Nevin Manimala

Otolaryngol Head Neck Surg. 2025 Dec 7. doi: 10.1002/ohn.70076. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare surgical outcomes of patients with Graves’ disease undergoing total thyroidectomy through the transoral endoscopic thyroidectomy vestibular approach versus the transcervical approach.

STUDY DESIGN: Retrospective cohort study.

SETTING: Tertiary care academic institution.

METHODS: Patients were offered a choice of either approach, undergoing surgery between September 2016 (when TOETVA was first offered) and March 2024. Patients were excluded if they were under 18 years old or received a neck dissection or re-operation. Collected data includes demographics, clinical and surgical variables, pathology, and postoperative complications.

RESULTS: In total, 152 transcervical and 81 transoral cases were included. The transoral group was younger (36.1 vs 45.3 years, P < .0001) and had more females (95.1% vs 77.0%, P = .0003) but had comparable body mass index to the transcervical group. There were no significant differences in the median maximum lobe size (5.9 (transcervical) vs 5.6 (transoral) cm, P = .647). Complication rates were similar between groups. Of the minor complications, temporary hypoparathyroidism was the most prevalent with 12 (7.9%) cases in the transcervical and 7 (8.6%) in the transoral groups. There were 2 (1.3%) and 4 (5.0%) cases of major complications in transcervical and transoral groups, respectively. Multivariable regression for age, sex, length of admission, and surgery duration confirmed no significant associations between approach and complication rates.

CONCLUSION: Transcervical and transoral approaches for surgical management of Graves’ disease show statistically comparable rates of minor and major complications, even early in the learning curve. The choice of approach should involve shared decision-making between surgeon and patient, as highly motivated patients may not be excellent candidates.

PMID:41353724 | DOI:10.1002/ohn.70076

Knee Surg Sports Traumatol Arthrosc. 2025 Dec 7. doi: 10.1002/ksa.70220. Online ahead of print.

ABSTRACT

PURPOSE: Return to performance (RTPerf) after anterior cruciate ligament (ACL) surgery remains difficult to predict in elite alpine skiers, as general criteria may not fully apply. This study aimed to identify determinants and the time needed to achieve RTPerf at the same competitive level.

METHODS: A prospective cohort of 71 elite alpine skiers (mean age: 23.6 ± 5.2 years; height: 173.0 ± 7.8 cm; weight: 72.0 ± 12.1 kg) who underwent ACL surgery was analysed. Demographic and contextual variables, including sex, age, world ranking and type of injury, were collected. Isokinetic knee muscle strength was assessed six months postsurgery. RTPerf (YES/NO) and time to return were evaluated 2 years postoperatively using the International Ski and Snowboard Federation points system. Associations with categorical and quantitative variables were assessed using χ² and t- or Mann-Whitney U tests. Variables with p < 0.2 were included in multivariable logistic regression. Predictors of return time were analysed using Cox regression and receiving operating characteristic (ROC) curves. Statistical significance was set at p < 0.05.

RESULTS: Seventy-nine percent of skiers returned to preinjury performance within 2 years. Primary ACL injury (vs. revision) (odds ratio [OR]: 6.6; 95% confidence interval [CI]: 1.85-23.6; p = 0.004) and isolated injury (vs. complex) (OR: 5.35; 95% CI: 1.39-20.48; p = 0.014) were significant predictors. Average return time was 348 ± 51.6 days. Greater relative knee extensor strength was associated with earlier return. Limb symmetry in knee extension at 60°/s predicted return within 1 year, while the hamstring-to-quadriceps functional ratio at 90°/s predicted later return (area under the curve [AUC]: 0.78; p < 0.01).

CONCLUSIONS: Primary and isolated ACL injuries were linked to higher RTPerf rates, while greater knee extensor isokinetic strength was associated with shorter time to RTPerf in elite alpine skiers.

LEVEL OF EVIDENCE: Level II.

PMID:41353718 | DOI:10.1002/ksa.70220

Psychooncology. 2025 Dec;34(12):e70354. doi: 10.1002/pon.70354.

ABSTRACT

BACKGROUND: Sarcopenic obesity (SO)-excess adiposity with low muscle strength and mass-is a concern in oncology as it may exacerbate functional decline and cancer-related fatigue (CRF). The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recently proposed diagnostic criteria for SO, but these remain untested in breast cancer (BC). We examined associations between SO, CRF, quality of life (QoL), and physical function in women with early BC.

METHODS: Sixty-six patients (48.0 ± 9.9 years; stages I-III) underwent assessments of body mass index (BMI) and composition (DXA), waist circumference (WC), and handgrip strength. Physical function was evaluated using the timed up-and-go (TUG) and the 6-m walk test (6-MWT), while QoL and CRF were assessed using the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire (EORTC QLQ-C30) and the Cancer Fatigue Scale (B-CFS). The ESPEN-EASO consensus was applied to classify participants as Eutrophic (normal BMI and WC), Obesity (high BMI and/or WC with preserved muscle strength and mass), or SO (high BMI and/or WC with reduced muscle strength and mass).

RESULTS: Global health/QoL (p = 0.03) was lower in SO (61.6 ± 7.2) and Obesity (60.4 ± 3.7) than Eutrophic (81.1 ± 6.9). Physical functioning scale/QoL was lower in Obesity (84.6 ± 2.2) than Eutrophic (97.0 ± 4.1). Mean physical and overall fatigue in both Obesity (5.3 ± 5.5 and 19.6 ± 9.9) and SO (5.0 ± 4.1 and 18.8 ± 8.6) were not statistically different from Eutrophic (2.0 ± 2.9 and 14.3 ± 7.8). TUG was worse in SO (7.5 ± 0.2 s) than both Eutrophic (6.6 ± 0.2 s) and Obesity (6.8 ± 0.1 s-p < 0.01). Comparisons were adjusted for age, menopausal status, and physical activity. SO-related traits were correlated to physical function and to domains of QoL and CRF.

CONCLUSIONS: Obesity and SO are associated with poorer QoL, while SO is also linked with worse physical function in early BC. Assessing SO traits in clinical settings will improve the management of BC, though confirmation across disease stages is needed.

PMID:41353712 | DOI:10.1002/pon.70354

World J Surg. 2025 Dec 7. doi: 10.1002/wjs.70195. Online ahead of print.

ABSTRACT

BACKGROUND: Access to guideline-concordant global-standard breast cancer care remains limited in many low- and middle-income countries (LMICs), where high-cost technologies for diagnostics, surgical diagnosis and treatment (such as radioisotope mapping, ICG fluorescence, and intraoperative margin assessment) are not widely available. The BRIDGE Course (Breast Surgery Resource Integration & Development for Global Excellence) was designed as a short, virtual educational program to educate and update surgeons with validated, low-cost techniques that ensure oncologic safety while addressing resource constraints.

METHODS: A 7-h online course was designed and conducted in September 2025 with participation from international and national faculty. Content emphasized pragmatic adaptations of global guidelines, including triple assessment, surgical decision-making for mastectomy versus breast conservation, sentinel lymph node biopsy (SLNB) using methylene blue and fluorescein torch, and low-cost oncoplastic approaches. Pre- and post-course surveys assessed baseline practice, perceived barriers, satisfaction, confidence, and intent to implement. Descriptive statistics were analyzed.

RESULTS: Seventy-five participants completed the pre-course survey and 66 completed the post-course survey. At baseline, mastectomy was the most common primary operation (30.7%), whereas only 20% predominantly performed breast-conserving surgery; SLNB was mainly performed using methylene blue (68.5%). Reported barriers included lack of resources, training gaps, and patient mindset. Post-course, ≥ 85% of participants reported improved confidence across all domains: triple assessment (83% strongly agreed), mastectomy versus BCS decision-making (74%), SLNB with low-cost tracers (66%), and complication management (60%). Implementation intent was high, with nearly all (96%) planning to adopt at least one new technique and all intending to share knowledge with colleagues or trainees.

CONCLUSION: The BRIDGE Course successfully enhanced knowledge and confidence in resource-adapted breast cancer surgery, with strong intent to implement and improve practices. Such short, focused virtual programs may serve as a scalable model for narrowing disparities in breast cancer care across LMICs.

PMID:41353710 | DOI:10.1002/wjs.70195

Psychooncology. 2025 Dec;34(12):e70346. doi: 10.1002/pon.70346.

ABSTRACT

PURPOSE: Marriage is associated with better health-related quality of life (HRQOL) among cancer survivors, but it is unclear whether these benefits generalize across sexual orientation and gender identities (SOGI). We examined whether marriage is associated with better HRQOL among cancer survivors with diverse SOGI.

METHODS: We analyzed Behavioral Risk Factor Surveillance System (BRFSS) data from 2014 to 2023 among U.S. adults aged 18 and older who self-reported a cancer diagnosis and completed the optional SOGI module (N = 220,896). HRQOL was assessed using the CDC HRQOL-4, including self-rated general health, frequent mental or physical distress, and activity limitation (each defined as ≥ 14 days in the past 30 days). Logistic regression models estimated adjusted odds ratios for HRQOL outcomes by marital status (married, unmarried couple, not married) within SOGI subgroups, controlling for sociodemographic and healthcare access factors.

RESULTS: Marriage was consistently associated with better HRQOL among heterosexual men and women. Among SGM survivors, gay men and transfeminine individuals showed the clearest marriage-related benefits, including lower odds of mental distress and activity limitation. No consistent benefit was observed among lesbian or bisexual women, bisexual men, or transmasculine individuals. Unmarried couples did not consistently show similar protective effects in any group, though small cell sizes limit precision.

CONCLUSION: The health benefits of marriage vary across SOGI subgroups, challenging assumptions of a universal marriage advantage in survivorship.

IMPLICATIONS FOR CANCER SURVIVORS: Survivorship care should account for relational and structural differences in support networks, especially among SGM individuals who may not benefit equally from legal marital status.

PMID:41353709 | DOI:10.1002/pon.70346

Skeletal Radiol. 2025 Dec 7. doi: 10.1007/s00256-025-05101-2. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to validate a new MRI-based scoring system for pyogenic spondylodiscitis (PS) using contrast-enhanced MRI at admission. The system was designed to classify disease severity and provide a quantifiable tool for risk stratification and treatment planning.

MATERIALS AND METHODS: We retrospectively analysed 60 patients with clinically and laboratory-confirmed PS at a single tertiary hospital between September 2016 and September 2024. A novel scoring system, the MRI-SSI, evaluated vertebral destruction, signal abnormalities, endplate erosion, and epidural or paravertebral extension. The scores (0-9, 10-19, ≥ 20) categorised disease as mild, moderate, or severe. Two experienced radiologists scored the images, and we recorded hospitalisation duration and the need for surgery. Statistical analysis included independent samples t-tests, ANOVA, and interobserver agreement was assessed using Cohen’s kappa and intraclass correlation coefficients (ICCs).

RESULTS: Of the 60 patients, 17 (28.3%) required surgical intervention. Patients needing surgery had significantly higher MRI-SSI scores than those managed conservatively (18.58 vs. 13.86; p = 0.004). The scoring system had a strong predictive value for surgical requirement (AUC = 0.720), with 58% sensitivity and 88% specificity. Interobserver agreement for the total MRI-SSI score was excellent (ICC = 0.906).

CONCLUSION: The MRI-SSI accurately predicted hospitalisation duration and surgical needs in PS patients. This tool, based solely on admission MRI findings, can refine initial treatment decisions, leading to more targeted resource utilisation and improved overall patient outcomes.

PMID:41353696 | DOI:10.1007/s00256-025-05101-2

Discov Oncol. 2025 Dec 7. doi: 10.1007/s12672-025-04185-5. Online ahead of print.

NO ABSTRACT

PMID:41353687 | DOI:10.1007/s12672-025-04185-5

Psicol Reflex Crit. 2025 Dec 7;38(1):36. doi: 10.1186/s41155-025-00368-9.

ABSTRACT

BACKGROUND: This study validates the Spanish version of the Brief-COPE in the Colombian context. This tool assesses 14 different coping strategies, including positive coping, planning, emotional support, instrumental support, substance use, and religion, among others. The structural validations of this tool in Latin America, Europe, North America, and Asia yielded heterogeneous results, with validations in Latin America often having limitations in their data analysis methodologies and sample size. This study aims to address these limitations and provide methodologically sound evidence on the structural validity, reliability, and convergent and divergent validity of the instrument for adults in Colombia.

METHODS: A total of 762 participants completed the Brief-COPE along with the ERQ, the Wellbeing Index, the HSCL-25, the PCL-C, and the Kessler 6. Categorical Confirmatory Factor Analysis (CFA) was employed to assess the fit of 12 different theory and data-driven models. After identifying the best-fitting model, reliability, divergent, and convergent validity were assessed for the resulting factors.

RESULTS: The best-fitting CFA model for the Brief-COPE had 11 factors: active coping, social support, acceptance, venting, self-distraction, behavioral disengagement, denial, self-blame, humor, religion, and substance use. Substance use, active coping, religion, social support, humor, self-blame, denial, and behavioral disengagement demonstrated good reliability (Omega > = .7), whereas the remaining subscales demonstrated insufficient reliability (Omega > .6 and Omega < .7). Maladaptive coping strategies were found to positively correlate with distress measures, while adaptive strategies exhibited negative correlations, as expected. However, social support and humor presented significant positive associations with PCL-C and HSCL.

CONCLUSIONS: This study provides evidence supporting an 11-factor structure for the Brief-COPE in Colombian adults, with most factors demonstrating satisfactory reliability. Researchers should use caution when interpreting subscales with lower reliability. The results also underscore the influence of cultural context on coping patterns, given the heterogeneous factor structures found in other validations. Future studies should recruit more diverse samples to enhance generalizability and further investigate the predictive validity of this adapted tool.

PMID:41353669 | DOI:10.1186/s41155-025-00368-9

Neuromodulation. 2025 Dec 6:S1094-7159(25)01103-1. doi: 10.1016/j.neurom.2025.09.318. Online ahead of print.

ABSTRACT

OBJECTIVES: Chronic bladder pain syndrome (CBPS) is a debilitating condition with limited treatment efficacy. This meta-analysis evaluates the effectiveness of sacral nerve stimulation (SNS) in the management of pain, urinary symptoms, and quality of life (QoL) in patients with CBPS.

MATERIALS AND METHODS: A systematic review was conducted across EMBASE, PubMed, and the Cochrane Library, adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Studies involving adult patients with bladder pain symptoms treated with SNS and reported pain scores were included. Pain scores were the primary outcome measure of interest. Secondary outcome measures included Interstitial Cystitis Problem Index (ICPI)/Interstitial Cystitis Symptom Index (ICSI), urinary frequency, nocturia, and QoL. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies-of Interventions, and pooled effect estimates were calculated using random-effects meta-analysis models.

RESULTS: A total of 15 studies (N = 494) were included in the meta-analysis. SNS was associated with a statistically significant reduction in pain scores (mean difference: -2.27 on a 0-10 scale, 95% CI: -2.94 to -1.60, p < 0.001), ICSI (-2.18, 95% CI: -2.99 to -1.37, p < 0.001), urinary frequency (-1.71 voids/d, 95% CI: -2.29 to -1.12), and nocturia (-1.49 episodes/night, 95% CI: -2.35 to -0.63). Changes in ICPI and QoL were not statistically significant. Complication rates ranged from 0% to 40.6%, and explantation rates from 0% to 18%.

CONCLUSIONS: This meta-analysis suggests that SNS may offer clinically meaningful pain and urinary symptom relief in patients with CBPS. However, substantial methodological heterogeneity, moderate-to-high risk of bias, and the absence of randomized control trials limit the strength of conclusions. Larger, high-quality trials with standardized diagnostic criteria and outcome measures are essential to establish SNS as a validated treatment option for CBPS.

PMID:41353655 | DOI:10.1016/j.neurom.2025.09.318

Acta Med Port. 2025 Dec 2;38(12):785-794. doi: 10.20344/amp.23398. Epub 2025 Dec 2.

ABSTRACT

INTRODUCTION: Involuntary hospitalization of a patient with a mental disorder is broadly defined as the admission to an inpatient unit without the patient’s consent. Literature suggests that involuntary hospitalizations are associated with low levels of treatment satisfaction, avoidance of mental health care, and an increased risk of emergency involuntary re-hospitalization. Despite being a lifesaving treatment, involuntary admissions can also be stigmatizing, undermine the long-term therapeutic relationship and reduce adherence to care. In this context, little research has been conducted to evaluate how shifting a patient’s hospitalization from involuntary to voluntary affects health outcomes, such as psychiatric decompensation and healthcare use. The main aim of this study was to identify and assess the frequency of readmissions within one year among patients who transitioned to voluntary treatment, compared with those who remained involuntarily treated.

METHODS: An observational retrospective study was conducted using secondary data from medical records of adult inpatients involuntarily admitted to the inpatient psychiatry department of Unidade Local de Saúde São João. All involuntary hospitalizations occurring between January 1st and December 31st, 2022, were classified into two distinct groups: patients who were initially admitted involuntarily and subsequently converted to voluntary hospitalization during their stay or patients who remained under involuntary hospitalization until discharge. Data registered in medical records within one year after the index hospitalization was collected and assessed (whether structured data or free text entries). Descriptive and comparative analyses were performed.

RESULTS: A total of 120 patients were included. More patients converted to voluntary hospitalization (60.8%) than remained involuntarily hospitalized (39.2%). In comparison to voluntary inpatients, involuntary inpatients had significantly higher readmission rates within one year (36.2% vs 15.3%, p = 0.009) and were more often readmitted under involuntary status (88.2% vs 45.5%, p = 0.030).

CONCLUSION: Involuntary hospitalization was associated with worse outcomes within one year, underscoring the need for its use to be proportional to the risk and subject to periodic review. Conversion to voluntary hospitalization is reasonable, respects patient autonomy and, provided that appropriate treatment is maintained, does not worsen psychiatric decompensation.

PMID:41353642 | DOI:10.20344/amp.23398