Nevin Manimala

Foot Ankle Surg. 2025 Sep 18:S1268-7731(25)00222-X. doi: 10.1016/j.fas.2025.09.009. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the relationship between chronic ankle instability (CAI) and both the anatomical characteristics of the anterior talofibular ligament (ATFL) and the bony morphometry of its attachment sites on the fibula and talus using MRI.

METHODS: A total of 94 patients were included in this retrospective study (44 with CAI, 50 controls). Morphometric parameters including ATFL length, width, thickness, and the ATFL/PTFL angle were measured, along with sagittal and coronal widths of the fibula and talus at ATFL attachment levels.

RESULTS: The ATFL was significantly longer, thinner, and narrower in the CAI group compared to controls (p < 0.001). The ATFL/PTFL angle was also significantly greater in the CAI group (p = 0.007). However, no statistically significant differences were observed in the sagittal or coronal widths of the talus and fibula. ROC analysis revealed that ATFL length had the highest diagnostic performance (AUC = 0.881). Logistic regression identified increased ATFL/PTFL angle and decreased ATFL width and thickness as independent predictors of instability.

CONCLUSION: While the ligamentous characteristics of the ATFL, particularly its length and angulation, are strongly associated with CAI, the morphometric features of its bony attachment sites do not appear to contribute significantly. The ATFL/PTFL angle may be considered a reliable, indirect MRI marker in the assessment of CAI and should be considered in routine evaluations.

PMID:40975665 | DOI:10.1016/j.fas.2025.09.009

Curr Probl Pediatr Adolesc Health Care. 2025 Sep 19:101838. doi: 10.1016/j.cppeds.2025.101838. Online ahead of print.

ABSTRACT

OBJECTIVE: Upstream oil and gas development (OGD) can release carcinogenic and radioactive agents into air and water. This review summarizes evidence on the relationship between residential proximity to upstream OGD and cancer risk among children, adolescents, and young adults (CAYA).

METHODS: We systematically searched PubMed and Embase through April 25, 2025, for original, peer-reviewed epidemiologic investigations of residential proximity to upstream OGD and cancer in CAYA (≤25 years). We excluded studies of downstream activity, those lacking CAYA-specific results, and non-English publications. Two reviewers independently screened records, extracted data, and assessed risk of bias with a World Health Organization tool.

RESULTS: From 3274 screened articles, 10 met inclusion criteria. Four case-control studies, all United States-based (Pennsylvania n = 3, Colorado n = 1), used individual-level proximity metrics during defined temporal windows and controlled for confounders. Six ecological studies (Ecuador n = 4, Croatia n = 1, Pennsylvania n = 1) used area-based density or binary exposure metrics with limited confounder adjustment. All studies assessed hematopoietic malignancies. All case-control studies observed positive associations between OGD proximity and cancer with three reporting elevated leukemia risk. Two studies from different states reported highly similar leukemia risk in the closest OGD buffer zones (Colorado: 3 km OR 2.07, 95 % CI 1.08-3.74; Pennsylvania: 2 km OR 1.98, 95 % CI 1.06-3.69). Ecologic study findings were mixed, including elevated risks for hematologic and central nervous system cancers. Limitations include few studies, imprecise exposure metrics, and potential residual confounding.

DISCUSSION: Despite limited evidence, the majority of studies reported positive, statistically significant associations between OGD and childhood cancer, most consistently for leukemia, supporting efforts to reduce OGD proximity to children.

PMID:40975664 | DOI:10.1016/j.cppeds.2025.101838

Eur Urol Oncol. 2025 Sep 19:S2588-9311(25)00224-X. doi: 10.1016/j.euo.2025.09.001. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion guided biopsy is the cornerstone of prostate cancer (PC) diagnosis. While prior studies have focused on detection rates, the impact of fusion registration methods-elastic registration techniques (ERT) versus rigid registration techniques (RRT)-on International Society of Urological Pathology (ISUP) grade concordance remains underexplored. Our objectives were to assess the effect of ERT versus RRT on the concordance between targeted biopsy (TBx) and overall biopsies (OBx) for detection of (1) clinically significant PC (csPC; defined as ISUP grade ≥2) and (2) high-grade PC (hgPC; defined as ISUP grade ≥3) in biopsy-naïve men with confirmed PC.

METHODS: Our multicenter retrospective study included 888 biopsy-naïve men with confirmed PC (prostate-specific antigen ≤20 ng/ml, cT1-2, Prostate Imaging-Reporting and Data System [PI-RADS] score 3-5) who underwent MRI-TRUS fusion guided biopsy using ERT (n = 479) or RRT (n = 409) at two high-volume institutions. After 1:1 propensity score matching (PSM) to control for confounding, a sample of 674 patients was included in the final analysis. The primary endpoint was the concordance of csPC detection between TBx and OBx. Secondary endpoints included concordance for hgPC detection (ISUP grade ≥3) between TBx and OBx, concordance for hgPC (ISUP grade ≥3) between systematic biopsy (SBx) and OBx, biopsy sampling metrics, and subgroup analyses for PI-RADS 3 lesions. Multivariable logistic binomial regression models adjusted for clinical and imaging covariates were tested.

KEY FINDINGS AND LIMITATIONS: There was a significant difference in the frequency of csPC concordance between the ERT and RRT groups (60.2% vs 33.6%; p < 0.0001). Moreover, the ERT approach was associated with significantly higher odds of being classified as concordant csPC in comparison to RRT (adjusted odds ratio [aOR] 4.82, 95% confidence interval 2.82-8.24). ERT was also significantly associated with higher odds of hgPC concordance after adjusting for PSA density, clinical TNM stage and PI-RADS score (aOR 2,51, 95% confidence interval 1.51-4.16; corrected p = 0.0014). ERT reduced overgrading of ISUP grade 1 lesions (12.5% vs 39.2%; p < 0.001). Despite lower core volume and fewer positive cores, ERT achieved similar maximum cancer core length, suggesting superior spatial targeting. PI-RADS 3 subgroup analyses showed favorable trends for ERT, although the results were not statistically significant (p >0.05).

CONCLUSIONS AND CLINICAL IMPLICATIONS: ERT was associated with better concordance for detection of both csPC and hgPC on TBx, supporting more accurate risk stratification while reducing detection of indolent cancer. While our findings indicate diagnostic advantages for ERT over RRT, prospective multicenter studies with centralized pathology review are warranted for external validation and evaluation of the downstream clinical impact.

PMID:40975636 | DOI:10.1016/j.euo.2025.09.001

Indian J Tuberc. 2025 Oct;72(4):527-531. doi: 10.1016/j.ijtb.2025.02.018. Epub 2025 Mar 10.

ABSTRACT

BACKGROUND: Paediatric tuberculosis is a surrogate indicator of ongoing TB transmission. The present study explores the relationship between the burden of paediatric TB cases and their ecological determinants in different states of India.

METHODS: Based on a conceptual model framework, an ecological record-based analysis was conducted using accessible national data from 33 Indian states and union territories. Based on the exploratory factors, negative binomial regression was performed to predict the number of paediatric tuberculosis cases.

RESULTS: There was statistically significant geospatial clustering in paediatric TB incidence among states. Notification of paediatric cases was not affected by the size of the state. The rate of paediatric tuberculosis increased significantly by a factor of 1.004 and 1.107 for each unit increase in TB incidence per 100,000 population and the proportion of stunted children. The rate dropped significantly by a factor of 0.888 for each unit increase in chemoprophylaxis proportion. The rate of paediatric tuberculosis increases by 1.004, 1.100, and 1.899 times for every unit increase in BPL %, BCG coverage, and mean household size, respectively.

CONCLUSION: Adult TB case pool, malnutrition, overcrowding, and chemoprophylaxis are important predictors of variation in paediatric cases in India.

PMID:40975586 | DOI:10.1016/j.ijtb.2025.02.018

Indian J Tuberc. 2025 Oct;72(4):513-516. doi: 10.1016/j.ijtb.2024.12.002. Epub 2024 Dec 24.

ABSTRACT

BACKGROUND: The diagnosis of Extrapulmonary TB(EPTB) has always been a challenge for health care providers as it generally requires resource and greater clinical expertise. Timely detection and proper treatment of TB are the key elements of an effective TB control program. Our aim in this study is to determine the diagnostic delay and the factors associated with delay, to estimate the out of pocket expenditure, and the treatment outcome in Extrapulmonary TB Patients.

METHODS: A mixed method study was carried out in Five TB Units of Bangalore Urban District on the newly diagnosed Extrapulmonary TB Patients of the last quarter of 2021. Data from registers and telephonic interviews were used to collect information for the quantitative data and the qualitative assessment was done through In-depth interviews.

RESULTS: Out of 174 patients, 44.2% had a diagnostic delay of more than 1 month. The average expenditure among the subjects for diagnosis and treatment was estimated to be ₹ 56,681. 63% of the patients incurred an expenditure of above ₹ 10,000 before diagnosis and 18.9% had incurred an expenditure above ₹ 10,000 during treatment. 16.7% were lost to follow up, 0.6% were declared cured and 82.2% as treatment completed. In-depth interviews of 30 randomly selected patients with diagnostic delay was done to explore the reasons for delay, which were manually coded to generate the following codes-lack of awareness of symptoms and delayed referral, neglected symptoms and self medication, atypical presentation, misdiagnosis, wrong choice of diagnostic procedure, co-morbidities with overlapping symptoms, incidental finding, ignorance about Government facilities and free TB treatment, and absent or mild symptoms/slow progression of symptoms.

CONCLUSION: Guidelines for diagnosis and treatment of EPTB to health care workers and public awareness about EPTB and provisions of Government facilities needs further emphasis. This will help reduce diagnostic delay of EPTB and its financial burden on the patients thereby ensuring better treatment completion and cure rate aiding in TB elimination.

PMID:40975583 | DOI:10.1016/j.ijtb.2024.12.002

Indian J Tuberc. 2025 Oct;72(4):465-470. doi: 10.1016/j.ijtb.2025.02.016. Epub 2025 Feb 25.

ABSTRACT

BACKGROUND: TB Preventive Treatment (TPT) is considered as an effective intervention to reduce TB incidence by reducing the pool of TB infection in the community. This study was aimed to assess TPT outcome and its associations in West Bengal.

METHOD: ology: A retrospective cohort study conducted using the data from Ni-kshay, the web-based TB information management portal of India. All TPT beneficiaries who have initiated with TPT in the year 2022 were included in the study. To find out the independent risk factor associated with unsuccessful outcome, risk ratio (RR) and adjusted risk ratio (aRR) has been calculated using regression models.

RESULTS: Median age and BMI of the participants were 32 years, & 20.9 kg/m2 respectively. Median delay to TPT initiation from diagnosis of the index TB patients was 23 days. 90.5% (90.2-90.7) outcomes were successful while 9.5% (9.3-9.8) outcomes were unfavourable. 0-9yrs (aRR = 1.31), 10-19yrs (aRR = 1.16) & 20-39yrs (aRR = 1.10) age-groups were more likely to be associated with unsuccessful TPT outcomes. Overweight (aRR = 1.10) & Obese (aRR = 1.19) were associated with unsuccessful outcomes. Participants belong to urban areas (aRR = 1.37) & attending Private Health Facility (aRR = 1.17) were more likely to be associated with an unsuccessful outcome. TPT initiation delay of 8-30 days (aRR = 2.03) and >30 days (aRR = 2.90) was associated with unsuccessful TPT outcomes.

CONCLUSION: There are few gaps as well as few opportunities in the TPT programs in West Bengal. Gaps are both in policy level as well as implementation level. Identified gaps should be addressed for a better TB preventive strategy in West Bengal.

PMID:40975575 | DOI:10.1016/j.ijtb.2025.02.016

Indian J Tuberc. 2025 Oct;72(4):460-464. doi: 10.1016/j.ijtb.2024.11.004. Epub 2024 Nov 19.

ABSTRACT

INTRODUCTION: India has the highest burden of Tuberculosis (TB) in the world. Delay in diagnosis and treatment is one of the main reasons for high burden of TB in India. Proper knowledge, attitude and practice regarding Tuberculosis among health care workers is essential to improve case finding and treatment in TB. Nursing students are the prospective healthcare providers in the fight against tuberculosis.

AIM: To assess the knowledge, attitude, and practice regarding tuberculosis among nursing students.

METHODS: This was a Cross-sectional, analytical type of study done on 313 nursing students after taking Institutional Ethical committee clearance. It was done using a pre-tested, semi-structured questionnaire, on selected nursing colleges in Mangalore city of Karnataka state. Analysis of data was done using the software “IBM SPSS Statistics”. Chi-square test was used to test association. P value less than 0.05 was considered statistically significant.

RESULTS: Only 24.9% of the respondents had good knowledge and 58.8% had moderate knowledge about tuberculosis. Students studying B.Sc. nursing knew more about tuberculosis than those studying General Nursing. 67.4% of students had good attitude towards tuberculosis. Practice towards various aspects of tuberculosis was not satisfactory in more than 50% of the students.

CONCLUSION: Most of the nursing students have moderate knowledge about tuberculosis, but their attitude and practice towards TB is not at satisfactory level. Hence specific training measures should be included in their curriculum to improve their knowledge, attitude, and practice regarding tuberculosis. This will help in early diagnosis and proper treatment of TB.

PMID:40975574 | DOI:10.1016/j.ijtb.2024.11.004

Indian J Tuberc. 2025 Oct;72(4):455-459. doi: 10.1016/j.ijtb.2025.09.001. Epub 2025 Sep 2.

ABSTRACT

BACKGROUND: Tuberculosis (TB) remains a major public health challenge, especially in low- and middle-income countries. Operational Research (OR), supported by robust statistical methods, plays a critical role in optimizing TB control strategies.

OBJECTIVE: This review highlights the statistical tools applied in TB Operational Research, their applications, and the emerging role of Artificial Intelligence (AI) in strengthening data-driven decision-making.

METHODS: We examine classical statistical approaches alongside predictive modeling, cost-effectiveness analysis, and AI-based frameworks. Case examples from diverse settings illustrate their practical impact.

FINDINGS: Statistical methods underpin surveillance, diagnosis, treatment evaluation, and policy modeling in TB programs. AI-driven techniques, such as machine learning and deep learning, are expanding the analytical landscape by enhancing prediction, identifying high-risk populations, and enabling real-time program monitoring.

CONCLUSION: Statistical tools from traditional inference to AI-modeling are essential for advancing TB control. Strengthening methodological rigor, reporting standards and interdisciplinary collaboration will be pivotal in harnessing data for effective TB elimination strategies.

PMID:40975573 | DOI:10.1016/j.ijtb.2025.09.001

Radiologia (Engl Ed). 2025 Sep-Oct;67(5):101576. doi: 10.1016/j.rxeng.2025.101576. Epub 2025 Aug 5.

ABSTRACT

INTRODUCTION: Scientific journals are a fundamental tool for the dissemination of evidence-based medicine. The scientific quality of a journal is related to the level of evidence of its publications. The aim of our study is to analyse and quantify changes in the levels of evidence assigned to articles published in the Radiología journal over the last six years.

MATERIAL AND METHODS: We evaluated articles published in Radiología from 2018 to 2023. A critical reading of the selected articles was carried out and a level of evidence was assigned using two scales that are specific to the field of radiology (Insights into Imaging and the 2011 Oxford Center Evidence Based Medicine). Pearson residuals were used to establish differences in the level of evidence over the years, with a p-value < 0.05 being considered statistically significant. The level of agreement between the two scales for assessing levels of evidence was also compared using the Kappa coefficient.

RESULTS: Of the total 404 publications in Radiología from 2018 to 2023, 275 articles were included for analysis. There was evidence of a progressive increase in the level of evidence for the publications, with a peak in 2023, consistently on both scales (p = 0.043). A Kappa coefficient of 0.92 was obtained in the analysis of agreement between scales (almost perfect agreement).

CONCLUSION: The level of evidence for publications in the Radiología journal has significantly increased in 2023.

PMID:40975552 | DOI:10.1016/j.rxeng.2025.101576

Cardiovasc Pathol. 2025 Sep 18:107782. doi: 10.1016/j.carpath.2025.107782. Online ahead of print.

ABSTRACT

Aortic valve (AV) malformation and AV malfunction have been linked to aortic wall degeneration. Studies concomitantly assessing AV morphology, AV function, age, ascending aortic dilatation, and aortic biomechanical properties are lacking. This exploratory study aims to close this gap. Surgical samples of the ascending aorta (n=102) were histologically assessed. Based on echocardiographic studies, the elastic modulus (slope stress-strain curve) was calculated. Patient characteristics were collected from the patient charts. Samples obtained during autopsy (n=10) served as reference for the microscopic analysis. The patient characteristics, structural aortic wall changes, and biomechanical wall properties were statistically explored using comparative analyses and a Spearman correlation matrix. Marked medial degeneration was found significantly earlier in life for unicuspid AV morphology compared to bicuspid and tricuspid AV. Significantly fewer lamellar units and thinner aortic walls were found in surgical samples compared to the reference group regardless of AV morphology, AV function, age, and aortic dilatation. Adventitial structural impairment was associated with stiffer aortic walls. Hints were found that AV morphology (rather than AV function, age, and presence/absence of aortic dilatation) affects structural and functional ascending aortic wall properties. Additionally, the observations suggest more advanced aortic degeneration in association with unicuspid AV, underpin the need for non-surgical control samples in surgical pathological studies, and highlight the importance of the adventitial layer for aortic biomechanics.

PMID:40975478 | DOI:10.1016/j.carpath.2025.107782