Nevin Manimala

Ulus Travma Acil Cerrahi Derg. 2025 Nov;31(11):1109-1118. doi: 10.14744/tjtes.2025.52643.

ABSTRACT

BACKGROUND: Hemorrhagic shock is a leading cause of preventable trauma deaths, particularly within the first hours following injury. Early identification of patients requiring massive transfusion or with high mortality risk is critical to optimizing trauma management. Early identification of massive transfusion needs supports timely blood product preparation. Likewise, predicting mortality risk early can influence therapeutic planning and clinical decisions. Numerous trauma and transfusion scoring systems have been developed to guide such early decisions; however, their comparative predictive performance remains unclear. This study aimed to evaluate the effectiveness of trauma and transfusion scoring systems in predicting massive transfusion requirements and in-hospital mortality within the first four hours of trauma.

METHODS: This retrospective study included 117 trauma patients who received at least one unit of red blood cell transfusion within the first four hours of admission to a tertiary care center between 2018 and 2022. Data on demographics, trauma mechanism, clinical and laboratory findings were collected. Each patient was evaluated using 16 trauma and transfusion scoring systems. Patients were categorized based on the need for massive transfusion, defined as receiving ≥5 units of blood products within four hours. Receiver Operating Characteristic (ROC) analysis was used to assess the performance of each scoring system, and optimal cut-off values were determined using the Youden Index.

RESULTS: Massive transfusion was required in 23 patients (19.7%), with firearm injuries being the most common mechanism among these cases. All 16 scoring systems significantly differentiated patients with and without massive transfusion. The Shock Index demonstrated the highest predictive accuracy for massive transfusion (area under the curve [AUC]=0.911). For in-hospital mortality, all scoring systems except the Schreiber Score showed significant predictive ability. The Trauma Related Injury Severity Score (TRISS) achieved the highest predictive value for mortality (AUC=0.975). Several scoring systems required revised threshold values for optimal performance in this cohort, highlighting the need for population-specific calibration.

CONCLUSION: Early-phase application of trauma and transfusion scoring systems provides valuable insights for predicting clinical outcomes in trauma patients. Among the systems analyzed, the Shock Index was the most reliable predictor of massive transfusion. Separately, TRISS demonstrated superior accuracy in forecasting in-hospital mortality. These findings emphasize the importance of rapid, score-based assessment in early trauma care and support further validation of scoring systems across diverse patient populations.

PMID:41392841 | DOI:10.14744/tjtes.2025.52643

Ulus Travma Acil Cerrahi Derg. 2025 Nov;31(11):1075-1081. doi: 10.14744/tjtes.2025.03388.

ABSTRACT

BACKGROUND: Pediatric femoral neck fractures (PFNFs) are rare but are associated with high complication rates due to the precarious vascularity of the femoral head. Cannulated screw fixation (CSF) is the most common surgical technique, though optimal strategies remain debated. The objective of this study was to evaluate the radiological and functional outcomes of proximal femoral neck fractures (PFNFs) treated with CSF and to identify predictors of postoperative complications.

METHODS: The retrospective study was performed of 28 patients (mean age 12.4 years; range 5-18) treated with CSF between June 2020 and December 2024. Fractures were classified using the Delbet-Colonna and Garden systems. Reduction quality was assessed radiographically, and functional outcomes were measured by the Harris Hip Score (HHS). Statistical analyses included univariate and multivariate logistic regression.

RESULTS: Radiographic union was achieved in 92.9% of patients. The overall complication rate was 42.9%, including coxa vara (17.8%), avascular necrosis (AVN, 14.3%), premature physeal closure (PPC, 10.7%), and non-union (7.1%). Patients with AVN (mean HHS 72.5) and non-union (mean HHS 70.0) had the lowest functional scores, while those with coxa vara (82.0) and PPC (85.0) maintained relatively better function. Patients without complications achieved the best outcomes (mean HHS 88.5). Multivariate analysis identified higher Garden grade (OR 4.1, p=0.038) and non-anatomical reduction (OR 3.75, p=0.046) as independent predictors. PPC was significantly associated with implant removal (p=0.003). Despite the small sample, a post-hoc power analysis based on HHS indicated approximately 85% power to detect large effects.

CONCLUSION: PFNFs remain a challenging pediatric injury with high complication rates despite surgical fixation. Precise anatomic alignment is essential to minimize complications, particularly AVN and coxa vara. Close monitoring is recommended for patients with PPC, as it may necessitate implant removal and carries a risk of hip deformity or leg length discrepancy. Larger prospective studies are needed to refine surgical strategies for this rare but clinically significant injury.

PMID:41392836 | DOI:10.14744/tjtes.2025.03388

Riv Psichiatr. 2025 Oct-Dec;60(6):270-278. doi: 10.1708/4617.46260.

ABSTRACT

BACKGROUND: Mental pain (psychache) is a key risk factor for suicide, surpassing traditional constructs like depression and anxiety. While its correlation with suicidal ideation is well-established, few studies have evaluated its predictive value for actual suicide attempts in clinical populations. This study aimed to evaluate whether mental pain predicts short-term suicide attempts in a clinical sample, and to assess its potential role as a screening tool in suicide prevention.

METHODS: A longitudinal study on 179 psychiatric outpatients recruited at the University Hospital of Varese between 2020 and 2022. At baseline, participants completed the Psychache Scale (PAS), Beck Hopelessness Scale (BHS), Beck Depression Inventory-II (BDI-II), and Columbia Suicide Severity Scale (C-SSRS), among others. Sociodemographic, clinical, and laboratory data were also collected. Suicide attempts were tracked over a 12-month follow-up. Binary logistic regression was used to identify predictors of suicide attempts.

RESULTS: Twenty-six patients attempted suicide during follow-up, with 24 cases occurring within the first 6 months. Higher scores on the PAS, BHS, BDI-II, and Columbia Severity Rating Scale (C-SSRS) were significantly associated with increased suicide risk. In logistic regression, the PAS emerged as an independent predictor: each point increase corresponded to a 3.8% rise in suicide attempt probability (p=0.015). The BDI-II showed the strongest model fit (R2=0.169). Unemployment and history of substance abuse were also significantly associated with increased risk. No significant associations were found with routine laboratory parameters.

CONCLUSIONS: The PAS, alongside the BDI-II, BHS, and C-SSRS scales may serve as an effective tool for early suicide risk detection, especially in psychiatric and primary care settings. Mental pain appears to be a relevant short-term risk indicator, highlighting the need for targeted screening and prevention strategies. Further research should explore its application in general healthcare to enhance suicide prevention efforts.

PMID:41392811 | DOI:10.1708/4617.46260

Riv Psichiatr. 2025 Oct-Dec;60(6):232-252. doi: 10.1708/4617.46258.

ABSTRACT

The objective of this review is to examine the recent literature on intimate partner violence (IPV) and witnessing domestic violence (WDV) with a view to providing definitions, prevalence data for Italy and other countries, and for special populations (such as patients with severe mental illness), investigations into risk factors (alcohol, substances, child abuse) and the consequences for general and mental health. In addition to a free search with Google, Medline was interrogated, using PubMed and PsycInfo for both topics. A total of 757 publications were extracted from PubMed and 338 from PsycInfo for IPV and mental disorders, while 334 publications were found in PubMed and 205 in PsycInfo for WDV; updated epidemiological data was obtained from Italian websites (e.g. ISTAT, Office for National Statistics). We concluded that given the increasing incidence of domestic violence, health and academic institutions should frame the phenomenon in epidemiological and clinical terms, providing updated research data to the stakeholders in order to improve treatment and prevention practices.

PMID:41392809 | DOI:10.1708/4617.46258

Am J Hum Biol. 2025 Dec;37(12):e70177. doi: 10.1002/ajhb.70177.

ABSTRACT

BACKGROUND: Across generations, girls’ early marriage recurs in high-risk groups; however there is poor understanding of how behavior and biology interact in this context. We hypothesized an intergenerational cycle of risk, linking early marriage, preterm birth, and school dropout, and evaluated evidence for specific components of this cycle in low-/middle-income countries.

METHODS: We conducted a systematized review, searching articles published from 2000 to 2025. We tested four hypotheses. H1: early marriage is associated with preterm birth; H2: preterm birth is associated with low educational attainment; H3: school dropout is associated with early marriage. Hypothesis-specific search terms and eligibility criteria were applied. We also tested hypothesis H4: preterm birth is associated with reduced cognitive function, by evaluating systematic reviews of research from any setting.

RESULTS: We identified 184 empirical articles for H1-H3, with 26 satisfying the criteria for full review, and 5 systematic reviews for H4. The available evidence supported H1 and H3, but was weak for H2. For H3, studies indicated contrasting directions of association. The systematic reviews demonstrated evidence supporting H4. The majority of empirical studies reviewed had a low risk of bias.

CONCLUSIONS: An intergenerational cycle of risk linking early marriage, preterm delivery and low educational attainment is plausible, involving both behavioral pathways (e.g., school dropout and early marriage) and biological mechanisms (e.g., preterm birth and cognitive function). Few studies have investigated the prospective associations of preterm birth with school outcomes, or school dropout with early marriage, in low- and middle-income countries.

PMID:41392805 | DOI:10.1002/ajhb.70177

BJPsych Open. 2025 Dec 15;12(1):e17. doi: 10.1192/bjo.2025.10931.

ABSTRACT

BACKGROUND: There is ample evidence that women do not progress in mental health publishing as quickly as men. The movement from first to last (senior) author is one indicator of progression.

AIMS: To understand whether there are changes in women’s authorship position following our academic institution’s introduction of support mechanisms to reduce the gender gap in career development.

METHOD: Data from publicly held databases in three cohorts (2016, 2018 and 2020) were assessed for gender and authorship position at the Institute of Psychiatry, Psychology and Neuroscience. Regression analyses included authorship gender and change over time in authorship roles, by school and topic.

RESULTS: We found substantial, statistically significant differences in gender between author roles (χ²(2) = 29.18, P < 0.0001), with women being mainly first authors (marginal mean 62.2:40.1%, respectively, odds ratio 2.463, 95% CI 1.807 to 3.357). The three schools differed (χ²(2) = 14.06, P < 0.001) and, although men were predominant as last authors in all topics in both 2016 and 2020, women did show a modest increase. The trend for an interaction between gender and first-author publications on the likelihood of last-author publications in 2018 (incidence rate ratio 1.839, 95% CI 0.914 to 3.698) had disappeared by 2020.

CONCLUSIONS: Although women were represented as first and corresponding authors, there was still a gender gap for last-author positions. Over time, women have increased their representation in many of the topic areas. The disappearance of any gender-moderating effect suggests that institutional policies may have had an effect, in addition to sector-wide changes.

PMID:41392762 | DOI:10.1192/bjo.2025.10931

BJPsych Open. 2025 Dec 15;12(1):e13. doi: 10.1192/bjo.2025.10925.

ABSTRACT

BACKGROUND: AVATAR therapy, a digitally supported intervention, utilises avatars to promote recovery in people who experience distressing auditory hallucinations. This approach was recently evaluated in a multicentre randomised controlled trial comparing brief (AV-BRF) and extended (AV-EXT) forms of therapy with treatment as usual (TAU). There was evidence for the effectiveness of therapy, particularly for AV-EXT. However, value for money needs to be assessed.

AIMS: To compare separately the cost utility of the brief and extended forms of AVATAR therapy with TAU.

METHOD: In a three-arm randomised controlled trial the use of health services was measured, and costs (2021/2022; pounds sterling) calculated from a health and social care perspective over a 28-week follow-up period. Quality-adjusted life years (QALYs; derived from the 5-level version of the EuroQol 5-Dimension questionnaire) were combined with costs.

RESULTS: AV-BRF resulted in extra costs of £319 (95% CI, -£1558 to £2496), and AV-EXT in lower costs of £1965 (95% CI, -£1912 to £1519), compared with TAU. Over the follow-up, AV-BRF resulted in 0.0159 (95% CI, -0.0103 to 0.0422) and AV-EXT in 0.0173 (95% CI, -0.0049 to 0.0395) more QALYs than TAU. The cost per QALY for AV-BRF compared with TAU was £20 016, while AV-EXT dominated TAU (lower costs and more QALYs).

CONCLUSIONS: Neither version of AVATAR had a substantial impact on QALYs. However, AV-EXT did result in reduced care costs – albeit not statistically significant – and was potentially cost-effective compared with TAU. AV-BRF had an incremental cost-effectiveness ratio that indicated lower potential cost-effectiveness. These findings are uncertain, but could still inform decision-making regarding interventions in this field.

PMID:41392761 | DOI:10.1192/bjo.2025.10925

BJOG. 2025 Dec 14. doi: 10.1111/1471-0528.70109. Online ahead of print.

ABSTRACT

OBJECTIVE: A randomised controlled trial found no significant reduction in severe postpartum haemorrhage (≥ 3 packed red blood cell units and/or total blood loss > 1000 mL) when intrauterine balloon tamponade and second-line uterotonics were used simultaneously compared with balloon use after failure of second-line uterotonics. However, one quarter of participants had already lost more than 1000 mL at randomisation, increasing heterogeneity and coagulopathy risk. This may have obscured a potential benefit in women with moderate bleeding (500-1000 mL). We aimed to assess the effect of early versus later balloon use in this subgroup.

DESIGN: Exploratory analysis of a randomised controlled trial.

SETTING: Maternity units across France.

POPULATION: Women with 500-1000 mL of blood loss at the time of second-line uterotonic administration after vaginal delivery (n = 264).

METHODS: Outcomes were compared between women randomised to early intrauterine balloon tamponade (n = 128) and those who received balloon after failure of second-line uterotonics (n = 136). Risk ratios were estimated using multivariate Poisson regression with robust variance.

MAIN OUTCOME MEASURES: Severe postpartum haemorrhage (≥ 3 packed red blood cell units and/or total blood loss > 1000 mL).

RESULTS: Severe postpartum haemorrhage occurred in 57.8% of the early group and 70.6% of the later group (adjusted risk ratio 0.83; 95% CI 0.69-1.01; p = 0.06).

CONCLUSIONS: Early intrauterine balloon tamponade was not associated with a statistically significant reduction in severe haemorrhage among women with moderate bleeding; estimates are compatible with a modest benefit and should be considered hypothesis-generating.

PMID:41392334 | DOI:10.1111/1471-0528.70109

Int Wound J. 2025 Dec;22(12):e70789. doi: 10.1111/iwj.70789.

ABSTRACT

Self-treatment of benign symptoms using hot water bottles, steam inhalation or hot tea is common in households and poses risks of severe scald injuries. This study aims to investigate associated hazards and identify high-risk patient groups to facilitate targeted prevention. A retrospective, single-center descriptive study was conducted on adult burn patients with scald injuries from hot water bottles, steam inhalation or hot tea. Demographic information, injury mechanism and outcomes were analysed. A total of 43 patients (mean age: 37.5 years; female:male ratio 23:20) were included. Injuries were caused by hot water/tea (37.2%), steam (34.9%) and hot water bottles (27.9%). The average burned total body surface area (TBSA) was 4%, with 79.1% of injuries being superficial partial-thickness burns. Surgical intervention was required in 13.9% of cases. Hot water bottle injuries predominantly affected young females (75%, mean age 32.6 years), with a high incidence of genital burns (58.3%). Hot tea-related injuries were more frequent in older males (62.5%, mean age 41.6 years), involving greater TBSA (6.5%) and a higher necessity for skin grafting (18.8%). Common self-treatment strategies can cause serious scalds, particularly in specific demographic groups, thereby burdening healthcare systems. Awareness of these risks is pivotal for effective education and prevention.

PMID:41392332 | DOI:10.1111/iwj.70789

Eur J Cardiothorac Surg. 2025 Dec 14:ezaf451. doi: 10.1093/ejcts/ezaf451. Online ahead of print.

ABSTRACT

OBJECTIVES: Mitral valve (MV) disease shows sex-specific differences in morphology and outcomes. Women often present later, undergo replacement more frequently, and experience worse survival. This study investigated sex-related disparities in surgical approach, repair rates and outcomes of MV surgery.

METHODS: 1,531 consecutive patients undergoing MV surgery with or without concomitant tricuspid valve procedure were analyzed retrospectively. Baseline characteristics, operative strategies, and outcomes were compared between sexes. Propensity score matching was used to adjust for baseline differences. Primary outcomes were 30-day and 5-year mortality. Baseline and procedural characteristics, including morphology, repair rates, use of minimally invasive MV surgery (MIMVS), and concomitant tricuspid disease, were compared between groups.

RESULTS: Female patients (44%) were older (68 vs 62 years, p < 0.001), more symptomatic (NYHA III: 60% vs 46%, p < 0.001) and more likely to have annular calcification (15% vs 5%, p < 0.001) or concomitant tricuspid disease (25 vs 36%, p < 0.001). Carpentier type IIIa was more prevalent in women (21% vs 4%), while type II predominated in men (75% vs 49%). MIMVS and repair were less frequent in women (49% vs 65% and 67% vs 85%, both p < 0.001). Female sex was associated with increased 30-day (HR 4.07, 95% CI 1.51-11.0; p = 0.006) and five-year mortality (HR 1.58, 1.02-2.46; p = 0.043). After adjusting for morphology and calcification, sex was no longer an independent predictor of repair rates or long-term mortality.

CONCLUSIONS: Women present at a later stage of the disease and with more complex MV pathology, resulting in lower repair and MIMVS rates and higher perioperative mortality. These disparities are largely attributable to disease morphology rather than sex per se. Earlier referral of women is essential to improve outcomes.

PMID:41392323 | DOI:10.1093/ejcts/ezaf451