Nevin Manimala

BMC Emerg Med. 2025 Aug 15;25(1):156. doi: 10.1186/s12873-025-01311-y.

ABSTRACT

BACKGROUND: Medical communication centre operators of the 1-1-3 medical emergency number in Norway use the decision support tool, the Norwegian Index for Medical Emergency, to categorise the problem and determine the correct handling and urgency level of the situation. The index comprises 42 chapters, one of which is titled ‘Non-specific problem’. Studies in Denmark frequently use this chapter; however, there are no published Norwegian studies on the demographics of this patient group. Thus, we investigated the characteristics of the patients assigned to this chapter and their 1- and 30-day mortality outcomes.

METHODS: This was a registry-based, retrospective cohort study. Descriptive statistics were used to compare the two groups; t-tests were performed for continuous variables, and data were presented with corresponding 95% confidence intervals. Categorical data were compared using the chi-square test. Statistical significance was set at p < 0.05.

RESULTS: Out of the 25,474 included calls to the emergency medical communication centre in 2022, 1,860 (7.3%) were categorised as ‘Non-specific problem’. Patients in this group had a higher mean age, were more often men, had a shorter hospital stay, and showed more comorbidities than the control group. The use of this chapter was associated with the allocation of a higher urgency level, and a reduction in the use of these criteria was observed during nighttime. Significantly higher 1- and 30-day mortality rates were observed in patients with non-specific symptoms (1.40% and 6.94%, respectively; p < 0.05).

CONCLUSIONS: The group presenting symptoms categorised as non-specific comprised older patients, more men, and a higher number of patients showing comorbidities than the control group. Patients presenting symptoms categorised as non-specific typically perceived a high level of urgency. Most of these patients had a non-specific main diagnosis after hospital admission and a significantly higher mortality rate than those presenting with symptoms categorised as specific.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40817051 | DOI:10.1186/s12873-025-01311-y

BMC Public Health. 2025 Aug 15;25(1):2789. doi: 10.1186/s12889-025-23993-6.

ABSTRACT

BACKGROUND: Mental disorders among the elderly are a growing public health concern contributing significantly to disease burden, disability, and mortality. However, there is a lack of nationally representative studies examining the prevalence and correlates of mental disorders among older adults in community settings. Considering 55 years old is the beginning of “young old”, our study targets the population of adults aged 55 years old and above. Using data from the China Mental Health Survey (CMHS), we aim to estimate the prevalence and distribution of mental disorders and to investigate the correlates of mental disorders.

METHODS: Data of study was derived from the CMHS, a nationally representative community-based epidemiological survey. CMHS employed Composite International Diagnostic Interview (CIDI), a structured diagnostic tool, to collect relevant data. A total of 12,667 adults aged 55 and above were included in this survey. Weighted prevalence estimates were calculated, and design-corrected Rao-Scott χ² test, along with logistic regression model were used to identify correlates of mental disorders.

RESULTS: A total of 10,840 participants (85.6%) completed the CIDI. The lifetime and 12-month prevalence of mental disorders among the Chinese elderly population were 19.16% and 10.62%, respectively. Anxiety disorders were the most prevalent mental disorders, with a lifetime prevalence and 12-month prevalence was 9.07% and 5.97%, respectively. The corresponding data for mood disorders were 8.19% and 4.36%, and for substance use disorders were 4.16% and 0.89%, respectively. Having ≥ 3 physical diseases (OR = 3.22, 95% CI: 2.35-4.40), experiencing chronic pain (OR = 2.94, 95% CI: 1.77-4.90), and having sleep disturbances (OR = 4.02, 95% CI: 3.14-5.13) were all significantly associated with higher odds of mental disorders. Conversely, individuals aged 70 years and older had significantly lower odds of mental disorders (OR = 0.42, 95% CI: 0.29-0.62). All associations were statistically significant (p < 0.05).

CONCLUSION: Mental disorders are highly prevalent among Chinese adults aged 55 years and above, with anxiety disorders, mood disorders, and substance use disorders being the most common. Chronic disease, chronic pain and sleep disturbances played an important role in the risk of mental disorders mental disorders.

PMID:40817050 | DOI:10.1186/s12889-025-23993-6

J Neurosurg. 2025 Aug 15:1-7. doi: 10.3171/2025.4.JNS242409. Online ahead of print.

ABSTRACT

OBJECTIVE: Chronic subdural hematoma (CSDH) is a common cause of morbidity in the older population and the incidence of CSDH is likely to increase in upcoming years due to the increasing age of the population. Surgical intervention is the cornerstone of treatment, but trials have shown conflicting results regarding the optimal type of surgical drainage. The aim of this study was to compare outcomes between patients with CSDH who were surgically treated with active subgaleal drainage versus passive subdural drainage.

METHODS: This retrospective single-center cohort study included patients who underwent surgery for CSDH from 2020 to 2022. In a neurosurgical department in Lund, Sweden, the clinical routine changed from use of a passive subdural drain to an active subgaleal drain during this period. Data were collected from patient medical records and analyzed using univariable analysis followed by multivariable logistic regression analysis. The primary outcome was reoperation for recurrent hematoma within 3 months. Secondary outcomes were postoperative morbidity and mortality.

RESULTS: Of 452 patients (331 male, median age 78 years) included in the analysis, 3 were lost to follow-up, leaving 230 patients who received passive subdural drainage and 219 patients who received active subgaleal drainage for outcomes assessment. The risk of recurrent surgery for CSDH within 3 months was significantly lower in the active subgaleal drain group (12.7%) compared with the passive subdural drain group (20.1%) (p = 0.022). Regarding secondary outcomes, no statistically significant differences were found.

CONCLUSIONS: Risk of recurrent CSDH requiring surgery was lower in patients who received active subgaleal drainage compared with those who received passive subdural drainage, with no increased risk of postoperative complications. These findings support use of the active subgaleal drain system for CSDH surgery.

PMID:40815860 | DOI:10.3171/2025.4.JNS242409

J Neurosurg Spine. 2025 Aug 15:1-9. doi: 10.3171/2025.4.SPINE241540. Online ahead of print.

ABSTRACT

OBJECTIVE: Complex locoregional closure of back wounds following spine surgery via muscle flap closure, as opposed to traditional layer-by-layer approximation, decreases rates of complications such as seroma, infection, and dehiscence. However, the impact of barbed suture use on operative time, surgical cost, and patient outcomes for these cases remains unknown. In this study, the authors aimed to evaluate the complication profile, time, and cost savings of barbed suture in complex flap closure of back wounds following the placement of spinal instrumentation.

METHODS: An IRB-approved retrospective analysis was conducted on the medical records of all patients who underwent spine surgery followed by locoregional muscle flap complex closure at the authors’ institution between January 2016 and July 2021. Patients were in either the barbed or conventional suture cohort. Odds ratios and 95% confidence intervals were computed using multivariable logistic regression with Firth’s correction. Estimated cost savings were calculated using literature-reported figures.

RESULTS: A total of 110 patients with comparable baseline demographics were included. Rates of seroma (p > 0.99), infection (p = 0.21), and dehiscence (p = 0.66) were statistically similar between groups. After adjusting for the length of surgical closure, the mean times were 3.1 mins/cm and 4.6 mins/cm for the barbed and conventional suture cohorts, respectively, resulting in a time savings of 1.5 mins/cm (p < 0.001). The calculated time savings for muscle flap closure of an average incision length was 34.5 minutes (95% CI 18.6-50.4 minutes), and the overall financial savings were calculated to be $1094.10 (95% CI $513.75-$1674.45) per case.

CONCLUSIONS: Knotless barbed suture use in complex closure of back wounds results in decreased operative time and hospital cost while conferring similar complication rates to conventional suture.

PMID:40815856 | DOI:10.3171/2025.4.SPINE241540

JMIR Hum Factors. 2025 Aug 15;12:e65569. doi: 10.2196/65569.

ABSTRACT

BACKGROUND: Informed consent (IC) is a cornerstone of ethical clinical research, yet comprehension gaps persist. The i-CONSENT guidelines aim to improve IC materials by enhancing clarity, accessibility, and tailoring them to the needs of diverse populations. This study evaluates the effectiveness of electronic IC (eIC) materials developed under these guidelines for 3 target populations-minors, pregnant women, and adults-across Spain, the United Kingdom, and Romania.

OBJECTIVE: The primary aim of this study is to assess participants’ comprehension of and satisfaction with eIC materials tailored to their specific needs. The secondary objectives are to identify demographic predictors of comprehension, evaluate the cross-cultural applicability of materials, and explore format preferences.

METHODS: A cross-sectional study was conducted with 1757 participants (620 minors, 312 pregnant women, and 825 adults), who reviewed eIC materials through a digital platform offering layered web content, narrative videos, printable documents, and infographics. Materials were co-designed using participatory methods, including design thinking sessions with minors and pregnant women, and online surveys with adults. Comprehension was assessed using an adapted version of the Quality of the Informed Consent questionnaire. Objective comprehension (part A) was categorized as low (<70%), moderate (70%-80%), adequate (80%-90%), or high (≥90%). Subjective comprehension (part B) was measured using a 5-point Likert scale. Satisfaction was evaluated through Likert scales and usability questions, with scores ≥80% considered acceptable. Multivariable regression models were applied to identify predictors of comprehension.

RESULTS: Objective comprehension exceeded 80% across all groups: minors (mean 83.3, SD 13.5), pregnant women (mean 82.2, SD 11.0), and adults (mean 84.8, SD 10.8). Women/girls outperformed men/boys (β=+.16 to +.36). Generation X adults scored higher than millennials (β=+.26, P<.001), while prior trial participation was associated with lower comprehension scores (β=-.47 to -1.77). Among minors, compared with participants from Spain with no previous clinical trial experience, comprehension was significantly lower in Spain (P=.03), Romania (P<.001), and the United Kingdom (P<.001). Format preferences varied: 382 out of 620 (61.6%) minors and 152 out of 312 (48.7%) pregnant women preferred videos, whereas 452 out of 825 (54.8%) adults favored text (P<.001). Satisfaction rates surpassed 90% in all groups (minors, 604/620, 97.4%; pregnant women, 303/312, 97.1%; and adults, 804/825, 97.5%), with 777 out of 825 (94.2%) adults also indicating that the materials facilitated understanding. While translated materials maintained high efficacy across countries, comprehension scores in Romania were lower among participants with lower educational levels (β=-1.05, P=.001). Materials cocreated in Spain were effective across countries but yielded higher comprehension within the original target population.

CONCLUSIONS: eIC materials developed following the i-CONSENT guidelines achieved high levels of comprehension and satisfaction across diverse populations, demonstrating scalability for multinational trials. Cocreation and multimodal design effectively addressed participant preferences; however, cultural adaptation remained crucial for optimizing outcomes. The negative impact of prior trial participation highlights the need for tailored engagement strategies for returning participants. Future research should explore regional disparities, evaluate interventions for overconfident returning participants, and validate these tools across broader cultural contexts.

PMID:40815855 | DOI:10.2196/65569

Am J Sports Med. 2025 Aug 15:3635465251360794. doi: 10.1177/03635465251360794. Online ahead of print.

ABSTRACT

BACKGROUND: Posttraumatic osteoarthritis (PTOA) often follows anterior cruciate ligament reconstruction (ACLR), especially when combined with meniscal surgery (ACLR+M). The mechanisms underlying development of PTOA remain unclear, including the early mechanical and compositional changes after surgery that potentially lead to irreversible cartilage degeneration.

PURPOSE: To investigate the early effects of ACLR+M on joint arthrokinematics using dual-fluoroscopy with model-based tracking and cartilage composition using quantitative magnetic resonance imaging (qMRI).

STUDY DESIGN: Controlled laboratory study.

METHODS: Twelve participants who underwent ACLR+M were assessed 1 to 2 years after surgery. Dual-fluoroscopy with model-based tracking was used to quantify 6 degrees of freedom joint movements during walking and jogging. Arthrokinematics were assessed at 6% and 3% of the gait cycle for walk and jog, respectively, using magnetic resonance-based cartilage models. qMRI measured T1ρ relaxation times in the weightbearing tibial and femoral cartilage of both medial and lateral compartments.

RESULTS: Reconstructed knees showed increased anterior and lateral tibial translation during walking and jogging, larger abduction rotation during jogging, and a posterior shift of the tibiofemoral contact points on the tibia during walking relative to contralateral knees. The cartilage contact overlap area was increased in the medial compartment during walking in the reconstructed knee compared with the contralateral knee. Higher T1ρ relaxation times were observed in both medial and lateral femoral cartilages of the reconstructed knee compared with the contralateral knee. No correlation was found between reconstructed side-to-normal side differences in arthrokinematics and T1ρ relaxation times.

CONCLUSION: These findings indicate early side-to-side differences in arthrokinematics and cartilage composition 1 to 2 years after ACLR with meniscal surgery, but patients with bigger side-to-side differences in arthrokinematics did not demonstrate bigger side-to-side differences in cartilage composition.

CLINICAL RELEVANCE: Understanding mechanical and compositional differences after surgery, as well as the relationship between mechanics and composition, provides insight into their roles in PTOA initiation. This study underscores how ACLR with meniscal surgery affects tibiofemoral joint arthrokinematics and cartilage composition via qMRI. Results may provide insights into the early stages of PTOA and could inform postoperative strategies and/or targets for rehabilitation.

PMID:40815853 | DOI:10.1177/03635465251360794

Am J Sports Med. 2025 Aug 15:3635465251358487. doi: 10.1177/03635465251358487. Online ahead of print.

ABSTRACT

BACKGROUND: Despite advancements in surgical techniques, the recurrence rate of anterior cruciate ligament (ACL) rupture after reconstruction remains between 2% and 20%. An increased posterior tibial slope (PTS) is associated with higher ACL rupture and reconstruction failure rates.

HYPOTHESIS: Anterior closing wedge high tibial osteotomy (ACW-HTO) combined with ACL reconstruction will result in a lower rate of failure and better functional outcomes for patients with excessive PTS.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: The study was conducted on patients who underwent ACW-HTO combined with ACL reconstruction between 2000 and 2020. Inclusion criteria included knee anterior and lateral rotatory instability, ACL rupture, and PTS (≥12°). Exclusion criteria included follow-up <2 years, normal tibial slope, multiligament knee injuries, significant valgus/varus deformity, and Kellgren-Lawrence stage >2 symptomatic osteoarthritis. Primary outcome measures included the International Knee Documentation Committee (IKDC) score, Tegner activity scale score, Self Knee Value, patient satisfaction, and laxity measurements. Radiographic assessments measured PTS on true lateral views of the entire tibia. The surgical goal was to achieve a PTS between 4° and 10°. A subgroup analysis was performed according to the time from surgery (±10 years) and the postoperative correction of the PTS (4°-10°).

RESULTS: The study included 27 patients (23 men, 4 women), with a mean age of 33.4 ± 8.5 years and a mean follow-up of 7.7 ± 5.2 years. No graft failures were reported. Significant improvement was observed in side-to-side anterior laxity (9.9 ± 3.1 mm preoperatively to 1.4 ± 1.2 mm postoperatively; P < .001). The mean IKDC score improved from 59.3 ± 23.0 to 75.8 ± 24.4 (P = .037), and the Tegner activity scale score improved from 3.6 ± 2.6 to 5.9 ± 2.9 (P = .037). The mean PTS decreased from 15.9° ± 2.8° to 5.5° ± 3.7° postoperatively (P < .0001). Overall, 25.9% of patients required reoperation, mainly for hardware removal. There were no statistical differences in both subgroup analysis concerning patient-reported outcome measures and satisfaction.

CONCLUSION: ACW-HTO combined with ACL reconstruction shows promising long-term outcomes, significantly reducing PTS and improving knee stability and function with an acceptable complication rate.

PMID:40815851 | DOI:10.1177/03635465251358487

Am J Sports Med. 2025 Aug 15:3635465251362504. doi: 10.1177/03635465251362504. Online ahead of print.

ABSTRACT

BACKGROUND: Treating lateral meniscal injuries in elite athletes is challenging because of the high demands on knee function and the need for rapid return to play (RTP). Although meniscal repair is often recommended, data are lacking that compare outcomes of partial meniscectomy and repair in elite athletes with isolated lateral meniscal tears.

PURPOSE: To evaluate subsequent surgery after the treatment of isolated lateral meniscal tears and to compare RTP, career longevity, and performance level between meniscal repair and partial meniscectomy in professional soccer players.

STUDY DESIGN: Retrospective case comparative study; Level of evidence, 3.

METHODS: A retrospective review was conducted on a consecutive series of professional soccer players who underwent partial meniscectomy or meniscal repair for isolated lateral meniscal tears between January 2011 and September 2022 with a minimum follow-up of 2 years. The groups were compared for age, tear configuration, tear location, subsequent surgery, RTP rates, career longevity, and performance level. Repair failure was defined as the need for additional surgery to address a recurrent or persistent meniscal tear after the initial repair or not returning to play. Cox proportional hazards models were used to evaluate career longevity based on treatment modality, adjusting for age.

RESULTS: This study included 89 professional soccer players (mean ± SD age, 23.2 ± 5.2 years) who underwent primary isolated lateral meniscal surgery: 49 (55.1%) had partial meniscectomy and 40 (44.9%) underwent repair. Subsequent surgery was required in 15 players (16.9%), with no significant difference between groups (12.2% for meniscectomy vs 22.5% for repair; P = .258). Meniscal repair failure occurred in 6 players (15%), with a mean time to failure of 8.6 ± 8.2 months. RTP was achieved by 98.9% of the total cohort, but meniscectomy led to faster RTP (median, 4 months; range, 0.5-20) than repair (median, 6 months; range, 3-22; P < .001). No significant difference was found in early retirement risk (hazard ratio, 0.65; 95% CI, 0.31-1.3; P = .237) when adjusted for age. At 5 years, retirement rates were 28% (repair) and 32.6% (meniscectomy; P = .789), rising to 45.5% and 58.3% at 10 years (P = .716). Most players (70% for repair and 89% for meniscectomy) returned to the same or higher league, declining to 48.6% and 51.1% at 2 years and 36% and 20.9% at 5 years (P > .05).

CONCLUSION: Partial meniscectomy and repair achieve high RTP rates, with meniscectomy allowing a faster RTP. While 15% of meniscal repairs failed, rates of subsequent surgery and 5- and 10-year professional sport participation did not differ significantly from those after partial meniscectomy, although the lack of statistical significance may be due to the limited sample size. Hence, partial meniscectomy for isolated lateral meniscal tears may be acceptable in carefully selected patients with proper management and recovery.

PMID:40815849 | DOI:10.1177/03635465251362504

Am J Sports Med. 2025 Aug 15:3635465251362501. doi: 10.1177/03635465251362501. Online ahead of print.

ABSTRACT

BACKGROUND: The revision rate due to postoperative instability after anterior cruciate ligament reconstruction (ACLR) remains at 4% to 25%. The physiological mechanisms of tendon-bone healing involve intricate processes, particularly neovascularization and osseointegration at the bone tunnel interface. Currently, no standardized noninvasive method exists to comprehensively evaluate tendon-bone healing progression.

PURPOSE: To investigate longitudinal changes in bone mineral density (BMD) at tendon-bone interface (TBI) sites after ACLR and evaluate their associations with graft maturation and clinical outcomes.

STUDY DESIGN: Cohort study; Level of evidence, 2.

METHODS: This prospective study enrolled 36 consecutive patients undergoing arthroscopic all-inside single-bundle ACLR using a hamstring autograft between October 2020 and October 2021. Quantitative CT assessments using phantom-less software measured BMD at femoral (anterior, posterior, proximal, and distal) and tibial (anterior, posterior, medial, and lateral) tunnel regions (entry/mid/exit segments) at postoperative day 1 (baseline), 6 months, 1 year, and 2 years. Graft maturity was evaluated via the signal-to-noise quotient (SNQ) on magnetic resonance imaging at 1- and 2-year follow-ups.

RESULTS: Significant increases in volumetric BMD (vBMD) were observed at different segments and orientations in the femoral and tibial tunnel regions. From baseline to 6 months, femoral tunnel segments showed increases ranging from +36.1% to +52.7%, and tibial segments from +44.9% to +57.5% (P < .05). From 6 months to 1 year, additional gains were observed in most regions (femoral: +22.4% to +26.1%; tibial: +15.8% to +19.2%; P < .05). However, changes between 1 and 2 years were generally smaller (femoral: +8.6% to +12.5%; tibial: +6.9% to +19.2%) and not statistically significant in all segments and orientations (P > .05). Graft SNQ values demonstrated regional variations, with femoral tunnel areas showing higher values than tibial regions at both the 1-year and 2-year assessments. No significant changes occurred between 1- and 2-year. Negative correlations emerged between BMD changes and SNQ values in corresponding regions (femoral: r = -0.477 to -0.542; tibial: r = -0.427 to -0.493; P < .05).

CONCLUSION: Within 2 years after ACLR, the BMD at the TBI of both femoral and tibial bone tunnels demonstrates a progressive increase. The BMD at these TBIs shows positive correlations with graft maturity at corresponding anatomic locations, providing a valuable reference for clinical assessment of tendon-bone healing.

PMID:40815846 | DOI:10.1177/03635465251362501

J Am Acad Orthop Surg. 2025 Aug 14. doi: 10.5435/JAAOS-D-25-00597. Online ahead of print.

ABSTRACT

BACKGROUND: Total ankle arthroplasty (TAA) has been increasingly used to treat end-stage of ankle arthritis, leading to a corresponding rise in revision TAA (rTAA). Given the greater complexity of rTAA procedures, assessing whether early postoperative complications differ from primary TAA and whether current reimbursement models appropriately account for this complexity remains essential.

METHODS: Using the National Surgical Quality Improvement Program database from 2013 to 2022 and current procedural terminology codes, patients undergoing TAA or rTAA were identified. Demographics, comorbidities, and 30-day early postoperative complications were compared. Compensation metrics included surgical time, work relative value units (wRVU) per hour (wRVU/hr), and reimbursement rate ($/hr). Statistical analyses included chi square tests, unpaired t-tests, and analysis of covariance adjusting for age and postoperative complication rates.

RESULTS: A total of 2,418 TAA and 276 rTAA cases were identified. No statistically notable differences were noted in 30-day mortality, readmission, or revision surgery rates. Secondary complications were similar between groups, except for cardiac arrest, which was higher in the rTAA cohort (0.36% vs. 0%, P = 0.003), although the absolute incidence was low. rTAA was associated with more concomitant procedures (1.10 vs. 0.79, P = 0.001), longer surgical time (166.78 vs. 151.45 minutes, P = 0.003), and higher mean wRVU (20.98 vs. 17.04, P < 0.001), wRVU/hr (9.63 vs. 7.57, P < 0.001), and reimbursement rate/hr ($311.65/hr vs. $244.78/hr, P < 0.001).

CONCLUSION: No notable differences were found in early postoperative outcomes between TAA and rTAA, indicating comparable early postoperative safety. rTAA procedures received appropriately higher compensation metrics, aligning with their greater surgical demands. These findings support the adequacy of current reimbursement models for rTAA in accounting for the increased complexity and surgical time associated with rTAA compared with primary TAA.

LEVEL OF EVIDENCE: Level III.

PMID:40815842 | DOI:10.5435/JAAOS-D-25-00597