Nevin Manimala

Spine (Phila Pa 1976). 2025 Sep 4. doi: 10.1097/BRS.0000000000005494. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective Cohort.

SUMMARY OF BACKGROUND DATA: Spinal fusions are common interventions for degenerative spine disease (DSD), with increasing utilization in obese and metabolic syndrome populations. Glucagon-like peptide-1 (GLP-1) receptor agonists (RA), widely adopted for diabetes and weight management, may offer systemic benefits that exert a parallel influence on surgical outcomes.

OBJECTIVE: We aimed to evaluate whether preoperative GLP-1 RA use influences 90-day medical and 2- and 10-year surgical complications following thoracic and/or lumbar spinal fusion for DSD, stratified by BMI.

METHODS: Using a national claims database (2010-2023), we identified patients undergoing thoracic and/or lumbar spinal fusion for degenerative conditions. GLP-1 RA users within 6 months pre-op were 4:1 matched to controls by age, sex, and CCI across six BMI strata. Outcomes included 90-day medical and 2- and 10-year surgical complications (e.g., revisions for infection, pseudoarthrosis, and mechanical failure). Chi-square, t-tests, and Cox models were used for statistical analysis.

RESULTS: Among 291,677 patients, 19,232 GLP-1 RA users were matched to 76,778 controls. Ninety-day medical complications-such as infection, pneumonia, thromboembolism, sepsis, stroke, and UTI-were significantly reduced in GLP-1 RA users across BMI categories ≥25. Two-year surgical complications were lower among GLP-1 RA users in BMI 35-39.9 (1.1% vs. 1.6%, P=0.007 for pseudarthrosis-related revision; 0.8% vs. 1.2%, P=0.038 for mechanical failure) and ≥40 groups. At 10 years, GLP-1 RA use was associated with significantly reduced risk of revision in the 25.0-29.9 (HR 0.79, P=0.046) BMI group. Revision due to pseudarthrosis was reduced in BMI 35.0-39.9 (HR 0.69, P=0.014) and ≥40.0 (HR 0.73, P=0.041), while revision for mechanical failure was lower in BMI 35.0-39.9 (HR 0.65, P=0.013) and ≥40.0 (HR 0.57, P=0.003).

CONCLUSION: GLP-1 RA use was linked with reduced perioperative and long-term surgical complications in patients undergoing thoracic and/or lumbar fusions for degenerative spine disease, particularly in those with BMI ≥25. This risk reduction may be attributed to weight loss and/or the systemic metabolic, inflammatory, and vascular benefits of these medications.

PMID:40905270 | DOI:10.1097/BRS.0000000000005494

Epidemiol Psychiatr Sci. 2025 Sep 4;34:e46. doi: 10.1017/S2045796025100218.

ABSTRACT

INTRODUCTION: Suicide rates in the United States have been increasing, necessitating an understanding of demographic variations by ethnicity, age, sex and method to inform effective prevention strategies.

OBJECTIVE: To dissect suicide rates in the US population from 2001 to 2023 by age, sex, ethnicity, and method.

METHODS: This retrospective observational study utilized suicide data and population statistics from the CDC’s WISQARS database for the years 2001 (n = 30,418), 2018 (n = 48,132), 2020 (n = 45,721) and 2023 (n = 49,014). Cases were stratified by age, sex, ethnicity, and suicide method to assess trends and demographic differences.

RESULTS: From 2001 to 2023, the overall US suicide rate rose from 10.7 to 14.6 per 100,000, with a temporary decrease in 2019 and 2020 (14.4 and 13.8, respectively). The primary driver of the increase was firearm-related suicides among White males, contributing 25.8% of the rise from 2001 to 2018 and 51.6% from 2020 to 2023. Decline between 2018 and 2020 was mainly due to reductions in firearm and drug-related suicides among White males, but firearm suicides surged again from 2020 to 2023. Additionally, firearm suicides among ethnic minorities, especially Black/African-American males, accounted for 14.0% of the increase during 2020-2023. Drug-related suicides also increased by 8.6% among White females aged 45 and older in the same period.

CONCLUSIONS: Firearm suicides are the leading factor in the changing suicide rates in the United States from 2001 to 2023, alongside rising drug-related suicides among White females. These trends highlight the necessity for targeted prevention efforts that consider demographic-specific factors and method accessibility.

PMID:40905268 | DOI:10.1017/S2045796025100218

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2025 Aug 20. doi: 10.5507/bp.2025.024. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Vitamin D deficiency is linked to increased cancer risk and death but the effect of vitamin D substitution on the prognosis of patients with malignant disease is debatable. We aimed to investigate the value of serum vitamin D3 levels in patients with a history of malignancy and confirmed lung metastases.

MATERIALS AND METHOD: Serum Vitamin D2 (25-hydroxyergokalciferol) and D3 (25‑hydroxycholekalciferol) levels were measured in 38 patients (28 with and 10 without lung metastases) using high performance liquid chromatography (HPLC). Serum Vitamin D2 + D3 levels of patients with lung metastases were analysed with respect to season, number of metastases, number of malignancies in the history, value according to the ASA (The American Society of Anaesthesiologists) physical status classification, and compared to patients with a history of malignancy without confirmed lung metastasis.

RESULTS: Overall, mean serum vitamin D3 levels were significantly higher in summer (summer vs. winter; 85.06 nmol/L vs. 61.01 nmol/L; P=0.013). There was no significant difference in vitamin D3 levels in summer or winter between patients with or without lung metastases. There was also no significant difference in vitamin D3 levels in the summer months between patients with a history of one malignancy versus those with two or more. In winter however, patients with a history of one malignancy had significantly higher vitamin D3 levels (mean, 75.25 nmol/L) than those with two or more malignancies (mean 44.6 nmol/L) (P=0.027). The differences between vitamin D3 levels in patients with ASA 2 and 3 were not statistically significant.

CONCLUSION: Vitamin D supplementation may be advisable for patients with a history of multiple malignancies, particularly during the winter months. However, confirmation in a clinical trial with a larger patient cohort is warranted before firm recommendations can be made.

PMID:40905227 | DOI:10.5507/bp.2025.024

Emerg Med Australas. 2025 Oct;37(5):e70134. doi: 10.1111/1742-6723.70134.

ABSTRACT

OBJECTIVE: To determine the proportion of patients who are admitted to hospital following a ‘did not wait’ (DNW) encounter that are related to the initial episode of care, and to assess the frequency of clinical deterioration in this cohort.

METHODS: A retrospective observational study conducted at Dubbo Health Service in Western New South Wales, Australia, using patient-level data from 29 May to 1 October 2023. Patients with a DNW episode recorded anywhere within the Western NSW Local Health District who subsequently presented to Dubbo Emergency Department (ED) and were admitted within 28 days were included. Clinical records were reviewed to determine if the admission was related to the original DNW episode and whether clinical deterioration had occurred.

RESULTS: Out of 14,247 ED presentations, 1123 (7.4%) were classified as DNW. 315 patients re-presented to Dubbo ED within 28-days of a DNW episode of care and 32 were admitted to hospital. 26 of these admissions were related to the initial DNW episode, and 5 patients with admissions related to the initial DNW episode showed evidence of clinical deterioration (0.4% of the DNW cohort).

CONCLUSIONS: The majority of DNW episodes did not result in clinical deterioration or related hospital admission. These findings support existing evidence that challenges the assumption of high risk among DNW patients and suggest that health systems should re-evaluate performance metrics and resource investments focused on reducing DNW episodes of care.

PMID:40905223 | DOI:10.1111/1742-6723.70134

Emerg Med Australas. 2025 Oct;37(5):e70132. doi: 10.1111/1742-6723.70132.

ABSTRACT

OBJECTIVE: Investigate the effect of interim care plans (ICP) for direct inpatient general medical and cardiology admissions on Emergency Department (ED) length of stay (LOS), and whether ICP were associated with adverse patient outcomes.

METHODS: This was a single-site retrospective study across 12 months in 2023, where ICP was implemented from 1st January. Adults presenting to ED and admitted under general medicine or cardiology, but not requiring high dependency unit care, were included. Patients admitted under ICP (ICP group) were matched to those admitted without ICP (NO-ICP group) via variable ratio up to 1:4 (ICP:NO-ICP) based on age (±10 years), sex, date of presentation (±7 days) and presentation time (day, evening or night). Patients in the NO-ICP group were excluded if vital signs at the time of triage or referral did not fulfil the ICP criteria. The primary outcome was ED LOS, with secondary outcomes including time to inpatient referral, time to bed booking, hospital LOS, and Medical Emergency Team (MET) calls within 24 h after referral.

RESULTS: ICP facilitated admissions were associated with shorter ED LOS compared with admissions without ICP (ICP 535.16 [342.28-728.03] min (median [interquartile range]); NO-ICP 995.00 [642.49-1347.51] min, p < 0.001). However, there was no difference in total hospital LOS (p = 0.28) or rate of adverse events between ICP and NO-ICP groups (Odds ratio 0.73; 95% confidence interval 0.24-2.21).

CONCLUSION: This single-site study suggests that the ICP model of care for direct inpatient admissions was associated with reduced ED LOS, without increasing adverse outcomes for patients.

PMID:40905220 | DOI:10.1111/1742-6723.70132

Head Neck. 2025 Sep 4. doi: 10.1002/hed.70029. Online ahead of print.

ABSTRACT

BACKGROUND: This multicenter study examines the impact of stratified surgical margins on treatment outcomes in oral SCC.

METHODS: Margins were stratified into 1 mm increments from 0 to ≥ 5 mm. Outcomes included local recurrence, overall and disease-specific survivals. Sub-analyses assessed the impact of margin status by risk factors, oral subsites, and peripheral versus deep margins.

RESULTS: Among 2737 patients, ≥ 2 to < 3 mm margins were associated with improved outcomes compared to 0 mm. Further benefits were observed in the ≥ 4 to < 5 mm group. The differences between these two groups were not statistically significant. Improved outcomes were observed with ≥ 2 mm deep margins, but not for peripheral margins. High-risk tumors had better overall and disease-specific survivals with ≥ 2 mm margins. Subsites of the tongue, palate, mandible, and floor of the mouth had improved local control with ≥ 2 mm margins.

CONCLUSION: Margins beyond 4 mm do not confer additional oncological benefit, while achieving ≥ 2 mm, especially in deep margins or high-risk tumors, is critical for optimal outcomes.

PMID:40905207 | DOI:10.1002/hed.70029

J Clin Ultrasound. 2025 Sep 4. doi: 10.1002/jcu.70061. Online ahead of print.

ABSTRACT

OBJECTIVE: A predictive model of cervical lymph node metastasis and metastasis volume was constructed based on a machine learning algorithm and ultrasound characteristics before surgery.

METHODS: A retrospective analysis was conducted on 573 cases of PTC patients who underwent surgery in our institution, from 2017 to 2022. Patient demographic and clinical characteristics were systematically collected. Feature selection was performed using univariate analysis, Logistic regression (LR) analysis. Statistically significant variables were identified using a threshold of p < 0.05. Predictive models for cervical lymph node metastasis and metastatic volume in papillary thyroid carcinoma were constructed using advanced machine learning algorithms: K-Nearest Neighbors (KNN), Gradient Boosting Machine (XGBoost), and Support Vector Machine (SVM). Model performance was rigorously assessed using validation cohort data, evaluating area under the Receiver Operating Characteristic (ROC) curve, sensitivity, specificity, and accuracy.

RESULTS: In this retrospective study of 573 patients (320 had lymph node metastasis, 127 had small volume lymph node metastasis, and 193 had medium-volume lymph node metastasis). In the model predicting the neck lymph node metastasis, the Gradient Boosting method exhibited the best performance, with an area under the ROC curve of 0.784, sensitivity of 76.2%, specificity of 70.6%, and accuracy of 73.8%. In the model predicting the metastatic volume in neck lymph nodes for PTC, the Gradient Boosting method also demonstrated the best performance, with an area under the ROC curve of 0.779, sensitivity of 71.7%, specificity of 75.9%, and accuracy of 74.4%.

CONCLUSION: Machine learning-based predictive models integrating preoperative ultrasound features demonstrate robust performance in stratifying neck lymph node metastasis risk for PTC patients. These models optimize surgical planning by guiding lymph node dissection extent and individualizing treatment strategies, potentially reducing unnecessary extensive surgeries. The integration of advanced computational techniques with clinical imaging provides a data-driven paradigm for preoperative risk assessment in thyroid oncology.

PMID:40905206 | DOI:10.1002/jcu.70061

Ned Tijdschr Geneeskd. 2025 Aug 21;169:D8612.

ABSTRACT

OBJECTIVE: Gain insight into usage, environmental impact and user experience of different absorbent mats.

DESIGN: Prospective implementation study and life cycle assessments (LCAs).

METHOD: Conducted at the LUMC and UMCG, insight into usage of disposable cellulose pads was obtained through focus groups, interviews and surveys. LCAs analysed the environmental impact of disposable and reusable mats. User experience was evaluated through surveys for patients and healthcare professionals. Finally, functionality and usage trends were evaluated.

RESULTS: Findings reveal that disposable pads are often used for incorrect indications due to convenience and ineffective safety behaviour. The reusable mat has a lower environmental impact than the disposable pad. After implementing the reusable mat, a reduction in usage numbers is acquired and usage is perceived positively.

CONCLUSION: The environmental impact of absorbent mats in healthcare can be reduced by using them more efficiently and replacing them with reusable mats while maintaining a positive user experience.

PMID:40905204

Trop Med Int Health. 2025 Sep 4. doi: 10.1111/tmi.70024. Online ahead of print.

ABSTRACT

BACKGROUND: Ensuring a continuum of care in accessing antenatal to postnatal healthcare services is crucial for improving maternal and child health outcomes. This study aims to explore trends in the continuum of care over the years, both nationally and across regions; to provide district-level estimates; and to examine socio-economic disparities and determinants of continuum of care uptake in Bangladesh.

METHODS: A total of 28,260 samples were analysed. Continuum of care was considered as the outcome variable. District, wealth index, and several socio-demographic factors were included as explanatory variables. Trends of the continuum of care estimates were illustrated over survey years using descriptive statistics. Additional exploration of inequality was conducted across wealth quintiles, educational attainment and urban-rural residence through Equiplot. Finally, a multilevel multinomial logistic regression model was used to assess the factors associated with continuum of care.

RESULTS: The study revealed a significant increase in the highest level of continuum of care, rising from 6.0% in 2004 to 30.5% in 2017/2018, before declining to 24.8% in 2022. However, notable dropouts from the continuum of care were observed, particularly during the transitions from Antenatal Care to Skilled Birth Attendant and from Skilled Birth Attendant to postnatal Care. The analysis also identified district-level variations, urban-rural disparities and differences across wealth quintiles. Maternal socio-demographic characteristics, such as higher education and belonging to a higher wealth quintile, were associated with increased likelihoods of achieving moderate to the highest levels of continuum of care. In contrast, higher parity and rural residence were associated with lower likelihoods of attaining these levels of care.

CONCLUSION: The findings underscore substantial progress in maternal healthcare services uptake in Bangladesh over the years, alongside persistent challenges in ensuring continuous care throughout the maternal healthcare continuum and district-level variations. Addressing district-level disparities and socioeconomic inequalities is crucial, necessitating tailored, area-specific policies and programmes to achieve universal access to quality maternal healthcare services across the country.

PMID:40905197 | DOI:10.1111/tmi.70024

J Med Econ. 2025 Sep 4:1-14. doi: 10.1080/13696998.2025.2555138. Online ahead of print.

ABSTRACT

BACKGROUND: Ulcerative colitis (UC) imposes persistent clinical and economic burden on patient and healthcare management in Japan.

PURPOSE: To evaluate impact of prolonged oral corticosteroid (OC) use on healthcare resource utilization (HCRU) and treatment-related costs, and to assess discontinuation patterns of 5-amino salicylic acid (5-ASA), immunomodulators (IMs), and OCs in Japanese UC patients after biologic initiation.

METHODS: Data were extracted from the Japan Medical Data Centre for patients diagnosed with UC with ≥1 prescription of OC with 5-ASA and/or IM, prior or at the index date (first biologic initiation) between 2016-2022, grouped by </≥180 days of OC use, and analyzed using descriptive statistics, Kaplan-Meier and linear regression.

RESULTS: For all identified patients (N = 1494; mean ± SD age: 38.6 ± 13.7 years; male: 65.3%), HCRU (inpatient and outpatient visits, length of stay, and procedures) per patient-year (PPY) declined after biologics initiation. Direct inpatient medical costs decreased throughout the study; outpatient costs increased from pre-index to the 1-year post-index period, followed by slight decreases in the 2-year and 3-year post-index. PPY costs of non-biologic UC-related drugs (OCs, 5-ASA, IMs) increased slightly during the post-index period. Overall, HCRU and costs dynamics were similar in patients with <180 days and those with ≥180 days OC use. Patients with <180 days OC use had shorter median time to OC discontinuation after biologic initiation compared with ≥180 days group (3.1 months vs 9.5 months).

CONCLUSIONS: Biologic initiation was associated with reduced HCRU and inpatient costs, with similar trends observed regardless of prolonged or shorter OC use duration.

PMID:40905194 | DOI:10.1080/13696998.2025.2555138