Nevin Manimala

Stat Methods Med Res. 2025 Feb 12:9622802241304113. doi: 10.1177/09622802241304113. Online ahead of print.

ABSTRACT

Survival models with cure fractions, known as long-term survival models, are widely used in epidemiology to account for both immune and susceptible patients regarding a failure event. In such studies, it is also necessary to estimate unobservable heterogeneity caused by unmeasured prognostic factors. Moreover, the hazard function may exhibit a non-monotonic shape, specifically, an unimodal hazard function. In this article, we propose a long-term survival model based on a defective version of the Dagum distribution, incorporating a power variance function frailty term to account for unobservable heterogeneity. This model accommodates survival data with cure fractions and non-monotonic hazard functions. The distribution is reparameterized in terms of the cure fraction, with covariates linked via a logit link, allowing for direct interpretation of covariate effects on the cure fraction-an uncommon feature in defective approaches. We present maximum likelihood estimation for model parameters, assess performance through Monte Carlo simulations, and illustrate the model’s applicability using two health-related datasets: severe COVID-19 in pregnant and postpartum women and patients with malignant skin neoplasms.

PMID:39936340 | DOI:10.1177/09622802241304113

Head Neck. 2025 Feb 12. doi: 10.1002/hed.28096. Online ahead of print.

ABSTRACT

BACKGROUND: Neck hematoma following thyroid surgery is a potentially life-threatening complication.

METHODS: This retrospective case-control study reviewed neck hematoma reoperations following thyroid surgery (2009-2024), using 3:1 matching. Univariable analysis identified hematoma and delayed onset (≥ 6 h) risk factors, with odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS: Among 5502 surgeries, the hematoma incidence was 0.55% (n = 30). The mean age was 54 and the female-to-male ratio was 7:3. Key risk factors included pre-induction blood pressure > 160 mmHg (OR = 3.04 [95% CI = 1.25-7.39], p = 0.014) and limited blood pressure change postmedication (OR = 6.25 [95% CI = 1.03-38.08], p = 0.047). The hematoma group had higher rates of smoking, hypertension, diabetes, Graves’ disease, and prior thyroid surgery, and, in delayed hematoma cases, larger nodules, total thyroidectomy, and central neck dissection, though not statistically significant.

CONCLUSION: Patients with poorly controlled blood pressure may not be candidates for outpatient thyroidectomy.

PMID:39936339 | DOI:10.1002/hed.28096

J Adv Nurs. 2025 Feb 12. doi: 10.1111/jan.16781. Online ahead of print.

ABSTRACT

AIM: To evaluate the relationship between time spent in sedentary behaviour and physical activity and sarcopenia in older adults, and to analyse the effect of reallocating time between different intensities of activities on sarcopenia.

DESIGN: Systematic review and meta-analysis.

METHODS: Following PRISMA guidelines, data were synthesised using a random-effects model, with heterogeneity assessed via Cochran’s Q test and the I² statistic. Study quality was evaluated using the Newcastle-Ottawa Scale by two independent reviewers.

DATA SOURCES: A comprehensive search was conducted in PubMed, Web of Science, Embase, CINAHL and Cochrane databases for studies published up to November 5, 2024, with no language or date restrictions. Relevant reference lists were also manually screened.

RESULTS: The present review included six studies involving 9914 older adults. Three studies suggested that older adults without sarcopenia spent more time performing light physical activities (SMD: 0.35; 95% CI: 0.24-0.45) and moderate to vigorous physical activity (SMD: 0.61; 95% CI: 0.49-0.74) and had less sedentary behaviour (SMD: -0.34; 95% CI: -0.51 to -0.16) than did older adults with sarcopenia. Replacing sedentary behaviour with an equivalent amount of moderate to vigorous physical activity (10, 30, or 60 min) each day can reduce the risk of sarcopenia, with 30 min showing the best preventive effect. However, research findings on the relationship between substituting sedentary behaviour time with light physical activities and sarcopenia are inconsistent.

IMPLICATIONS FOR THE PROFESSION: Encouraging older adults to engage in moderate to vigorous physical activity, even in short bouts of 10 min, can significantly reduce the risk of sarcopenia. Healthcare professionals should tailor activity recommendations to individual preferences and physical conditions to promote overall health and reduce sedentary behaviour.

PATIENT AND PUBLIC CONTRIBUTION: No Patient or Public Contribution.

TRIAL REGISTRATION: CRD42023416166.

PMID:39936334 | DOI:10.1111/jan.16781

Int J Qual Health Care. 2025 Feb 12:mzaf013. doi: 10.1093/intqhc/mzaf013. Online ahead of print.

ABSTRACT

Background The COVID-19 pandemic significantly affected global healthcare systems, revealing their resilience to crises. Despite this, national-level research on its impact across key healthcare domains – such as acute and chronic disease management, cancer screening and care, mental health, and palliative care – is scarce. This study examines pandemic’s impact on contacts, quality of care, and social disparity in these healthcare domains to guide better preparedness for future health emergencies. Methods The study utilised data from Danish national clinical quality registries, covering January 2015 to June 2022, to create a nationwide cohort for comparing healthcare metrics across the pandemic’s phases and the pre-pandemic period. Healthcare contacts were assessed through descriptive analyses, whilst the quality of care and social disparities were analysed using multivariable regression models, providing estimated prevalence ratios and 95% confidence intervals. Results The first wave of the COVID-19 pandemic in Denmark led to community and healthcare lockdowns, which were associated with fewer hospital contacts and reduced participation in national cancer screening programs. However, a gradual recovery towards pre-pandemic levels was found, with the exceptions of chronic obstructive pulmonary disease (COPD) contacts and colorectal cancer incidence. Overall, the quality of care across various healthcare domains in Denmark remained largely unchanged or improved slightly during the pandemic. However, social disparities in contacts were increased across all examined healthcare domains, with patients who were immigrants, living alone, had limited educational level or low income experiencing reduced contact compared to the pre-pandemic period. Conclusions Overall, the Danish healthcare system appeared to be resilient and largely unaffected throughout the pandemic, and the quality of care in several healthcare domains remained high. Nevertheless, the increasing social disparities in healthcare contacts during the pandemic demands attention. In preparing for future health crises, it is important to address and mitigate potential social inequalities, focusing on achieving equity in healthcare.

PMID:39936327 | DOI:10.1093/intqhc/mzaf013

Alzheimers Dement. 2025 Feb 12:e14551. doi: 10.1002/alz.14551. Online ahead of print.

ABSTRACT

INTRODUCTION: One of the pathological hallmarks of Alzheimer’s disease (AD) is the accumulation of amyloid beta 42 (Aβ42). Decreased venous drainage may enhance Aβ42 accumulation. We aimed to compare venous cross-sectional area (CSA) of AD patients to cognitively healthy controls.

METHODS: All patients underwent neurocognitive evaluation and brain magnetic resonance imaging, including time-of-flight sequence. Venous CSA was measured at the jugular foramen level.

RESULTS: Thirty-nine AD/mild cognitive impairment patients and 20 cognitively healthy controls were included. Total venous CSA was smaller in the cognitively impaired group (mean CSA 139.77 mm² [SD: 32.22] vs 166.55 mm² [SD: 33.1], p = 0.004]. When divided, both internal jugular and non-jugular systems were smaller within cognitively impaired patients; statistical significance was achieved only for the non-jugular system (mean CSA 41.21 mm² [SD: 21.52] vs 54.5 mm² [SD: 27.31], p = 0.045).

DISCUSSION: There is an association between smaller venous systems and cognitive impairment, most prominently in the non-jugular system. Venous narrowing may cause impaired venous drainage, leading to an accumulation of Aβ42.

HIGHLIGHTS: The non-jugular venous system, including the vertebral plexus and pterygopalatine plexus, plays an important role in cerebral drainage. The total venous CSA is significantly smaller in cognitively impaired patients compared to healthy controls. Reduced venous drainage may contribute to the accumulation of Aβ and other waste products and potentially plays a role in AD pathology.

PMID:39936326 | DOI:10.1002/alz.14551

Ann Surg. 2025 Feb 12. doi: 10.1097/SLA.0000000000006664. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the association between glycemic control, measured by glycated hemoglobin (HbA1c) levels, and post-operative complications across various procedures, identify the prevalence of patients with undiagnosed prediabetes or diabetes undergoing surgery, and explore whether better glycemic management is associated with reduced short-term postoperative complications.

BACKGROUND: The presence of diabetes and the level of long-term glycemic control, as measured using HbA1c, can influence perioperative morbidity and mortality. Current evidence is largely based on small, single-center studies, with heterogeneous analysis strategies.

METHODS: Data from the 2021-2022 multi-institutional American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were utilized. Adult patients with recorded HbA1c were selected and categorized into eight groups based on the presence of a diabetes diagnosis and their HbA1c values. Various preoperative, surgical, and postoperative variables were extracted and analyzed using multivariate regression models.

RESULTS: The study included 502,478 patients with recorded HbA1c. Among those diagnosed with diabetes (n=179,697; 35.8%), HbA1c levels were distributed as follows: 27,516 (5.5%) had HbA1c <6% (<42 mmol/mol), 63,644 (12.7%) had HbA1c 6-6.9% (42-52 mmol/mol), 45,534 (9.1%) had HbA1c 7-7.9% (53-63 mmol/mol), 19,985 (4.0%) had HbA1c 8-8.9% (64-74 mmol/mol), and 23,018 (4.6%) had HbA1c ≥9% (≥75 mmol/mol). Of the patients without a diabetes diagnosis (n=322,781; 64.2%), 91,097 (18.1% of total) had HbA1c in the prediabetes range (5.7-6.4%, 39-46 mmol/mol) and 25,818 (5.1% of total) in the diabetes range (>6.4%, ≥47 mmol/mol). Multivariate logistic analysis revealed that, compared to patients without prediabetes or diabetes, patients with undiagnosed prediabetes had a lower risk of surgical complications, while patients with undiagnosed diabetes had a higher risk of medical complications. Patients with diagnosed diabetes with near-normal glycemia and those with very poor glycemic control had higher odds of any complication. Patients with undiagnosed prediabetes and undiagnosed diabetes had significantly lower chances of transfusion. Patients with undiagnosed diabetes and patients with diagnosed diabetes with near-normal glycemia, suboptimal glycemic control, or very poor glycemic control had significantly longer hospital stays compared to patients without prediabetes or diabetes.

CONCLUSIONS AND RELEVANCE: Glycemic control significantly impacts morbidity and mortality in surgical patients. A total of 23% of patients were patients with undiagnosed prediabetes or diabetes, underscoring the importance of preoperative HbA1c screening for all patients. Both very low and very high HbA1c levels should be preoperatively addressed, with moderate control (HbA1c 7-8%, 53-64 mmol/mol) identified as optimal. Overall, these findings emphasize the need for personalized diabetes management plans tailored to each patient’s needs and should inform clinical guidelines.

PMID:39936298 | DOI:10.1097/SLA.0000000000006664

Hypertension. 2025 Feb 12. doi: 10.1161/HYPERTENSIONAHA.124.24542. Online ahead of print.

ABSTRACT

BACKGROUND: The mediating role of inflammatory biomarkers in the causal relationship between body composition and hypertension remains unclear and requires further investigation.

METHODS: This study used a combination of retrospective observational analysis and Mendelian randomization approaches. Observational data were derived from 4717 Chinese children and adolescents aged 6 to 18 years who underwent dual-energy X-ray absorptiometry to assess body composition. Mendelian randomization analyses utilized summary statistics from large-scale data sets, including UK Biobank, deCODE2021, International Consortium of Blood Pressure, FinnGen, and other consortia. The inflammatory biomarkers included leptin, insulin, adiponectin, osteocalcin, FGF23 (fibroblast growth factor 23), and PTH (parathyroid hormone).

RESULTS: The observational analysis revealed that increased fat mass positively influenced diastolic blood pressure through osteocalcin, while fat-free mass had an inverse effect. Insulin mediated the association between fat mass and systolic blood pressure, diastolic blood pressure, and hypertension, with additional indirect effects observed for PTH (all P<0.05). The Mendelian randomization analyses demonstrated a causal relationship between childhood body mass index and hypertension mediated by insulin (indirect effect: odds ratio, 0.87 [95% CI, 0.78-0.97]) and adiponectin (odds ratio, 1.13 [95% CI, 1.04-1.23]). Adiponectin mediated the effects of fat-free mass (odds ratio, 0.81 [95% CI, 0.71-0.93]) and fat mass (odds ratio, 1.30 [95% CI, 1.11-1.51]) on hypertension. Leptin, adiponectin, and insulin also mediated the causal effects of body composition on systolic blood pressure, diastolic blood pressure, and hypertension.

CONCLUSIONS: These findings indicate that body composition influences blood pressure through distinct inflammatory biomarkers. Targeting inflammatory biomarkers may provide tailored strategies for managing body composition and hypertension.

PMID:39936290 | DOI:10.1161/HYPERTENSIONAHA.124.24542

Dan Med J. 2024 Dec 19;72(1):A01240067. doi: 10.61409/A01240067.

ABSTRACT

INTRODUCTION: Blunt cerebrovascular injuries (BCVI) associated with cervical spine injuries (CSI) carry a high risk of morbidity and mortality. This nationwide Danish study, covering the years 2017-2023, aimed to identify key BCVI predictors in patients with CSI to support improved early detection and management strategies.

METHODS: The study analysed data from four level-1 trauma centres using the Abbreviated Injury Scale to classify BCVI cases. Factors assessed included age, sex, type of cervical injury and the Injury Severity Score (ISS).

RESULTS: Age and sex were not significant predictors of BCVI (p = 0.12, p = 0.65). However, any form of CSI was a strong predictor (p less-than 0.001; odds ratios (OR) = 26.3; confidence intervals (95% CI): 16.84-41.12), as were cervical spine ligamentous injuries (p = 0.0007; OR = 5.4; 95% CI: 2.3-12.89). An increase in ISS score significantly correlated with BCVI risk (p = 0.001; OR = 1.03 per unit increase; 95% CI: 1.01-1.05). Specific cervical fractures were not independent predictors of BCVI.

CONCLUSIONS: From a Danish cohort of patients admitted to a level 1 trauma centre, we found a BCVI incidence of three per thousand. In case of verified injury to the cervical region, the incidence rose to 6.25%. Our findings underscore the need for increased vigilance and a standardised nationwide algorithm to prevent disability, loss of health-related quality of life, and mortality in CSI patients at risk of BCVI.

FUNDING: The study was funded by Offerfonden, Dagmar Marshall Fonden, and Torben and Alice Frimodt Fonden.

TRIAL REGISTRATION: The data collection was approved by the local ethical committee and the Central Denmark Region Office for Research: 1-45-70-19-23.

PMID:39936272 | DOI:10.61409/A01240067

Dan Med J. 2024 Dec 11;72(1):A06240378. doi: 10.61409/A06240378.

ABSTRACT

INTRODUCTION: Ankyloglossia in breastfeeding infants has been proposed to cause maternal nipple pain. Lingual frenotomy has been cited to reduce maternal nipple pain. The aim of this systematic review was to investigate if frenotomy in infants with ankyloglossia and breastfeeding problems reduces maternal nipple pain.

METHODS: We conducted a systematic literature search for RCTs comparing frenotomy to a sham procedure or usual care in mother-infant dyads with ankyloglossia and maternal nipple pain. Maternal nipple pain was registered as the main outcome. We conducted a meta-analysis and assessed the risk of bias using Rob 2.0 and the quality of evidence, adopting the GRADE approach.

RESULTS: Five RCTs were included in the review. Three RCTs were used for the meta-analysis. The meta-analysis showed a significant pre-post intervention reduction in maternal nipple pain in the frenotomy group compared with the comparison group: mean difference = -1.23; 95% confidence interval: -1.88 to -0.57. The overall bias was assessed to range from “some concerns” to “high”. The quality of evidence for the assessed outcome, maternal nipple pain, was classified as “low” to “very low”.

CONCLUSIONS: We found that frenotomy reduced maternal nipple pain in the short term. Despite being statistically significant, the clinical relevance of a 1.2-point reduction on a ten-point VAS must be questioned. Due to a considerable risk of bias along with a low study quality, the definitive benefit of frenotomy on maternal nipple pain remains unproven. Hence, quality large-scale RCTs are warranted.

PMID:39936271 | DOI:10.61409/A06240378

Dan Med J. 2024 Dec 11;72(1):A06240407. doi: 10.61409/A06240407.

ABSTRACT

INTRODUCTION: Acid-base disturbances are common in the emergency department, with acidosis and alkalosis being associated with an elevated risk of mortality and morbidity. Understanding the relationship between pH and mortality may serve to optimise patient outcomes. The primary objective was to describe the association between arterial blood pH and 0-2-day mortality in adult non-traumatic acute visits. The secondary objective was to describe this association for 3-7-day mortality.

METHODS: This population-based, multicentre cohort study included all adult non-traumatic acute visits in the Region of Southern Denmark between 2016 and 2018 who had an arterial blood gas (ABG) drawn within four hours of arrival. We described 0-2- and 3-7-day mortality stratified by pH level, controlled for confounding factors and reported as hazard ratio (HR) compared to normal pH.

RESULTS: A total of 64,725 acute visits in 31,650 individuals with an ABG were included. The overall mortality rate for index visits was 2.4% on days 0-2 and 2.1% on days 3-7. Patients with severe acidosis (pH less-than 7.20) had 20.8% and 8.9% mortality rates (HR = 9.6 and 5.2), whereas patients with acidosis (pH 7.20-7.34) had mortality rates of 7.4% and 5.2% (HR = 4.1 and 2.7) on day 0-2 and 3-7, respectively. Our secondary analysis found a 0-2-day mortality rate of nearly 60% in patients with a pH less-than 6.90.

CONCLUSION: The short-term mortality rates increased with the severity of acidosis. The highest mortality rate was found in patients with a pH less-than 6.90.

FUNDING: None.

TRIAL REGISTRATION: Not relevant.

PMID:39936269 | DOI:10.61409/A06240407