Nevin Manimala

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

Prostate. 2025 Dec 7. doi: 10.1002/pros.70106. Online ahead of print.

ABSTRACT

BACKGROUND: Post-prostatectomy urinary incontinence significantly impacts quality of life. Techniques that preserve periprostatic structures have shown promise in promoting earlier continence recovery, particularly with robotic-assisted surgery. The study aimed to evaluate the effect of pubovesical complex (PVC) preservation on urinary continence recovery in patients undergoing laparoscopic radical prostatectomy (LRP).

METHODS: In this randomized, blinded, prospective clinical trial, 72 patients with localized prostate cancer were assigned to standard LRP or LRP with PVC preservation. The primary endpoint was urinary continence recovery, defined as complete absence of leakage or pad use, assessed at 24 h, 15 days, 1, 3, and 6 months post-catheter removal. Secondary endpoints included operative time, blood loss, complications, and oncologic outcomes.

RESULTS: At 6 months, continence was significantly higher in the PVC group (82.4% vs. 57.6%; p = 0.027). Earlier timepoints showed improved, though not statistically significant, continence rates in the PVC group. Operative time (109 vs. 75 min; p < 0.001) and blood loss (365 vs. 247 ml; p = 0.010) were greater with PVC preservation. Complication and margin positivity rates were similar between groups.

CONCLUSION: PVC preservation during LRP significantly improves urinary continence recovery without compromising oncologic safety. This accessible technique can be adopted in centers lacking robotic platforms, offering equitable benefits for patients in resource-limited settings.

TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBEC), RBR-7f25wsz.

PMID:41353629 | DOI:10.1002/pros.70106

Am J Hosp Palliat Care. 2025 Dec 7:10499091251406573. doi: 10.1177/10499091251406573. Online ahead of print.

ABSTRACT

BackgroundAlthough previous research has highlighted the protective effect of social support in caregiving contexts, further investigation is needed to understand its complex roles in modifying and explaining the impact of caregiver stressors. This cross-sectional study assessed family caregivers’ social support, digital literacy, and caregiving-related stressors, examining their relationships and impact on mental health outcomes (anxiety and depressive symptoms). Specifically, we investigated (1) whether digital literacy interacted with stressors to influence caregivers’ perceived social support and (2) whether social support mediates the relationship between caregiver stressors and mental health.MethodsData were collected from 308 caregivers of people living with dementia receiving hospice care using structured assessments, including validated measures of social support, digital literacy, anxiety, depressive symptoms, and key sociodemographic characteristics.ResultsThe direct and total effects of caregiver stressors on mental health outcomes were statistically significant, whereas the indirect effects mediated by social support were not. Although tangible support was individually associated with both outcomes, the overall mediating effect of social support was not accounted for by either emotional/informational or tangible support alone. The moderating effect of digital literacy was also not statistically significant.ConclusionsThe association between caregiver stressors and mental health appears to be more directly driven than mediated by social support. The absence of significant indirect or moderating effects highlights the complexity of these relationships and underscores the need for future research to explore additional pathways, contextual influences, and conditions under which aspects of social support or digital literacy may exert greater impact.

PMID:41353626 | DOI:10.1177/10499091251406573

Infect Dis (Lond). 2025 Dec 7:1-11. doi: 10.1080/23744235.2025.2598808. Online ahead of print.

ABSTRACT

OBJECTIVES: Evaluation of pancreatic stone protein (PSP) plasma levels has been proven effective in predicting unfavourable outcomes in patients with Ventilator-Associated Pneumonia (VAP), infection after cardiothoracic surgery and peritonitis. It is also being studied as a sepsis biomarker with promising results compared to other commonly used biomarkers. We aim to validate PSP in septic patients with community acquired infections. This will help to establish its role in point-of-care settings.

METHODS: Adult patients consecutively admitted to the Emergency Department (ED) of a tertiary medical centre, with the diagnosis of intra-abdominal infection (IAI), urinary tract infection (UTI) and lower respiratory tract infection (LRTI) who met the inclusion criteria were enrolled. PSP was measured in whole blood, within one hour since admission, by spectrophotometry using abioSCOPE device. Statistical analysis was performed, and a cut-off value for PSP to predict the composite outcome of sepsis, readmission, antibiotic treatment escalation and need for invasive treatment was estimated. Patients were followed for 28 days to document their outcomes.

RESULTS: A total of one hundred and one (n = 101) patients were included. Forty-five were male. The most common comorbidity was hypertension (33%). Fifty-three (52.5%) had LRTI, thirty-seven (36.6%) had UTI and nineteen (18.8%) had IAI. Thirteen of them had more than one type of infection. Our primary outcome met statistical significance, as PSP predicted the composite outcome of sepsis, readmission, antibiotic treatment escalation and need of invasive treatment with an Area Under Curve (AUC) =0.844 (95% CI 0.767-0.920), in the optimal cut-off of 48.5 ng/ml. PSP predicted sepsis with an AUC = 0.892 (95% CI 0.826-0.956) and was also an independent risk factor for sepsis and mortality after age adjustment. PSP was superior to the common used sepsis biomarkers, C-reactive protein (CRP), ferritin, lactate dehydrogonase (LDH)/albumin ratio, White Blood Cell count (WBC), fibrinogen and lactate both for sepsis and for the composite outcome. It was also correlated with Sequential Organ Failure Assessment (SOFA) day 1 (D1), SOFA peak and qSOFA and its prognostic value was independent of renal function, despite being inversely proportional to estimated Glomerular Filtration Rate (eGFR), reflecting the sepsis-related acute kidney injury (SAKI).

CONCLUSIONS: PSP is a valuable biomarker that can rule out patients who do not have sepsis and are not in high risk to develop sepsis the following days, giving valuable insights regarding their antimicrobial coverage and management in general. It seems to be superior to other biomarkers in sepsis prediction and adequately compatible with frequently used sepsis assessment scores, such as SOFA. In the Emergency Department setting PSP can distinguish infected patients at high risk for sepsis who have low qSOFA scores.

PMID:41353590 | DOI:10.1080/23744235.2025.2598808

J Orthop Surg (Hong Kong). 2025 Sep-Dec;33(3):10225536251407382. doi: 10.1177/10225536251407382. Epub 2025 Dec 7.

ABSTRACT

BackgroundThis study aims to compare the performance of two artificial intelligence (AI) models, ChatGPT-4.0 and DeepSeek-R1, in addressing clinical questions related to degenerative lumbar spinal stenosis (DLSS) using the North American Spine Society (NASS) guidelines as the benchmark.Methods15 clinical questions spanning five domains (diagnostic criteria, non-surgical management, surgical indications, perioperative care, and emerging controversies) were designed based on the 2013 NASS evidence-based clinical guidelines for the diagnosis and management of DLSS. Responses from both models were independently evaluated by two board-certified spine surgeons across four metrics: accuracy, completeness, supplementality, and misinformation. Inter-rater reliability was assessed using Cohen’s κ coefficient, while Mann-Whitney U and Chi-square tests were employed to analyze statistical differences between models.ResultsDeepSeek-R1 demonstrated superior performance over ChatGPT-4.0 in accuracy (median score: 3 vs 2, P = 0.009), completeness (2 vs 1, P = 0.010), and supplementality (2 vs 1, P = 0.018). Both models exhibited comparable performance in avoiding misinformation (P = 0.671). DeepSeek-R1 achieved higher inter-rater agreement in accuracy (κ = 0.727 vs 0.615), whereas ChatGPT-4.0 showed stronger consistency in ssupplementality (κ = 0.792 vs 0.762).ConclusionsWhile both AI models demonstrate potential for clinical decision support, DeepSeek-R1 aligns more closely with NASS guidelines. ChatGPT-4.0 excels in providing supplementary insights but exhibits variability in accuracy. These findings underscore the need for domain-specific optimization of AI models to enhance reliability in medical applications.

PMID:41353581 | DOI:10.1177/10225536251407382

Med Sci Monit. 2025 Dec 7;31:e949115. doi: 10.12659/MSM.949115.

ABSTRACT

BACKGROUND Peripheral intravenous (IV) access is a fundamental pre-hospital procedure performed by emergency medical services (EMS) personnel and remains the primary route for drug administration. Pediatric IV cannulation is often challenging in out-of-hospital settings. The aim of this study was to evaluate the frequency of peripheral intravenous access being established in pre-hospital settings by EMS staff in pediatric patients. MATERIAL AND METHODS This retrospective study analyzed 6331 records of emergency medical services (EMS) dispatches involving patients under 18 years of age between 2020 and 2022. The study protocol included an assessment of cannulation rate depending on the patient’s age, case characteristics, ICD 10 (International Classification of Diseases, Tenth Revision) diagnosis and whether the patient required transport to a hospital. RESULTS Peripheral intravenous access was established in 1073 of 6331 pediatric patients (16.94%). The cannulation rate increased significantly with age, from 1.03% in infants (<1 year) to 75.12% in adolescents (12-18 years) (p<0.001). Logistic regression analysis identified age, trauma (OR=1.96), poisoning (OR=3.88), and transfer by Helicopter Emergency Medical Services (HEMS) (OR=5.86) as predictors of IV cannulation (p<0.001). CONCLUSIONS The overall rate of peripheral intravenous access establishment in pediatric patients in pre-hospital settings is relatively low, with the lowest rates observed in children under 1 year of age. Age, trauma, poisoning, and referral to HEMS teams significantly increased the likelihood of cannulation. It is essential to develop evidence-based algorithms and targeted training to support EMS personnel in managing vascular access in critically ill children.

PMID:41353559 | DOI:10.12659/MSM.949115