Nevin Manimala

J Craniofac Surg. 2025 Apr 2. doi: 10.1097/SCS.0000000000011351. Online ahead of print.

ABSTRACT

INTRODUCTION: Alveolar bone grafting during the mixed dentition period is a common treatment, but the optimal surgical timing remains unclear. This study aims to evaluate how age influences the outcomes of secondary alveolar cleft repair, focusing on bone formation and midfacial symmetry.

MATERIALS AND METHODS: This study retrospectively analyzed patients who underwent autologous iliac cancellous bone grafting for alveolar cleft repair from January 2019 to August 2023. Preoperative and 1-year postoperative skull CT data were used to measure osteogenesis rate and midface bony structures, with statistical analysis conducted using R.

RESULTS: A total of 68 patients aged 8 to 12 years were included in the study, with no significant differences in baseline data. Autologous iliac bone grafting for alveolar cleft repair resulted in significant improvements in the symmetry of the midfacial skeletal structure, with younger patients showing more pronounced improvements. Univariate linear regression analysis revealed a linear relationship between age and osteogenesis rate, which was further confirmed by multiple linear regression analysis. Age was identified as the most significant factor influencing the osteogenesis rate (β=-0.037, P=0.003), while the deviation of the nasal septum was also found to significantly affect the osteogenesis rate (β=0.004, P=0.009).

CONCLUSIONS: Age significantly impacts the outcomes of alveolar cleft repair using autologous iliac cancellous bone grafting. Younger patients have better bone formation and facial symmetry improvements, suggesting that earlier surgery may be more beneficial. Preoperative nasal septal deviation assessment is also essential for optimizing surgical planning.

PMID:40172976 | DOI:10.1097/SCS.0000000000011351

J Craniofac Surg. 2025 Apr 2. doi: 10.1097/SCS.0000000000011321. Online ahead of print.

ABSTRACT

The surgery for dental implants in atrophic sites is a constant challenge. The sinus lift has some recognized techniques; however, the use of low morbidity and low-cost techniques is a trend in surgery. This study aims to identify implant stability observed in dental implants installed in an atrophic maxillary sinus using the lateral window technique without bone graft or biological barrier. A clinical series included 20 patients with 25 conical design dental implants installed, with 1 year of follow-up performed. Bone height was analyzed in the preoperative stage and at 1 year of follow-up using panoramic radiography. All the implants were installed using a lateral window sinus lift, respecting a minimum insertion torque of 35N. Four months later, the second surgery installed the healing abutment and then the prosthetic abutment; the fixed prosthesis on the implant was performed conventionally. After 1 year of follow-up, only one implant was lost at the healing abutment installation stage, the remaining 24 implants were rehabilitated conventionally with no issues. All the implants were stable 1 year after surgery; an average bone gain of 4.9 mm was observed between the preoperative stage and the 1-year follow-up, a statistically significant increase (P > 0.05). The immediate implant with primary stability in maxillary sinus lift using the lateral window approach, without bone grafts or biological barriers, has a high survival rate and facilitates new bone formation around the implant.

PMID:40172973 | DOI:10.1097/SCS.0000000000011321

J Craniofac Surg. 2025 Apr 1. doi: 10.1097/SCS.0000000000011304. Online ahead of print.

ABSTRACT

INTRODUCTION: Evaluating pediatric airways is challenging, particularly in identifying those at risk for difficult intubation, which is often linked to craniofacial malformations. Limited cooperation from preschoolers further complicates this evaluation.

OBJECTIVE: To evaluate the predictive accuracy of the Arné Score in identifying risk factors for difficult intubation in preschool-aged children (under 6 y) and develop a model to prevent difficult laryngoscopy and intubation. Secondary objectives include determining the incidence of difficult intubation and the appropriate age for preanesthetic airway assessments.

METHODS: This retrospective observational study analyzed 1385 patients aged 0 to 16 years, all undergoing general anesthesia and tracheal intubation in 2018 at a tertiary hospital in Barcelona. Among them, 708 were under 6 years. Predictive tests included the Arné Score, with difficult intubation defined by Cormack-Lehane scores, intubation attempts, and alternative device use. Logistic regression analyzed predictors with significant odds ratios.

RESULTS: Unrecorded Mallampati test values were common in children under 6 years (99.04%). Of those without a history, 8.07% faced intubation difficulties, compared with 50% with a history. Relative risk was 6.23, and the odds ratio was 11.46. Among 202 classified with airway difficulties, 82.67% had no intubation issues. Statistically significant associations highlighted greater risks for those with a difficult intubation history.

CONCLUSIONS: Arné Score tests are impractical for children under 6. If no history or airway pathology exists, there’s a 95.14% chance of successful intubation. The history of difficult intubation increases risks more than airway pathology alone.

PMID:40172950 | DOI:10.1097/SCS.0000000000011304

Pain Med. 2025 Apr 2:pnaf039. doi: 10.1093/pm/pnaf039. Online ahead of print.

ABSTRACT

OBJECTIVE: This study examines the relationship between racial discrimination and physical pain outcomes.

METHODS: A geographically representative sample of 887 individuals was recruited online through CloudResearch from diverse racial backgrounds, including Black/African American, Latine/Hispanic American, Asian American, and White/European American adults. Participants completed measures on racial and ethnic discrimination, racial microaggressions, pain severity, depression symptoms, and coping styles. Statistical analyses included multiple regression and mediation models.

RESULTS: Our findings indicate that racialized participants experienced greater ethnic discrimination and racial microaggressions compared to their non-Hispanic White counterparts. Hispanic/Latine participants also reported greater pain severity than other groups. Lifetime experiences of discrimination, depression symptoms, avoidant coping style, and age emerged as significant predictors of pain severity, while mediation analyses revealed that lifetime discrimination partially mediated the relationship between race/ethnicity and pain severity for racially marginalized participants, compared to non-Hispanic White participants. Further, greater reliance on avoidant coping combined with greater lifetime discrimination experiences was associated with increased severity of pain.

CONCLUSIONS: The findings indicate how racism may result in worse pain outcomes in people of color, with potentially amplified adverse effects for those who engage in avoidant coping. While therapeutic interventions targeting avoidance may benefit racialized individuals, ultimately, the results highlight the critical need for large-scale policy interventions targeting racial discrimination to improve health equity and reduce the burden of pain among racialized populations.

PMID:40172915 | DOI:10.1093/pm/pnaf039

JAMA Psychiatry. 2025 Apr 2. doi: 10.1001/jamapsychiatry.2025.0318. Online ahead of print.

ABSTRACT

IMPORTANCE: Traumatic brain injury is common and occurs across all ages. Observational studies have shown that traumatic brain injury is associated with a wide range of mental disorders and suicide. Whether these associations represent a causal effect is, however, difficult to establish, and confounding by genetic liability for mental disorder may play a substantial role.

OBJECTIVE: To investigate whether observational associations between traumatic brain injury and mental disorder or suicide could be confounded by genetic liability for mental disorder.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted from October 2023 to January 2025. The study population consisted of the general population subcohort of the Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH) sample, which is a representative sample of the Danish population born between 1981 and 2008 that has been genotyped.

EXPOSURES: Polygenic risk scores (PRSs) for schizophrenia, bipolar disorder, depression, and attention-deficit/hyperactivity disorder (ADHD) calculated from the genotypes and genome-wide association summary statistics.

MAIN OUTCOMES AND MEASURES: The primary outcome was traumatic brain injury, operationalized via hospital diagnoses. The associations between PRSs for schizophrenia, bipolar disorder, depression, and ADHD, respectively, and traumatic brain injury were examined via Cox proportional hazards regression, yielding hazard rate ratios (HRRs) with 95% confidence intervals.

RESULTS: The final cohort consisted of a total of 40 274 individuals, of whom 19 802 (49.2%) were female. A total of 3341 (8.3%) of the cohort members (of whom 1464 [43.8%] were female and 1877 [56.2%] were male) experienced traumatic brain injury during follow-up. All 4 PRSs showed statistically significant positive associations with traumatic brain injury (PRS-schizophrenia: HRR, 1.06; 95% CI, 1.02-1.10; P = .002; PRS-bipolar disorder: HRR, 1.04; 95% CI, 1.00-1.08; P = .04; PRS-depression: HRR, 1.10; 95% CI, 1.06-1.14; P < .001; and PRS-ADHD: HRR, 1.12; 95% CI, 1.08-1.16; P < .001).

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that confounding by genetic liability for mental disorder could explain some of the association between traumatic brain injury and mental disorder or suicide. Consequently, genetic liability for mental disorder should be factored into future studies of these associations to avoid overestimation of causality.

PMID:40172901 | DOI:10.1001/jamapsychiatry.2025.0318

JAMA Netw Open. 2025 Apr 1;8(4):e252875. doi: 10.1001/jamanetworkopen.2025.2875.

ABSTRACT

IMPORTANCE: The use of nurse overtime and agency nurses has increased in recent years, making it important to understand the opportunities and limits of these alternative staffing strategies on patient safety outcomes.

OBJECTIVE: To examine the association between overtime and agency nurse staffing hours and hospital patient safety.

DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study used data from 70 US hospitals, from January 2019 through December 2022. Participants included patients and nurse staff across the 70 hospitals.

EXPOSURE: The use of overtime and agency nursing.

MAIN OUTCOMES AND MEASURES: The main outcomes were 10 of the US Agency for Healthcare Research and Quality’s patient safety indicators and their associations with regular, overtime, and agency nursing hours per patient day: pressure ulcers, iatrogenic pneumothorax, in-hospital fall with hip fracture, perioperative hemorrhage or hematoma, postoperative acute kidney injury requiring dialysis, postoperative respiratory failure, perioperative thromboembolism, postoperative sepsis, postoperative wound dehiscence, and accidental puncture or laceration. A baseline Poisson regression model and a structural breakpoint analysis were used to identify safety thresholds. Pairwise interactions between staffing intensity variables and hospital bed size were also included. Adjustments were made for the COVID-19 hospital census, patient case mix, and hospital characteristics.

RESULTS: The sample included 46 hospitals in the South, 20 in the West, and 4 in the Northeast; 48 hospitals were urban, 32 hospitals had fewer than 200 beds, 26 had between 200 and 399 beds, and 12 had 400 or more beds. The average use of nurse overtime and agency nurse hours exceeded safe thresholds for pressure ulcers by 140.0% for agency staffing and by 63.6% for overtime, representing a 6.44% increase associated with excess agency nurse hours and a 2.09% increase for excess use of overtime. There also was a statistically significant association of agency hours with postsurgery hemorrhage or hematoma rates, but no breakpoint threshold. There were no significant associations with other outcomes.

CONCLUSIONS AND RELEVANCE: These findings suggest that both nurse overtime and nurse agency hours are associated with increased rates of pressure ulcers, a measure that is one of the most sensitive to nursing care. In future research, hospitals could use their own data to track safe thresholds.

PMID:40172888 | DOI:10.1001/jamanetworkopen.2025.2875

JAMA Netw Open. 2025 Apr 1;8(4):e253018. doi: 10.1001/jamanetworkopen.2025.3018.

ABSTRACT

IMPORTANCE: As more than 50% of Medicare beneficiaries are enrolled in Medicare Advantage (MA), understanding whether the treatment covered by MA vs traditional Medicare (TM) is comparable can aid in providing high-value care. As the majority of patients with cancer undergo radiotherapy, it is important to quantify TM and MA utilization in oncology.

OBJECTIVE: To analyze the primary type of radiotherapy technology used, treatment length, and estimated spending for MA patients with cancer undergoing radiotherapy compared with TM patients with cancer.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used 2018 Medicare claims data for TM and MA patients aged 65 years or older who received radiotherapy for 1 of 15 cancer types. Analyses were performed between May 1 and December 28, 2024.

EXPOSURES: Insurance type (MA vs TM), cancer type, age, dual-eligibility status, medical comorbidities, county, and radiotherapy center type.

MAIN OUTCOMES AND MEASURES: Primary type of radiotherapy technology used, treatment length, and estimated spending for 90-day radiotherapy episodes. Adjusted rates and odds ratios (ORs) were calculated to compare technology types and rate ratios (RRs) to compare treatment length and estimated spending between TM and MA episodes.

RESULTS: Of 31 563 treatment episodes among 30 941 patients, 22 594 (71.58%) were covered by TM (mean [SD] age, 74.76 [6.57] years; 50.76% among males) and 8969 (28.42%) were covered by MA (mean [SD] age, 74.51 [6.24] years; 51.78% among males). For radiotherapy episodes in patients with MA, adjusted analyses revealed lower odds of proton therapy use (52 [0.58% (95% CI, 0.34%-0.82%)] vs 373 [1.65% (95% CI, 1.50%-1.80%)]; OR, 0.36 [95% CI, 0.27-0.48]) and stereotactic radiotherapy use (1235 [13.77% (95% CI, 13.13%-14.41%)] vs 3391 [15.01% (95% CI, 14.61%-15.41%)]; OR, 0.87 [95% CI, 0.81-0.95]), higher odds of 2- or 3-dimensional radiotherapy use (3962 [44.17% (95% CI, 43.39%-44.96%)] vs 9584 [42.43% (95% CI, 41.93%-42.92%)]; OR, 1.13 [95% CI, 1.06-1.21]), greater mean treatment length (21.38 [95% CI, 21.14-21.61] vs 19.48 [95% CI, 19.33-19.62] treatments; RR, 1.10 [95% CI, 1.08-1.11]), and higher estimated radiotherapy spending ($8677.56 [95% CI, $8566.58-$8788.54] vs $8393.20 [95% CI, $8323.34-$8463.05]; RR, 1.04 [95% CI, 1.02-1.06]) compared with episodes in patients with TM.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, MA patients with cancer undergoing radiotherapy had higher estimated spending and greater mean treatment length than those covered by TM. Despite lower utilization of more expensive advanced treatment modalities, MA was not associated with cost savings. Whether MA meets the value proposition for radiation oncology requires further investigation.

PMID:40172887 | DOI:10.1001/jamanetworkopen.2025.3018

JAMA Netw Open. 2025 Apr 1;8(4):e254121. doi: 10.1001/jamanetworkopen.2025.4121.

ABSTRACT

IMPORTANCE: Ozone (O3) is the most frequently exceeded air pollutant standard in the US. While short-term exposure is associated with acute respiratory health, the epidemiologic evidence linking postnatal O3 exposure to childhood asthma and wheeze is inconsistent and rarely evaluated as a mixture with other air pollutants.

OBJECTIVES: To determine associations between ambient O3 and subsequent asthma and wheeze outcomes both independently and in mixture with fine particulate matter and nitrogen dioxide in regions with low annual O3 concentrations.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study consisted of a pooled, multisite analysis across 6 US cities using data from the prospective ECHO-PATHWAYS consortium (2007-2023). Included children had complete airway surveys, complete address histories from age 0 to 2 years, and a full term birth (≥37 weeks). Logistic regression and bayesian kernel machine regression (BKMR) mixture analyses were adjusted for child anthropomorphic, socioeconomic, and neighborhood factors.

EXPOSURES: Exposure to ambient O3 in the first 2 years of life derived from a validated point-based spatiotemporal model using residential address histories.

MAIN OUTCOMES AND MEASURES: The primary outcome was asthma and wheeze at ages 4 to 6 years; the secondary outcome was asthma and wheeze at ages 8 to 9 years. Outcomes were based on caregiver reports derived from a validated survey.

RESULTS: The analytic sample of 1188 participants had a mean (SD) age of 4.5 (0.6) years at the age 4 to 6 years visit and consisted of 614 female participants (51.7%) and 663 mothers who had a bachelor’s degree or higher (55.8%). The mean (SD) O3 concentration was 26.1 (2.9) parts per billion (ppb). At age 4 to 6 years, 148 children had current asthma (12.3%) and 190 had current wheeze (15.8%). The odds ratio per 2 ppb higher O3 concentration was 1.31 (95% CI, 1.02-1.68) for current asthma and 1.30 (95% CI, 1.05-1.64) for current wheeze at age 4 to 6 years; null associations were observed for outcomes at age 8 to 9 years, and for sensitivity covariate adjustment. BKMR suggested that higher exposure to O3 in mixture was associated with current asthma and wheeze in early childhood.

CONCLUSIONS AND RELEVANCE: In this cohort study with relatively low ambient O3 exposure, early-life O3 was associated with asthma and wheeze outcomes at age 4 to 6 years and in mixture with other air pollutants but not at age 8 to 9 years. Regulating and reducing exposure to ambient O3 may help reduce the significant public health burden of asthma among US children.

PMID:40172886 | DOI:10.1001/jamanetworkopen.2025.4121

JAMA Netw Open. 2025 Apr 1;8(4):e255235. doi: 10.1001/jamanetworkopen.2025.5235.

ABSTRACT

IMPORTANCE: Uterine fibroids are benign tumors that can cause severe symptoms. Fibroid burden among Asian or Pacific Islander individuals, particularly in specific subgroups, remains largely unexamined.

OBJECTIVE: To describe fibroid diagnosis rates by race and ethnicity.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study (January 2009 to December 2022) used data from electronic health records of the Kaiser Permanente Northern California (KPNC) integrated health care system. Eligible participants included female (sex assigned at birth) KPNC members aged 18 to 54 years with at least 12 months of continuous membership, no prior fibroid diagnosis, and no history of hysterectomy. Data were analyzed January to September 2024.

EXPOSURE: Race and ethnicity was categorized into 9 groups: Black (African American, other Black [ie, any Black race or ethnicity not otherwise specified], and unknown Black race or ethnicity), East Asian (Chinese, Japanese, and Korean), Hispanic (Hispanic or Latino), South Asian (Asian Indian, Bangladeshi, East Indian, Nepali, Sri Lankan, and any South Asian ethnicity not otherwise specified), Southeast Asian (Filipino, Vietnamese, and other Southeast Asian [ie, any Southeast Asian ethnicity not otherwise specified]), White (White or White Middle Eastern), other Asian or Pacific Islander (Native Hawaiian or Pacific Islander, multiethnic Asian, and other or unspecified Asian ethnicity [ie, any Asian ethnicity not otherwise specified]), other races and ethnicities (American Indian or Alaska Native and multiracial), and unknown race or ethnicity.

MAIN OUTCOMES AND MEASURES: Incident fibroid diagnosis was identified using diagnostic codes. Poisson regression models were used to calculate incidence rates of fibroid diagnosis by racial and ethnic group, standardized to the 2022 US female population. Incidence rate ratios (IRRs) and 95% CIs compared incidence within each racial and ethnic group with White participants.

RESULTS: A total of 1 917 794 patients were included (median [IQR] percentage, 7% [6%-7%] Black; 5% [5%-6%] East Asian; 22% [21%-23%] Hispanic; 3% [2%-3%] South Asian; 7% [7%-8%] Southeast Asian; 42% [39%-45%] White; 8% [6%-10%] other Asian or Pacific Islander; 2% [2%-2%] of other races and ethnicities; 4% [4%-5%] unknown or missing race and ethnicity), and 84 206 patients (4.4%) received a first fibroid diagnosis during the study period. Compared with White patients, there was a higher rate of fibroid diagnosis among Southeast Asian (IRR, 1.29; 95% CI, 1.26-1.33), East Asian (IRR, 1.47; 95% CI, 1.43-1.51), and South Asian patients (IRR, 1.71; 95% CI, 1.65-1.78). Black (IRR, 3.11; 95% CI, 3.05-3.17) and Hispanic patients (IRR, 1.37; 95% CI, 1.34-1.39) also had elevated rates of fibroid diagnosis. All Asian patients were less likely than other groups to have ICD-9 or ICD-10 coded symptoms before diagnosis.

CONCLUSIONS AND RELEVANCE: In this cohort study of nearly 2 million KPNC patients, South Asian, East Asian, Southeast Asian, Hispanic, and Black patients had higher fibroid diagnosis rates than White patients. If diagnosis rates reflect true variation in disease prevalence, future research should identify sources of these disparities and strategies to reduce them.

PMID:40172885 | DOI:10.1001/jamanetworkopen.2025.5235

JAMA Cardiol. 2025 Apr 2. doi: 10.1001/jamacardio.2025.0328. Online ahead of print.

ABSTRACT

IMPORTANCE: The impact of hypertensive disorders of pregnancy on developing dilated cardiomyopathy is unknown.

OBJECTIVE: To determine whether hypertensive disorders of pregnancy are associated with long-term risk of dilated cardiomyopathy.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study performed in England used the following linked electronic health records databases: Clinical Practice Research Datalink (CPRD) Pregnancy Register, CPRD Aurum (primary care), Hospital Episode Statistics Admitted Patient Care, and Office for National Statistics mortality data. Participants included an exposed cohort of 14 083 patients in their first pregnancy with hypertensive disorders of pregnancy (index date observed: January 1997 to December 2018; followed up until July 2023) and unexposed cohort of 70 415 with normotensive pregnancies randomly sampled from the Pregnancy Register (5:1 ratio).

EXPOSURE: Hypertensive disorder of pregnancy (preeclampsia, gestational hypertension).

MAIN OUTCOMES AND MEASURES: Cox proportional hazards models were fitted to estimate hazard ratios (HRs) of developing dilated cardiomyopathy.

RESULTS: The cohort included 14 083 individuals with a hypertensive disease of pregnancy during their first pregnancy and 70 415 individuals with normotensive first pregnancies. A first-time pregnancy complicated by a hypertensive disorder of pregnancy, compared with a normotensive first-time pregnancy, was associated with a 93% higher risk of developing dilated cardiomyopathy (adjusted HR, 1.93 [95% CI, 1.33-2.81]; P = .001; adjusted for maternal age). Dilated cardiomyopathy developed a median (IQR) of 5.1 (0.7-10.6) years post partum in those with HDP and 10.6 (4.2-15.8) years post partum in those with normotensive first pregnancies. The association remained significant after adjusting for maternal age, birth year, gestational diabetes, postpregnancy diabetes, postpregnancy hypertension, total parity, ethnicity, and socioeconomic status (adjusted HR, 1.55 [95% CI, 1.04-2.31]; P = .03). There was a dose response; there was a higher risk of DCM in those with preeclampsia (adjusted HR, 1.85 [95% CI, 1.24-2.76]; P = .002) and severe preeclampsia (adjusted HR, 4.29 [95% CI, 2.32-7.96]; P < .001). Maternal age (adjusted HR per year of age, 1.06 [95% CI, 1.03-1.08]; P < .001) and postpartum incident hypertension (adjusted HR, 1.68 [95% CI, 1.16-2.42]; P = .006) were independently associated with the development of DCM.

CONCLUSIONS: Patients with hypertensive disorders of pregnancy had a greater risk of developing dilated cardiomyopathy. Older maternal age and postpartum hypertension were associated with higher risk of dilated cardiomyopathy after a hypertensive disorder of pregnancy. These findings support long-term clinical vigilance of patients with a history of hypertensive disorders of pregnancy.

PMID:40172877 | DOI:10.1001/jamacardio.2025.0328