Nevin Manimala

World J Surg. 2025 Dec 7. doi: 10.1002/wjs.70195. Online ahead of print.

ABSTRACT

BACKGROUND: Access to guideline-concordant global-standard breast cancer care remains limited in many low- and middle-income countries (LMICs), where high-cost technologies for diagnostics, surgical diagnosis and treatment (such as radioisotope mapping, ICG fluorescence, and intraoperative margin assessment) are not widely available. The BRIDGE Course (Breast Surgery Resource Integration & Development for Global Excellence) was designed as a short, virtual educational program to educate and update surgeons with validated, low-cost techniques that ensure oncologic safety while addressing resource constraints.

METHODS: A 7-h online course was designed and conducted in September 2025 with participation from international and national faculty. Content emphasized pragmatic adaptations of global guidelines, including triple assessment, surgical decision-making for mastectomy versus breast conservation, sentinel lymph node biopsy (SLNB) using methylene blue and fluorescein torch, and low-cost oncoplastic approaches. Pre- and post-course surveys assessed baseline practice, perceived barriers, satisfaction, confidence, and intent to implement. Descriptive statistics were analyzed.

RESULTS: Seventy-five participants completed the pre-course survey and 66 completed the post-course survey. At baseline, mastectomy was the most common primary operation (30.7%), whereas only 20% predominantly performed breast-conserving surgery; SLNB was mainly performed using methylene blue (68.5%). Reported barriers included lack of resources, training gaps, and patient mindset. Post-course, ≥ 85% of participants reported improved confidence across all domains: triple assessment (83% strongly agreed), mastectomy versus BCS decision-making (74%), SLNB with low-cost tracers (66%), and complication management (60%). Implementation intent was high, with nearly all (96%) planning to adopt at least one new technique and all intending to share knowledge with colleagues or trainees.

CONCLUSION: The BRIDGE Course successfully enhanced knowledge and confidence in resource-adapted breast cancer surgery, with strong intent to implement and improve practices. Such short, focused virtual programs may serve as a scalable model for narrowing disparities in breast cancer care across LMICs.

PMID:41353710 | DOI:10.1002/wjs.70195

Psychooncology. 2025 Dec;34(12):e70346. doi: 10.1002/pon.70346.

ABSTRACT

PURPOSE: Marriage is associated with better health-related quality of life (HRQOL) among cancer survivors, but it is unclear whether these benefits generalize across sexual orientation and gender identities (SOGI). We examined whether marriage is associated with better HRQOL among cancer survivors with diverse SOGI.

METHODS: We analyzed Behavioral Risk Factor Surveillance System (BRFSS) data from 2014 to 2023 among U.S. adults aged 18 and older who self-reported a cancer diagnosis and completed the optional SOGI module (N = 220,896). HRQOL was assessed using the CDC HRQOL-4, including self-rated general health, frequent mental or physical distress, and activity limitation (each defined as ≥ 14 days in the past 30 days). Logistic regression models estimated adjusted odds ratios for HRQOL outcomes by marital status (married, unmarried couple, not married) within SOGI subgroups, controlling for sociodemographic and healthcare access factors.

RESULTS: Marriage was consistently associated with better HRQOL among heterosexual men and women. Among SGM survivors, gay men and transfeminine individuals showed the clearest marriage-related benefits, including lower odds of mental distress and activity limitation. No consistent benefit was observed among lesbian or bisexual women, bisexual men, or transmasculine individuals. Unmarried couples did not consistently show similar protective effects in any group, though small cell sizes limit precision.

CONCLUSION: The health benefits of marriage vary across SOGI subgroups, challenging assumptions of a universal marriage advantage in survivorship.

IMPLICATIONS FOR CANCER SURVIVORS: Survivorship care should account for relational and structural differences in support networks, especially among SGM individuals who may not benefit equally from legal marital status.

PMID:41353709 | DOI:10.1002/pon.70346

Skeletal Radiol. 2025 Dec 7. doi: 10.1007/s00256-025-05101-2. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to validate a new MRI-based scoring system for pyogenic spondylodiscitis (PS) using contrast-enhanced MRI at admission. The system was designed to classify disease severity and provide a quantifiable tool for risk stratification and treatment planning.

MATERIALS AND METHODS: We retrospectively analysed 60 patients with clinically and laboratory-confirmed PS at a single tertiary hospital between September 2016 and September 2024. A novel scoring system, the MRI-SSI, evaluated vertebral destruction, signal abnormalities, endplate erosion, and epidural or paravertebral extension. The scores (0-9, 10-19, ≥ 20) categorised disease as mild, moderate, or severe. Two experienced radiologists scored the images, and we recorded hospitalisation duration and the need for surgery. Statistical analysis included independent samples t-tests, ANOVA, and interobserver agreement was assessed using Cohen’s kappa and intraclass correlation coefficients (ICCs).

RESULTS: Of the 60 patients, 17 (28.3%) required surgical intervention. Patients needing surgery had significantly higher MRI-SSI scores than those managed conservatively (18.58 vs. 13.86; p = 0.004). The scoring system had a strong predictive value for surgical requirement (AUC = 0.720), with 58% sensitivity and 88% specificity. Interobserver agreement for the total MRI-SSI score was excellent (ICC = 0.906).

CONCLUSION: The MRI-SSI accurately predicted hospitalisation duration and surgical needs in PS patients. This tool, based solely on admission MRI findings, can refine initial treatment decisions, leading to more targeted resource utilisation and improved overall patient outcomes.

PMID:41353696 | DOI:10.1007/s00256-025-05101-2

Discov Oncol. 2025 Dec 7. doi: 10.1007/s12672-025-04185-5. Online ahead of print.

NO ABSTRACT

PMID:41353687 | DOI:10.1007/s12672-025-04185-5

Psicol Reflex Crit. 2025 Dec 7;38(1):36. doi: 10.1186/s41155-025-00368-9.

ABSTRACT

BACKGROUND: This study validates the Spanish version of the Brief-COPE in the Colombian context. This tool assesses 14 different coping strategies, including positive coping, planning, emotional support, instrumental support, substance use, and religion, among others. The structural validations of this tool in Latin America, Europe, North America, and Asia yielded heterogeneous results, with validations in Latin America often having limitations in their data analysis methodologies and sample size. This study aims to address these limitations and provide methodologically sound evidence on the structural validity, reliability, and convergent and divergent validity of the instrument for adults in Colombia.

METHODS: A total of 762 participants completed the Brief-COPE along with the ERQ, the Wellbeing Index, the HSCL-25, the PCL-C, and the Kessler 6. Categorical Confirmatory Factor Analysis (CFA) was employed to assess the fit of 12 different theory and data-driven models. After identifying the best-fitting model, reliability, divergent, and convergent validity were assessed for the resulting factors.

RESULTS: The best-fitting CFA model for the Brief-COPE had 11 factors: active coping, social support, acceptance, venting, self-distraction, behavioral disengagement, denial, self-blame, humor, religion, and substance use. Substance use, active coping, religion, social support, humor, self-blame, denial, and behavioral disengagement demonstrated good reliability (Omega > = .7), whereas the remaining subscales demonstrated insufficient reliability (Omega > .6 and Omega < .7). Maladaptive coping strategies were found to positively correlate with distress measures, while adaptive strategies exhibited negative correlations, as expected. However, social support and humor presented significant positive associations with PCL-C and HSCL.

CONCLUSIONS: This study provides evidence supporting an 11-factor structure for the Brief-COPE in Colombian adults, with most factors demonstrating satisfactory reliability. Researchers should use caution when interpreting subscales with lower reliability. The results also underscore the influence of cultural context on coping patterns, given the heterogeneous factor structures found in other validations. Future studies should recruit more diverse samples to enhance generalizability and further investigate the predictive validity of this adapted tool.

PMID:41353669 | DOI:10.1186/s41155-025-00368-9

Neuromodulation. 2025 Dec 6:S1094-7159(25)01103-1. doi: 10.1016/j.neurom.2025.09.318. Online ahead of print.

ABSTRACT

OBJECTIVES: Chronic bladder pain syndrome (CBPS) is a debilitating condition with limited treatment efficacy. This meta-analysis evaluates the effectiveness of sacral nerve stimulation (SNS) in the management of pain, urinary symptoms, and quality of life (QoL) in patients with CBPS.

MATERIALS AND METHODS: A systematic review was conducted across EMBASE, PubMed, and the Cochrane Library, adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Studies involving adult patients with bladder pain symptoms treated with SNS and reported pain scores were included. Pain scores were the primary outcome measure of interest. Secondary outcome measures included Interstitial Cystitis Problem Index (ICPI)/Interstitial Cystitis Symptom Index (ICSI), urinary frequency, nocturia, and QoL. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies-of Interventions, and pooled effect estimates were calculated using random-effects meta-analysis models.

RESULTS: A total of 15 studies (N = 494) were included in the meta-analysis. SNS was associated with a statistically significant reduction in pain scores (mean difference: -2.27 on a 0-10 scale, 95% CI: -2.94 to -1.60, p < 0.001), ICSI (-2.18, 95% CI: -2.99 to -1.37, p < 0.001), urinary frequency (-1.71 voids/d, 95% CI: -2.29 to -1.12), and nocturia (-1.49 episodes/night, 95% CI: -2.35 to -0.63). Changes in ICPI and QoL were not statistically significant. Complication rates ranged from 0% to 40.6%, and explantation rates from 0% to 18%.

CONCLUSIONS: This meta-analysis suggests that SNS may offer clinically meaningful pain and urinary symptom relief in patients with CBPS. However, substantial methodological heterogeneity, moderate-to-high risk of bias, and the absence of randomized control trials limit the strength of conclusions. Larger, high-quality trials with standardized diagnostic criteria and outcome measures are essential to establish SNS as a validated treatment option for CBPS.

PMID:41353655 | DOI:10.1016/j.neurom.2025.09.318

Acta Med Port. 2025 Dec 2;38(12):785-794. doi: 10.20344/amp.23398. Epub 2025 Dec 2.

ABSTRACT

INTRODUCTION: Involuntary hospitalization of a patient with a mental disorder is broadly defined as the admission to an inpatient unit without the patient’s consent. Literature suggests that involuntary hospitalizations are associated with low levels of treatment satisfaction, avoidance of mental health care, and an increased risk of emergency involuntary re-hospitalization. Despite being a lifesaving treatment, involuntary admissions can also be stigmatizing, undermine the long-term therapeutic relationship and reduce adherence to care. In this context, little research has been conducted to evaluate how shifting a patient’s hospitalization from involuntary to voluntary affects health outcomes, such as psychiatric decompensation and healthcare use. The main aim of this study was to identify and assess the frequency of readmissions within one year among patients who transitioned to voluntary treatment, compared with those who remained involuntarily treated.

METHODS: An observational retrospective study was conducted using secondary data from medical records of adult inpatients involuntarily admitted to the inpatient psychiatry department of Unidade Local de Saúde São João. All involuntary hospitalizations occurring between January 1st and December 31st, 2022, were classified into two distinct groups: patients who were initially admitted involuntarily and subsequently converted to voluntary hospitalization during their stay or patients who remained under involuntary hospitalization until discharge. Data registered in medical records within one year after the index hospitalization was collected and assessed (whether structured data or free text entries). Descriptive and comparative analyses were performed.

RESULTS: A total of 120 patients were included. More patients converted to voluntary hospitalization (60.8%) than remained involuntarily hospitalized (39.2%). In comparison to voluntary inpatients, involuntary inpatients had significantly higher readmission rates within one year (36.2% vs 15.3%, p = 0.009) and were more often readmitted under involuntary status (88.2% vs 45.5%, p = 0.030).

CONCLUSION: Involuntary hospitalization was associated with worse outcomes within one year, underscoring the need for its use to be proportional to the risk and subject to periodic review. Conversion to voluntary hospitalization is reasonable, respects patient autonomy and, provided that appropriate treatment is maintained, does not worsen psychiatric decompensation.

PMID:41353642 | DOI:10.20344/amp.23398

Prostate. 2025 Dec 7. doi: 10.1002/pros.70106. Online ahead of print.

ABSTRACT

BACKGROUND: Post-prostatectomy urinary incontinence significantly impacts quality of life. Techniques that preserve periprostatic structures have shown promise in promoting earlier continence recovery, particularly with robotic-assisted surgery. The study aimed to evaluate the effect of pubovesical complex (PVC) preservation on urinary continence recovery in patients undergoing laparoscopic radical prostatectomy (LRP).

METHODS: In this randomized, blinded, prospective clinical trial, 72 patients with localized prostate cancer were assigned to standard LRP or LRP with PVC preservation. The primary endpoint was urinary continence recovery, defined as complete absence of leakage or pad use, assessed at 24 h, 15 days, 1, 3, and 6 months post-catheter removal. Secondary endpoints included operative time, blood loss, complications, and oncologic outcomes.

RESULTS: At 6 months, continence was significantly higher in the PVC group (82.4% vs. 57.6%; p = 0.027). Earlier timepoints showed improved, though not statistically significant, continence rates in the PVC group. Operative time (109 vs. 75 min; p < 0.001) and blood loss (365 vs. 247 ml; p = 0.010) were greater with PVC preservation. Complication and margin positivity rates were similar between groups.

CONCLUSION: PVC preservation during LRP significantly improves urinary continence recovery without compromising oncologic safety. This accessible technique can be adopted in centers lacking robotic platforms, offering equitable benefits for patients in resource-limited settings.

TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBEC), RBR-7f25wsz.

PMID:41353629 | DOI:10.1002/pros.70106

Am J Hosp Palliat Care. 2025 Dec 7:10499091251406573. doi: 10.1177/10499091251406573. Online ahead of print.

ABSTRACT

BackgroundAlthough previous research has highlighted the protective effect of social support in caregiving contexts, further investigation is needed to understand its complex roles in modifying and explaining the impact of caregiver stressors. This cross-sectional study assessed family caregivers’ social support, digital literacy, and caregiving-related stressors, examining their relationships and impact on mental health outcomes (anxiety and depressive symptoms). Specifically, we investigated (1) whether digital literacy interacted with stressors to influence caregivers’ perceived social support and (2) whether social support mediates the relationship between caregiver stressors and mental health.MethodsData were collected from 308 caregivers of people living with dementia receiving hospice care using structured assessments, including validated measures of social support, digital literacy, anxiety, depressive symptoms, and key sociodemographic characteristics.ResultsThe direct and total effects of caregiver stressors on mental health outcomes were statistically significant, whereas the indirect effects mediated by social support were not. Although tangible support was individually associated with both outcomes, the overall mediating effect of social support was not accounted for by either emotional/informational or tangible support alone. The moderating effect of digital literacy was also not statistically significant.ConclusionsThe association between caregiver stressors and mental health appears to be more directly driven than mediated by social support. The absence of significant indirect or moderating effects highlights the complexity of these relationships and underscores the need for future research to explore additional pathways, contextual influences, and conditions under which aspects of social support or digital literacy may exert greater impact.

PMID:41353626 | DOI:10.1177/10499091251406573

Infect Dis (Lond). 2025 Dec 7:1-11. doi: 10.1080/23744235.2025.2598808. Online ahead of print.

ABSTRACT

OBJECTIVES: Evaluation of pancreatic stone protein (PSP) plasma levels has been proven effective in predicting unfavourable outcomes in patients with Ventilator-Associated Pneumonia (VAP), infection after cardiothoracic surgery and peritonitis. It is also being studied as a sepsis biomarker with promising results compared to other commonly used biomarkers. We aim to validate PSP in septic patients with community acquired infections. This will help to establish its role in point-of-care settings.

METHODS: Adult patients consecutively admitted to the Emergency Department (ED) of a tertiary medical centre, with the diagnosis of intra-abdominal infection (IAI), urinary tract infection (UTI) and lower respiratory tract infection (LRTI) who met the inclusion criteria were enrolled. PSP was measured in whole blood, within one hour since admission, by spectrophotometry using abioSCOPE device. Statistical analysis was performed, and a cut-off value for PSP to predict the composite outcome of sepsis, readmission, antibiotic treatment escalation and need for invasive treatment was estimated. Patients were followed for 28 days to document their outcomes.

RESULTS: A total of one hundred and one (n = 101) patients were included. Forty-five were male. The most common comorbidity was hypertension (33%). Fifty-three (52.5%) had LRTI, thirty-seven (36.6%) had UTI and nineteen (18.8%) had IAI. Thirteen of them had more than one type of infection. Our primary outcome met statistical significance, as PSP predicted the composite outcome of sepsis, readmission, antibiotic treatment escalation and need of invasive treatment with an Area Under Curve (AUC) =0.844 (95% CI 0.767-0.920), in the optimal cut-off of 48.5 ng/ml. PSP predicted sepsis with an AUC = 0.892 (95% CI 0.826-0.956) and was also an independent risk factor for sepsis and mortality after age adjustment. PSP was superior to the common used sepsis biomarkers, C-reactive protein (CRP), ferritin, lactate dehydrogonase (LDH)/albumin ratio, White Blood Cell count (WBC), fibrinogen and lactate both for sepsis and for the composite outcome. It was also correlated with Sequential Organ Failure Assessment (SOFA) day 1 (D1), SOFA peak and qSOFA and its prognostic value was independent of renal function, despite being inversely proportional to estimated Glomerular Filtration Rate (eGFR), reflecting the sepsis-related acute kidney injury (SAKI).

CONCLUSIONS: PSP is a valuable biomarker that can rule out patients who do not have sepsis and are not in high risk to develop sepsis the following days, giving valuable insights regarding their antimicrobial coverage and management in general. It seems to be superior to other biomarkers in sepsis prediction and adequately compatible with frequently used sepsis assessment scores, such as SOFA. In the Emergency Department setting PSP can distinguish infected patients at high risk for sepsis who have low qSOFA scores.

PMID:41353590 | DOI:10.1080/23744235.2025.2598808