Category: Nevin Manimala

Int J Low Extrem Wounds. 2025 Jun 27:15347346251353684. doi: 10.1177/15347346251353684. Online ahead of print.

ABSTRACT

Diabetic foot osteomyelitis is the most frequent infection in diabetes-related foot ulcers, often associated with delayed healing, prolonged hospitalization, and increased risk of amputation. The contribution of microbiological factors to its clinical severity remains uncertain. While severe cases are often associated with soft tissue complications such as abscesses or necrotizing infections, it is unclear whether the bacterial profile influences infection severity. This study aimed to determine whether severe presentations are associated with a higher frequency of polymicrobial infections, multidrug-resistant organisms, or specific bacterial species. We conducted a secondary analysis of a prospective cohort of patients with moderate or severe diabetic foot infections confirmed to involve osteomyelitis through histopathological evaluation. Bacterial species isolated from bone biopsy cultures were compared between moderate and severe cases. Among 114 patients included, 73 were classified as moderate and 41 as severe. Bone cultures were positive in 101 cases, yielding 173 isolates. Staphylococcus aureus was the most frequently isolated species, followed by Enterococcus faecalis and Streptococcus agalactiae. No significant differences were found between severity groups in the distribution of individual species, polymicrobial cultures (46.6% in moderate vs 56.1% in severe; p = 0.435), or multidrug-resistant organisms (12.3% vs 12.2%; p = 1.000). A global comparison of species distribution also showed no statistical association with severity (p = 0.941). These findings suggest that severity is not explained by the microbiological profile identified through conventional aerobic cultures. Instead, host-related or anatomical factors may be more relevant, although the lack of anaerobic cultures may have underestimated microbial diversity.

PMID:40576955 | DOI:10.1177/15347346251353684

J Am Geriatr Soc. 2025 Jun 27. doi: 10.1111/jgs.19606. Online ahead of print.

ABSTRACT

BACKGROUND: Cost-effectiveness of family conferences on deprescribing with joint prioritization of treatment goals in primary care has not been investigated so far. We assessed cost-effectiveness in the cluster-randomized controlled COFRAIL trial conducted with general practitioners and 521 older frail patients with polypharmacy cared for at home in Germany.

METHODS: Hospital admissions averted and quality-adjusted life years (QALYs) gained were associated with costs from the German Social Insurance perspective. We applied adjusted GLM regressions with specified distributions to estimate group differences on imputed data, plotted bootstrap cost-outcome pairs by simulated resampling of the study population to illustrate uncertainty and calculate the probability of cost-effectiveness given a willingness-to-pay threshold, and assessed robustness in sensitivity analyses.

RESULTS: Intervention-related costs were €391 (US$459) per capita. On 100 people, the COFRAIL intervention had about 7 more hospital admissions (95% CI: -12; 26), 2 QALYs gained (95% CI: -1; 6), and additional costs of €117,681 (95% CI: -28,838; 264,201)/US$138,027 (95% CI: -33,824; 309,880) or €124,866 (95% CI: -12,649; 262,380)/US$146,455 (95% CI: -14,836; 307,745) without or with hospital costs, respectively, compared to usual care. By bootstrapping, we observed the COFRAIL intervention to have higher costs and more hospital admissions with a relative frequency of 28%-78%, or in terms of QALYs 57%-91%. The COFRAIL intervention had additional costs of €50,966 (US$59.778) per QALY gained with a 46% probability of being cost-effective at a willingness to pay of €45,000/QALY (≈US$50,000/QALY).

CONCLUSION: The COFRAIL intervention affected QALYs rather than hospital admissions after 12 months. The intervention tended to be associated with higher costs and QALYs but was less likely to be cost-effective than usual care at commonly used willingness-to-pay thresholds. Long-term cost-effectiveness should be assessed.

PMID:40576953 | DOI:10.1111/jgs.19606

Spine Deform. 2025 Jun 27. doi: 10.1007/s43390-025-01135-7. Online ahead of print.

ABSTRACT

INTRODUCTION: For early-onset scoliosis (EOS) patients with growth-friendly implants, posterior distraction is a known contributor to proximal junctional kyphosis (PJK). Rib-based proximal fixation is thought to potentially reduce the risk of PJK compared to spine-based anchors. However, the effect of revising proximal rib-based implants to rib vs. spine-based implants on PJK has not yet been investigated.

HYPOTHESES: (1) Patients converted from rib-based to spine-based proximal anchors (RTS) have a higher risk of PJK two years post-revision compared to those revised to rib-based anchors (RTR). (2) Revising the upper instrumented vertebra (UIV) to a lower level increases the risk of PJK at two years post-revision compared to revising to a higher or same level.

METHODS: In this retrospective cohort study of EOS patients with rib-based growing constructs undergoing revision surgery with a minimum 2-year follow-up, we assessed pre-revision, post-revision, and 2-year follow-up radiographs. We excluded patients lacking lateral radiographs and attachment data and conducted descriptive analyses.

RESULTS: 280 subjects were included, with an average age of 7.2 years at revision; RTS patients were slightly older (8.6y vs 7.2y), and 51% female. At 2 years, 32% of all patients developed PJK. This risk was higher in RTS patients compared to RTR patients (42.8% vs 30.2%, p = 0.17). RTS patients had a greater pre-revision total spine height (p = 0.02), a more negative sagittal balance at 2 years (p = 0.01) and were predominantly male (p = 0.08) compared to RTR. Of the factors associated with a greater risk of PJK, proximal anchor conversion from rib-to-spine had the highest predictive value of PJK development (OR 2.23, p = 0.04). While statistically significant, there was no clinical difference in risk at 2 years of developing PJK among patients revised to a lower level compared to those revised to a higher or same level (32.1% vs 32.5% vs 30.9%, respectively; p = 0.05).

CONCLUSION: 32% of all subjects developed PJK at a 2-year follow-up. The risk of PJK in RTS patients was 40% higher than in RTR patients. While this did not reach statistical significance to the 0.05 level, due to the associations of risk established by literature and replicated in this study, and the magnitude of this difference, we believe these results to be clinically significant. We intend to re-evaluate this population in the future as more data becomes available. With no demonstrated risk in revision levels, these results should guide providers in revision decision-making in growing rods.

PMID:40576947 | DOI:10.1007/s43390-025-01135-7

Updates Surg. 2025 Jun 27. doi: 10.1007/s13304-025-02206-0. Online ahead of print.

ABSTRACT

This study evaluates the impact of enhanced recovery after bariatric surgery (ERABS) on length of hospital stay (LoS), postoperative pain, postoperative nausea and vomiting (PONV), adherence to ERABS protocol, postoperative complications, and readmission rates via gradual stepwise implementation. Between January 2017 and December 2018, an observational, controlled, prospective study was performed, enrolling consecutively followed patients who underwent sleeve gastrectomy. Patients were divided into two groups treated with an ERABS protocol which was implemented in two steps. In 2017, this included 12 items (subgroup B1); in 2018, two more items were introduced (subgroup B2). These results were then compared retrospectively to a control group of patients who underwent the same procedure from 2015-2016 whilst adhering to the ‘traditional’ treatment approach (group A). 367 patients were included. 146 patients in group A, 99 in subgroup B1 and 122 in subgroup B2. The median LoS was 4.5 days in group A, 3.8 days in B1, and 2.3 days in B2. Postoperative pain was 35.7% in group A, 35.6% in B1, and 25% in B2 (p = 0.18). The PONV rate was significantly lower in group B than in group A. Adherence to the ERABS protocol increased from 67% in group B1 to 80% in B2. No statistical difference in terms of 30-day postoperative complications rate and 30-day readmission rate was found. ERABS protocol showed significant improvement in LoS, postoperative pain, and PONV without increasing postoperative complications and readmissions, showing progressively better outcomes with a stepwise implementation.

PMID:40576945 | DOI:10.1007/s13304-025-02206-0

Updates Surg. 2025 Jun 27. doi: 10.1007/s13304-025-02302-1. Online ahead of print.

ABSTRACT

Thrombosed external hemorrhoids are a complication of hemorrhoids characterized by severe pain, swelling, and lump formation due to acute venous engorgement. Treatment options remain controversial, with limited evidence guiding the choice between surgical and conservative approaches. PubMed, Embase, and Cochrane Library databases were searched from inception to December 2024 to identify clinical trials comparing surgery with conservative treatment in thrombosed external hemorrhoids. Statistical analyses were performed using Review Manager 5.4.1 with a random-effects model. Heterogeneity was assessed using the I² test. We included six studies with a total of 851 patients, of whom 390 (45.8%) underwent surgical treatment. Surgical treatment was associated with a lower risk of recurrence compared to conservative management (RR 0.49; 95% CI 0.26-0.91; P < 0.05; I² = 54%). However, there were no significant differences in the risk of bleeding between the groups (RR 0.96; 95% CI 0.27-3.44; P = 0.95; I² = 60%). Subgroup analyses of the excision surgery group revealed no differences between approaches. Our main findings indicated no significant difference in bleeding between surgery and conservative treatment groups. However, operative management is associated with significantly lower recurrences, which should be the preferred choice.

PMID:40576944 | DOI:10.1007/s13304-025-02302-1

J Clin Monit Comput. 2025 Jun 27. doi: 10.1007/s10877-025-01318-7. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to test a new method to determine the positive-end expiratory pressure (PEEP) that maintains the lungs open after a recruitment maneuver (RM).

METHODS: In eleven anesthetized patients, we compared the standard RM searching for the optimal PEEP based on the highest respiratory compliance (PEEP_Crs), with a new method. This method performs a RM during a slow pressure-volume curve and detects the optimal PEEP using the novel barometric capnography curve (BCap); i.e. the plot of expired carbon dioxide versus airway pressure. The lungs’ closing pressure was detected when the slope of phase III of the BCap changed along this slow expiration (PEEP_BCap). The main objective was to compare PEEP_BCap with the reference PEEP_Crs. As a secondary objective, we explored the association between PEEP_BCap and the polarity change in end-expiratory transpulmonary pressure (PEEP_PL) during the deflation phase of a slow flow PV curve.

RESULTS: We found a PEEP_BCap of 8.5(3.3) cmH₂O that was no statistically different from the PEEP_Crs of 10.0(4.0) cmH₂O (p = 0.72). Both methods correlated well with a Rho of 0.84 (p < 0.001). The Bland-Altman plot showed a bias of 0.19 and LOA of 1.92 cmH₂O (95%CI -0.39 to 0.77 cmH₂O). During the PV slow deflation limb, PEEP_PL was 9.3(4.3), which was statistically similar to PEEP_BCap (p = 0.61). Both pressures were strongly correlated (Rho = 0.93, p < 0.001) with a bias of -0.3 cmH₂O and LOA of 1.52 (95%CI -0.76 to 0.16 cmH₂O).

CONCLUSIONS: We concluded that BCap is feasible to detect lungs collapse using a constant flow PV curve.

PMID:40576942 | DOI:10.1007/s10877-025-01318-7

J Relig Health. 2025 Jun 27. doi: 10.1007/s10943-025-02369-5. Online ahead of print.

ABSTRACT

Cultural factors are effective in the emergence of psychological resilience. This study aims to determine the psychological resilience, spiritual gratitude, and religious coping levels of students who experienced the Kahramanmaraş earthquake 1 year after the earthquake, and to examine the effect of spiritual gratitude and religious coping levels on the level of psychological resilience. This is a descriptive and correlational study. A total of 176 Emergency Relief and Disaster Management students who experienced the Kahramanmaraş earthquake in Türkiye were included in the study. Data were collected using the Personal Information Form, Brief Psychological Resilience Scale, Spiritual Gratitude Scale, and Religious Coping Scale. Statistical evaluations were made using descriptive analyses as well as Independent Sample t-test, One-way ANOVA, Pearson’s correlation, and multiple linear regression analysis. Psychological resilience was positively associated with spiritual gratitude and positive religious coping levels (p < .05). The findings showed that 1 year after the earthquake, spiritual gratitude and religious coping levels of earthquake survivor students were associated with psychological resilience.

PMID:40576927 | DOI:10.1007/s10943-025-02369-5

Obstet Gynecol Sci. 2025 Jun 27. doi: 10.5468/ogs.25052. Online ahead of print.

ABSTRACT

OBJECTIVE: Random blood glucose (rBG) levels are commonly measured in Japan; however, no standardized cutoff values exist for glucose tolerance screening in early pregnancy. The contribution of glycated hemoglobin (HbA1c) and glycated albumin (GA) measurements to the diagnosis of gestational diabetes mellitus (GDM) remains unclear. Therefore, we aimed to evaluate the significance of these glycemic indicators in early pregnancy for predicting GDM.

METHODS: This observational cohort study enrolled pregnant women who underwent initial prenatal examinations to determine their rBG, HbA1c, and GA levels at a rural maternity facility. Clinical data were retrospectively reviewed.

RESULTS: A total of 449 patients were analyzed, comprising 394 with normal glucose tolerance (NGT) and 55 with GDM. The rBG, HbA1c, and GA levels were significantly higher during early pregnancy in women who developed GDM than in those with NGT. Receiver operating characteristic curve analysis revealed that the areas under the curve (AUC) for rBG, HbA1c, and GA were 0.733, 0.591, and 0.608, respectively, with cutoff values of 100 mg/dL, 5.2%, and 14.6%, respectively. These cutoff values had sensitivities of 52.7%, 70.9%, and 36.4% and specificities of 87.6%, 43.4%, and 82.5%, respectively. The product of rBG and HbA1c levels demonstrated improved performance, with an AUC of 0.750, cutoff value of 509, 63.6% sensitivity, and 83.5% specificity.

CONCLUSION: Glucose tolerance screening in early pregnancy using an rBG level of 100 mg/dL and an HbA1c level of 5.2% as cutoff values may help identify high-risk cases and enable early diagnosis of GDM.

PMID:40576006 | DOI:10.5468/ogs.25052

Liver Int. 2025 Jul;45(7):e70191. doi: 10.1111/liv.70191.

ABSTRACT

BACKGROUND AND AIMS: Little is known about the contribution of sociodemographic and behavioural factors to developing liver disease in individuals with an HIV and chronic hepatitis B virus (HBV) co-infection. We aimed to quantify the impact of these factors on incident liver disease in individuals with HIV/HBV receiving care in the Netherlands.

METHODS: We used data from the Dutch observational ATHENA cohort combined with Statistics Netherlands. We included all hepatitis B surface antigen-positive individuals with HIV in care from 2008-2022. Severe liver disease (i.e., significant fibrosis (≥F2), cirrhosis, hepatocellular carcinoma, liver transplantation) was defined by physician diagnosis or a transient elastography result > 7 kPa. Determinants of incident liver disease were assessed using Cox proportional hazard models.

RESULTS: In the 1319 individuals included (12,277 person-years (PY); 93.3% HIV-RNA < 200 copies/ml), the incidence rate of severe liver disease was 0.59 per 100 PY [95% confidence interval (CI) = 0.47-0.75]. After adjustment for age and time since HBV diagnosis, tobacco smoking, HCV coinfection and body mass index > 25 kg/m² increased the risk of liver disease [adjusted hazards ratio (aHR) = 2.33, 95% CI = 1.38-3.94; aHR = 4.00, 95% CI = 2.18-7.33, aHR = 1.75, 95% CI = 1.05-2.92, respectively]. Conversely, men who have sex with men (vs. other transmission routes, aHR = 0.54, 95% CI = 0.32-0.90), and individuals living in an urbanised municipality (aHR = 0.50, 95% CI = 0.30-0.85) had a reduced risk of liver disease.

CONCLUSIONS: Liver disease progression in people living with HIV/HBV appears to be linked to psychosocial/behavioural factors. More effective screening/management of coinfection and metabolic syndrome, as well as strategies for smoking cessation, should be included in clinical follow-up.

PMID:40576003 | DOI:10.1111/liv.70191

Liver Int. 2025 Jul;45(7):e70195. doi: 10.1111/liv.70195.

ABSTRACT

BACKGROUND: The epidemiology of cryoglobulinemia in Spain has likely changed following the widespread adoption of direct-acting antivirals (DAAs) since 2015 for the treatment of hepatitis C virus (HCV) infection, the principal cause of mixed cryoglobulinemia (MC).

METHODS: All hospital admissions of patients with cryoglobulinemic disease at the National Registry of Hospital Discharges were retrospectively examined in Spain from 1997 to 2022. The following primary conditions associated with cryoglobulinemia were considered: chronic viral infections, haematological diseases (HD), and autoimmune diseases (AD).

RESULTS: A total of 16 929 admissions for patients with cryoglobulinemic disease were recorded during the study period. Hospitalisation rates for patients with cryoglobulinemia steadily increased from 1997 to 2015 (from 10.8 to 17.9 admissions per 1 million habitants, APC = +2.1), and decreased from 2018 to 2022 (from 15.7 to 11 admissions per 1 million habitants, APC = -7) (p < 0.001 for all). The drastic changes in HCV prevalence rates determined this shift (26.3% in 1997, 52.7% in 2016 and 27.9% in 2022, p < 0.001). The proportion of patients with cryoglobulinemia associated with hepatitis B virus (HBV), paraproteinemias, non-Hodgkin lymphoma, systemic lupus erythematosus, primary Sjögren syndrome and rheumatoid arthritis steadily increased during the study period as cause of hospitalisation in patients with cryoglobulinemia (from 1997 to 2022, p < 0.001), while human immunodeficiency virus infection remained fairly stable since 2005.

CONCLUSIONS: The introduction of DAA as treatment for HCV has resulted in a significant reduction in hospitalisations due to cryoglobulinemia in Spain. As a result, cases due to HBV, hematologic and autoimmune diseases have emerged as conditions of growing importance associated with cryoglobulinemia hospitalisations.

PMID:40576002 | DOI:10.1111/liv.70195