Category: Nevin Manimala

J Neurosurg Spine. 2025 Mar 21:1-11. doi: 10.3171/2024.11.SPINE24609. Online ahead of print.

ABSTRACT

OBJECTIVE: Previous research suggests elective surgical procedures performed later in the week have worse outcomes. This study investigated whether the day of the week on which elective anterior cervical discectomy and fusion (ACDF) surgery was performed impacts clinical outcomes.

METHODS: Using data from the Quality Outcomes Database, a nationwide, multicenter prospective registry, this study included patients undergoing elective ACDF for cervical spondylosis. Patients were categorized into groups based on the surgery day (early week, Monday and Tuesday; late week, Thursday and Friday). Analyzed outcomes included postoperative complications, readmissions, reoperations, and patient-reported outcomes. Statistical methods included the independent t-test, Pearson’s chi-square test, and multivariable logistic regression.

RESULTS: The study analyzed 19,818 patients, with 41.7% undergoing surgery early in the week and 36.9% later. There were no significant differences in 30-day mortality, readmissions, or reoperations between the two groups. Early-week surgical procedures were associated with a higher incidence of postoperative dysphagia requiring nasogastric tubes (0.6% vs 0.3%, p = 0.02) and a higher incidence of vocal cord paralysis (0.5% vs 0.3%, p = 0.01). The data indicate a surgical selection bias with more complex surgical procedures and higher risk patients typically scheduled earlier in the week, which likely contributed to the increased rates of dysphagia. Conversely, patients who underwent operations on Fridays were more likely to be discharged on the same day compared to those earlier in the week (p = 0.02), without a significant difference in length of stay overall. Surgical procedures performed later in the week were more likely to be performed at ambulatory surgical centers rather than inpatient facilities (p < 0.01), indicating a strategic selection of healthier patients for end-of-week procedures.

CONCLUSIONS: The day of elective ACDF surgery does not affect mortality, readmissions, or reoperation rates. However, early-week surgical procedures may see slightly higher rates of postoperative dysphagia and vocal cord paralysis, likely due to the scheduling of more complex cases or higher risk patients during these days. Overall, the authors’ data confirm that day of surgery does not influence overall patient recovery significantly. This information is useful for surgical planning and for providing patient reassurance that the day of the week does not significantly impact surgical outcomes.

PMID:40117661 | DOI:10.3171/2024.11.SPINE24609

J Neurosurg Pediatr. 2025 Mar 21:1-13. doi: 10.3171/2024.11.PEDS24322. Online ahead of print.

ABSTRACT

OBJECTIVE: The goal in this study was to retrospectively evaluate the safety and feasibility of purely neuroendoscopic removal of choroid plexus tumors (CPTs) in children using a monoportal or biportal technique.

METHODS: The clinical, radiological, and surgical data of all children with CPTs removed via purely endoscopic or microsurgical approaches in the last 12 years at two centers were retrospectively reviewed. Both centers were fully equipped with advanced neuroendoscopic technology, and surgical teams were fully trained in complex neuroendoscopic intraventricular surgical procedures.

RESULTS: The study involved 32 patients, divided into two groups: 13 undergoing endoscopic procedures and 19 undergoing microsurgical procedures. In the endoscopic group, the mean age was 2.11 years. Eight tumors were located in the lateral ventricles, and 5 in the third ventricle. The mean tumor volume was 6.59 cm3 (range 0.25-15.4 cm3); 9 patients had hydrocephalus at presentation. The monoportal technique was used in 9 patients, and the biportal technique was used in 4 patients. Gross-total removal was achieved in all patients-within a single procedure in 11 patients, and in a two-stage procedure in 2 patients. In the microsurgical group the mean age was 3.75 years. Seventeen tumors were located in the lateral ventricles, and 2 in the third ventricle. The mean tumor volume was 15.07 cm3 (range 1.2-84.35 cm3). The following microsurgical approaches were used: transcortical (n = 11), transcallosal (n = 5), and interhemispheric transprecuneal (n = 3). There was no statistically significant difference between the cases treated via microsurgical and endoscopic approaches with regard to CPT volume (p = 0.06), presence of hydrocephalus (p = 0.22), need for shunt surgery (p = 0.78), or complications (p = 0.06). Furthermore, a statistically significant difference was found in surgery time and blood loss: in endoscopic procedures there was significantly lower blood loss and a shorter surgery time (p < 0.005).

CONCLUSIONS: The present study conducted at two hospitals has demonstrated that neuroendoscopic removal of the CPT is a safe and feasible alternative to the conventional microsurgical procedure. The lower blood loss, lower rates of serious complications, and full resolution of hydrocephalus are the main points in favor of neuroendoscopic surgery to obtain gross-total removal of intraventricular CPT in infants and children.

PMID:40117660 | DOI:10.3171/2024.11.PEDS24322

J Neurosurg. 2025 Mar 21:1-9. doi: 10.3171/2024.11.JNS241896. Online ahead of print.

ABSTRACT

OBJECTIVE: Atypical intracranial meningiomas are characterized by brain invasion and faster growth than lower-grade counterparts. Surgery improves survival for patients with atypical meningiomas, and this study assesses the association between the timing of surgery and survival.

METHODS: Patients > 18 years of age with intracranial atypical meningiomas resected (2004-2019) and cataloged in the National Cancer Database were included. Descriptive statistics of sociodemographic and clinical characteristics were generated. Kaplan-Meier survival curves for each variable were generated. Cox proportional hazards models were developed to assess the association of time between diagnosis and surgery with overall survival, while controlling for age, sex, race, ethnicity, facility type, tumor size, comorbidity, resection type, adjuvant radiotherapy, and systemic therapy.

RESULTS: A total of 5452 patients were included; 17.81% of the patients were between 18 and 50 years, 66.89% were between 51 and 75 years, and 15.30% were > 75 years. Among the cohort, 55.98% of patients were female. The average time between diagnosis and surgery was 0.8 months; 63.33% of the patients underwent gross-total resection, 28.28% received adjuvant radiotherapy, and 0.92% received systemic therapy. Overall, 21.39% of the patients died during the study period, and the average follow-up time after surgery was 50.9 months. Bivariate analysis showed that the risk of patient mortality over the entire study period increased significantly for every additional month between diagnosis and surgery (hazard ratio [HR] 1.03, 95% CI 1.01-1.06; p = 0.01). On multivariable analysis, a longer time between diagnosis and surgery (HR 1.03, 95% CI 1.00-1.05; p = 0.02) remained a significant predictor of mortality after adjusting for age, sex, race, ethnicity, treatment facility type, tumor size, frailty, resection type, adjuvant radiotherapy, and systemic therapy. On subgroup analysis, delayed time to surgery was associated with increased mortality for those who received subtotal resection (HR 1.04, 95% CI 1.01-1.07; p = 0.01), but not for those who received gross-total resection (HR 1.02, 95% CI 0.97-1.06; p = 0.43). Patients who were female, Asian, treated at an academic program, and received radiotherapy were associated with significantly decreased mortality, whereas patients who were male, African American, had a tumor size > 60 mm, had more comorbidities, and underwent subtotal resection experienced increased mortality.

CONCLUSIONS: Additional time between diagnosis and surgery is associated with an increased risk of mortality after adjusting for confounders. The authors recommend surgery as soon as safely possible after diagnosis for patients with intracranial meningiomas with signs of atypia.

PMID:40117658 | DOI:10.3171/2024.11.JNS241896

Surg Technol Int. 2025 Mar 21;45:sti45/1860. Online ahead of print.

ABSTRACT

INTRODUCTION: There is a wide range of nonoperative options to manage symptomatic knee osteoarthritis (OA). This paper aimed to 1) define the treatment sequence for patients undergoing up to four subsequent rounds (i.e., cryoneurolysis) of superficial (Cryo-Superficial) and/or deep genicular nerves (Cryo-Deep/Both), intra-articular corticosteroid injections (IA-CS), triamcinolone extended-release (IA-TA-ER), hyaluronic acid (IA-HA), or non-steroidal anti-inflammatory drugs (IA-NSAIDs); 2) compare usage of extended-release versus standard corticosteroid injections; and 3) quantify distribution of repeated treatments.

MATERIALS AND METHODS: We identified 502 patients with symptomatic knee OA and received nonoperative intervention within the Innovations in Genicular Outcomes (IGOR) registry from 2021 to 2024. Treatment journey during follow up was presented aggregating baseline patient demographics, along with sequence of nonoperative treatments per patient, duration, and frequency of repeated use. Repeated use of Round 1 treatment for subsequent treatment rounds was estimated with descriptive statistics.

RESULTS: Fifty-three percent of patients received only the original Round 1 treatment option, either single/repeated dose and did not receive any alternative treatment. Seventy-three percent of patients treated with intra-articular extended-release triamcinolone (IA-TAER) repeated the treatment at least once, whereas 60% of those treated with other treatments did so. No adverse events were reported in patients during repeated treatments.

CONCLUSION: Patients who received IA-TAER were more likely to repeat the same injection, with 73% repeating at least once and no adverse events were attributed to repeated injections. Approximately half of the patients have switched from the initial treatment offered during follow up, with the use of IA-TAER associated with higher rates of repeated treatment. Significance and Innovation 1. Our study used a newly developed real-world registry IGOR to characterize treatment progression for patients with symptomatic knee OA undergoing up to five rounds of nonoperative treatment. 2. Non-surgical interventions included cryoneurolysis, intra-articular injections of NSAIDs, hyaluronic acid injections, corticosteroid, or extended release steroid (triamcinolone) injections. 3. We found 73% of patients treated with intra-articular extended-release steroid injections repeated treatment at least once, relative to 60% by other treatments. 4. We found approximately half of patients switched from initial treatment offered during follow up, with the use of IA-TAER associated with higher rates of repeated treatment.

PMID:40117656

Hepatology. 2025 Mar 21. doi: 10.1097/HEP.0000000000001312. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: This large-scale, population-based cohort study examined the associations between metabolic syndrome and cholangiocarcinoma risk, including its intra- and extra-hepatic forms.

APPROACH AND RESULTS: A total of 4,932,211 adults aged ≥40 years participated in a government-initiated health checkup program (2012-2017), which collected lifestyle data, anthropometric measurements, and biochemical tests. Follow-up continued until 2021, with data linkage to National Cancer and Death Registries to ascertain the occurrence of cholangiocarcinoma and obtain vital status information. Fine and Gray models accounted for competing risks. During 35,879,371 person-years of follow-up, 6,117 cholangiocarcinoma cases were identified, with an incidence rate of 17.05 (95% CI: 15.90-18.20) per 100,000 person-years. Individuals with metabolic syndrome had significantly higher incidences of both intra- and extra-hepatic cholangiocarcinoma (p<0.0001). The multivariate-adjusted hazard ratio (HR) for cholangiocarcinoma among those with metabolic syndrome was 1.20 (1.14-1.27). Stratification analyses by age, sex, liver enzyme levels, and comorbidities consistently demonstrated an increased cholangiocarcinoma risk among individuals with metabolic syndrome. A dose-response relationship was observed, with a higher number of metabolic components correlating with an elevated cholangiocarcinoma risk, even after accounting for all-cause mortality as a competing risk. The adjusted subdistribution HRs ranged from 1.16 (95% CI: 1.02-1.32) for individuals with one metabolic component to 1.67 (95% CI: 1.45-1.94) for those with five (p for trend <0.0001).

CONCLUSIONS: The positive association between metabolic syndrome and cholangiocarcinoma risk suggests that managing metabolic risk factors might reduce the occurrence of both intra- and extra-hepatic cholangiocarcinoma.

PMID:40117647 | DOI:10.1097/HEP.0000000000001312

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1404a4566.

ABSTRACT

INTRODUCTION: Hidradenitis suppurativa is a disease with a decisive burden on sufferers, both physical and psychological. It was expected that the more intense the severity of symptoms the patients experienced, the greater the correlation with the psychosomatic manifestations would be.

OBJECTIVES: The present study aimed to explore the correlation between hidradenitis suppurativa and the psychosomatic burden, the personality, and the demographic characteristics of the participants.

METHODS: The participants were 90 outpatients of the hospital, aged 18 to 65, who had been diagnosed with hidradenitis and were sufficiently proficient in Greek. The psychometric instruments administered were the Symptom Checklist-90 (SCL90), the Beck Depression Inventory (BDI), the Eysenck Personality Questionnaire (EPQ), the short-form McGill Pain Questionnaire (SF-MPQ), the Hurley and refined Hurley classifications, the International Hidradenitis Suppurativa Severity Scoring System (IHS4), and a short demographic questionnaire. All statistical analyses were performed using the SPSS-28 statistical package.

RESULTS: According to statistical analyses, there was no statistically significant relationship between disease severity, psychosomatic burden, and personality. However, there were statistically significant associations with demographic factors, such as being female or not being in a relationship, the patient’s body mass index, the locus of the skin lesion, a history of hospitalization, comorbidities, psychiatric history, and pain with psychopathological manifestations and personality.

CONCLUSIONS: It is important that further research be conducted that will include more mental disorders besides anxiety and depression while at the same time excluding confounding factors for safer interpretation of the results.

PMID:40117646 | DOI:10.5826/dpc.1404a4566

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1501a4871.

ABSTRACT

INTRODUCTION: Pustular psoriasis (PP) is a rare life-threatening skin disease with negatively impact on quality of life (QoL). Clinically, it may be systemic (generalized pustular psoriasis [GPP]) or localized on palms and soles (palmoplantar pustulosis [PPP]). It is not rare to observe plaque psoriasis associated with GPP.

OBJECTIVES: We explored the therapies used for PP and their correlation with patient QoL scores, through a cross-sectional study using retrospective data from a monocentric database in the period 2017-2021.

METHODS: Patient characteristics were summarized using descriptive statistics and treatment predictors of QoL were identified by multiple regression analysis. Among 108 patients with PP, 57.4% had GPP + PSO whereas 42.6% had PPP. The therapeutic management is based on systemic conventional treatments and biological therapies in both GPP and PPP.

RESULTS: GPP + PSO patients with an impaired QoL (DLQI≥10) were associated with biological therapy including certolizumab (odds ratio [OR]=2.38), etanercept (OR=2.25), secukinumab (OR=2.03) or ustekinumab (OR=2.79) whereas, PPP patients were positively associated with secukinumab (OR=2.85) or apremilast (OR 4.28, 95%-CI 0.56-9.62).

CONCLUSIONS: Currently, systemic conventional therapy remains the therapeutic fulcrum of PP management. A great effect on QoL, especially for GPP+PSO, was assessed regardless the ongoing treatment and only newer biologic options were able to somehow positively impact.

PMID:40117644 | DOI:10.5826/dpc.1501a4871

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1501a4648.

ABSTRACT

INTRODUCTION: Non-vitiligo hypopigmented skin lesions may be close clinical mimickers of vitiligo, resulting in a diagnostic dilemma. Dermoscopic features of vitiligo have been studied, but those of other hypopigmentation disorders are not well-characterized.

OBJECTIVES: We aimed to describe and compare the dermoscopic features of vitiligo and other hypopigmented skin lesions.

METHODS: This was a cross-sectional study including 105 vitiligo and 137 other hypopigmented skin lesions, including ash-leaf macules (N=17), nevus depigmentosus (N=16), post-inflammatory hypopigmentation (N=16), pityriasis alba (N=15), pityriasis versicolor (N=14), idiopathic guttate hypomelanosis (IGH) (N=14), lichen sclerosus (N=12), leprosy (N=9), and others. Dermoscopic findings were recorded by concordance of at least two qualified dermatologists.

RESULTS: Common dermoscopic findings in vitiligo were intermediate or ill-defined margins (96/105, 91.4%) and a complete absence of pigment network (70/105, 66.7%). Nevus depigmentosus lesions were mostly hypopigmented, with a faint pigment network throughout the lesion. In 15/17 (88.2%) ash-leaf macules, a characteristic pattern of sharply demarcated areas of normal pigment network was seen within a depigmented lesion. Almost all lesions of IGH had a sharply defined margin with completely absent pigment network; discernible eccrine openings within the lesion were seen in 9/14 (64.3%). Dermoscopic findings of a complete absence of pigment network, perifollicular retention of pigment, presence of vascular pattern, loss of discernibility of eccrine openings within the lesion, and lack of scaling were statistically significantly more common in vitiligo than other hypopigmented skin lesions (P <0.001).

CONCLUSION: Vitiligo, nevus depigmentosus, ash-leaf macule, and IGH have distinctive dermoscopic features. Dermoscopy can aid in the differential diagnosis of vitiligo and other hypopigmented skin lesions.

PMID:40117638 | DOI:10.5826/dpc.1501a4648

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1501a4481.

ABSTRACT

INTRODUCTION: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary scarring alopecias that few authors consider the same entity, and some consider them different. Only a few reviews focus on trichoscopic findings in delineating these two alopecias.

OBJECTIVE: We describe and summarize the trichoscopic features of both conditions.

METHODS: We performed an extensive literature search using the PubMed and Google Scholar databases. The Chi-square test was applied to compare the trichoscopic features in LPP and FFA. P-values less than 0.05 were considered statistically significant.

RESULTS: Out of 60 articles, 33 (16 LPP, 17 FFA) were considered for quantitative analysis due to availability in English literature with full text. We found that peripilar cylindrical casts and perifollicular erythema with arborizing vessels were predominant features suggesting early LPP. In contrast, yellow dots, perifollicular erythema, and scattered pigmentation suggested active FFA. Shiny-white area was seen in both groups in the inactive stages. The target arrangement of blue-grey dots, milky-red areas, and irregularly arranged white fibrotic dots were seen in late LPP, and black dots, lonely hairs, and loss of vellus hairs were detected in the later stages of FFA. Features such as blue-grey structureless areas, blue-white veil, and variability in morphologies of hair shafts were not significantly different between the two groups.

CONCLUSION: This article provides a comprehensive literature review on the trichoscopic features of LPP and FFA, including comparing the similarities, differences, and peculiarities of both conditions.

PMID:40117622 | DOI:10.5826/dpc.1501a4481

Dermatol Pract Concept. 2025 Jan 30;15(1). doi: 10.5826/dpc.1501a4838.

ABSTRACT

INTRODUCTION: Risankizumab and secukinumab are effective treatment options for patients with moderate to severe psoriasis.

OBJECTIVES: We sought to estimate the efficacy and the cost per responder of risankizumab and secukinumab by comparing these two drugs in a real-life setting.

METHODS: A multicentric retrospective study was conducted in patients from the Lazio region of Italy affected by moderate-to-severe psoriasis who initiated risankizumab or secukinumab between September 2020 to September 2022. Psoriasis Area and Severity Index (PASI) was measured at baseline and after 16, 52, and 78 weeks. Clinical responses were evaluated by PASI90 and PASI100 responses at the same timepoints. The cost per responder at week 16 and 52 was adopted as a cost-effectiveness indicator.

RESULTS: Included were 141 patients, 74 (52.5%) treated with risankizumab and 67 (47.5%) treated with secukinumab. PASI90 responses in risankizumab-treated patients were higher than those observed in patients treated with secukinumab at both weeks 16 and 52 (79.7% versus 64.2% (P = 0.041) and 98.6% versus 83.6% (P = 0.003), respectively). Risankizumab also showed superior PASI100 rates at week 52 (85.5% versus 65.6%, P = 0.009). No statistically significant differences were observed in PASI90 and PASI100 rates between the 2 groups at week 78. The cost per PASI90 and PASI100 responder for risankizumab was lower at both weeks 16 (€5833.66 and €8394.78, compared to €8747.18 and €10746.53 for secukinumab) and 52 (€11798.90 and €13598.73 vs €15347.70 and €19568.31, respectively).

CONCLUSIONS: Risankizumab showed superior efficacy than secukinumab and a lower cost per responder.

PMID:40117618 | DOI:10.5826/dpc.1501a4838