Nevin Manimala

Orthop Surg. 2025 Aug 5. doi: 10.1111/os.70142. Online ahead of print.

ABSTRACT

OBJECTIVE: Hinge fracture is a known complication of lateral open wedge distal femoral osteotomy (LOWDFO). However, few studies have differentiated between intraoperative hinge fractures (IHF) and postoperative hinge fractures (PHF). This study aims to investigate the causes of these two types of fractures to help reduce complication rates and improve surgical outcomes.

METHODS: We retrospectively analyzed data from 100 patients with genu valgum deformity and lateral unicompartmental osteoarthritis who underwent distal femoral osteotomy at our hospital between January 1st, 2022, and January 1st, 2024, in our hospital. Clinical parameters, radiological data, and the associated factors influencing IHF and PHF were analyzed. Radiological data such as mechanical axis deviation (MAD) and mechanical lateral distal femur angle (mLDFA) were collected. Clinical outcomes such as osteoarthritis index and time of healing were evaluated. Based on fracture morphology, IHF and PHF were further classified into Type 1 (extension), Type 2 (distal) and Type 3 (proximal) for detailed analysis. Statistical analyses included t-tests, Chi-square tests, and regression models to identify factors associated with IHF and PHF.

RESULTS: A total of 87 patients were included in this study. The mean healing time of patients with all kinds of hinge fractures (3.4 ± 1.2 months) was longer than that of patients with no hinge fractures (2.8 ± 0.7 months), which was significant, p = 0.013. The MAD correction, mLDFA correction, and mLDFA correction ratio were related to hinge fractures (p = 0.010, 0.002, and 0.002 respectively). The body weight was higher in all types of hinge fractures group (IHF and PHF together) than the no hinge fractures group. The IHF group had a longer time of healing than the no IHF group. In the IHF group, the mLDFA correction (p = 0.005), mLDFA correction ratio (p = 0.005), and BMI (p = 0.031) were higher than the no IHF group. The PHF was related to hinge position. The group of hinge localized proximal to the adductor tubercle (AT) had a higher rate of PHF than the group of hinge localized in the adductor tubercle (p = 0.001). The healing time in the IHF group (3.9 ± 1.4 months) was significantly longer than the healing time in the PHF group (2.7 ± 0.4 months) (p = 0.002).

CONCLUSION: In patients with genu valgum undergoing LOWDFO, IHF and PHF represent distinct clinical entities. IHF is associated with greater mLDFA correction, higher mLDFA correction ratios, and increased body weight. In contrast, PHF is primarily associated with hinge position, with a higher incidence observed when the hinge is located proximal to the adductor tubercle. Among the two, IHF has a more pronounced impact on delayed bone healing.

LEVEL OF EVIDENCE: Retrospective study Level IV.

PMID:40762034 | DOI:10.1111/os.70142

J Environ Health Sci Eng. 2025 Aug 2;23(2):26. doi: 10.1007/s40201-025-00951-3. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: Phthalates are one of the most common environmental contaminants and endocrine disruptors. Environmental exposure to phthalates may increase the risk for allergic diseases. However, the existing literature presents conflicting findings regarding the long-term impact of early-life exposure to these substances.

METHODS: We searched the Web of Science, PubMed and Google Scholar, Medline and Embase databases for all related publications from 1974 to September 1st, 2024. Ultimately, 22 studies with a total of 16,161 participants were selected. The relative risks (RRs) with 95% confidence intervals (95% CIs) were used to evaluate whether prenatal phthalate exposure is associated with allergic endpoints. To assess statistical heterogeneity across studies, both the Q-test and I ² statistic were adopted. Publication bias of the included studies was evaluated using Begg’s and Egger’s tests. Stratified analysis was conducted based on the gender of children, molecular weight of phthalates, disease type, phthalate species, parental exposure period and region. The systematic literature search protocol was formally registered in PROSPERO.

RESULTS: Childhood wheeze (RR 1.10, 95% CI: 1.00-1.21), eczema (RR 1.09, 95% CI: 1.01-1.17), and rhinitis (RR 1.05, 95% CI: 1.02-1.09) are potentially associated with prenatal exposure to phthalates, particularly butyl-benzyl phthalate (RR 1.15, 95% CI: 1.06-1.24), di-ethyl-hexyl phthalate (RR 1.08, 95% CI: 1.02-1.15) and di-iso-nonyl phthalate (RR 1.12, 95% CI: 1.02-1.23).

CONCLUSION: Maternal phthalate exposure during pregnancy exhibits a significant association with elevated risks of childhood respiratory and allergic manifestations, including wheezing episodes, eczematous dermatitis, and rhinitis symptoms.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40201-025-00951-3.

PMID:40762014 | PMC:PMC12317961 | DOI:10.1007/s40201-025-00951-3

Front Dent Med. 2025 Jul 21;6:1593218. doi: 10.3389/fdmed.2025.1593218. eCollection 2025.

ABSTRACT

BACKGROUND: Dickkopf-1 is a glycoprotein that inhibits Wingless-related integration site signaling, impairing osteoblast and osteoclast functions, leading to bone loss and systemic inflammation linked to periodontitis and rheumatoid arthritis. Porphyromonas gingivalis exacerbates rheumatoid arthritis through citrullination and inflammation, highlighting their bidirectional relationship. To date no meta-analysis has examined the role of Dickkopf-1 in periodontitis, rheumatoid arthritis, and their comorbidity. Therefore, we conducted this meta-analysis to investigate the association and role of Dickkopf-1 in these comorbid conditions.

METHODS: The present study was conducted in accordance with the guidelines of Transparent Reporting of Systematic Reviews and Meta-Analyses PRISMA statement (registered at PROSPERO under the number CRD42025643227). A total of 15 studies (14 case-control and 1 cross-sectional) were selected out of 386 using databases like PubMed and Google Scholar (by BM, JM, and DP). A random-effects model evaluated Dickkopf-1 levels in serum/gingival crevicular fluid in periodontitis and rheumatoid arthritis via standardized mean difference (SMD) and 95% confidence intervals (CI). Heterogeneity and publication bias were assessed using statistical metrics, forest plots, funnel plots, Begg’s test, and Egger’s regression.

RESULTS: A total of 386 studies were retrieved and 15 were included in the meta-analysis, encompassing 4,438 participants (2,190 cases and 2,248 controls). The pooled SMD of 2.694 (p = 0.02; 95% CI: 1.170-6.203) indicated a significant association of Dickkopf-1 with periodontitis and/or rheumatoid arthritis compared to healthy controls. However, Egger’s test revealed a t-value of 3.05 (p = 0.009), indicating significant publication bias.

CONCLUSION: Elevated Dickkopf-1 levels in rheumatoid arthritis and periodontitis patients suggest its critical role in the pathogenesis of both conditions. Hence, Dickkopf-1 holds therapeutic potential for managing interconnected inflammatory and bone disorders and may serve as a biomarker for diagnosing these diseases.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/search, PROSPERO CRD42025643227.

PMID:40762009 | PMC:PMC12318980 | DOI:10.3389/fdmed.2025.1593218

Aesthet Surg J Open Forum. 2025 Jun 24;7:ojaf070. doi: 10.1093/asjof/ojaf070. eCollection 2025.

ABSTRACT

BACKGROUND: Body dysmorphic disorder (BDD) is a mental health condition characterized by an obsessive focus on perceived physical flaws, causing significant psychological distress. Aesthetic practitioners often interact with appearance-focused patients, increasing their potential exposure to BDD and its psychological effects. Understanding BDD prevalence and awareness among practitioners is crucial for their professional and personal well-being.

OBJECTIVES: The authors of this study aim to assess the prevalence of BDD among aesthetic practitioners (physicians and surgeons) and evaluate their awareness of the disorder.

METHODS: A cross-sectional study was conducted with 199 participants, including 98 aesthetic practitioners and 101 lawyers (control group). Participants completed the Depression, Anxiety, and Stress Scale (DASS-10) and the Cosmetic Procedure Screening (COPS) questionnaires, along with questions assessing BDD knowledge. Statistical analyses included Pearson’s correlations, χ ² tests, analysis of covariance, and logistic regression.

RESULTS: Possible BDD was identified in 8.2% of aesthetic practitioners vs 2% of controls (P = .056). Aesthetic practitioners showed a significant association with self-reported physical-aesthetic disorders (χ ²(2) = 11.25, P = .004). Total COPS scores correlated significantly with distress, anxiety, and depression levels (all P < .001). Regression analysis revealed that aesthetic practitioners were 7 times more likely to exhibit BDD symptoms compared with controls (b = 2.03, P = .03, odds ratio = 7.59), even after controlling for anxiety and depression.

CONCLUSIONS: In this study, the authors underscore the need for enhanced BDD awareness and mental health training among aesthetic practitioners. Addressing mental health within the aesthetic field is essential to improve professional practices and safeguard psychological well-being.

PMID:40762003 | PMC:PMC12318658 | DOI:10.1093/asjof/ojaf070

Cureus. 2025 Jul 5;17(7):e87339. doi: 10.7759/cureus.87339. eCollection 2025 Jul.

ABSTRACT

OBJECTIVE: This study aimed to analyze cancer incidence and mortality patterns based on population-based cancer registry data for a defined region in Punjab, India, covering the period from January 2012 to December 2016.

MATERIALS AND METHODS: Active hospital and laboratory surveillance and community health worker monitoring identified cases, which were validated using CanReg5 for accuracy. We determined age-adjusted incidence rates (AARs) together with crude rates (CRs) and mortality-to-incidence ratios (M/I %).

RESULTS: A total of 11,471 new cancer cases were recorded, comprising 5,394 (47.0%) men and 6,077 (53.0%) women. The AARs were 108.2 per 100,000 in men and 124.6 per 100,000 in women. The overall CR was 92.7 per 100,000, and the M/I % was 26.9%. The most common cancer sites were the esophagus (987; 18.3%) in men and breast (1,489; 24.5%) in women. Rural residents had higher M/I % (28.5%) than urban residents (24.3%; p = 0.003), indicating later-stage diagnosis and care barriers. The Indian registries recorded the highest incidence of childhood lymphoma among girls.

CONCLUSION: The findings demonstrate the immediate requirement for specific awareness programs and early detection initiatives that should focus on rural regions to decrease Punjab’s cancer statistics.

PMID:40761994 | PMC:PMC12320960 | DOI:10.7759/cureus.87339

Cureus. 2025 Jul 5;17(7):e87322. doi: 10.7759/cureus.87322. eCollection 2025 Jul.

ABSTRACT

Background Helicobacter pyloriis a widespread bacterial infection that is often linked to significant health and economic burdens in affected populations. The rise of antibiotic resistance has reduced the effectiveness of standard triple therapy (TT), highlighting the need for alternative treatment strategies, especially in resource-constrained countries like Pakistan, where comparative research on different H. pylori treatment regimens remains limited. This study aims to compare the efficacy of concomitant therapy (CT) versus TT in the eradication of H. pylori infection. Methods This retrospective study was conducted over a 12-month period (July 2021 to July 2022) in the medicine and gastroenterology departments of Jinnah Hospital, Lahore, Pakistan. A total of 296 patients diagnosed with H. pylori infection via the urea breath test were enrolled using consecutive sampling, following predefined inclusion and exclusion criteria. Patients were divided into two groups of 148 each: Group A received CT (esomeprazole, amoxicillin, clarithromycin, and metronidazole), and Group B received standard TT (esomeprazole, amoxicillin, and clarithromycin). Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, NY, USA), applying independent samples t-tests, chi-square tests, and logistic regression analysis. A p-value of less than 0.05 was considered statistically significant. Results Among the 296 patients, the overall H. pylori eradication rate was 82.09%. The eradication rate was significantly higher in the CT group (91.90%) compared to the TT group (72.29%) (p = 0.008). In the CT group, age (OR: 1.57; 95% CI: 1.25-1.98; p = 0.03) and duration of symptoms (OR: 1.42; 95% CI: 1.10-1.77; p = 0.02) were significant predictors of successful eradication, while gender (OR: 1.10; 95% CI: 1.01-1.32; p = 0.06) was not. In the TT group, age (OR: 1.22; 95% CI: 1.05-1.51; p = 0.06), gender (OR: 1.01; 95% CI: 0.71-1.47; p = 0.07), and duration of symptoms (OR: 1.26; 95% CI: 1.17-1.60; p = 0.09) were not significant predictors of eradication. Conclusions This study suggests that CT is more effective than TT in eradicating H. pylori infection. In the CT group, being younger than 45 years and having symptoms for less than six months were significant predictors of treatment success. These findings provide valuable insights into optimal treatment strategies for H. pylori in resource-limited settings and emphasize the need for further research to establish effective eradication protocols.

PMID:40761984 | PMC:PMC12320471 | DOI:10.7759/cureus.87322

Cureus. 2025 Jul 5;17(7):e87350. doi: 10.7759/cureus.87350. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Metformin is a drug primarily used for the treatment of diabetes mellitus (DM), but it also offers clinical benefits that extend beyond glycemic control. Existing literature provides an unclear conclusion as to whether metformin’s benefits extend to preventing neurodegeneration, such as in Alzheimer’s disease (AD).

METHODS: A retrospective database study was conducted to evaluate the likelihood of developing AD in DM patients taking metformin compared to those taking glucagon-like peptide (GLP-1) analogs, sulfonylureas, and short-acting insulin variants. An analysis was also run to assess whether metformin has a protective benefit for AD and mortality when used in those with DM compared to those without DM.

RESULTS: In analyses totaling greater than 2.5 million patients, those on metformin had lower A1C percentages and a decreased mortality risk when compared to sulfonylureas (HR = 0.519, (CI: (0.493,0.546)), and short-acting insulins (HR = 0.372, (CI: (0.364,0.380)). Metformin use for DM was associated with a statistically significant increased likelihood of AD diagnosis compared to GLP-1 use (HR = 2.228, CI: (1.036,4.794)) but an insignificant difference compared to both sulfonylureas and insulins. Those with DM were at a significantly higher risk of being diagnosed with Alzheimer’s compared to those without DM (HR = 1.826, (CI: 1.579, 2.111)).

CONCLUSIONS: Metformin, previously thought to have significant benefits in preventing neurodegeneration, may not be the optimal pharmacologic agent of choice, particularly in patients with DM, if neurodegeneration is a primary concern in treatment decision-making based on other risk factors.

PMID:40761983 | PMC:PMC12321270 | DOI:10.7759/cureus.87350

Cureus. 2025 Jul 5;17(7):e87344. doi: 10.7759/cureus.87344. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Medication adherence is vital for successful recovery after a myocardial infarction (MI). Unfortunately, many patients experience depression following an MI, which can negatively affect their ability to stick to prescribed medication plans. It is important to explore how depression influences medication adherence, especially in South Asian clinical environments where cultural factors can significantly impact health outcomes.

METHODS: A cross-sectional study was carried out among 385 post-MI patients who attended outpatient clinics in Islamabad, Pakistan. The Patient Health Questionnaire-9 (PHQ-9) was used to measure depression, and the Morisky Medication Adherence Scale (MMAS-8) was used to quantify medication adherence. Statistical tests involved descriptive statistics, normality tests using Shapiro-Wilk, Spearman correlation, Kruskal-Wallis, chi-square, and linear regression. Data were collected between January and May 2025.

RESULTS: There was also a weak, statistically significant positive relation between the PHQ-9 and the MMAS-8 scores (r = 0.124, p < 0.05). In a linear regression model, PHQ-9 scores were significantly predictive of MMAS-8 scores (B = 0.064, p = 0.002), which means that the higher the depressive symptoms, the more likely medication adherence was. Depression scores worsened over time since MI and heavier medication burden, whereas adherence was highest among patients taking moderate numbers of medications (three to five/day). The rates of adherence and psychological distress also differed significantly depending on the treatment type, with the best rates being in angioplasty patients.

CONCLUSION: This study, unlike the majority of the previous findings, reported a minor positive correlation between self-reported medication adherence and depressive symptoms in post-MI patients. The findings indicate that, in particular, in the cultural backdrop, depressive symptoms can be present alongside more health conscientiousness or planned-out care use. Comorbidities and complexities of treatment should be assessed, and mental health screening and adherence support to medications should be a component of post-MI care strategies.

PMID:40761975 | PMC:PMC12321158 | DOI:10.7759/cureus.87344

Cureus. 2025 Jul 4;17(7):e87290. doi: 10.7759/cureus.87290. eCollection 2025 Jul.

ABSTRACT

Context Early childhood educators (ECEs) are central to the development and care of children, but they often lack adequate access to resources and expert guidance for managing common childhood health issues. These challenges can lead to significant stress for both educators and parents. To address this gap, a pilot intervention involving virtual “coffee chat” sessions was implemented. These sessions aimed to provide ECEs with evidence-based knowledge and practical strategies to handle frequent childhood health concerns. Objective The primary objective of this study was to enhance the knowledge and confidence of ECEs in addressing common health and behavioral issues among children in the New River Valley, USA. The sessions, facilitated by pediatricians and medical students, covered a range of topics identified as high-priority by educators. The goal was to create a sustainable educational model for improving child health management in childcare settings. Methods This study used a self-designed pre- and post-survey format to measure the effectiveness of eight virtual “coffee chat” sessions conducted over two years. The initial sessions focused on educators in the New River Valley, USA, and the final session expanded across Virginia, USA. Topics included common illnesses (e.g., cough, diarrhea), trauma management, obesity, and behavioral issues such as self-regulation and temper tantrums. Each session consisted of a brief evidence-based presentation followed by interactive discussions. Participants were recruited through local and statewide child care organizations, and surveys were used to assess changes in their confidence and knowledge levels. Descriptive statistics and a Wilcoxon Signed Rank test were applied to analyze the data, while qualitative feedback from open-ended responses was categorized thematically. Results Across the eight sessions, 30 registrations were recorded, with 19 participants, some of whom attended multiple sessions. Pre- and post-survey results demonstrated significant improvements in knowledge and confidence, with an overall p-value of <0.001. Six out of eight topics showed increased post-survey scores, with the session on self-regulation and temper tantrums, which had the largest cohort (N=10), yielding a significant improvement (p=0.0041), highlighting its broad impact and relevance. Feedback from participants highlighted the value of practical, evidence-based strategies and the opportunity to engage directly with healthcare professionals. However, variability was observed in some topics, such as diarrhea, where post-survey scores declined slightly, pointing to potential areas for improvement. Conclusion Virtual “coffee chat” sessions proved to be an effective, scalable method for improving the health management skills of ECEs. The intervention’s interactive and accessible format was particularly appreciated by participants and shows promise as a model for ongoing professional development. However, given the study’s design and sample size, these findings should be interpreted as preliminary. Future efforts should focus on refining content, expanding participation, and exploring long-term impacts on both educator practices and child outcomes.

PMID:40761974 | PMC:PMC12320190 | DOI:10.7759/cureus.87290

Cureus. 2025 Jul 4;17(7):e87306. doi: 10.7759/cureus.87306. eCollection 2025 Jul.

ABSTRACT

Introduction Yoga, rooted in Indian tradition, is recognized for its holistic health benefits. With a growing global emphasis on preventive health, yoga has gained attention for its capacity to mitigate stress, improve concentration and enhance general well-being. Burdened with academic pressures, irregular routines and sedentary lifestyles, medical students represent a group that could significantly benefit from incorporating yoga into their daily lives. This study aims to bridge this gap by evaluating MBBS students’ awareness, perceptions, readiness to adopt yoga and the practical challenges they face, along with their views on integrating structured yoga sessions into their curriculum. Methods A cross-sectional study was conducted at AIIMS, Nagpur, among MBBS students, with a total of 155 students (100%) from the 2019 to 2023 batches. A structured, pre-validated questionnaire (Cronbach’s α=0.973) was administered electronically using a Google Form link shared via student WhatsApp groups. The survey comprised five sections: awareness about yoga, perceptions about its preventive role in lifestyle disorders, readiness to integrate it into daily life, barriers to practice and preferences regarding formal integration of yoga practice in the MBBS curriculum. Responses were recorded on 5-point Likert scales. Data analysis was performed using Python (Jupyter) for cleaning, statistics and reliability testing, and Jamovi (v2.3.28) for non-parametric tests due to non-normal distribution. Results The findings revealed a high awareness among participants, with an average awareness score (87.6%), high agreement on yoga’s role in stress reduction (4.45%) and overall health (4.63%). Perception of yoga as preventive and therapeutic for lifestyle disorders was strong (mean=84.0%). Batch-wise differences were noted in yoga awareness scores (p<0.001), and interns were more likely to endorse yoga as a complementary therapy (p=0.037). The readiness score was 68.2%, with only a 3.41/5 average agreement on willingness to integrate yoga daily. A significant gender-based difference was observed for perceived physical preparedness (p=0.035) and preference for educational content in yoga, with males scoring higher. Major barriers included time constraints (112, 72.2%), inconsistency (93, 60%) and lack of motivation to wake up early (84, 54.54%). Overall, 140 (90.3%) agreed that yoga practice should be part of the MBBS curriculum. Most preferred physical sessions (116, 74.84%), held three days a week (63, 40.65%), for 20-30 mins (93, 61.59%), with a focus on postures, breathing, meditation and stress relief. Some students preferred sessions to be optional and scheduled flexibly around academic hours. Conclusion This study highlights a significant gap between high levels of awareness and relatively low readiness to incorporate yoga into daily life among MBBS students. Despite recognizing its benefits, students face notable practical challenges, especially time management and consistency. However, the overwhelming support for integrating structured yoga sessions into the medical curriculum presents an actionable opportunity. Addressing identified barriers through flexible scheduling, optional participation and an emphasis on stress management may enhance adoption. These findings underscore the potential of yoga not just as a wellness tool but as an integral component of medical education aimed at fostering personal resilience and long-term professional well-being.

PMID:40761968 | PMC:PMC12319258 | DOI:10.7759/cureus.87306