Nevin Manimala

J Pediatr Orthop. 2025 Oct 6. doi: 10.1097/BPO.0000000000003123. Online ahead of print.

ABSTRACT

BACKGROUND: Our aim is to investigate the association between soft tissue infection in the popliteal fossa and hamstring muscles to determine the risk of DVT formation in children with infections in the knee and posterior thigh.

METHODS: This prospective cohort study (the Peterborough Paediatric Musculoskeletal Infection Study) has gathered data for 181 children aged 0 to 15 years with infection of their limbs or spine. Those with MRI evidence for infection of the popliteal fossa of the knee were identified, as well as those with thrombosis in the venous system.

RESULTS: Popliteal fossa infection was present in 15 children (8% of the 181 in the entire study). Most were associated with septic arthritis of the knee (80%), but some were due to pyomyositis of the hamstrings or calf (20%). Venous thrombosis was noted in 1.1% of the entire 181 study group, but 13% of those with popliteal fossa infection, a 12-fold difference (Fisher exact test statistic 0.0064, P<0.01). One of those with a DVT died from pulmonary embolism a few hours after their MRI scan had been performed.

CONCLUSION: Thirteen percent of children with popliteal fossa infection had an associated DVT, so it may be an independent risk factor for thrombosis. To minimize the risk of DVT and its serious complications, we recommend that children presenting to the Emergency Department with pain in the knee, thigh or calf and raised inflammatory markers (CRP/ESR) suspicious for musculoskeletal infection should have their popliteal fossa examined, and if tender, an urgent Doppler ultrasound should be organised. On MRI, attention should be paid to the popliteal fossa on axial STIR images, and if oedema is present around the popliteal vessels, then prophylactic dose anticoagulation should be started, while those with a dilated popliteal vein on MRI should receive treatment dose anticoagulation.

LEVEL OF EVIDENCE: Level II. A lesser quality prospective study with patients enrolled at different points in their disease.

PMID:41051763 | DOI:10.1097/BPO.0000000000003123

Int J Clin Pharm. 2025 Oct 6. doi: 10.1007/s11096-025-02017-8. Online ahead of print.

ABSTRACT

INTRODUCTION: Bariatric surgery may induce changes in the effects of oral medication, which may result in medication related problems. Therefore, tailored pharmacotherapy is necessary for individual patients following surgery. In case pharmacotherapy is not adjusted, adverse drug events and even unplanned hospital readmissions may occur. The prevalence of these medication-related readmissions is not known.

AIM: The primary objective of this study was to determine the prevalence of medication-related readmissions within two years after bariatric surgery. Secondary objectives were to determine the percentage of potentially preventable medication-related readmissions. The reasons for readmission, the associated medication, and medication errors involved in the potentially preventable readmissions were also determined.

METHOD: A retrospective, observational study in a large Dutch teaching hospital was performed. Unplanned readmissions of patients who underwent primary bariatric surgery between January 1, 2018 and August 31, 2020 were included with a follow-up of two years. Records were screened to identify potential medication-related reasons for readmissions. Identified records were independently assessed using adjusted versions of the algorithms of Kramer, Schumock & Thornton for causality and preventability by a doctor and pharmacist. All readmissions assessed as possibly (Kamer scores 0 through 3) or probably (Kramer score 4) related to medication were included. In addition, reasons for readmission, associated medication and medication errors were recorded. Descriptive statistics were used to analyze the data.

RESULTS: In total, 606 unplanned readmissions of 356 individual patients were included. Eighty-three of 606 (13.7%, 95% CI 11.1-16.7%) readmissions were identified as medication-related with a median time between index hospitalization and readmission of 152 days (IQR 16-438). Of these readmissions 36 (43.3%) from 32 unique patients were potentially preventable. The most frequently occurring reasons for readmissions were abdominal pain and infections. Medication most frequently associated with readmissions were Proton Pump Inhibitors, opioids and antibiotics. Medication errors involved in the preventable readmissions were most often prescribing errors followed by non-adherence.

CONCLUSION: Medication-related readmissions frequently occur after bariatric surgery. More attention is needed for correct pharmacotherapy and patient education in this population.

PMID:41051716 | DOI:10.1007/s11096-025-02017-8

Neurol Sci. 2025 Oct 6. doi: 10.1007/s10072-025-08579-9. Online ahead of print.

NO ABSTRACT

PMID:41051688 | DOI:10.1007/s10072-025-08579-9

Sleep Breath. 2025 Oct 6;29(5):307. doi: 10.1007/s11325-025-03494-x.

ABSTRACT

PURPOSE: This observational study aimed to compare the effectiveness of mandibular advancement devices (MAD) and continuous positive airway pressure (CPAP) therapy in patients diagnosed with obstructive sleep apnea (OSA), with a specific focus on changes in heart rate parameters.

METHODS: Fifty-two patients treated with MAD were compared with fifty-two patients treated with CPAP. All participants underwent sleep study prior to the initiation of therapy (T0), followed by a control sleep study after a (3-month) predefined treatment period (T1). Changes in cardiac parameters between baseline (T0) and post-treatment (T1) were analyzed both within each group (MAD and CPAP) and between groups. To enhance comparability between patients treated with MAD and those treated with CPAP, a propensity score matching approach was applied based on pre-treatment variables, in order to minimize selection bias and optimize the validity of the between-group comparison.

RESULTS: For intragroup comparisons, both the MAD and C-PAP groups demonstrated statistically significant reductions in AHI and ODI following treatment (p < 0.001). Additionally, a modest but significant decrease in mean heart rate was noted in both groups (MAD: p = 0.033; CPAP: p = 0.002). For intergroup comparisons, both treatment modalities resulted in a significant reduction in AHI and ODI values. Regarding heart rate parameters, no statistically significant differences were observed between the two groups after treatment for mean HR (p = 0.350), minimum HR (p = 0.602), or maximum HR (p = 0.942).

CONCLUSION: The use of MAD and CPAP leads to significant improvements in heart rate in patients with OSA. However, no significant differences were found between the two treatment modalities in terms of heart rate reduction.

PMID:41051681 | DOI:10.1007/s11325-025-03494-x

Environ Monit Assess. 2025 Oct 6;197(11):1178. doi: 10.1007/s10661-025-14650-x.

ABSTRACT

Freshwater aquaculture in the Indian Sundarbans has witnessed significant growth over the past four decades, largely driven by declining agricultural viability due to increasing soil salinization, erratic rainfall, and rising demand for fish protein. This study aims to assess the spatial and temporal expansion of freshwater aquaculture from 1985 to 2024 and evaluate its production outcomes and livelihood implications. Employing a mixed-methods approach, the analysis integrates remote sensing data (Landsat and Sentinel-2 imagery), supervised and unsupervised land use classification, and field surveys involving 350 fish-farming households. Results indicate a 96.9% increase in aquaculture area-from 80.54 km² in 1985 to 860.96 km² in 2024-with growth concentrated in Pathar Pratima, Gosaba, and Basanti blocks. The majority (82.12%) of ponds are small-scale, yielding an average household production of 87 kg and generating ₹13,918 annually, with a mean productivity of 120 kg/ha/year. Labeo rohita and Labeo catla are the dominant cultured species. Despite expansion, key challenges include seed and feed shortages, salinity intrusion, and inadequate infrastructure. Government interventions such as MGNREGS and the Jal Dharo Jal Bharo scheme have facilitated water management and pond development. The findings underscore the need for strategic ecological planning and policy support to ensure the sustainability and climate resilience of freshwater aquaculture in this vulnerable coastal ecosystem.

PMID:41051654 | DOI:10.1007/s10661-025-14650-x

J Neurotrauma. 2025 Oct 6. doi: 10.1177/08977151251383542. Online ahead of print.

ABSTRACT

Mild traumatic brain injury (mTBI) is common in adolescents. Magnetoencephalography (MEG) studies (primarily reporting on adult males) have demonstrated abnormal resting-state (RS) brain activity in mTBI. The present study sought to identify RS abnormalities in male and female adolescents with mTBI (no previous Diagnostic and Statistical Manual of Mental Disorders – 5th Edition diagnosis) identified from an outpatient specialty care concussion program setting as a basis for evaluating potential clinical utility. Visit 1 MEG RS data were obtained from 46 adolescents with mTBI (mean age: 15.4 years, 25 females) within 4 months of a mTBI (mTBI acute to subacute period) as well as from 34 typically developing (TD) controls (mean age: 14.8 years; 17 females) identified from the local community. Visit 2 RS data (follow-up ∼4.3 months after Visit 1; mTBI subchronic period) were obtained from 36 mTBI (19 females) and 29 TD (14 females) of those participants. Source-space RS neural activity was examined from 4 to 56 Hz. Visit 1 t-tests showed that group differences were largest in the beta range (16-30 Hz; mTBI < TD), with whole-brain linear mixed model (LMM) analyses examining beta-band group differences as a function of Visit. A main effect of Group indicated Visits 1 and 2 beta-band group differences in midline superior frontal gyrus, right temporal pole, and right central sulcus (all mTBI < TD). The group effects were large (Cohen’s d values 0.75 to 1.31). Of clinical significance in the mTBI group, a decrease in mTBI symptoms from Visit 1 to 2 was associated with an increase in beta power in 4 other brain regions. Present findings suggest that RS beta power has potential as a measure and perhaps as a mechanism of clinical recovery in adolescents with mTBI.

PMID:41048046 | DOI:10.1177/08977151251383542

Trans R Soc Trop Med Hyg. 2025 Oct 6:traf108. doi: 10.1093/trstmh/traf108. Online ahead of print.

ABSTRACT

BACKGROUND: Chemical control remains a widely used strategy to reduce morbidity from vector-borne diseases such as dengue. However, the potential health risks to exposed populations necessitates ongoing monitoring, particularly due to the toxicity and volume of insecticides employed.

METHODS: This study assessed butyrylcholinesterase activity in residents of a city in southern Mexico during distinct periods of exposure to carbamate and organophosphate insecticides.

RESULTS: A statistically significant inhibition of enzymatic activity was observed during the rainy season, which coincided with an increase in insecticide application.

CONCLUSIONS: These findings highlight the need for public health authorities to implement preventative measures aimed at minimizing poisoning risks associated with vector control activities.

PMID:41048036 | DOI:10.1093/trstmh/traf108

Circ Genom Precis Med. 2025 Oct 6:e005198. doi: 10.1161/CIRCGEN.125.005198. Online ahead of print.

ABSTRACT

Coronary artery disease remains the leading cause of death worldwide. One of the greatest developments in preventive cardiology has been the identification and treatment of standard modifiable risk factors associated with coronary artery disease. However, despite advances in the management of standard modifiable risk factors, there is an escalating number of patients who continue to present with acute coronary syndromes, a trend that is particularly concerning given the decreasing age-adjusted incidence rates of these conditions. This persistent clinical challenge underscores the urgency to explore alternative approaches for early detection and improved risk stratification. In recent years, the emergence of proteomics technologies has brought forth promising avenues for the discovery of novel biomarkers that hold the potential to revolutionize the timely detection and management of coronary artery disease. Proteomics enables the high throughput and often unbiased analysis of protein abundance, modifications, and interactions within pathways relevant to cardiovascular disease pathogenesis. Of particular importance is the capability to detect low-abundance proteins including those with currently unknown functions. While the functional assessment of these proteins aligns more with mechanistic studies, their role in biomarker discovery is equally important. Such detection may provide new insights into cardiac pathophysiology, including potential new markers for early disease detection and risk assessment. Although the latest proteomics technology and bioinformatic approaches do provide the opportunity for novel discoveries, understanding the limitations of each technology platform is important. This review provides an updated overview of major proteomic platforms and discusses their methodological strengths, constraints, and applications, using recent coronary artery disease studies as illustrative examples. By integrating proteomics data with clinical information, including advanced noninvasive imaging techniques and other omics disciplines, such as genomics and metabolomics, we can deepen our understanding of disease mechanisms and improve risk stratification. Although the discovery of novel biomarkers represents a significant step forward in the field, their true clinical value is contingent upon their rigorous validation in clinical trials and implementation studies. With our current capabilities and emerging advancements, we are well-positioned to advance proteomics-guided precision medicine in cardiovascular care over the coming decade.

PMID:41048024 | DOI:10.1161/CIRCGEN.125.005198

Am J Clin Pathol. 2025 Oct 6:aqaf107. doi: 10.1093/ajcp/aqaf107. Online ahead of print.

ABSTRACT

OBJECTIVE: Targeted therapy in non-small cell lung cancer (NSCLC) is now often included as first-line treatment in the neoadjuvant and adjuvant settings. Delays in optimizing treatments based on biomarker status can affect outcomes. Therefore, we assessed the turnaround time (TAT) of reflex biomarker testing for all NSCLCs clinical stage 1B and greater.

METHODS: A next-generation sequencing (NGS) and PD-L1 immunohistochemistry reflex protocol for NSCLC clinical stage 1B and greater was implemented. Turnaround time intervals between procedure date, pathology sign-out, date received in the molecular laboratory, and date of NGS sign-out were calculated. Median and IQR of each interval before and after implementation of the reflex protocol were calculated and compared using the Mann-Whitney U test.

RESULTS: In total, 492 lung cancer NGS cases were identified, 351 before and 141 after implementation of the reflex protocol. The prereflex cases, after exclusion of biomarker testing ordered on older blocks and outside consults (n = 165), demonstrated a 22-day median time from procedure to NGS sign-out (range, 11-70 days; IQR, 9; mean, 24 days), compared to a 20-day median time (range, 13-54 days; IQR, 4.5; mean, 21 days) postimplementation (n = 120) (P < .000103).

CONCLUSIONS: Reduction in median TAT from procedure to NGS sign-out was statistically significant after implementation of reflex biomarker testing in NSCLC samples.

PMID:41048009 | DOI:10.1093/ajcp/aqaf107

Aliment Pharmacol Ther. 2025 Oct 6. doi: 10.1111/apt.70395. Online ahead of print.

ABSTRACT

BACKGROUND: Faecal microbiota transplantation (FMT) is effective for Clostridioides difficile infection (CDI), but real-world effectiveness data are warranted to refine treatment algorithms. We previously found that FMT effectiveness varied with donors, and the effect of a single capsule FMT administration was lower than expected.

AIMS: To improve FMT outcomes through empirical donor exclusion and application of an optimised capsule FMT dosing regimen.

METHODS: In this multi-site Danish quality improvement study, we included patients with CDI treated with capsule-based FMT from 24 June 2019 to 30 September 2024. The primary outcome was cure of C. difficile-associated diarrhoea (CDAD) 8 weeks after FMT. We assessed this using statistical process control charts monitored separately for the primary FMT centre and the external FMT sites. We used multivariable, mixed-effect logistic regression analysis to evaluate the impact of FMT dosing while adjusting for patient, donor and CDI-related factors.

RESULTS: We included 1176 patients (1707 FMT treatments). At external FMT sites, the cure rate from one FMT treatment changed from 50% (95% confidence interval (CI): 45%-56%) to 59% (55%-63%) following the exclusion of three low-performing donors in November 2022. After implementing a two-dose capsule FMT dosing regimen in February 2024, the cure rate increased to 72% (65%-77%). The impact of the two-dose capsule FMT dosing regimen remained statistically significant after adjustment (odds ratio 1.22; 95% CI 1.16-1.28; p < 0.001).

CONCLUSION: Empirical donor selection and a two-dose capsule FMT regimen improved clinical outcomes in a large-scale system treating patients with CDI.

PMID:41047993 | DOI:10.1111/apt.70395