Nevin Manimala

Endocr Connect. 2024 Dec 1:EC-24-0437. doi: 10.1530/EC-24-0437. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Isolated hypogonadotropic hypogonadism (IHH) may be associated with pituitary gland and olfactory system disorders. We aimed to correlate findings of Magnetic Resonance Imaging (MRI) of the pituitary gland and olfactory system in IHH patients with the patients’ olfactory phenotype.

PATIENTS AND METHODS: The present research was a single-center retrospective case-control study. MRI patterns of pituitary gland and olfactory system were studied in 46 patients, of whom 29 (63%) were classified on the basis of olfactometry as having Kallmann syndrome (KS) (16 patients with anosmia; 13 patients with hyposmia) and 17 (37%) as having normosmic IHH (nIHH). Results were compared with age- and sex-matched healthy controls. Genetic diagnosis was conducted in all IHH patients based on next-generation sequencing (NGS).

RESULTS: Almost 70% prevalence of pituitary hypoplasia was observed in IHH subjects. Olfactory Bulb (OB) abnormalities were identified in 80.4% of all patients, both the KS (82.8%) and the nIHH (76.5%) subjects. Incidence of unilaterally abnormal, hypoplastic Olfactory Sulcus (OS) was equally frequent in nIHH and KS. Statistically, piriform cortical thickness was significantly lower in all patient groups than in controls.

CONCLUSIONS: MRI cannot exclusively differentiate between KS and nIHH, as both conditions may present with OB and OS abnormalities. A surprisingly high frequency of olfactory system abnormalities was observed in nIHH patients, while anterior pituitary hypoplasia was prevalent across all IHH patients. Notably, OB abnormalities were more predominant in KS patients than in those with nIHH.

PMID:39719010 | DOI:10.1530/EC-24-0437

J Am Acad Orthop Surg Glob Res Rev. 2024 Dec 23;8(12). doi: 10.5435/JAAOSGlobal-D-24-00324. eCollection 2024 Dec 1.

ABSTRACT

BACKGROUND: Computer-assisted fluoroscopic navigation and robotic technologies aim to optimize implant placement and alignment in primary total hip arthroplasty (THA) to improve patient outcomes. This study uses a retrospective hospital billing database covering 1,300 hospitals to compare the clinical and economic effect of these technologies.

METHODS: The study compared patients undergoing THA with robotic versus computer-assisted fluoroscopic navigation technologies between January 1, 2016, and September 30, 2021, using the Premier Healthcare Database. Primary outcomes were operating room time and readmission rates. Secondary outcomes were length of stay, discharge status, revision rates within 90- and 365-day follow-up, and hospital costs. Baseline covariate differences between the two cohorts were balanced using fine stratification methodology and analyzed using generalized linear models. A sensitivity analysis was conducted using the nearest neighbor matching as the covariate balancing technique.

RESULTS: The cohorts included 4,378 fluoroscopically navigated THA and 10,423 robotic-assisted THA procedures with 90-day follow-up. Operating room time was markedly lower with fluoroscopic navigation compared with robotic-assisted technology (137.74 vs. 156.00 minutes; P < 0.001). Hip-related readmission rates were markedly lower (P < 0.001) for fluoroscopic navigation for both 90- and 365-day follow-up, by 43% and 40% respectively, compared with robotic-assisted technology. Results showed increased discharge ratio to home/home health, reduced length of stay, and lower hospital costs for fluoroscopic navigation compared with robotic-assisted technology. Revision rates were similar for both cohorts.

CONCLUSION: Using computer-assisted fluoroscopic navigation in THA was associated with markedly lower operating room time and readmission rates while also having improved healthcare outcomes and costs compared with robotic-assisted technology.

PMID:39719008 | DOI:10.5435/JAAOSGlobal-D-24-00324

JMIR Public Health Surveill. 2024 Dec 24;10:e51786. doi: 10.2196/51786.

ABSTRACT

BACKGROUND: Convenience, privacy, and cost-effectiveness associated with web-based data collection have facilitated the recent expansion of web-based survey research. Importantly, however, practical benefits of web-based survey research, to scientists and participants alike, are being overshadowed by the dramatic rise in suspicious and fraudulent survey submissions. Misinformation associated with survey fraud compromises data quality and data integrity with important implications for scientific conclusions, clinical practice, and social benefit. Transparency in reporting on methods used to prevent and manage suspicious and fraudulent submissions is key to protecting the veracity of web-based survey data; yet, there is limited discussion on the use of antideception strategies during all phases of survey research to detect and eliminate low-quality and fraudulent responses.

OBJECTIVE: This study aims to contribute to an evolving evidence base on data integrity threats associated with web-based survey research by describing study design strategies and antideception tools used during the web-based administration of the Garnering Effective Outreach and Research in Georgia for Impact Alliance-Community Engagement Alliance (GEORGIA CEAL) Against COVID-19 Disparities project surveys.

METHODS: GEORGIA CEAL was established in response to the COVID-19 pandemic and the need for rapid, yet, valid, community-informed, and community-owned research to guide targeted responses to a dynamic, public health crisis. GEORGIA CEAL Surveys I (April 2021 to June 2021) and II (November 2021 to January 2022) received institutional review board approval from the Morehouse School of Medicine and adhered to the CHERRIES (Checklist for Reporting Results of Internet E-Surveys).

RESULTS: A total of 4934 and 4905 submissions were received for Surveys I and II, respectively. A small proportion of surveys (Survey I: n=1336, 27.1% and Survey II: n=1024, 20.9%) were excluded due to participant ineligibility, while larger proportions (Survey I: n=1516, 42.1%; Survey II: n=1423, 36.7%) were flagged and removed due to suspicious activity; 2082 (42.2%) and 2458 (50.1%) of GEORGIA CEAL Surveys I and II, respectively, were retained for analysis.

CONCLUSIONS: Suspicious activity during GEORGIA CEAL Survey I administration prompted the inclusion of additional security tools during Survey II design and administration (eg, hidden questions, Completely Automated Public Turing Test to Tell Computers and Humans Apart verification, and security questions), which proved useful in managing and detecting fraud and resulted in a higher retention rate across survey waves. By thorough discussion of experiences, lessons learned, and future directions for web-based survey research, this study outlines challenges and best practices for designing and implementing a robust defense against survey fraud. Finally, we argue that, in addition to greater transparency and discussion, community stakeholders need to be intentionally and mindfully engaged, via approaches grounded in community-based participatory research, around the potential for research to enable scientific discoveries in order to accelerate investment in quality, legitimate survey data.

PMID:39718988 | DOI:10.2196/51786

Int J Epidemiol. 2024 Dec 16;54(1):dyae165. doi: 10.1093/ije/dyae165.

ABSTRACT

BACKGROUND: Mammographic breast density has been suggested to play a role as a mediator between the risk factors for breast cancer (BC) and BC risk. We investigated the extent to which never breastfeeding is a risk factor for BC and how this risk is further mediated by increased mammographic breast density.

METHODS: This retrospective cohort study included 4 136 723 women aged ≥40 years who underwent mammographic screening between 2009 and 2010 and were followed up until 31 December 2020. Breastfeeding information was obtained by using a self-administered questionnaire. Mammographic breast density was extracted from national BC screening results, which were assessed by trained radiologists and categorized into dense and fatty breasts. We estimated the hazard ratios (HRs) and the proportion of the associations between breastfeeding and BC risk mediated by breast density.

RESULTS: The HR of never breastfeeding on BC risk was 1.34 (95% CI, 1.32-1.37) when adjusted for only parity, body mass index and smoking status, which were selected as covariates through a directed acyclic graph and 1.21 (95% CI, 1.19-1.23) when breast density was additionally adjusted. The proportion of the association between never breastfeeding and BC risk mediated by breast density in total, pre- and post-menopausal women was 35.48%, 17.86% and 24.0%, respectively (all P < 0.001). The HR of never breastfeeding on BC risk was 1.10 (95% CI, 1.08-1.12) when adjusted for nine known breast cancer risk factors and 1.09 (95% CI, 1.07-1.12) when breast density was additionally adjusted. The proportion of the association between never breastfeeding and BC risk mediated by breast density in the total, pre- and post-menopausal women was 7.50%, 3.71% and 12.21%, respectively (all P < 0.001).

CONCLUSIONS: Our findings suggest that the association between never breastfeeding and BC risk may be mediated by breast density. However, the HR and proportion of medications varied according to the adjusted covariates, highlighting that variables for adjustment should be selected based on directed acyclic graphs.

PMID:39718984 | DOI:10.1093/ije/dyae165

Br J Surg. 2024 Dec 24;112(1):znae306. doi: 10.1093/bjs/znae306.

ABSTRACT

BACKGROUND: Oncoplastic breast-conserving surgery may be a better option than mastectomy, but high-quality comparative evidence is lacking. The aim of the ANTHEM study (ISRCTN18238549) was to explore clinical and patient-reported outcomes in a multicentre cohort of women offered oncoplastic breast-conserving surgery as an alternative to mastectomy with or without immediate breast reconstruction.

METHODS: Women with invasive/pre-invasive breast cancer who were offered oncoplastic breast-conserving surgery with volume replacement or displacement techniques to avoid mastectomy were recruited prospectively. Demographic, operative, oncological, and 3- and 12-month complication data were collected. The proportion of women choosing oncoplastic breast-conserving surgery and the proportion in whom breast conservation was successful were calculated. Participants completed the validated BREAST-Q questionnaire at baseline, 3 months after surgery, and 12 months after surgery. Questionnaires were scored according to the developers’ instructions and scores for each group were compared over time.

RESULTS: In total, 362 women from 32 UK breast units participated, of whom 294 (81.2%) chose oncoplastic breast-conserving surgery. Of the oncoplastic breast-conserving surgery patients in whom postoperative margin status was reported, 210 of 255 (82.4%) had clear margins after initial surgery and only 10 (3.9%) required completion mastectomy. Major complications were significantly more likely after immediate breast reconstruction. Women having oncoplastic breast-conserving surgery with volume displacement techniques reported significant improvements in baseline ‘satisfaction with breasts’ and ‘psychosocial well-being’ scores at 3 and 12 months, but both oncoplastic breast-conserving surgery groups reported significant decreases in ‘physical well-being: chest’ at 3 and 12 months.

CONCLUSION: Oncoplastic breast-conserving surgery allows greater than 95% of women to avoid mastectomy, with lower major complication rates than immediate breast reconstruction, and may improve satisfaction with outcome. Oncoplastic breast-conserving surgery should be offered as an alternative to mastectomy in all women in whom it is technically feasible.

PMID:39718969 | DOI:10.1093/bjs/znae306

J Minim Access Surg. 2024 Dec 24. doi: 10.4103/jmas.jmas_62_24. Online ahead of print.

ABSTRACT

INTRODUCTION: In laparoscopic inguinal hernia repair (LIHR), fixation means for meshes (FMMs) are commonly used to reduce hernia recurrence risk. Their use may result in post-operative pain (PP) and may even increase surgical time (ST). Recently, self-gripping meshes (SGMs) have been developed, which leave aside fixation devices; they could potentially reduce PP and even decrease ST. Our primary outcome was to compare ST, PP and recurrence rates in LIHR using SGM versus FMM.

PATIENTS AND METHODS: A comparative retrospective study with prospective case registry was conducted. All patients who underwent LIHR with transabdominal pre-peritoneal approach from January to December 2022 in a high-volume centre were analysed. Patients were divided into two groups according to the type of mesh used in surgery (SGM vs. FMM). Demographic variables, hernia type and size, mesh type and size, ST, PP, recurrence and other morbidities were compared between the groups.

RESULTS: A total of 411 LIHRs were performed during the period, of which 283 were included in the study. Of these, 234 patients were repaired with FMM and 49 with SGM. ST had a statistically significant reduction in the SGM group (P = 0.0004) with a mean time of 58.9 min (±13.6), compared to 68.1 min (±18.9) for the FMM group. A trend towards lower PP in the SGM group was noted (P = 0.08). No recurrences were found in the SGM group with a median follow-up of 18 months (interquartile range: 3).

CONCLUSIONS: SGMs have proven to be a safe, efficient and fast for LIHR in our series. They are a feasible alternative for LIHR, reducing ST and potentially reducing PP. Prospective randomised trials are needed to confirm this trend, along with a longer follow-up period to determine potential advantages in terms of recurrences.

PMID:39718940 | DOI:10.4103/jmas.jmas_62_24

JMIR Serious Games. 2024 Dec 24;12:e58452. doi: 10.2196/58452.

ABSTRACT

BACKGROUND: For years, Mexico has reported the highest global incidence of school bullying, with approximately 19% of students going through some form of hostile peer interactions. Despite numerous interventions, these harmful conducts remain deeply entrenched in educational environments.

OBJECTIVE: To address this issue, we developed Bernstein, a serious game that promotes assertiveness-an essential protective factor that reduces the negative effects of bullying.

METHODS: Bernstein was designed using multiple composite scenarios, a methodology grounded in cognitive behavioral therapy. To evaluate the game’s effectiveness, we conducted an exploratory trial using the Rathus Assertiveness Schedule to assess assertiveness levels before and after the intervention. Participants were high school students who met the inclusion criteria of being open to playing a serious game (with no prior gaming experience required) and having access to a computer with internet connectivity for remote participation. A total of 100 students (65 boys and 35 girls) enrolled in the intervention; however, only 46 participants in the treatment group and 46 in the control group completed the study, resulting in a dropout rate of 8% (8/100). A paired 1-tailed t test was used to compare pre- and postintervention scores within each group, and a one-way ANOVA was conducted to compare the average score improvements between the 2 groups.

RESULTS: The treatment group showed a pretest mean Rathus Assertiveness Schedule score of -2.78 (SD 25.93) and a posttest mean of 1.69 (SD 29.48), with a paired 1-tailed t test yielding a P value of .01. The control group had a pretest mean of 2.07 (SD 25.69) and a posttest mean of -2.39 (SD 32.98), with a paired 1-tailed t test yielding a P value of .04. The one-way ANOVA (between groups) yielded a P value of .006, indicating a statistically significant difference, favoring Bernstein over the alternative protocol. Participant feedback highlighted the game’s engaging narrative and character design, although usability issues, such as navigation challenges, were noted as areas for improvement.

CONCLUSIONS: The results suggest that Bernstein is a promising tool for promoting assertiveness in high school students, providing a potential strategy for addressing bullying-related issues. The study underscores the value of integrating Bernstein into educational programs, offering students a safe and interactive environment to develop resilience. As an exploratory trial, this study faced limitations affecting the generalizability of findings, including the remote format’s impact on facilitator guidance and a relatively small sample size. Further trials with larger, more diverse groups are recommended to validate these early results and enhance Bernstein’s scalability as part of a comprehensive antibullying strategy.

PMID:39718822 | DOI:10.2196/58452

Intern Med J. 2024 Dec 24. doi: 10.1111/imj.16558. Online ahead of print.

ABSTRACT

BACKGROUND: The frequency of EoE has been increasing in Northern Hemisphere cohorts, yet there is a scarcity of data in our region. Regional climatic factors, and lifestyle habits may influence the presentation of EoE, and appropriate management is crucial to prevent complications. WIth this is mind we undertook the first comprehensive multisite study of EoE in Australasian children.

AIM: To determine the incidence, prevalence, clinical characteristics and management of eosinophilic esophagitis (EoE) in Australasian children.

METHODS: Retrospective audit of endoscopic records, histology reports and case notes (ICD code) over a 10-year period (1 January 2008 to 31 December 2018). Cases were defined as having >15 eosinophils per high-power field (HPF) at endoscopy and oesophageal biopsy, while treatment response was defined as <5 eosinophils per HPF. Included were patients aged 0-18 years presenting to tertiary paediatric hospitals in seven capital cities (Adelaide, Auckland, Brisbane, Christchurch, Melbourne, Perth and Sydney), while those with conditions that could cause eosinophilia (organ transplantation, hyper-eosinophilic syndrome) or taking medications that may influence tissue eosinophilia (systemic corticosteroids immunosuppressants) were excluded. Australian Bureau of Statistics and Stats NZ were used to define comparative population data. Demographics (age at diagnosis, gender, country of birth, race) comorbidities (atopic conditions, e.g. asthma, seasonal rhinitis, eczema) and treatment (diet, steroids, proton pump inhibitors) were noted.

RESULTS: The prevalence of EoE ranged from 15 to 54 per 100 000 children, where cases were more common in Adelaide than other localities. Incidence increased significantly in all sites across the 10 years, with peak incidence in Adelaide of 6.4 per 100 000 children in 2017. EoE was most frequent in males (male:female ratio = 3:1) and >90% were white Caucasian. Polynesian racial background in Auckland (10%) and middle eastern racial background in Sydney (10%) were the next most frequent. Treatment choice varied across sites, and greater than 30% of patients did not undergo endoscopy to assess initial treatment success.

CONCLUSION: The prevalence of EoE in Australasian children is comparable to that observed elsewhere, and the incidence is increasing significantly. Regional differences in disease frequency, management practices and access to endoscopy warrant further study.

PMID:39718817 | DOI:10.1111/imj.16558

Intern Med J. 2024 Dec 24. doi: 10.1111/imj.16616. Online ahead of print.

ABSTRACT

BACKGROUND: Iron deficiency anaemia (IDA) related to occult gastrointestinal tract (GIT) blood loss is associated with high rates of GIT malignancies. Major society guidelines recommend bidirectional endoscopic evaluation for all men and post-menopausal women with newly diagnosed, unexplained IDA. However, in patients prescribed direct oral anticoagulants (DOACs), the endoscopic yield, specifically the rate of high-risk findings, including colorectal cancers (CRCs) and advanced adenomas (AAs), is unknown.

AIM: Our aim is to determine the endoscopic yield, specifically the prevalence of these high-risk findings in patients presenting with new-onset unexplained IDA while on a DOAC.

METHODS: This is a single-centre, retrospective analysis performed at a tertiary hospital in Australia. Between January 2015 and July 2019, 178 consecutive patients underwent endoscopic evaluation for IDA while prescribed a DOAC. Patient demographics, laboratory data, medications and endoscopic findings were summarised and compared by diagnostic yield. Associations were explored using logistic regression analysis.

RESULTS: CRCs were present in 2/178 (1.1% (95% confidence interval (CI): 0.1-4.0)) patients. AAs were found in 35/178 (19.6% (95% CI: 14.1-26.3)) patients. The most common AAs were tubular adenomas (45.7%), tubulovillous (31.4%) and sessile serrated adenomas (14.2%). Older age (P = 0.013) and lower ferritin levels (P = 0.009) were associated with the presence of high-risk findings.

CONCLUSION: In patients presenting with new-onset, unexplained IDA while on a DOAC, the prevalence of CRCs is lower than previously reported in studies involving populations not prescribed DOACs. Conversely, there is a higher incidence of AAs, including high-risk histological features, such as tubulovillous adenomas and sessile serrated polyps.

PMID:39718804 | DOI:10.1111/imj.16616

Rheumatology (Oxford). 2024 Dec 24:keae696. doi: 10.1093/rheumatology/keae696. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the short and long term effects of an online, interactive, multifactorial lifestyle intervention program (Leef! Met Reuma) on health risk and all ICHOM-recommended patient reported outcome measures(PROMs) in patients with an Inflammatory Arthritis(IA), OsteoArthritis(OA) or FibroMyalgia(FM).

METHODS: Patients with an IA, OA or FM, could register for the lifestyle intervention program. The program consists of a 3-month intensive part followed by a 21-month aftercare period and focuses on 4 pillars, namely nutrition, exercise, relaxation and sleep. Health risk and PROMs are collected 3-monthly during the first 6 months and 6-monthly during the next 18 months. Health risk includes self-reported weight, waist circumference and BMI. Following PROMs were included: pain, morning stiffness severity, fatigue, Health Assessment Questionnaire, quality of life, perceived stress, sleep disturbance and impact on life. Descriptive statistics were used to assess the change in health risk and PROMs during the intensive part of the program and aftercare period.

RESULTS: Of the 264 patients studied, 88, 105 and 71 were diagnosed with IA, OA and FM, respectively. Health risk significantly improved in all three diagnosis groups during the intensive part of the program. The mean BMI reduction was -1.36 (0.26), -1.22 (0.23) and -1.48 (0.33), whereafter it stabilized in the aftercare period. All PROMs showed a similar trend.

CONCLUSION: An online, interactive lifestyle intervention program has a positive long-term effect, even after 2-years of follow-up, on health risk and all PRO domains in patients with an inflammatory arthritis, osteoarthritis and fibromyalgia.

PMID:39718783 | DOI:10.1093/rheumatology/keae696