Nevin Manimala

North Clin Istanb. 2025 Feb 3;12(1):12-20. doi: 10.14744/nci.2023.66891. eCollection 2025.

ABSTRACT

OBJECTIVE: The purpose of this study is to analyze the situation of Methicillin-Resistant Staphylococcus aureus (MRSA) in TRNC by examining the prevalence of Community-acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA)/Hospital-acquired Methicillin-Resistant Staphylococcus aureus (HA-MRSA) cases, the acceleration of CA-MRSA/HA-MRSA patients from past to present, the impact of pandemic, gender and age on MRSA cases.

METHODS: In order to analyze the trend of MRSA cases and the effects of selected parameters on MRSA cases, statistical tests are employed to the obtained data including ANOVA test, regression analysis tests and Post-hoc Tukey test.

RESULTS: Incidence rate of MRSA carriage in the community has increased over the years to 45.6%. p-value of the relationship between community-acquired MRSA cases and hospital-acquired MRSA cases is less than 0.05. The results also revealed that the p-value of both the relationship between COVID-19 and MRSA cases and the relationship between 50+ age and MRSA cases are significant. On the other hand, p-value of the relationship between gender and MRSA cases is found to be greater than 0.05.

CONCLUSION: It is concluded that MRSA carriage in the community has increased over the years and CA-MRSA and HA-MRSA cases are related since p<0.05. Moreover, it’s revealed that there is an effect of COVID-19 pandemic and 50+ age (66% of the cases) on MRSA cases because of p<0.05 while the gender is not an effect for MRSA cases in the country, since p-value for gender comparison is greater than 0.05.

PMID:40838240 | PMC:PMC12364480 | DOI:10.14744/nci.2023.66891

North Clin Istanb. 2025 Feb 4;12(1):55-61. doi: 10.14744/nci.2023.84770. eCollection 2025.

ABSTRACT

OBJECTIVE: To investigate the effects of methylenetetrahydrofolate reductase (MTHFR) gene C677T/A1298C polymorphisms on serum homocysteine levels and hypertension.

METHODS: Venous blood samples were collected in EDTA tubes from patients and controls (80 hypertensive patients and 67 healthy controls) and genomic DNA was isolated. The polymorphisms of MTHFR C677T and A1298C were identified using the polymerase chain reaction (PCR) and restriction fragment length polymorphisms (RFLP) technique. The enzyme-linked immunosorbent assay (ELISA) method was used to determine serum homocysteine levels. ANOVA, Student’s t-test, chi-square test and logistic regression analysis tests used in the evaluation of statistical analysis between patient and control groups were performed with SPSS 21.0 program.

RESULTS: A statistically significant difference was observed between the patient group, which were hypertension-diagnosed patients, and control group for C677T polymorphism (p<0.001), but not for the A1298C polymorphism (p=0.058). When serum homocysteine levels were compared between the patient and control groups, no significant difference was observed (p=0.065). A significant difference was observed between C677T allele frequency (TT + CT versus CC) and homocysteine levels in both groups (p=0.027), whereas no significant difference was observed between A1298C allele frequency (CC + AC versus AA) and homocysteine levels (p=0.996).

CONCLUSION: The MTHFR C677T polymorphism is more common in hypertensive patients. T allele frequencies (CT and TT genotypes) and TT genotypes might increase the risk of hypertension and homocysteine levels. Although the A1298C C allele frequency (AC and CC genotypes) might increase the risk of hypertension, CC genotype distributions and homocysteine levels show no statistical significance on hypertension. C677T polymorphism is associated with hypertension thus it may be used as a potential biomarker.

PMID:40838236 | PMC:PMC12364473 | DOI:10.14744/nci.2023.84770

North Clin Istanb. 2025 Feb 3;12(1):1-11. doi: 10.14744/nci.2023.40799. eCollection 2025.

ABSTRACT

OBJECTIVE: In our study, our aim was to compare the clinical outcomes of utilizing a 6-stranded hamstring autograft (HAG) lacking tibial attachment site separation in Anterior Cruciate Ligament Reconstruction (ACLR), an approach previously unreported in literature, with alternative methodologies.

METHODS: A total of 85 patients admitted to our Orthopedics and Traumatology clinic between April 2019 and July 2022 with Anterior Cruciate Ligament (ACL) rupture, who underwent surgical treatment, were retrospectively analyzed. ACLR was initiated using HAG in all patients. The surgical procedure was determined based on the length of the HAG used during ACLR. In all cases, femoral fixation was performed with an adjustable loop endobutton. 3 methods were applied to all patients. These are: repair with a 6-strand hamstring tendon graft without severing the tibial insertion (new method), repair with 4-strand hamstring tendon graft without severing the tibial insertion and repair with 4-strand hamstring tendon graft without protecting the tibial insertion. Preoperative and postoperative International Knee Documentation Committee (IKDC) subjective evaluation score, Lysholm score and Tegner activity score were used in the evaluation of the patients. Comparisons between groups were made according to these scores.

RESULTS: 78 patients were included in the study. There were 31 patients in Group 1, 23 in Group 2 and 24 in Group 3. The mean age of the patients was 29 (19-40) in Group 1, 32 (16-49) in Group 2 and 31 (18-54) in Group 3. In the comparison of the groups, there was a significant increase in tendon thickness in Group 1 (p<0.001) and a significant decrease in the rate of re-rupture as a complication (p<0.05). There was no statistically significant difference between the groups in terms of age, side of surgery, follow-up period, and length of hospital stay. There was statistical significance between Group 1 and Group 2 in terms of tendon diameter (p<0.05) and re-rupture (p<0.05). In the comparison of Group 2 and Group 3, there was statistical significance between Group 2 and Group 3 in terms of tendon thickness and length of hospital stay (p<0.05), while no significant difference was found in terms of re-rupture (p>0.05).

CONCLUSION: ACLR with 6-strand tendon graft with preservation of the HAG insertion is not a method described in the literature. As a result of our study, it was concluded that the functional results of this newly described method are as good as other methods and have lower re-rupture rates.

PMID:40838235 | PMC:PMC12364475 | DOI:10.14744/nci.2023.40799

North Clin Istanb. 2025 Jan 29;12(1):45-54. doi: 10.14744/nci.2024.38991. eCollection 2025.

ABSTRACT

OBJECTIVE: Lung cancer is one of the most prevalent malignancies worldwide, with 80-85% of cases diagnosed as non-small cell lung cancer (NSCLC). The majority of NSCLC patients present with advanced disease, contributing to high mortality and limited treatment options. Angiogenesis, a crucial process in cancer progression, is largely regulated by growth factors and cytokines. Vascular Endothelial Growth Factor (VEGF) is a key regulator of angiogenesis. Asymmetric Dimethyl Arginine (ADMA) inhibits endothelial nitric oxide synthase (eNOS), leading to reduced nitric oxide (NO) release and subsequent endothelial dysfunction. The aim of this study is to investigate the serum levels of ADMA, NO, VEGF and several tumor markers including Carcinoembryonic Antigen (CEA), Cancer Antigen 125 (CA 125), Neuron Specific Enolase (NSE), Lactate dehydrogenase (LDH) and Cyfra 21-1 in NSCLC patients to assess their potential role in early diagnosis, tumor invasion, and staging of the disease.

METHODS: Our study consisted of 56 newly diagnosed NSCLC patients and 32 controls with similar demographic characteristics. Patients with chronic diseases and inflammatory disorders were excluded. Statistical analysis was conducted using R Statistical Software.

RESULTS: In our study, compared to the control group, the serum VEGF, NO, ADMA, CA 125, CEA, Cyfra 21-1 and NSE levels were significantly higher in NSCLC group (p=0.001, p=0.013, p=0.041, p<0.001, p<0.001, p<0.001 and p=0.001, respectively). In the diagnosis of NSCLC, Cyfra 21-1 exhibited the highest diagnostic efficacy with a 71% sensitivity and 94% specificity. The combination of VEGF, CA125, and Cyfra 21-1 showed a 73% sensitivity and 100% specificity, while the combination of CA125, CEA, and Cyfra 21-1 achieved an 85% sensitivity and 91% specificity.

CONCLUSION: Our study revealed that the serum concentrations of VEGF, NO, ADMA, CA125, Cyfra 21-1, CEA, and NSE were significantly elevated in patients with NSCLC compared to the control group, and that levels of Cyfra 21-1, LDH, and NSE increased with advancing TNM stage. The combination of markers distinguished NSCLC with high sensitivity and specificity. Further studies involving larger populations, including those with benign lung diseases, are needed to validate and expand upon our findings.

PMID:40838233 | PMC:PMC12364467 | DOI:10.14744/nci.2024.38991

North Clin Istanb. 2025 Feb 4;12(1):121-128. doi: 10.14744/nci.2024.04307. eCollection 2025.

ABSTRACT

OBJECTIVE: To assess the health status and functional impairments in patients with axial spondyloarthritis (axSpA) using the Assessment of SpondyloArthritis International Society Health Index (ASAS-HI) and Environmental Factors (ASAS-EF) Index, and to evaluate the correlation of these indices with established clinical parameters.

METHODS: This cross-sectional study included 91 patients diagnosed with axSpA at the Rheumatology Department between November 2017 and July 2018. Participants were evaluated using ASAS-HI, ASAS-EF, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, and Health Assessment Questionnaire (HAQ). Descriptive statistics and correlation analyses were performed to examine relationships between these indices and various clinical and demographic variables.

RESULTS: The study found that 49.5% of patients had a BASDAI score >4, indicating high disease activity. The mean ASAS-HI score was 6.8, reflecting moderate to severe functional impairment in the study population. Significant positive correlations were observed between ASAS-HI and BASFI, BASDAI, spinal pain, and HAQ scores (p<0.05). However, no significant correlations were found between ASAS-HI and ASQoL, disease duration, CRP, or ESR. ASAS-EF was also positively correlated with BASFI, BASDAI, spinal pain, and HAQ scores.

CONCLUSION: The ASAS-HI and ASAS-EF indices effectively evaluate health status and functional impairments in patients with axSpA. The significant correlations with established clinical parameters highlight the indices’ utility in capturing the multifaceted impact of axSpA, emphasizing the importance of comprehensive disease assessment in guiding targeted interventions.

PMID:40838230 | PMC:PMC12364474 | DOI:10.14744/nci.2024.04307

World J Orthop. 2025 Aug 18;16(8):107083. doi: 10.5312/wjo.v16.i8.107083. eCollection 2025 Aug 18.

ABSTRACT

BACKGROUND: Aneurysmal bone cysts (ABCs) are usually treated with curettage or various minimally invasive percutaneous procedures. Patient refractory to these treatments, as well as those with locally advanced or unresectable tumors, present a challenge for orthopedic surgeons and require new treatment approaches. Anti-resorptive drugs inhibit osteoclastic resorption and increase intralesional osteogenesis. Denosumab induces tumor ossification, but this effect may disappear after drug withdrawal due to limited impact on neoplastic cells. Bisphosphonates (BPs) may induce apoptosis of tumor cells and allow for long-term local control. We hypothesized that after denosumab treatment, BPs would better accumulate in the tumor and exert an irreversible antitumor effect.

AIM: To test the hypothesis that the sequential use of BPs after denosumab induction improves treatment outcomes in surgically unsalvageable ABCs.

METHODS: Using data from five electronic databases (Scopus, MEDLINE, EMBASE, PubMed, Web of Science), we aimed to identify all patients who received denosumab therapy (DT) for unresectable ABCs. Among published case reports and case series, we identified patients who discontinued denosumab for various reasons and divided them into two groups: Group 1 included 31 patients without further anti-resorptive therapy and Group 2 included 12 patients who received BPs in the context of rebound hypercalcemia. Local control rates in both groups were analyzed.

RESULTS: As of December 2024, 43 patients have been reported in the literature who received DT for locally advanced/unresectable ABCs. There were 27 males and 16 females with a mean age of 15.8 years. At a median follow-up time of 15.5 months, there were 10 confirmed and two pathologically unconfirmed relapses after denosumab discontinuation. All 10 relapses occurred in patients in Group 1 at a median time of 13.5 months. Among patients in Group 2, with a median follow-up time of 12.5 months after completion of therapy, no local relapses were observed. The difference between local recurrence rates (32% vs 0%) is statistically significant (P value = 0.02). Kaplan-Meier estimates show the same trend with marginal statistical significance (P value = 0.085). Here we put forward a novel treatment algorithm.

CONCLUSION: BPs used in post-denosumab ossifying ABCs appear to improve treatment outcomes, presumably by targeting residual tumor cells. Prospective clinical studies are warranted to validate this promising two-stage conceptual strategy in difficult-to-treat ABC.

PMID:40838228 | PMC:PMC12362605 | DOI:10.5312/wjo.v16.i8.107083

World J Orthop. 2025 Aug 18;16(8):109904. doi: 10.5312/wjo.v16.i8.109904. eCollection 2025 Aug 18.

ABSTRACT

BACKGROUND: This is a retrospective study on endoscopic treatment of cervical spinal radiculopathy (CSR) conducted at a single academic institution. Conventional full-spine endoscopy is performed in a single portal which has certain limitations of high technical requirements, steep learning curve, and narrow indications. Although unilateral biportal endoscopy (UBE) technique has a gentle learning curve and is gradually applied to treat CSR, all procedures were performed in the uniportal working channel that potentially increase the surgical risk and time in the treatment of complex cases. It is worthy to delve novel technique for more working channels in the treatment of complex CSR.

AIM: To propose a hybrid technique (HT) that utilizes spine endoscopy in UBE to treatment of CSR.

METHODS: A total of 81 patients with single-segment CSR who underwent uniportal endoscopic surgery (UES), UBE, or HT at a single institution between September 2019 and August 2021 were retrospectively studied. Perioperative patient data were compared between the groups. The pre-operative and post-operative images were compared to confirm adequate decompression of the nerve root canal. Patients’ visual analogue scale (VAS) scores and neck disability index (NDI) were recorded before surgery, and three days, three months and six months after surgery.

RESULTS: The UBE and HT groups had a significantly shorter operation duration than the UES group. Data for bleeding and length of hospital stay were significantly higher in the UBE group than in the UES and HT groups. The hospitalization cost was lowest in the UES group and highest in the HT group. Soft tissue edema reaction bands on post-operative day 3 were larger in the UBE and HT groups than in the UES group. Post-operative VAS and NDI scores were significantly lower in all three groups than the pre-operative levels. On post-operative day 3, the VAS score for neck pain was significantly higher in the UBE and HT groups than that in the UES group. However, there were no significant differences in the VAS scores for arm pain or NDI between the three groups. The post-operative 3-month and 6-month neck pain VAS, arm pain VAS, NDI, and modified Macnab success rates did not differ statistically between the three groups.

CONCLUSION: The HT for CSR treatment has the advantage of double working channels to facilitate decompression and hemostasis, improving the surgical efficiency and clinical outcomes of CSR.

PMID:40838218 | PMC:PMC12362629 | DOI:10.5312/wjo.v16.i8.109904

Patient Prefer Adherence. 2025 Aug 15;19:2493-2504. doi: 10.2147/PPA.S529666. eCollection 2025.

ABSTRACT

PURPOSE: To address limited population-level data on prescription medication taking during COVID-19, we assessed the impact of the pandemic on adherence to the costliest drug classes prescribed for chronic diseases in British Columbia (BC).

PATIENTS AND METHODS: Of the 100 top drug classes contributing to total drug spending in 2020, we categorized those prescribed for chronic diseases into 26 drug groups; specifically, drugs for psychiatric and neurologic, cardiac and respiratory, hormone-related, and immune and musculoskeletal conditions. Using administrative health data on all dispensed medications, we quantified adherence by monthly proportion of days covered (PDC) and performed interrupted time-series analysis (ITS) to estimate changes in PDC trends 1-year before and after the implementation of pandemic mitigation measures.

RESULTS: We included 3,906,377 adults with ≥1 prescription to ≥1 included drug groups. The most common prescriptions among our study population were for antidepressants (45.0%), drugs for obstructive airway diseases (41.6%), renin-angiotensin system agents (30.5%), diuretics (28.2%), and lipid modifying agents (24.8%). ITS models for 22 of 26 drug groups showed statistically significant changes in monthly PDC trends, with the greatest change occurring among parenteral immunosuppressants, injectable insulins and analogues, and renin-angiotensin system agents.

CONCLUSION: Findings suggest that the pandemic did not substantially impact adherence to commonly used medications; however, adherence was found to be suboptimal across all drug groups regardless of the impact of COVID-19. Medication adherence remains a critical therapeutic challenge requiring our attention irrespective of major healthcare system stressors such as COVID-19.

PMID:40838205 | PMC:PMC12363557 | DOI:10.2147/PPA.S529666

Acta Neurochir (Wien). 2025 Aug 21;167(1):225. doi: 10.1007/s00701-025-06651-z.

ABSTRACT

BACKGROUND: Trigeminal neuralgia secondary to vertebrobasilar dolichoectasia (VBD-TN) poses a significant challenge in the surgical management of trigeminal neuralgia. This study aimed to evaluate and compare the therapeutic efficacy of microvascular decompression (MVD) and percutaneous balloon compression (PBC) in patients with VBD-TN.

METHODS: We conducted a retrospective cohort analysis of consecutive VBD-TN patients treated at a tertiary hospital in China between September 2013 and August 2022. Participants were stratified by the intervention (MVD vs PBC), with systematic evaluation of postoperative pain control efficacy and complication rates.

RESULTS: This study enrolled 107 patients with VBD-TN, with a mean age of 64.8 ± 10.0 years and a mean follow-up duration of 3.9 ± 1.9 years. The cohort comprised 64 patients undergoing MVD and 43 receiving PBC. Both groups achieved excellent initial pain control (The Barrow Neurological Institute scoring system (BNI) pain score I or II). The recurrence (BNI Ⅲ, Ⅳ, Ⅴ) rates were 12.5% (8/64) in the MVD group versus 20.9% (9/43) in the PBC group (p = 0.242) at the last follow-up, showing no statistically significant difference. Early postoperative assessment revealed significantly higher incidences of trigeminal dysfunction including facial numbness, dry eye symptoms, and masticatory muscle weakness in the PBC group compared to the MVD group (p < 0.05 for all). Conversely, the MVD group demonstrated more diverse complications, with craniotomy-related adverse events including intracranial infection (4.7%), cerebrospinal fluid leakage (3.1%), and incision infection (3.1%), while cranial nerve complications comprised diplopia (3.1%), facial palsy (1.6%), hearing loss (7.8%), and tinnitus (9.4%). At the final follow-up, the PBC group exhibited significantly higher BNI numbness scores than the MVD group (p = 0.001). The PBC group showed advantages in healthcare utilization metrics, with significantly shorter postoperative hospital stays and lower hospitalization costs compared to the MVD group (p < 0.001).

CONCLUSIONS: Both MVD and PBC are safe and effective therapeutic options for VBD-TN. MVD is associated with higher hospitalization costs, prolonged hospital stays, and a greater incidence of cranial nerve complications, though most of these complications are treatable. The main disadvantage of PBC lies in the long-term facial numbness.

PMID:40836140 | DOI:10.1007/s00701-025-06651-z

Eur J Orthop Surg Traumatol. 2025 Aug 20;35(1):354. doi: 10.1007/s00590-025-04488-x.

ABSTRACT

PURPOSE: Several surgical techniques are used to treat large to massive reparable rotator cuff tears, including arthroscopic rotator cuff repair (ARCR), graft augmentation (GA), and superior capsular reconstruction (SCR). However, direct comparisons among these three approaches remain limited in the current literature.

METHODS: PubMed, Embase, Cochrane, and Web of Science databases were searched for randomized clinical trials (RCTs) and comparative studies focusing on large to massive rotator cuff tears. Outcomes included American Shoulder and Elbow Surgeons (ASES) scores, Constant-Murley scores, and retear rates. Data analyses were performed using Cochrane Review Manager, with statistical significance set at p ≤ 0.05.

RESULTS: A total of 10 studies (606 patients) were included in this analysis. The comparison between ARCR and GA comprised 7 RCTs and 1 comparative study. Although no significant difference was observed in Constant-Murley scores (mean difference 3.24, 95% Confidence Interval [CI] -1.36, 7.83), the ARCR group exhibited a higher retear rate than the GA group (Risk Ratio [RR] 0.53, 95% CI 0.28, 0.98, p < 0.05). One RCT comparing GA to SCR demonstrated similar ASES scores (GA 77.9 ± 19.9; SCR 74.8 ± 23.9), with SCR having slightly lower retear rates (GA 36%, SCR 25%). Only one cohort study compared SCR to ARCR, which reported similar ASES scores (SCR 85.4 ± 15; ARCR 85.4 ± 16.5) and retear rates (SCR 7%, ARCR 3.5%).

CONCLUSIONS: All three surgical interventions were effective in repairing large to massive rotator cuff tears. However, this analysis found no significant evidence favoring one surgical method, aside from a lower risk of retear in patients with GA compared to ARCR.

PMID:40836122 | DOI:10.1007/s00590-025-04488-x