Nevin Manimala

BMC Musculoskelet Disord. 2025 Jan 2;26(1):3. doi: 10.1186/s12891-024-08257-5.

ABSTRACT

BACKGROUND: Congenital Pseudarthrosis of the Tibia (CPT) is a rare pediatric condition presenting substantial challenges for orthopedic surgeons. Aiming to achieve bone union, with subsequent complications such as refractures being common. The aim of the present study is to evaluate the results of our intentional cross-union protocol and to compare these outcomes with those obtained from our previously used techniques.

MATERIALS AND METHODS: Sixteen patients, with a mean age of 4.8 years (range: 1-13.3 years), who were treated with the intentional cross-union protocol were included in Group (A) Eleven patients, with a mean age of 3.5 years (range: 1.3-7.6 years), who primarily underwent intramedullary rodding with bone graft, were included in Group (B) The intentional cross-union protocol involved cross-union of the tibia and fibula, autogenous iliac bone grafting, and the insertion of bone morphogenetic protein 2 (BMP-2) aimed at achieving tibia-fibula cross-union. Retrospective evaluation of serial radiographs was conducted, and the outcomes regarding union and any subsequent complications were analyzed.

RESULTS: A total of 27 patients with CPT were included in the study. All 16 patients (100%) in Group A successfully achieved primary union. Among the 11 patients in Group B, only 4 cases achieved primary union, with a primary healing rate of 36.4%. Seven cases with delayed healing required 2-4 revision surgeries for final healing. The time to union was significantly shorter in Group A (3.37 ± 0.64 months) compared to Group B (8.67 ± 3.0 months). The cross-sectional area of union was also significantly larger in Group A (6.71 ± 0.58 cm²) compared to Group B (1.18 ± 0.19 cm²). In Group A, there were no cases of refracture, whereas in Group B, 7 cases (77.8%) experienced refracture, indicating a statistically significant difference.

CONCLUSIONS: Our study demonstrates that the Cross-union protocol is highly effective for achieving union and preventing refracture in CPT. With such significant improvement, it has notably altered the prognosis of this challenging condition.

LEVEL OF EVIDENCE: IV.

PMID:39743526 | DOI:10.1186/s12891-024-08257-5

East Asian Arch Psychiatry. 2024 Dec;34(4):122-127. doi: 10.12809/eaap2445.

ABSTRACT

BACKGROUND: Endophenotypes aid in studying the complex genetic basis of bipolar disorder. We aimed to compare first-degree relatives of patients with bipolar I disorder in a hospital in India with unrelated healthy controls in terms of neurocognition and affective temperament METHODS. This cross-sectional study was conducted between August and November 2012 at a tertiary hospital in India. First-degree relatives (parents, siblings, and children) of patients with bipolar I disorder were included; they were aged 18 to 50 years and had education level of at least eighth grade. Additionally, matched healthy controls were recruited from the general population. Sociodemographic data were collected using a semi-structured proforma. Participants were assessed for verbal and visual working memory, executive function (including cognitive flexibility, response inhibition, as well as concept formation, abstract reasoning, and set-shifting abilities), and affective temperament by a single investigator.

RESULTS: Of the 52 first-degree relatives of patients diagnosed with bipolar I disorder, 30 were included in the analysis. Additionally, 30 matched healthy controls from the general population were included for comparison. Compared with healthy controls, first-degree relatives performed significantly poorer in all tests and had significantly higher scores for cyclothymic, hyperthymic, and anxious temperaments.

CONCLUSION: Impairments in working memory, executive function, and certain affective temperaments are potential endophenotypes for bipolar I disorder. Working memory and executive function are most important cognitive domains for social, occupational, and interpersonal functioning. These potential markers could be used to trace susceptible genes for bipolar disorder and thus enhance our understanding of the complex genetics of mood disorders.

PMID:39743486 | DOI:10.12809/eaap2445

East Asian Arch Psychiatry. 2024 Dec;34(4):115-121. doi: 10.12809/eaap2440.

ABSTRACT

BACKGROUND: Pakistani television dramas often depict scenes involving suicide that may affect the psychological wellbeing of viewers. We aimed to examine the effects of suicide depiction in Pakistani television dramas on their viewers.

METHODS: In April 2023, we searched the YouTube website for Urdu-language television dramas released between 2011 and 2022 that contained scenes of suicidal behaviours (both attempts and completed suicides) using the keywords ‘suicide in Pakistani dramas’. Data extracted included details of the characters involved including age group, sex, role, occupation, religion, and marital status, as well as details of the suicidal behaviours including method, reason/trigger, and place of suicide.

RESULTS: In total, 49 incidents of suicidal behaviours from 46 characters in 40 Urdu-language television dramas were included in the analysis. Of the 40 dramas, 42.5% were released in 2021 and 2022, and 57.5% were released between 2011 and 2020. Among the 46 characters with suicidal behaviour, 50.0% were male, 54.3% were young adults, 52.2% were married, 26.1% were housewives, 100% were Muslim, and 34.8% were in a leading role. Of the 49 incidents of suicidal behaviour, 29 were suicide, 19 were suicide attempts, and one was homicide-suicide. Common methods of suicidal behaviour depicted were gun shooting (30.6%), wrist cutting (18.3%), self-poisoning (12.2%), and jumping from height (12.2%). Common reasons for suicidal behaviour were failure in love (24.4%), familial issues (24.4%), and others (26.5%); 69.4% of suicidal behaviour occurred in home.

CONCLUSION: Television dramas with scenes involving suicidal behaviours may negatively affect the general population, particularly adolescents. These scenes should be censored to prevent imitation or identification among vulnerable young people. Television dramas should provide psychoeducational messages to promote help-seeking rather than suicide for emotional problems.

PMID:39743485 | DOI:10.12809/eaap2440

Subst Use Misuse. 2024 Dec 31:1-11. doi: 10.1080/10826084.2024.2440365. Online ahead of print.

ABSTRACT

BACKGROUND: People who inject drugs (PWID) are especially vulnerable to harms from opioid use disorder (OUD). Medications for OUD (MOUD) effectively reduce overdose and infectious disease transmission risks.

OBJECTIVE: We investigate whether state Medicaid coverage for methadone and buprenorphine is related to past-year MOUD use among PWID using cross-sectional, multilevel analyses with individual-level data on PWID from the Centers for Disease Control and Prevention’s 2018 National HIV Behavioral Surveillance. The sample included 8,142 PWID aged 18-64 who reported daily opioid use from 22 U.S. metropolitan areas. Our outcome was any self-reported MOUD use in the past 12 months. Exposures were state Medicaid coverage and prior authorization requirements for methadone and buprenorphine. We interacted these exposures with PWID race/ethnicity, insurance status, and spatial access to treatment and harm reduction resources.

RESULTS: Compared with PWID in states without Medicaid methadone coverage, odds of past-year MOUD use were 73% (p<0.05) higher among PWID in states with methadone coverage requiring prior authorization and 80% (p<0.05) higher among PWID in states with coverage without prior authorization. Insured PWID were twice as likely to report MOUD use than uninsured PWID, with no statistically significant differences between Medicaid versus other insurance. Medicaid prior authorization requirements for buprenorphine were not significantly associated with MOUD use. Non-Hispanic Black PWID were significantly less likely to use MOUD than non-Hispanic White and Hispanic PWID.

CONCLUSIONS: State Medicaid methadone coverage was strongly associated with higher odds that PWID utilized MOUD, suggesting that expanding methadone insurance coverage could improve MOUD treatment in a vulnerable population.

PMID:39741378 | DOI:10.1080/10826084.2024.2440365

Implement Sci Commun. 2024 Dec 31;5(1):144. doi: 10.1186/s43058-024-00682-w.

ABSTRACT

BACKGROUND: Doulas, non-clinical professionals who provide support throughout the perinatal period, can positively impact patient experiences and clinical outcomes during birth. Doulas often support hospital-based births without being employed by the hospital system, resulting in varied relationships with hospitals and clinicians. Systems-level changes are needed to maximize collaboration between hospitals and doulas to ensure facilitation of, and not barriers to, doula support. We implemented and evaluated a new program, called the “Supportive Birth Collaborative,” to maximize effectiveness of doula support in hospital settings.

METHODS: We conducted a single-site feasibility study of the use of implementation mapping to make systemic changes to clinician-doula collaboration for labor and delivery. Implementation mapping consisted of five steps: developing a collaborative of program implementers and knowledge holders, conducting a needs assessment, developing a logic model, applying implementation strategies, and evaluating changes in outcomes. To evaluate change, process data were collected throughout, and implementation outcomes were measured in 2022 and again after one year of implementation via online surveys to all clinicians who provided labor and delivery care. Descriptive statistics were calculated and change over time was analyzed in Stata using log-binomial regression models with clustering to account for respondents who completed both surveys.

RESULTS: The “Supportive Birth Collaborative” (SBC) was founded in November 2021. The first meeting included 19 people, who were obstetricians, anesthesiologists, nurses, doulas, students, social workers, administrators, researchers, and individuals who had given birth at the study hospital. From 2022-2023, the SBC adopted 11 implementation strategies and piloted or fully implemented 10 of them. Implementation strategies ranged from making training dynamic, to changes in the physical environment, to changes in formal policy. In 2022, 104 clinicians participated in the survey; 97 participated in 2023. There was significant improvement in clinician-reported trust in doulas (0.23, 95% CI: 0.12, 0.34) and doula-clinician communication (0.25, 95% CI: 0.12, 0.38). Clinicians had a limited understanding of the doula’s role, and that understanding did not significantly improve.

CONCLUSIONS: Using implementation mapping as a guide to collaborative work can lead to meaningful health system changes. Regular review of implementation outcomes could allow for adaptation and tailoring of implementation strategies.

PMID:39741364 | DOI:10.1186/s43058-024-00682-w

J Orthop Surg Res. 2024 Dec 31;19(1):895. doi: 10.1186/s13018-024-05420-5.

ABSTRACT

OBJECTIVE: Ankle osteoarthritis is a debilitating condition that significantly impairs patients’ quality of life. Platelet-rich plasma has emerged as a novel cellular therapy in clinical practice. This study evaluates the clinical efficacy of platelet-rich plasma (PRP) after intervention in ankle disorders, so as to provide strong evidence in support of clinical treatment.

METHODS: A comprehensive and systematic search of PubMed, the Cochrane Library, Embase and web of science databases was performed, and studies that met the requirements according to the inclusion criteria were analyzed using Review Manager and STATA version 14.0. Quality assessment was performed using the Cochrane Collaboration Risk of Bias 2.0 tool. The outcome indicators were the American Orthopaedic Foot and Ankle Society Rating Scale (AOFAS) and Visual Analog Scale (VAS) scores used to evaluate the efficacy of platelet-rich plasma.

RESULTS: A total of 10 studies met the inclusion criteria. Regarding the AOFAS score, a meta-analysis that included five randomized controlled trials (each study extracted the score results at the last follow-up time) showed no statistically significant differences between the platelet-rich plasma intervention group and the control group, and there was a great deal of heterogeneity in the results, with subgroup analyses based on disease type. (Mean Difference = 4.14, 95% CI=-0.60-8.87, p = 0.09, I² = 86%). Subgroup analysis showed a more significant effect in patients with talar cartilage injuries (Mean Difference = 8.66, 95%CI = 6.61-10.71, p < 0.00001, I² = 0%). And the treatment effect of PRP remained effective in long-term follow-up (Mean Difference = 7.83, 95% CI = 5.57-10.09, p = 0.46, I² = 0%). For VAS scores, PRP relieved patients’ pain (Standardized Mean Difference=-0.62, 95%CI=-1.13-0.10, p = 0.02, I² = 77%) but showed a greater advantage in patients with cartilage injuries of the talus (Standardized Mean Difference=-1.24, 95%CI=-1.68-0.81, p < 0.00001, I² = 0%). Subgroup analyses according to different disease types and different follow-up times showed that PRP had significant efficacy in talar cartilage injuries in both the short and long term. A meta-analysis of single-arm studies showed that PRP was helpful in improving patients’ pain before and after the intervention (Standardized Mean Difference = -1.76, 95% CI = -2.85 to -0.67, p = 0.002, I^2 = 87%).However, the high level of heterogeneity may be due to the large differences between the inclusion criteria of the single-arm studies.

CONCLUSION: More clinical studies are needed to further confirm the efficacy of platelet-rich plasma in ankle disorders, and the current study only suggests that platelet-rich plasma may be more effective in talus cartilage injuries than in other types of ankle disorders.

PMID:39741342 | DOI:10.1186/s13018-024-05420-5

J Intensive Care. 2024 Dec 31;12(1):55. doi: 10.1186/s40560-024-00772-w.

ABSTRACT

BACKGROUND: Fluid balance gap (FBgap-prescribed vs. achieved) is associated with hospital mortality. Downtime is an important quality indicator for the delivery of continuous renal replacement therapy (CRRT). We examined the association of CRRT downtime with FBgap and clinical outcomes including mortality.

METHODS: This is a retrospective cohort study of critically ill adults receiving CRRT utilizing both electronic health records (EHR) and CRRT machine data. FBgap was calculated as achieved minus prescribed fluid balance. Downtime, or percent treatment time loss (%TTL), was defined as CRRT downtime in relation to the total CRRT time. Data collection stopped upon transition to intermittent hemodialysis when applicable. Linear and logistic regression models were used to analyze the association of %TTL with FBgap and hospital mortality, respectively. Covariates included demographics, Sequential Organ Failure Assessment (SOFA) score at CRRT initiation, use of organ support devices, and the interaction between %TTL and machine alarms.

RESULTS: We included 3630 CRRT patient-days from 500 patients with a median age of 59.5 years (IQR 50-67). Patients had a median SOFA score at CRRT initiation of 13 (IQR 10-16). Median %TTL was 8.1% (IQR 4.3-12.5) and median FBgap was 17.4 mL/kg/day (IQR 8.2-30.4). In adjusted models, there was a significant positive relationship between FBgap and %TTL only in the subgroup with higher alarm frequency (6 + alarms per CRRT-day) (β = 0.87 per 1% increase, 95%CI 0.48-1.26). No association was found in the subgroups with lower alarm frequency (0-2 and 3-5 alarms). There was no statistical evidence for an association between %TTL and hospital mortality in the adjusted model with the interaction term of alarm frequency.

CONCLUSIONS: In critically ill adult patients undergoing CRRT, %TTL was associated with FBgap only in the subgroup with higher alarm frequency, but not in the other subgroups with lower alarms. No association between %TTL and mortality was observed. More frequent alarms, possibly indicating unexpected downtime, may suggest compromised CRRT delivery and could negatively impact FBgap.

PMID:39741337 | DOI:10.1186/s40560-024-00772-w

Eur J Med Res. 2024 Dec 31;29(1):639. doi: 10.1186/s40001-024-02242-3.

ABSTRACT

BACKGROUND: There are limited and controversial findings concerning ovulation induction using intrauterine and intramuscular human chorionic gonadotropin (hCG) injection compared to intramuscular hCG alone. The study aimed to examine the impact of intrauterine hCG injection, which is used to induce ovulation, on the efficacy of the intrauterine insemination (IUI) technique in patients with unexplained infertility.

METHODS: A randomized controlled clinical trial was conducted involving 80 subjects with unexplained primary infertility at the infertility clinic of Al-Zahra Hospital in northwest Iran. Patients were randomly allocated into two groups: control and intervention. Both groups received initial treatment with letrozole and Recombinant follicle-stimulating hormone (r-FSH). After confirmation of at least one follicle measuring 18 mm or larger through ultrasonography, in the control group, two ampoules of 5000 units of hCG were administered intramuscularly. The intervention group received 500 units of hCG diluted in 0.5 cc of normal saline and was injected into the uterine cavity along with the two intramuscular ampoules. Primary outcomes were clinical and chemical pregnancy rates and the secondary outcome was any adverse pregnancy outcomes. Multiple logistic regression analysis was used to estimate crude and adjusted odds ratios (AORs) of the pregnancy rates with 95% confidence intervals (CIs).

RESULTS: No significant differences were found between the two groups regarding baseline characteristics (p > 0.05). Chemical and clinical pregnancy rates in the control and intervention groups were (32.5 vs. 40%) (32.5% vs. 35%), respectively. In the final analysis after adjusting the potential confounders, intrauterine and intramuscular hCG injection increased the likelihood of chemical pregnancy by 1.39 times AOR = 1.42 (1.31-4.12; p = 0.036), and clinical pregnancy by AOR = 1.25 (1.03-3.74; p = 0.048) compared to intramuscular hCG alone. There were no statistical differences regarding adverse pregnancy outcomes between the study groups (p value > 0.05).

CONCLUSIONS: It seems that ovulation induction through intrauterine and intramuscular hCG injection increased the odds of both chemical and clinical pregnancy rates compared with intramuscular hCG alone. Multicenter clinical trials and meta-analysis studies are needed for decision making in clinical settings.

PMID:39741322 | DOI:10.1186/s40001-024-02242-3

J Orthop Surg Res. 2024 Dec 31;19(1):898. doi: 10.1186/s13018-024-05367-7.

ABSTRACT

OBJECTIVE: This study aims to explore the predictive value of endplate morphology and pedicle screw bone quality score on screw loosening after single-level lumbar spinal fusion surgery.

METHODS: A retrospective analysis was conducted on the clinical data of 207 patients who underwent single-level lumbar spinal fusion (34 in the screw loosening group and 173 in the non-screw loosening group). Univariate analysis and binary logistic regression model analysis were performed using SPSS 27.0. MedCalc 23 was used to plot the receiver operating characteristic (ROC) curve to evaluate diagnostic efficacy.

RESULTS: Through comparative analysis of clinical data, we found statistically significant differences between the two groups in terms of endplate morphology, lumbar CT values, and PBQ scores(P<0.05). The results of the binary logistic regression analysis indicated that endplate morphology (OR = 17.088, 95% CI: 3.886-75.142; p < 0.001) and PBQ score (OR = 3.347, 95% CI: 1.473-7.603; p = 0.004) are independent risk factors for screw loosening after single-level lumbar spinal fusion surgery. The ROC analysis showed that the area under the curve (AUC) for endplate morphology was 0.731 (95% confidence interval [CI]: 0.665-0.790), with the optimal threshold representing irregular endplate morphology (sensitivity: 94.1%, specificity: 52.0%). The AUC for the PBQ score was 0.791 (95% CI: 0.729-0.844), with an optimal threshold of 3.198 (sensitivity: 91.2%, specificity: 61.8%). Furthermore, the predictive model constructed using both endplate morphology and PBQ score had an AUC of 0.870 (95% confidence interval: 0.817-0.913), with a maximum Youden index of 0.668, yielding a diagnostic sensitivity of 88.2% and specificity of 78.6%.

CONCLUSION: Endplate morphology and pedicle screw bone quality score have significant reference value for diagnosing screw loosening after single-level lumbar spinal fusion surgery.

PMID:39741319 | DOI:10.1186/s13018-024-05367-7

BMC Oral Health. 2024 Dec 31;24(1):1574. doi: 10.1186/s12903-024-05377-1.

ABSTRACT

OBJECTIVE: Based on the critical role of implant length and placement timing in treatment success, this study aimed to compare clinical outcomes (implant failure, marginal bone loss, biological and mechanical complications) between short implants (4-8 mm) versus long implants (≥ 8 mm) with sinus floor elevation, and between delayed versus immediate placement of long implants in the posterior maxilla.

METHODS: This network meta-analysis was prospectively registered in the PROSPERO database (CRD42023495027). Adhering to PRISMA-NMA guidelines, we systematically reviewed eligible studies from January 2014 to November 2024 was conducted across major databases, such as the Cochrane Library, PubMed, Embase, Scopus and Web of Science. The main focus of this NMA was to determine the rate of implant failure, as well as to assess marginal bone loss and the occurrence of biological and mechanical complications related to the implants.

RESULTS: Data from 17 studies, involving 1,076 patients and 1,751 implants, was collected and examined. Long implants have lower failure rates (OR = 1.26; 95% CI = 0.53, 3.00) and short dental implants showed a trend towards lower biological (OR = 0.47; 95% CI = 0.19, 1.18) and mechanical (OR = 0.94; 95% CI = 0.45, 1.94) complications rates, although this trend was not statistically significant. Additionally, compared to longer implants, short implants resulted in a significant reduction in marginal bone loss, regardless of whether long implants were immediately (MD=-0.17; 95%CI: -0.29, -0.05) or delayed (MD = 0.35; 95%CI: 0.05, 0.64) placed following sinus floor elevation. The analysis of cumulative ranking probabilities revealed that delayed placement of long implants with SFE demonstrated the highest efficacy in reducing implant failure (73.9%). SIs were found to excel in reducing marginal bone loss (88.7%) and biological complications (88.2%%), while short implants with SFE proved to be the most effective in preventing mechanical complications (66.0%%).

CONCLUSION: Short implants achieved comparable clinical outcomes to long implants with sinus floor elevation in posterior maxilla with limited vertical bone height. Given the limitations of the network meta-analysis and included studies, treatment selection should be individualized based on specific patient conditions.

PMID:39741292 | DOI:10.1186/s12903-024-05377-1