bone of the femur as a whole (p=0,001).When analyzing up to – in the second group, statistically significant differences in absolute BMD values were observed in the lumbar region (p<0,001), in the hip as a whole (p<0,001) and in its neck (p=0,001).According to 3D-DXA data, statistically significant differences were found in three of the eight analyzed indicators, the volume of mineral density of the trabecular bone of the femur as a whole and in the neck (p<0,001 for both), as well as the volume of mineral density of the cortical bone in the neck, (p=0,001).

CONCLUSION: The 3D-DXA method allows us to evaluate not only BMD, but also its microarchitectonics, which is important for predicting the risk of fractures in patients with PHPT. Studies have shown that preoperative BPh therapy can negatively affect the recovery of BMD after PTE, especially in cortical bone tissue. Further studies are needed to confirm these data and clarify the effect of CF on the postoperative course of PHPT.

PMID:41014616 | DOI:10.14341/probl13574

Probl Endokrinol (Mosk). 2025 Sep 14;71(4):47-56. doi: 10.14341/probl13538.

ABSTRACT

BACKGROUND: Determination of body composition components – muscle and fat mass – is an important step in clinical and epidemiological studies. The most common methods for quantitative determination of body composition are indirect methods. However, the variety of methods and models of devices used makes direct comparison of data at both group and individual levels difficult.

AIM: The aim of the study is to analyze the consistency of estimates of absolute values of fat and lean body mass, as well as the proportion of body fat mass, obtained using bioimpedance analyzers ABC-02 «Medas» (STC Medas, Russia), 770InBody (InBody, Korea) and ultrasound scanner BodyMetrix BX2000 (IntelaMetrix, USA) in a group of men and women.

MATERIALS AND METHODS: An observational, single-center, cross-sectional, uncontrolled study was conducted. The main anthropometric characteristics (height and weight, waist circumference) were measured. Body composition was determined by bioimpedancemetry (BIA) using the octopolar scheme on the 770InBody device and the tetrapolar scheme on the ABC-02 Medass device and ultrasound scanning using the BodyMetrix BX2000 (BM) ultrasound scanner. The absolute (FM) and relative amount of body fat (PBF) and lean body mass were calculated.

RESULTS: A total of 48 people (38 women and 10 men) aged 24 to 74 years were examined. The anthropometric characteristics of the examined subjects were presented in a wide range. A strong correlation was found for all pairs of body composition components: the minimum value for the pair PBF ABC-BM was 0.853 [0.730, 0.913], the maximum was 0.988 [0.977, 0.993] for the pair FM ABC-InBody. Also, significant statistical differences (p<0.001) were found for all pairs of measurements, except for PBF determined by the BIA method. High agreement (CCC>0.95) of BIA estimates of the absolute amount of fat mass was shown, moderate agreement (CCC 0.9-0.95) is characteristic of the PBF determined by different BIA analyzers, and for all other pairs the agreement of measurements can be assessed as weak (CCC<0.90).

CONCLUSION: The best agreement at the group and individual levels was found for FM estimates by two different BIA analyzers (InBody and ABC).

PMID:41014615 | DOI:10.14341/probl13538

Probl Endokrinol (Mosk). 2025 Sep 14;71(4):9-15. doi: 10.14341/probl13487.

ABSTRACT

BACKGROUND: Currently, due to the lack of clear criteria for predicting the aggressive course of pituitary adenomas (APA), the search for diagnostic markers is highly relevant. Genetic markers, among others, may serve as such markers since their identification is possible at early stages of the pathological process.

OBJECTIVE: To study the prevalence of genotypic polymorphisms G634C of the VEGFA gene (locus rs2010963), C/T of the TP53_2 gene (locus rs17884159), C/T of the HIF1A gene (locus rs11549465), and G-197A of the IL-17A gene in a sample of patients with APA and their association with the development of various clinical variants of the aggressive course of the disease.

MATERIALS AND METHODS: The study included 100 patients with a clinically confirmed diagnosis of pituitary adenoma (main group) and 83 practically healthy individuals (control group). The polymorphism of the studied genes was analyzed using allele-specific polymerase chain reaction (PCR) with SNP-Express reagent kits in real-time mode (“Sintol”, Russia). The interpretation of the results was carried out using the “RotorGene” software of the PCR-RV device. The study also included general clinical, biochemical, and hormonal tests, as well as instrumental and neuroimaging methods, including magnetic resonance imaging (MRI) of the chiasmatic-sellar region and statistical analysis.

RESULTS: The study showed that the heterozygous mutation (G/C) of the G634C VEGFA polymorphism was recorded in 21 cases (26%), and the homozygous mutation with a complete replacement of guanine (G) by cysteine (C) at position 634 (C/C) was detected in 4 cases. In patients with invasive pituitary adenomas (PA), the heterozygous variant (G/C) was twice as frequent – 32.7% (n=17) compared to the control group – 15.7% (n=13). The homozygous genotype (C/C) was also more frequently observed in patients with invasive PA growth – 7.7% (n=4) compared to the control group.The heterozygous variant (C/T) of the HIF1A gene was significantly more common (p=0.02) in patients with invasive adenomas compared to the control group: 25% (n=13) and 9.8% (n=8), respectively. In non-invasive PAs, this genotype was observed three times less frequently. The study of TP53_2 polymorphism (locus rs17884159) showed that in patients with invasive PAs, the frequency of the heterozygous variant (C/T) was significantly higher – 15.4% (n=8) compared to the control group – 4.8% (n=4).

CONCLUSION: The conducted genetic analysis of polymorphisms in the VEGFA, HIF1A, TP53_2, and IL-17A genes revealed significant deviations, confirming their practical significance in the early diagnosis of aggressive pituitary adenomas.

PMID:41014611 | DOI:10.14341/probl13487

Global Spine J. 2025 Sep 27:21925682251384669. doi: 10.1177/21925682251384669. Online ahead of print.

ABSTRACT

Study DesignSingle-center retrospective comparative study.ObjectiveWhile vitamin D (VD) levels are known to correlate with outcomes in lumbar degenerative disease (LDD), it remains unclear whether LDD is related to elevated risk of VD deficiency. This study aimed to compare the prevalence and epidemiological characters of VD deficiency between surgical LDD patients and health screening (HS) populations.Methods7300 HS participants and 1147 surgical LDD patients were included. All participants accepted serum VD test. In both HS participants and LDD patients, the epidemiological characteristics and influence factors of VD deficiency were analyzed. Propensity score matching was used to create a matched healthy control group, and the prevalence of VD deficiency was further compared.Results66.9% of HS participants and 42.9% of LDD patients were with VD deficiency. Age, sex, BMI and season were influence factors of VD deficiency in both groups. As age grows, the VD levels increase in young age and decrease in older age after the peak. Female, high BMI and Winter/Spring season were risk factors of VD deficiency. Compared with matched control group, LDD group exhibited statistically higher median VD levels than controls [median (interquartile range), 21.6 (16.3, 27.9) vs 19.3 (15.0, 25.3), P < 0.001]. However, the prevalence of VD deficiency was not significantly different between the matched groups.ConclusionLDD does not appear to be associated with an elevated risk of VD deficiency. Compared with the HS cohort, surgical LDD patients exhibit similar epidemiological patterns of VD levels, including an unusual biphasic relationship with age.

PMID:41014591 | DOI:10.1177/21925682251384669

Global Spine J. 2025 Sep 27:21925682251383882. doi: 10.1177/21925682251383882. Online ahead of print.

ABSTRACT

Study DesignSystematic Review.IntroductionRandomized controlled trials (RCTs) on lumbar endoscopic decompression inform treatment decisions for disk disease, radiculopathy, and lumbar spinal stenosis. This study assessed the fragility of statistical outcomes in these RCTs.MethodsPubMed, Embase, and MEDLINE were queried for RCTs reporting dichotomous outcomes with at least 1 endoscopic decompression arm. The fragility index (FI) and reverse FI (rFI) represented the number of event reversals needed to change significance for significant and nonsignificant outcomes, respectively. The fragility quotient (FQ) was calculated by dividing FI by sample size. Subgroup analysis was performed by outcome type.Results37 RCTs met the inclusion criteria for analysis. A total of 160 outcomes were analyzed. The median FI was 4 (IQR: 3-5) and FQ 0.038 (IQR: 0.017-0.067). Significant outcomes (n = 23) had a median FI of 7 (IQR: 2-13), FQ 0.024 (IQR: 0.012-0.056); nonsignificant outcomes (n = 137) had FI 4 (IQR: 3-5), FQ 0.041 (IQR: 0.020-0.068). Revisions/reoperations were most robust (FI: 5, FQ: 0.037); microscopic outcomes most fragile (FI: 4, FQ: 0.022). Pain outcomes had FI 4 (FQ: 0.051); complications FI 4 (FQ: 0.038). In 47.5% of outcomes, patients lost to follow-up exceeded FI.ConclusionsFindings from RCTs on lumbar endoscopic decompression are vulnerable to small changes in outcome events. In nearly half of outcomes, patients lost to follow-up outnumbered the FI. Reporting FI and FQ with P-values may improve interpretation and reliability of trial results.

PMID:41014588 | DOI:10.1177/21925682251383882

Niger J Clin Pract. 2025 Sep 1;28(9):1111-1120. doi: 10.4103/njcp.njcp_305_25. Epub 2025 Sep 27.

ABSTRACT

BACKGROUND: Large tumor size is associated with poor outcomes in patients with hepatocellular carcinoma (HCC). Although some studies have evaluated the treatment response of HCC to transarterial radioembolization (TARE), none of them used radiomics features with machine learning (ML) models in large tumors.

AIM: To assess the performance of ML models using radiomics to predict the treatment response of TARE in large HCC lesions.

METHODS: This study included 49 patients with a large (>5 cm) HCC who underwent TARE. Treatment response was determined according to modified response evaluation criteria in solid tumors (mRECIST) criteria from the 3-month follow-up MR examinations. Complete or partial response was categorized as the responder group, while stable or progressive disease was classified as the non-responder group. Segmentation was performed on axial T2-weighted (T2W) and contrast-enhanced (CE) T1-weighted images. Classification learning models were used to create prediction models for TARE response.

RESULTS: Forty-nine patients (9 female, 40 male; mean age 63.58 ± 8.77) were included. None of the clinical, laboratory, and radiologic characteristics except the neutrophil counts showed statistical significance. Radiomics models obtained from CE-T1 and T2W images demonstrated an accuracy rate of 79.6%, while the area under the curve (AUC) rates were 0.92 and 0.77, respectively. The clinical model showed an accuracy rate of 77.6% and an AUC of 0.65. No statistically significant difference was found among all the models (P = 0.092).

CONCLUSION: ML-based models constructed with radiomics features obtained from MR images before the TARE procedure might predict response in large HCC lesions.

PMID:41014537 | DOI:10.4103/njcp.njcp_305_25

Niger J Clin Pract. 2025 Sep 1;28(9):1085-1089. doi: 10.4103/njcp.njcp_250_25. Epub 2025 Sep 27.

ABSTRACT

BACKGROUND: Split-thickness skin grafting (STSG) is a veritable reconstructive option for covering skin and soft tissue defects but donor site management remains a challenge. Attempts to improve STSG donor site care have been made using different methods and various dressing agents; however, there is no consensus on the standard method of donor site care.

AIM: This study aims to compare STSG healing rate using early versus late exposure of donor site dressing methods.

METHODS: This study was conducted in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Southeast, Nigeria. Forty patients were recruited for the study and assigned to two groups of 20 patients each by a simple random sampling method. Group A had late exposure of the donor site dressing, whereas Group B had early exposure of the donor site dressing. The percentage re-epithelialization rate on the 14th day and the duration for complete re-epithelialization for both groups were calculated. The results were analyzed using International Business Machine Corporation, Statistical Package for the Social Sciences, Chicago Illinois, USA. (IBM SPSS) Statistics for Windows version 26.

RESULTS: The early exposure dressing method showed a faster re-epithelialization rate with a mean value of 98.15 (±4.92) compared with late exposure dressing methods with a mean rate of 70.95 (±13.22), which was statistically significant with a P value of 0.001. The duration for complete re-epithelialization was 13.80 (±4.63) days for the early exposure method and 29.40 (±6.25) days for the late exposure method. This is statistically significant with P < 0.001.

CONCLUSION: Management of STSG donor site by early exposure of the donor site dressing is associated with increased re-epithelialization rate and shortened duration for complete donor site healing.

PMID:41014534 | DOI:10.4103/njcp.njcp_250_25

Niger J Clin Pract. 2025 Sep 1;28(9):1076-1084. doi: 10.4103/njcp.njcp_818_24. Epub 2025 Sep 27.

ABSTRACT

BACKGROUND: Oxygen-inhibited layer (OIL) is formed due to inadequate polymerization of resin composite (RC), which compromises its physical and mechanical properties.

AIM: This study focuses on analyzing the impact of different OIL control surface treatments on the color stability and microhardness of enamel shade RC.

METHODS: Discs (n = 240) were prepared out of two different types of nanohybrid enamel shade RCs, G-aenial A’CHORD (group AC) and Beautifil II Enamel (group BT). After allotting 60 samples each for the two experiments on color stability using spectrophotometer and surface microhardness using Vickers microhardness tester, they were further divided into four subgroups of 15 each based on the OIL control surface treatments: glycerin (G), mylar strip (M), finishing and polishing (FP), and no treatment (NT).

RESULTS: Group AC showed the least ∆E (color difference) values in subgroup M with statistical significance (one-way ANOVA; P = 0.001). However, group BT showed lesser ∆E in subgroups M and G (one-way ANOVA; P = 0.001). Between groups, AC showed significantly lower ∆ E and a higher mean hardness value (HV) than BT. The subgroup FP of both groups exhibited relatively high values (Tukey post-hoc; P = 0.001). The subgroup M showed the least ∆ E, and the subgroup FP showed the highest HV in both groups.

CONCLUSION: G-aenial A’CHORD showed relatively superior color stability and microhardness than that of Beautifil II Enamel. Finishing and polishing improved the microhardness of both the enamel shade RCs.

PMID:41014533 | DOI:10.4103/njcp.njcp_818_24

Niger J Clin Pract. 2025 Sep 1;28(9):1032-1038. doi: 10.4103/njcp.njcp_356_25. Epub 2025 Sep 27.

ABSTRACT

BACKGROUND: Sexual harassment allegations against physicians undermine trust in healthcare and present significant ethical and legal challenges. While such issues are widely discussed in the context of professional conduct, systematic analyses of judicial decisions-particularly in non-Western settings-remain limited.

AIM: This study aims to analyze Turkish Supreme Court decisions involving sexual harassment allegations by physicians toward their patients, focusing on identifying patterns, associated risk factors, and ethical implications.

METHODS: A total of 46 Supreme Court judgments (2009-2024) were identified using the Lexpera database, employing keywords such as “harassment by physician” and “harassment during medical examination.” Each case was evaluated according to physician specialty, nature of the act (penetrative vs nonpenetrative), examination context, witness presence, and judicial outcomes (conviction, acquittal, or reversal).

RESULTS: Most incidents occurred in public hospitals, and the majority of patients were female. Physicians most frequently accused belonged to family medicine, obstetrics and gynecology, and radiology specialties. Documentation of informed consent and the presence of witnesses was rare. Allegations often involved genital examinations performed without explicit consent. While 69.7% of local court decisions resulted in convictions, only 39.4% were upheld by the Supreme Court.

CONCLUSION: Clear communication, standardized informed consent procedures, and the presence of witnesses during sensitive examinations are essential in preventing both misconduct and false accusations. These findings underscore the ethical importance of transparency and institutional safeguards and highlight the need for proactive policies to protect both patients and physicians.

PMID:41014528 | DOI:10.4103/njcp.njcp_356_25

Niger J Clin Pract. 2025 Sep 1;28(9):1027-1031. doi: 10.4103/njcp.njcp_472_25. Epub 2025 Sep 27.

ABSTRACT

BACKGROUND: Head trauma was the significant public health issue and a common cause of emergency department visits. Cranial computed tomography (CT) was widely used in its evaluation; however, overuse-particularly in mild cases-raises concerns about patient safety and healthcare efficiency.

AIM: This study aimed to evaluate the appropriateness of cranial CT use in head trauma patients, its relationship with Glasgow Coma Scale (GCS) scores, and the prevalence of potentially avoidable imaging.

METHODS: This retrospective study included 1,000 patients presenting with head trauma, who underwent cranial CT. Data collected included demographics, trauma mechanism, GCS score, CT findings, and indication for imaging. CT necessity was assessed using the Canadian CT Head Rule and New Orleans Criteria. CTs performed in patients with GCS 13-15, normal findings, and no guideline-based indications were classified as potentially avoidable.

RESULTS: Of all patients, 65% were male, with a mean age of 42.1 ± 20.7 years. Mild trauma (GCS 13-15) was present in 77.5% of cases. Intracranial pathology was detected in 35.9% overall, with higher rates in patients with moderate and severe trauma. Unnecessary CT imaging was found in 57% of all cases, and in 80.2% of mild trauma cases. A statistically significant association was found between lower GCS scores and intracranial findings (P < 0.001).

CONCLUSION: Cranial CT was often overused in mild head trauma without adherence to clinical guidelines. Promoting the use of decision support tools and raising awareness among clinicians and patients are crucial for reducing potentially avoidable imaging, radiation exposure, and healthcare burden.

PMID:41014527 | DOI:10.4103/njcp.njcp_472_25