Nevin Manimala

J Am Acad Orthop Surg Glob Res Rev. 2025 Jun 11;9(6). doi: 10.5435/JAAOSGlobal-D-25-00143. eCollection 2025 Jun 1.

ABSTRACT

INTRODUCTION: Socioeconomic status has been correlated with clinical and functional outcomes in elective orthopaedic surgery; however, there has been limited application in orthopaedic trauma. The Area Deprivation Index (ADI) uses 17 different metrics to assess disadvantages at the neighborhood level by zip code. The purpose of this study was to examine the relationship between ADI and unplanned return to the operating room (UROR) in the orthopaedic trauma patient population.

METHODS: A retrospective review of adult orthopaedic trauma patients from 2014 to 2019 at a level 1 trauma center was done. Patient demographics, injury characteristics, and ADI were recorded. ADI was used to describe survival to UROR, and logistic regressions were used to identify factors that increased the odds of UROR.

RESULTS: In total, 1,031 patients were included in the study, with a UROR incidence of 14.3%. The average ADI score fell in the minimally deprived category (second quartile). Univariate analysis demonstrated a significant association between UROR and younger age (P < 0.001), higher Injury Severity Score (P < 0.001), ADI > 75 (P< 0.05), osteoporosis (P < 0.001), open fracture (P< 0.05), number of fractures (P < 0.05), and higher fracture complexity (P < 0.001). Multivariate analysis revealed that ADI > 75 (OR 3.486, P = 0.029), younger age (OR 0.982, P = 0.004), Injury Severity Score (OR 1.069, P < 0.001), and osteoporosis (OR 5.086, P < 0.001) was associated with UROR. Kaplan-Meier confirmed increased rates of UROR for the third and fourth ADI quartiles for all cases (P < 0.001) and when controlling for symptomatic implant (P < 0.001).

CONCLUSION: Defined by ADI, patients from severely deprived communities undergoing orthopaedic trauma interventions were found to have a 3.5-fold increased rate of UROR. This study shows outcome disparities in the orthopaedic trauma population when using a comprehensive measure for socioeconomic status even after controlling for other contributing factors. Understanding and addressing the unique challenges facing socioeconomically deprived patient populations has the potential to markedly improve outcomes for orthopaedic trauma patients.

PMID:40505132 | DOI:10.5435/JAAOSGlobal-D-25-00143

JMIR Res Protoc. 2025 Jun 12;14:e63586. doi: 10.2196/63586.

ABSTRACT

BACKGROUND: French Guiana, an overseas territory located in the Guiana Shield in South America, faces unique social and demographic challenges, particularly in relation to migration. Haitians represent 1 of the 3 largest foreign communities in the region and face specific barriers to health care access and prevention. They are also a population exposed to HIV infection.

OBJECTIVE: This Parcours d’Haïti study aims to update knowledge on the health of the Haitian population residing in French Guiana. From a quantitative standpoint, the primary objective of this study was to assess the frequency of sexual behaviors that expose Haitian individuals to HIV risk after arriving in French Guiana and explore the association of this risk with their living conditions. This study adopts a transdisciplinary approach to understand the broader determinants of health and the processes underlying HIV transmission.

METHODS: This mixed methods study involves a quantitative epidemiological and biographical analysis of Haitian individuals aged 18 to 60 years who have lived in French Guiana for more than 3 months. The biographical component uses a detailed grid that tracks key life events since birth. The qualitative component includes 3 substudies based on semistructured interviews and focus groups with Haitian people and health care professionals. These aim to deepen understanding of health care access, use of traditional and biomedical care, and mental health among Haitians. A phylogenetic component describes the distribution of clades of the Pol gene in the viruses of people living with HIV. The study materials were cocreated with local stakeholders. Recruitment of this partially hidden population used an innovative method involving all local actors and targeting key locations frequented by the Haitian community. Data collection and recruitment were carried out by Haitian Creole-speaking peer investigators (community health mediators).

RESULTS: Over 20 months between 2021 and 2023, the Parcours d’Haïti study was implemented in French Guiana. Anticipated results suggest that the main reasons for migration include insecurity and fleeing violence. Upon arrival, Haitian people likely experience significant economic hardship and social isolation. Mental health deterioration is expected, with high rates of posttraumatic stress disorder. People living with HIV are expected to face heightened vulnerability compared to HIV-negative individuals even though they already struggle with precarious living conditions. The qualitative findings regarding health care use indicate that Haitian people encounter numerous barriers to accessing health care, such as administrative complexity, language, and financial and mobility issues. The anthropological results are expected to emphasize the magical-religious origins of HIV and the use of plants and traditional medicine for its treatment. Phylogenetic results are anticipated to show a high prevalence of Caribbean B HIV subtypes.

CONCLUSIONS: The Parcours d’Haïti study aims to provide valuable insights into the health determinants and HIV-related risks in the Haitian population in French Guiana. These findings should help refine health care policies and practices to better meet the specific needs of this population. Trial Registration: ClinicalTrials.gov NCT05174234; https://clinicaltrials.gov/study/NCT05174234.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63586.

PMID:40505127 | DOI:10.2196/63586

J Am Acad Orthop Surg Glob Res Rev. 2025 Jun 11;9(6). doi: 10.5435/JAAOSGlobal-D-24-00059. eCollection 2025 Jun 1.

ABSTRACT

INTRODUCTION: Elderly patients are often dehydrated and are at risk of having prolonged recovery from surgery because of comorbidities and anesthesia. The aim of this study was to investigate the effects of perioperative fluid management on same-day discharge (SDS) rates, physical therapy performance, and complications in elective total joint arthroplasty (TJA).

METHODS: A retrospective review of 158 patients with primary TJA performed as first-start cases was conducted, consisting of 77 total knee and 81 total hip arthroplasty patients from 2021 to 2023. Intraoperative fluids and total perioperative fluids given on the date of surgery were compared between SDS and admitted patients.

RESULTS: Of the 158 TJA first-start cases, 13% of patients were discharged home on postoperative day 0, including 10% of TKA patients and 21% of THA patients. SDS patients were found to have a markedly higher total fluids/body mass index (BMI) ratio and mean intraoperative fluid administration by 400 mL compared with non-SDS patients. Patients who were hypotensive during therapy had a lower total fluids/BMI ratio.

CONCLUSION: The total fluids/BMI ratio may be a useful tool to help guide appropriate intraoperative fluid administration based on varying BMI ranges. Intraoperative fluids during surgical intervention may be more beneficial in postoperative recovery compared with relying on oral replenishment.

PMID:40505123 | DOI:10.5435/JAAOSGlobal-D-24-00059

JMIR Mhealth Uhealth. 2025 Jun 12;13:e71196. doi: 10.2196/71196.

ABSTRACT

BACKGROUND: Patients with cancer may experience physiological and psychological adverse reactions, such as fatigue, pain, anxiety, and depression, which seriously affect their quality of life. Research has shown that remote interventions based on apps or miniprograms may help improve the physiological and mental health of patients with cancer. However, due to the limited number of relevant studies, the impact of web-based interventions in cancer management remains unclear.

OBJECTIVE: We aimed to determine the efficacy of interventions based on apps, miniprograms, or other web-based tools on the physiological (body pain and fatigue) and psychological (anxiety and depression) states and the quality of life of patients with cancer.

METHODS: We conducted electronic literature searches in PubMed, Scopus, Web of Science, the Cochrane Library, CINAHL, and EMBASE databases. The search period spanned from the inception of each database to October 15, 2024. Two researchers independently conducted literature retrieval and data extraction. The risk of bias was assessed with the Cochrane risk-of-bias tool, and the quality of evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). All statistical analyses were performed using Review Manager version 5.4.

RESULTS: A total of 36 randomized controlled trials were included. The remote web-based interventions significantly improved the pain intensity (n=14, 39% studies; standardized mean difference [SMD] -0.39, 95% CI -0.64 to -0.14; I²=82%; GRADE rating=low) and fatigue status (n=11, 31% studies; SMD -0.52, 95% CI -0.95 to -0.09; I²=95%; GRADE rating=low) in patients with cancer. Regarding psychology, the results indicated that the remote web-based interventions significantly improved the anxiety (n=14, 39% studies; SMD -0.60, 95% CI -0.90 to -0.30; I²=91%; GRADE rating=low) and depressive state (n=10, 28% studies; SMD -0.36, 95% CI -0.58 to -0.14; I²=81%; GRADE rating=low) of patients with cancer. For quality of life, the results showed that the remote web-based interventions had a significant positive impact on the quality of life of patients with cancer (n=26, 72% studies; SMD 0.63, 95% CI 0.39-0.87; I²=92%; GRADE rating=low).

CONCLUSIONS: The remote web-based interventions were effective in reducing the intensity of physiological pain, relieving fatigue, improving depression and anxiety, and improving the quality of life of patients with cancer. However, due to the low certainty of evidence, more rigorous randomized controlled trials are needed to validate these findings further.

TRIAL REGISTRATION: PROSPERO CRD42024611768; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024611768.

PMID:40505121 | DOI:10.2196/71196

J Am Acad Orthop Surg Glob Res Rev. 2025 Jun 11;9(6). doi: 10.5435/JAAOSGlobal-D-25-00099. eCollection 2025 Jun 1.

ABSTRACT

BACKGROUND: Use of electric bikes (EBs) and electric scooters (ESs) has increased dramatically, and so are EB-related and ES-related orthopaedic injuries. There is limited research regarding the severity of EB injuries and whether they more closely resemble ES, motorcycle (MC), or pedal bicycle (PB) related injuries. The aim of this study was to characterize injury patterns associated with EB accidents and compare injury severity and details with those of PB, ES, and MC accidents.

METHODS: This was a retrospective review of trauma patients presenting to an academic, level one trauma center between 2019 and 2022 to compare EB, ES, PB, and MC trauma patients. Descriptive statistics were obtained to characterize demographic data. Two-sided Fisher exact tests were used to compare categorical data, and ANOVA was used to compare continuous variables between groups.

RESULTS: EB trauma patients were significantly more likely to experience traumatic brain injury (TBI), intracranial hemorrhage (ICH), or fractures of the head/face compared with MC (54.0% vs. 19.3%, P < 0.0001) and PB (54.0% vs. 33.5%, P = 0.0001) cohorts. EB trauma patients were more likely to lose consciousness than MC or PB trauma patients. Spine fractures (11.0%) were the most prevalent in the EB study population, followed by fractures of the acetabulum (6.0%) and clavicle/scapula/radius (5.0%). EB trauma patients were significantly more likely to be admitted to the intensive care unit (ICU) than MC trauma patients (25.0% vs. 16.0%, P = 0.0256) and were significantly more likely to present as critical trauma activations than PB trauma patients (14.0% vs. 6.0%, P = 0.0106).

CONCLUSIONS: While the overall injury severity scores are similar to the modes of transport, there are differences in injury severity and patterns. EB accidents have a higher prevalence of TBIs, ICH, and facial fractures. EB trauma patients can result in high utilization of resources because many are critical trauma activations and have a higher rate of ICU stays. These data can help providers better understand injury patterns of EB accidents.

PMID:40505114 | DOI:10.5435/JAAOSGlobal-D-25-00099

Genetics. 2025 Jun 12:iyaf112. doi: 10.1093/genetics/iyaf112. Online ahead of print.

ABSTRACT

Cellular diversification in processes from development to cancer progression and affinity maturation is often linked to the appearance of new mutations, generating genetic heterogeneity. Describing the underlying coupled genetic and growth processes that result in the observed diversity in cell populations is informative about the timing, drivers and outcomes of cell fates. Current approaches based on phylogenetic methods do not cover the entire range of evolutionary rates, often making artificial assumptions about the timing of events. We introduce CBA, a probabilistic method that infers the division, degradation and mutation rates from the observed genetic diversity in a population of cells. It uses a summarized backbone tree, intermediary between the true cell tree and the allelic tree representing the ancestral relationships between types, called a monogram, which allows for efficient sampling of possible phylogenies consistent with the observed mutational signatures. We demonstrate the accuracy of our method on simulated data and compare its performance to standard phylogenetic approaches.

PMID:40505111 | DOI:10.1093/genetics/iyaf112

Medwave. 2025 Jun 12;25(5):e2993. doi: 10.5867/medwave.2025.05.2993.

ABSTRACT

INTRODUCTION: According to the World Health Organization (WHO), 2.8 million mothers and newborns die each year from preventable causes, highlighting inequalities in access to quality healthcare services. The study describes the factors that limit institutional childbirth among Ashaninka mothers in the Peruvian Amazon.

METHODS: The research was descriptive, using a questionnaire administered to 152 Ashaninka mothers from five communities in Río Tambo.

RESULTS: Most Ashaninka mothers who gave birth at home were between 25 and 29 years old, lived with their partners, came from the Koterini Tarzo community, were Catholic, had incomplete secondary education, were housewives, and had a paternal income of less than or equal to 1000 PEN. They chose home birth for cultural reasons such as privacy, tradition, and economics, preferring traditional birth attendants because of their cultural acceptance and experience. Cultural practices included the burial of the placenta, the use of herbs such as “piri piri,” and vertical births. The perception of inadequate facilities and the prevalence of cesarean sections limit the acceptance of institutional childbirth. Added to this is a preference for female healthcare personnel, a lack of information about health procedures, and the prohibition of cultural practices.

CONCLUSIONS: There is a need to reform the maternal care model in Indigenous contexts, involving healthcare personnel, policymakers, and local authorities to create culturally relevant and accessible services. It is suggested that an intercultural approach be integrated into professional training and that traditional medicine be combined with the healthcare system. Future studies should evaluate the impact of these interventions on maternal and perinatal outcomes in Indigenous communities.

PMID:40505101 | DOI:10.5867/medwave.2025.05.2993

JMIR Infodemiology. 2025 Jun 12;5:e68469. doi: 10.2196/68469.

ABSTRACT

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common endocrinopathy among women that requires self-management to improve mental and physical health outcomes and reduce risk of comorbidity. Digital technology has rapidly emerged as a valuable self-management tool for people with chronic health conditions. However, little is known about the digital technology available for and used by women with PCOS. .

OBJECTIVE: The purpose of this scoping review was to identify what is known about digital technology currently available and used by women with PCOS for PCOS-specific knowledge, self-management, or social support.

METHODS: The databases PubMed, Embase, CINAHL, and Compendex were searched using Medical Subject Headings terms for PCOS, digital technology, health knowledge, self-management, and social support. Inclusion criteria were full-text, peer-reviewed publications of primary research from 2010 to 2025 in English about digital technology used for PCOS-specific knowledge, self-management, or social support by women aged 18 years and older with PCOS. Exclusion criteria were articles about pediatric populations and digital technology used for intervention recruitment or by health care providers to diagnose or treat patients.

RESULTS: In total, 34 full-text articles met the inclusion criteria. Given the scope of digital technology, eligible studies were grouped into 7 domains: mobile apps (n=14), internet-based programs (eg, Google; n=6), social media (n=6), SMS text message (n=2), machine learning (n=2), artificial intelligence (eg, ChatGPT [OpenAI]; n=3), and web-based intervention platforms (n=1). Findings highlighted participants’ varied perceptions of technology usefulness based on reliability of health care information, application features, accuracy of PCOS or fertility prediction, social group engagement, user-friendly interfaces, cultural sensitivity, and accessibility.

CONCLUSIONS: There is potential for digital technology to transform PCOS self-management, but further design and development are needed to optimize the technologies for women with PCOS. Future research should focus on including end users during the design phase of digital technology, refining predictive models, improving app inclusivity, conducting frequent reliability testing, and enhancing user engagement and support via additional features to promote more comprehensive self-management of PCOS. .

PMID:40505084 | DOI:10.2196/68469

Blood Adv. 2025 Jun 12:bloodadvances.2025016160. doi: 10.1182/bloodadvances.2025016160. Online ahead of print.

ABSTRACT

Pediatric patients with acute lymphoblastic leukemia and lymphoma (ALL/LL) and obesity are at increased risk for venous thromboembolism (VTE). The PREVAPIX-ALL trial was an open-label randomized controlled trial assessing the safety and efficacy of apixaban for VTE prevention in pediatric patients with ALL/LL. An a priori subgroup analysis of obese patients in PREVAPIX-ALL was planned due to increased VTE risk in this group. Obese patients, ages ≥ 2 to < 18 years, with a central venous catheter, and chemotherapy containing asparaginase were randomized to apixaban (prophylactic dose) versus standard of care (SOC-no anticoagulation) during induction chemotherapy (29 days). The primary efficacy endpoint was a composite of non-fatal symptomatic and asymptomatic VTE and VTE-related-death. The primary and secondary safety outcomes were major bleeding and a composite of major and clinically relevant non-major (CRNM) bleeding, respectively. Eighty-two PREVAPIX-ALL participants presented with obesity, of which 42 were randomized to apixaban. For the primary efficacy endpoint, a significant decrease in VTE events was present in the apixaban arm (1/42 [2.4%]) as compared to the SOC arm (10/40 [25%]), (Relative Risk (RR) 0.09; 95% confidence interval (CI), 0.01-0.97; P=0.007). There was a statistically significant treatment obesity interaction, P=0.03. No statistically significant difference was observed for the primary efficacy endpoint among the non-obese group (RR 0.85; 95% CI, 0.53-1.37; P=0.50). No significant difference was observed in major or CRNM bleeding among subgroups. Apixaban prophylaxis in obese ALL/LL patients resulted in a statistically significant VTE risk reduction with no increase in bleeding events. (NCT02369653).

PMID:40505060 | DOI:10.1182/bloodadvances.2025016160

JCO Oncol Pract. 2025 Jun 12:OP2500170. doi: 10.1200/OP-25-00170. Online ahead of print.

ABSTRACT

PURPOSE: To assess the impact and outcomes of a novel program for routine preemptive DPYD testing in fluoropyrimidine (FP)-naïve patients.

PATIENTS AND METHODS: This single-center, retrospective cohort study included adult patients who either received a systemic FP or had a DPYD test result between July 1, 2022, and June 30, 2023. Patients were categorized into preemptive or standard cohorts on the basis of the timing of their DPYD test relative to their initial FP dose. Primary outcomes measured were 90-day all-cause mortality, and FP-related hospitalizations and emergency department (ED) visits after the first FP dose. Secondary outcomes included the incidence of empiric dose reductions, FP avoidance, and dose escalation tolerability among patients with dihydropyrimidine dehydrogenase (DPD) deficiency.

RESULTS: Among 1,281 patients, 90-day all-cause mortality was 5.78% in the preemptive cohort versus 8.23% in the standard cohort (adjusted hazard ratio [HR], 0.69 [95% CI, 0.43 to 1.10]; P = .12), with a notable overrepresentation of patients treated with curative intent in the preemptive group (53.0% v 39.4%, P < .0001). Deaths attributed to DPD deficiency were one (0.18%) in the preemptive cohort and four (0.72%) in the standard cohort (not statistically significant with limited power). Hospitalizations and ED visits related to FP toxicity were paradoxically higher in the preemptive cohort (13.99% v 8.69%, adjusted HR, 1.67 [95% CI, 1.15 to 2.43]; P = .007). Among patients with DPD deficiency in the preemptive cohort, 84.6% received an empiric FP dose reduction, and dose escalation was attempted in 52.2% of these cases.

CONCLUSION: Preemptive DPYD testing did not significantly reduce treatment-related mortality, although a numerical decrease suggests potential benefits that may be substantiated with greater statistical power. Nearly half of the patients managed with a dose reduction did not undergo dose escalation.

PMID:40505058 | DOI:10.1200/OP-25-00170