Nevin Manimala

J Craniofac Surg. 2025 May 14. doi: 10.1097/SCS.0000000000011490. Online ahead of print.

ABSTRACT

Occipital neuralgia (ON) is a debilitating craniofacial pain disorder often refractory to conservative treatments. Nerve decompression surgery has emerged as a promising intervention, yet the long-term efficacy and optimal patient selection remain unclear. This systematic review and meta-analysis evaluate the effectiveness of occipital nerve decompression in reducing pain frequency, intensity, and duration in patients with ON. A systematic search of PubMed, Embase, and Scopus was conducted following PRISMA guidelines. Studies evaluating greater occipital nerve (GON) or lesser occipital nerve (LON) decompression for ON were included. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the Joanna Briggs Institute (JBI) checklist for case series and observational studies. A random-effects meta-analysis estimated pooled effects on pain reduction, and heterogeneity was analyzed using I² statistics. Twelve studies comprising 838 patients were included. Meta-analysis demonstrated a significant reduction in pain frequency by 20.30 days/month (95% CI: 16.53-24.08, P<0.0001) following nerve decompression. Subgroup analysis revealed superior outcomes for post-traumatic ON, while chronic migraine-related ON showed more variability. Technique modifications, such as midline versus separate incisions for LON decompression, influenced reoperation rates (4.4% versus 15.2%, P<0.05). Heterogeneity was high (I²=97.21%), likely due to surgical variability and patient selection differences. Nerve decompression significantly reduces ON-related pain, though patient selection and surgical technique optimization remain crucial. Standardized protocols and prospective trials are needed to refine clinical guidelines.

PMID:40367499 | DOI:10.1097/SCS.0000000000011490

Am J Gastroenterol. 2025 May 14. doi: 10.14309/ajg.0000000000003531. Online ahead of print.

ABSTRACT

OBJECTIVES: Forceps-assisted cannulation has been reported to facilitate difficult papillary cannulation during ERCP, especially in the context of abnormal papillary anatomy or associated papillary diverticula. We performed a randomized, controlled trial to evaluate if forceps-assisted cannulation improves cannulation success rates, reduces the incidence of difficult cannulations, and decreases the risk of post-ERCP pancreatitis.

METHODS: 152 patients with difficult papillary cannulation during ERCP were randomized to cannulation with or without forceps. Difficult cannulation was defined as: papilla in/on the rim of a diverticulum, difficult cannulation (defined as 5 or more attempts, 5 or more minutes, or 2 or more unintended PD wire passages), redundant tissue overlaying the papilla, or a type 2, 3, or 4 papilla. The primary clinical outcome was rate of successful cannulation.

RESULTS: 70 patients underwent forceps-assisted cannulation and 81 did not use forceps. Forceps patients were younger (62 vs. 68 years p=0.009), but otherwise baseline demographics, ERCP indication, trainee involvement and papilla classification were similar with failed initial cannulation the most common reason for enrollment. 100% of patients in the forceps-assisted group vs. 83.9% in the no forceps group (p<0.001) underwent successful cannulation. All patients in the no forceps group who crossed over to the forceps group had successful cannulation. While not statistically significant, the difficult cannulation rate (57.1 vs. 69.1, p=0.132) was higher in the no forceps group and the PEP rate was low in both groups (5.7 vs 3.7, p=0.705).

CONCLUSIONS: Using forceps-assisted technique to overcome difficult cannulation improves ERCP cannulation success rates.

PMID:40367484 | DOI:10.14309/ajg.0000000000003531

Wiad Lek. 2025;78(4):885-893. doi: 10.36740/WLek/203072.

ABSTRACT

OBJECTIVE: Aim: To detect the effect of an experimental 0.7% nanosilver in sodium fluoride (NSSF) and compare it to that of 5% sodium fluoride (NaF) on demineralized teeth, also observes the impact of applying 10% Casein phosphopeptide-amorphous-calcium phosphate (CPP-ACP) on those groups and compares that to CPP-ACP’s lone impact on demineralized teeth.

PATIENTS AND METHODS: Materials and Methods: The sample consisted of 60 sound, premolar teeth without hypo-mineralization or cracks. They were divided into three groups following the formation of caries-like lesions using a Feather Stone pH cycle. Group No.1 was treated with NSSF, group No.2 was treated with NaF, and deionized water was used for Group No.3. All groups had two minutes of application time and were then stored for 24 hours in artificial saliva. After that, they were treated with CPP-ACP, for seven days twice a day. Microhardness measurements were carried out four times: before any intervention, after the pH cycle, after 24 hours from the application of NSSF and NaF, and a final one after seven days from the application of CPP-ACP on the previous groups. An XRF, XRD analysis, and particle size analyzer were used to confirm the nanosilver properties of the powder.

RESULTS: Results: There was a statistically significant increase in microhardness values (P<0.05) following CPP-ACP’s application on teeth previously subjected to NSSF and NaF. The group that was subjected to deionized water before CPP-ACP’s application revealed a statistically significant value (P<0.001).

CONCLUSION: Conclusions: CPP-ACP enhances the microhardness and, hence, the mineralization of teeth previously treated with NSSF and NaF solutions.

PMID:40367474 | DOI:10.36740/WLek/203072

Wiad Lek. 2025;78(4):860-875. doi: 10.36740/WLek/203897.

ABSTRACT

OBJECTIVE: Aim: To investigate how lifestyle factors of patients with CHD and comorbid conditions, along with medicines properties, influence treatment adherence.

PATIENTS AND METHODS: Materials and Methods: include the results of a survey conducted among patients with CHD and comorbid conditions at the Department of Cardiology of the P.L. Shupyk National Healthcare University of Ukraine from June to September 2024 (n = 101). The study employed methods of analysis, synthesis, deduction, induction, comparison, statistical and bibliographic research.

RESULTS: Results: The study revealed a significantly low adherence rate of 13.9% [CI 95% 13.9 ± 0.002; p<0.0001] to risk factor modification and prescribed pharmacotherapy in secondary prevention of CHD. It confirmed a statistically significant influence of patient preferences with CHD and comorbid conditions on effective pharmacotherapy (χ2 = 3.350,232, p = 0.067). Patients receiving consultations from both doctors and pharmacists were 22 times more likely (OR = 22.67) to adhere to pharmacotherapy compared to those consulting only doctors. The study found that only 7.8% [CI 95% 7.8 ± 0.05; p<0.0001] of surveyed patients with CHD and comorbid conditions such as hypertension, diabetes mellitus and chronic kidney disease utilized the “Affordable Medicines” program.

CONCLUSION: Conclusions: The decline in the socioeconomic status of the population during the war in Ukraine negatively affects adherence to clinical guidelines for risk factor modification and secondary prevention of CHD, as evidenced by observational studies EUROASPIRE IV and V. The study identified that 42.8% of respondents prefer original medicines when selecting medications, but financial constraints prevent prolonged use as part of prescribed pharmacotherapy, adversely affecting treatment adherence. The effectiveness of a multidisciplinary approach in enhancing treatment adherence among patients with CHD and comorbid conditions was confirmed, demonstrating a 22-fold higher adherence rate compared to consultations with doctors alone.

PMID:40367472 | DOI:10.36740/WLek/203897

Wiad Lek. 2025;78(4):777-782. doi: 10.36740/WLek/203883.

ABSTRACT

OBJECTIVE: Aim: To analyze and compare the results of clinical usage of two protocols of bone drilling during the surgical stage of dental implantation.

PATIENTS AND METHODS: Materials and Methods: The clinical study group was formed from 30 patients. All selected patients underwent dental implantation in the lateral segments of the jaws using a delayed two-stage technique, using the standard drilling protocol (1000 rpm) and slow (50 rpm). The study included measuring implants’ torque during the installation, bone density, and marginal bone resorption after 1,5 years.

RESULTS: Results: The slow bone tissue preparation protocol showed the higher torque level during the installation, and did not cause significant changes in the structure of the bone tissue and level of sauserisation compared to the standard protocol for preparation.

CONCLUSION: Conclusions: The usage of two different protocols showed a significant difference at the moment of installation. However, it did not reveal any statistically significant differences between the two sgroups of patients during the long-term follow-up.

PMID:40367461 | DOI:10.36740/WLek/203883

J Med Microbiol. 2025 May;74(5). doi: 10.1099/jmm.0.002010.

ABSTRACT

Introduction. Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and negatively affects the health of mothers and infants. The aim of this study was to explore the associations between gut microbiota and the risk of GDM amongst overweight/obese women, and the interaction between gut microbiota dysbiosis and overweight/obesity in pregnant women with GDM.Hypothesis/Gap statement. Previous studies revealed that there may be a link between gut microbiota and GDM and obesity, but these studies have not reported the associations between gut microbiota and the risk of GDM amongst overweight/obese women, whilst the interaction between gut microbiota dysbiosis and overweight/obesity in pregnant women with GDM remains unknown.Aim. Based on a prospective cohort study, we explored the composition of gut microbiota in overweight/obese pregnant women and its association with GDM.Methodology.Participants (n=1820) were enrolled from the Pregnancy Metabolic Disease and Adverse Pregnancy Outcome cohort in Guangzhou, China, between 2019 and 2021. The participants’ information and faecal samples were collected, and the relative abundance of faecal microbiota was profiled using 16S rRNA V4 region sequencing. Pregnant women were divided into four groups: non- overweight (NOW)/obese without GDM (OB- NGDM), overweight (OW)/OB- NGDM, NOW/obese with GDM (OB- GDM) and OW/OB- GDM. Linear discriminant analysis effect size (LEfSe) analysis, Spearman’s correlation analysis and t- test were performed to estimate the association amongst microbiota, pre- pregnancy BMI and oral glucose tolerance test (OGTT) glucose levels.Results. Blautia, Anaerostipes, Synergistes (P<0.001) and Christensenellaceae_R_7_group (P=0.007) were significantly different between NOW/OB-GDM and OW/OB-GDM groups after adjusting for age. Odoribacter, Anaerostipes, Monoglobus, Romboutsia, Oscillospiraceae__UCG-003, Blautia and Dialisterwere significantly correlated with both OGTT 1 h (P<0.001) and 2 h (P<0.05) blood glucose levels, whilst Lactobacillus(P<0.001) were significantly correlated with OGTT 2 h blood glucose levels. Synergistes(P<0.001) were significantly correlated with OGTT fasting glucose levels, and Megasphaera and Odoribacter(P<0.05) were significantly correlated with pre-pregnancy BMI.Conclusions. GDM and OB/OW women was experiencing microbiota dysbiosis, especially the microbial communities related to glucose metabolism.

PMID:40366751 | DOI:10.1099/jmm.0.002010

Ophthalmic Genet. 2025 May 14:1-5. doi: 10.1080/13816810.2025.2503394. Online ahead of print.

ABSTRACT

INTRODUCTION: This original study presents an investigation of ophthalmological manifestations in Mucopolysaccharidosis IVA, a rare genetic disorder with limited characterization, particularly of ocular findings.

PURPOSE: To describe the ophthalmological manifestations in patients with Morquio disease in Medellín, Colombia.

STUDY DESIGN AND METHODOLOGY: A cross-sectional study was conducted with 23 patients diagnosed with Morquio syndrome. They underwent a comprehensive ophthalmological evaluation, and clinical findings were recorded in an online Excel sheet. Descriptive statistical methods were then applied, with data reported as absolute frequencies and percentages.

RESULTS: Refractive defects were found in 100% of patients, primarily hyperopia. Cataracts were the next most common finding (71%), particularly of the starry nuclear type. Corneal stromal opacity was observed in 60%, with 55% in children. In this group, 40% had moderate severity and 20% had total opacity. In adults, stromal opacity was present in 60%, with 66% showing moderate severity.

CONCLUSION: Most Morquio disease patients in Antioquia exhibit refractive defects, with hyperopia being the most common. Among physical examination findings, stromal corneal opacity and starry nuclear cataracts were the most prevalent.

PMID:40366728 | DOI:10.1080/13816810.2025.2503394

Laterality. 2025 May 14:1-20. doi: 10.1080/1357650X.2025.2497570. Online ahead of print.

ABSTRACT

Familial sinistrality (left-handedness) has been suggested as a proxy for functional language lateralization in the healthy adult brain. Previous studies show that individuals with familial sinistrality tend to have less lateralized language-related brain activation, while individuals without familial sinistrality show greater left-hemispheric lateralization for language. However, familial sinistrality trait has always been treated as a binary categorical variable. In this study a more sensitive quantitative estimate of familial sinistrality (LH load) has been modelled in 39 participants with different direction and degree of handedness by applying a standard genetic multifactorial model. This LH load was tested for an association with functional language lateralization based on an fMRI sentence completion task. Using frequentist and Bayesian statistical frameworks, the association between LH load and language lateralization was not confirmed. The findings of the present research suggest that a quantitative measure of familial sinistrality is not related to individual language representation in the brain measured by a sentence completion fMRI paradigm. However, considering the context of our study and previous research we suggest that familial sinistrality being related to personal handedness could drive functional language lateralization through it.

PMID:40366717 | DOI:10.1080/1357650X.2025.2497570

JAMA Psychiatry. 2025 May 14. doi: 10.1001/jamapsychiatry.2025.0702. Online ahead of print.

ABSTRACT

IMPORTANCE: Among hospitalized older adults, prolonged use of antipsychotic medications (APMs) following hospital discharge may increase the risk of APM-associated adverse events. There are limited data on whether early discontinuation of APMs is associated with reduced adverse clinical outcomes compared with APM continuation after discharge.

OBJECTIVE: To compare clinical outcomes between discontinuation vs continuation of APMs initiated to manage hospitalization-related delirium.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study examining nationwide US Medicare claims data from July 1, 2013, through December 31, 2018, and data from a large deidentified US commercial health care database (Optum CDM) from July 1, 2004, through May 31, 2024, included adults aged 65 years and older without psychiatric disorders or previous use of APMs who filled an APM prescription within 30 days of hospital discharge. Using incidence density sampling, APM discontinuers (gap ≥45 days) were matched with continuers based on the type of APM prescribed, the time since their first APM prescription, and whether they had been admitted to intensive care units prior to the first APM prescription. Data analysis was performed from July 12, 2024, to December 25, 2024.

EXPOSURE: Discontinuation vs continuation of APMs.

MAIN OUTCOMES AND MEASURES: Propensity score matching was applied to adjust for 162 covariates. Study outcomes included rehospitalization, specific rehospitalization reasons, and all-cause mortality. Hazard ratios (HRs) were estimated using the Cox proportional hazards model; estimates from the 2 databases were further pooled using the fixed-effects meta-analysis model.

RESULTS: A total of 13 712 propensity score-matched pairs were included, for an overall sample of 27 424 adults (discontinuers: mean [SD] age, 81.86 [7.26] years; 7400 [54.0%] female; continuers: mean [SD] age, 81.86 [7.27] years; 7360 [53.7%] female). During the median (IQR) follow-up of 180 (87-180) days, APM discontinuation vs continuation was associated with significantly lower risks of rehospitalization (HR, 0.89 [95% CI, 0.85-0.94]), inpatient delirium (HR, 0.87 [95% CI, 0.79-0.96]), fall-related emergency department visits or hospitalizations (HR, 0.77 [95% CI, 0.67-0.90]), hospitalization with urinary tract infection (HR, 0.79 [95% CI, 0.66-0.94]), and all-cause mortality (HR, 0.77 [95% CI, 0.69-0.86]). There was no statistical difference in the risks of pneumonia (HR, 0.88 [95% CI, 0.73-1.06]) or stroke (HR, 1.22 [95% CI, 0.97-1.53]) between discontinuers and continuers. Subgroups by dementia status, type and dose of APM prescribed, and duration of APM exposure showed consistent results.

CONCLUSIONS AND RELEVANCE: Based on 2 nationwide US cohorts including older adults without psychiatric disorders, APM discontinuation was associated with reduced risks of all-cause rehospitalization and mortality, suggesting the importance of minimizing the duration of APM use after acute hospitalization.

PMID:40366701 | DOI:10.1001/jamapsychiatry.2025.0702

JAMA Surg. 2025 May 14. doi: 10.1001/jamasurg.2025.1129. Online ahead of print.

ABSTRACT

IMPORTANCE: Approximately 2 million individuals are incarcerated in the US. Surgical needs increase with age, and an aging prison population means an increasing need for surgical care for incarcerated individuals. Challenges in logistics, privacy, communication, and comorbidities put people in law enforcement custody at risk for suboptimal care and outcomes. Little guidance exists for surgeons seeking to provide equitable care for these patients.

OBSERVATIONS: No national statistics are available on the need for surgery among incarcerated people. Autopsy data suggest that nearly a quarter of deaths among incarcerated individuals were attributable to causes that could have been treated with surgery, yet few received surgical care before death. Across the spectrum of custody, including police detention, jail, prison, probation, and parole, access to consistent preoperative and postoperative care are major challenges, as is sustaining appropriate levels of privacy and communication. Incarcerated people are often accompanied by guards, preventing privacy. Patients are shackled to hospital beds, restricting mobility. For incarcerated individuals, access to postoperative medication may be curtailed when they return to jail or prison. To be effective advocates for patient-centered care and to achieve the best outcomes, surgeons must remain vigilant to specific barriers to care.

CONCLUSIONS AND RELEVANCE: Individuals in law enforcement custody have particular needs regarding communication, surgical planning, and perioperative and postoperative care. Clinicians must remain alert to these challenges and serve as advocates for these marginalized patients, even adjusting their care practices. Professional societies and health systems can bolster care for this marginalized population by developing and disseminating guidelines and pathways for patient-centered surgical care for individuals in law enforcement custody.

PMID:40366700 | DOI:10.1001/jamasurg.2025.1129