Nevin Manimala

J Orthop Surg Res. 2025 Jul 21;20(1):685. doi: 10.1186/s13018-025-06087-2.

ABSTRACT

BACKGROUND: The aim of this study was to identify the radiographic parameters associated with failure of tension band wiring (TBW) in the treatment of transverse patellar fractures, with the goal of guiding surgical decision-making.

MATERIALS AND METHODS: A total of 76 patients underwent surgical treatment for patellar fractures at Trakya University between January 2013 and December 2022. We retrospectively analyzed 32 patients who met the study’s inclusion criteria for transverse fractures (AO Type 34- C1) treated with TBW. Radiographic parameters assessed included patellar width, inter-K-wire distance, K-wire-to-patella ratios, knot configuration, and K-wire length, all evaluated for their potential association with fixation failure. Failure was defined as cerclage wire slippage or breakage. Statistical analyses were conducted using SPSS and Jamovi software. Descriptive statistics, t-tests, chi-square or Fisher’s exact tests, logistic regression, and ROC analysis were performed. A p-value < 0.05 was considered significant.

RESULTS: The mean age was 50 years ± 15.8 (range 26-80), with 8 women (25%) and 24 men (75%). Nine patients (28.1%) experienced TBW failure. Notably, single-knot constructs had significantly higher failure rates (66.7% vs. 19.2%; OR = 0.119, 95% CI [0.017-0.843], p = 0.038). Increased K-wire length was associated with failure (p = 0.008; cutoff 69.1 mm, AUC = 0.785). Patella-K-wire length ratio was higher in failures (p = 0.035). Lateral K-wire to articular distance and lateral K-wire to articular distance surface to patella thickness ratio were also significant predictors in slippage group (p = 0.046 and p = 0.031).

CONCLUSION: The number of knots, K-wire length, and specific radiographic parameters are important predictors of TBW failure. Attention to construct configuration and K-wire placement is crucial to minimize failure risk.

PMID:40691604 | DOI:10.1186/s13018-025-06087-2

Int J Epidemiol. 2025 Jun 11;54(4):dyaf123. doi: 10.1093/ije/dyaf123.

ABSTRACT

BACKGROUND: Most women diagnosed with breast cancer (BC) survive treatment and become long-term survivors. This study examines the association between long-term survival of female BC patients and clinical factors, socio-economic determinants, healthcare utilization, and drug use.

METHODS: This retrospective population-based survival study uses linked cancer registry data, claims, and social security data at the individual level for all Belgian women diagnosed with invasive BC in 2010 (n = 9982). Ten-year survival probabilities were computed by using Kaplan-Meier and relative survival curves. A Weibull mixture cure model was employed to perform multivariable analysis.

RESULTS: The population consisted of women with early-stage (75.0%), locally advanced (13.1%), and metastatic BC (5.9%). The overall 10-year unadjusted survival was 68.2% [95% confidence interval (CI), 67.1%-69.3%], with decreasing survival in older women. However, survival was lower in women age <40 years compared with those aged 40-60 years. Multivariate analysis revealed that age was associated with long-term survivorship (odds ratio, 0.919; 95% CI, 0.918-0.919). Women receiving multimodal treatment (surgery followed by adjuvant radiotherapy and systemic treatment) were more likely to become long-term survivors compared with women receiving other treatments. Lastly, beneficiaries of increased reimbursement had lower odds of long-term survivorship.

CONCLUSION: Our study highlights the association between long-term survivorship in women diagnosed with invasive BC and factors such as age at diagnosis, treatment scheme, and entitlement to increased reimbursement. It is crucial to inform clinicians and policymakers on the appropriate use of mixture cure models, as their results can substantially impact healthcare decision-making. Furthermore, tailored BC screening strategies are essential to reduce social inequalities and mortality disparities.

PMID:40690797 | DOI:10.1093/ije/dyaf123

Int J Epidemiol. 2025 Jun 11;54(4):dyaf136. doi: 10.1093/ije/dyaf136.

NO ABSTRACT

PMID:40690794 | DOI:10.1093/ije/dyaf136

Medwave. 2025 Jul 21;25(6):e3002. doi: 10.5867/medwave.2025.06.3002.

ABSTRACT

INTRODUCTION: Since the first description of Thrombotic Thrombocytopenic Purpura, caused by a severe deficiency of ADAMTS13, plasma exchange and immunosuppression have become standard treatments, allowing to decrease its high mortality rate. Prospective records of Thrombotic Thrombocytopenic Purpura have provided valuable information on its pathophysiology, clinical presentation, and outcomes. The objective of this study is to update the local Chilean experience in the diagnosis and management of this disease, through a case series of patients treated between 2017 and 2022.

METHODS: Case series study that included patients over 18 years old diagnosed with Thrombotic Thrombocytopenic Purpura, treated between June 2017 and August 2022 at Hospital Clínico UC Christus. Information was collected from clinical records, which were used for cohort description and statistical analysis. Accepted definitions from the literature were used to describe the outcomes. The study was approved by the local ethics committee (ID 220524001).

RESULTS: Our series had higher age and prevalence of comorbidities compared to those reported in the literature. The most important clinical manifestations included constitutional, gastrointestinal, hemorrhagic, and neurological symptoms, with different presentation frequencies than those described internationally. We found a lower capacity of the PLASMIC Score for the detection of Thrombotic Thrombocytopenic Purpura in our series. The predominant therapeutic strategy was a combination of glucocorticoids and plasma exchange (61% of the patients). There was a high mortality rate (56.5%) and adverse events related to plasma exchange, especially of infections related to its use.

CONCLUSIONS: This study highlights the diagnostic and therapeutic challenges of Thrombotic Thrombocytopenic Purpura in the local context and the need to improve our management strategies through standardizing care and better application of clinical guidelines to reduce the high mortality rate in these patients.

PMID:40690786 | DOI:10.5867/medwave.2025.06.3002

J Speech Lang Hear Res. 2025 Jul 21:1-18. doi: 10.1044/2025_JSLHR-24-00899. Online ahead of print.

ABSTRACT

PURPOSE: The minimally detectable change (MDC), widely used in rehabilitation sciences to interpret changes in outcome measures, is calculated using a reliability method, reliability statistic, and standard error of measurement (SEM). This study examined how different methodological choices affect MDC thresholds of speech intelligibility in speakers with dysarthria. The goals of this study were to compare MDCs calculated using (a) three different reliability methods, (b) two different reliability statistics, and (c) three different SEM calculations.

METHOD: Recordings of the Speech Intelligibility Test from 200 speakers including speakers with amyotrophic lateral sclerosis (n = 16), Huntington’s disease (n = 44), multiple sclerosis (n = 60), and Parkinson’s disease (n = 40), along with healthy controls (n = 40), were drawn from two databases. Thirty inexperienced listeners completed two sessions, providing orthographic transcriptions of 20 speakers. MDCs of intelligibility were calculated using (a) three reliability methods (i.e., test-retest, split-half, and intrarater), (b) two reliability statistics (i.e., Pearson r and intraclass correlation coefficients [ICCs]), and (c) three different formulas for calculating the SEM. Kruskal-Wallis tests were used to assess the effects of reliability methods, statistics, and SEM calculations.

RESULTS: Significant differences were found between the MDCs when using split-half and test-retest reliability, when using Pearson r and ICC, and when using two of the three SEM calculations.

CONCLUSIONS: Results demonstrate that methodological decisions can impact MDCs of speech intelligibility in speakers with dysarthria, highlighting the need for specific, detailed reporting of methodology used to calculate MDCs in future work. Findings can provide methodological guidance for future studies and contextualize existing research on intelligibility changes.

PMID:40690785 | DOI:10.1044/2025_JSLHR-24-00899

Ann Intern Med. 2025 Jul 22. doi: 10.7326/ANNALS-25-00640. Online ahead of print.

ABSTRACT

BACKGROUND: “Weekend warrior” and regularly active physical activity patterns have been associated with reduced mortality risk in the general population. The association in patients with diabetes is unknown.

OBJECTIVE: To examine the associations of different physical activity patterns, particularly weekend warrior and regularly active behavior, with all-cause, cardiovascular, and cancer mortality among adults with diabetes.

DESIGN: Prospective cohort study.

SETTING: National Health Interview Survey (1997 to 2018) linked to the National Death Index records through 31 December 2019.

PARTICIPANTS: 51 650 U.S. adults with self-reported diabetes.

MEASUREMENTS: Participants categorized by 4 physical activity groups: inactive (reporting no moderate-to-vigorous physical activity [MVPA]), insufficiently active (MVPA <150 minutes per week), weekend warrior (MVPA ≥150 minutes per week in 1 to 2 sessions), and regularly active (MVPA ≥150 minutes per week in ≥3 sessions).

RESULTS: During a median follow-up of 9.5 years, 16 345 deaths (cardiovascular, 5620; cancer, 2883) were documented. Compared with inactive participants, multivariable-adjusted hazard ratios (HRs) for all-cause mortality were significantly lower across physical activity groups: insufficiently active persons (HR, 0.90 [95% CI, 0.85 to 0.95]), weekend warriors (HR, 0.79 [CI, 0.69 to 0.91]), and regularly active persons (HR, 0.83 [CI, 0.78 to 0.87]). These reductions were mostly due to benefits with cardiovascular mortality: insufficiently active persons (HR, 0.98 [CI, 0.89 to 1.07]), weekend warriors (HR, 0.67 [CI, 0.52 to 0.86]), and regularly active persons (HR, 0.81 [CI, 0.74 to 0.88]). There were fewer differences by cancer mortality: insufficiently active persons (HR, 0.88 [CI, 0.78 to 1.00]), weekend warriors (HR, 0.99 [CI, 0.76 to 1.30]), and regularly active persons (HR, 0.85 [CI, 0.75 to 0.96]).

LIMITATION: Physical activity was self-reported and assessed at a single time point.

CONCLUSION: Weekend warrior and regularly active physical activity patterns meeting current physical activity recommendations (MVPA ≥150 minutes per week) were associated with 21% and 17% lower risks for all-cause mortality and 33% and 19% lower hazards of cardiovascular mortality among adults with diabetes compared with those with diabetes who are physically inactive.

PRIMARY FUNDING SOURCE: Capital’s Funds for Health Improvement and Research, and National Natural Science Foundation of China.

PMID:40690774 | DOI:10.7326/ANNALS-25-00640

Ann Intern Med. 2025 Jul 22. doi: 10.7326/ANNALS-24-02648. Online ahead of print.

ABSTRACT

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been shown to decrease blood glucose levels, promote weight loss, and prevent cardiovascular events. However, evidence is limited regarding their effect on dementia, although emerging observational studies, some with serious methodological limitations, have suggested large reductions in dementia associated with GLP-1RAs that may not be entirely causally related.

OBJECTIVE: To compare the effect of GLP-1RAs versus dipeptidyl peptidase-4 inhibitors (DPP4is) as second-line therapy for type 2 diabetes on risk for dementia among older adults.

DESIGN: Target trial emulation.

SETTING: United States from January 2016 to December 2020.

PARTICIPANTS: Medicare fee-for-service beneficiaries aged 66 years or older with diabetes who used metformin and did not have dementia at baseline and initiated GLP-1RAs or DPP4is between January 2017 and December 2018.

MEASUREMENTS: Onset of dementia was defined as 1 year before the date of a new dementia diagnosis. Risks were calculated at 30 months in GLP-1RA and DPP4i groups matched in a 1:2 ratio on an estimated propensity score and compared via ratios and differences.

RESULTS: Among 2418 patients initiating GLP-1RAs and 4836 matched patients initiating DPP4is, the mean age was 71 years, and 55% were female. Over a median follow-up of 1.9 years, the outcome occurred in 96 patients in the GLP-1RA group and 217 in the DPP4i group. The estimated risk difference at 30 months was -0.93 (95% CI, -2.33 to 0.23) percentage points, and the estimated risk ratio was 0.83 (95% CI, 0.61 to 1.05). The estimated risk ratios were 0.64 (95% CI, 0.46 to 0.93) and 1.22 (95% CI, 0.74 to 1.66) among those younger than 75 years and aged 75 years or older, respectively.

LIMITATIONS: Potential residual confounding (no data on body mass index, glycemic control, or duration of diabetes), outcome misclassification, and short follow-up.

CONCLUSION: Among older adults with diabetes, no clear evidence was found that the incidence of dementia differed overall between patients using GLP-1RAs versus DPP4is. Under conventional statistical criteria, an effect of GLP-1RAs between a 39% decrease and a 5% increase in risk for dementia was highly compatible with the data, although estimates differed by age. Randomized trials are needed to quantify the effect of GLP-1RAs on dementia.

PRIMARY FUNDING SOURCE: Gregory Annenberg Weingarten, GRoW @ Annenberg.

PMID:40690769 | DOI:10.7326/ANNALS-24-02648

Eur J Public Health. 2025 Jul 21:ckaf123. doi: 10.1093/eurpub/ckaf123. Online ahead of print.

ABSTRACT

Lithuania has one of the highest adult mortality rates in Europe. A study analysing three large groups of healthcare employees, physicians, nurses, and assistant nurses, found no significant differences in all-cause mortality compared to other sectors. However, after controlling for education, physicians became the highest-risk group. Nurses and assistant nurses had the lowest risk, but no significant differences were found. Excess all-cause mortality of physicians after controlling for education is striking and needs to be investigated further. Given the low number of deaths by suicide among healthcare workers, more research is required to obtain more statistically robust inferences.

PMID:40690760 | DOI:10.1093/eurpub/ckaf123

JMIR Res Protoc. 2025 Jul 21;14:e69610. doi: 10.2196/69610.

ABSTRACT

BACKGROUND: University students and staff members, especially those who frequently eat out and spend considerable time on campus, form a crucial demographic facing challenges related to high salt and sugar intake in out-of-home food. Recognizing the high prevalence of eating out among these populations, it is imperative to understand the salt and sugar consumption levels of campus communities.

OBJECTIVE: This protocol describes the rationale and design of a 3-part cross-sectional and longitudinal interventional study to reduce salt and sugar contents in canteen foods and intakes among students and staff at Sunway University and Sunway College in Malaysia.

METHODS: First, the knowledge, attitudes, and practices (KAPs) and perception, barriers, and enablers (PBEs) of salt and sugar intake and reduction were assessed among students and staff (part 1 of the study). Second, the KAPs and PBEs of salt, oil, and sugar reduction were assessed among canteen staff (part 2 of the study). Third, a longitudinal interventional study was conducted by implementing a campus-wide executive order to reduce salt and sugar in all foods sold on campus (part 3 of the study). The salt and sugar contents of selected foods were measured at baseline and at 3 months and 6 months postreduction. Participants who eat frequently on campus were selected as the intervention group, while those who do not comprised the control group. All participants had their urine electrolytes and body compositions measured and recorded 24-hour dietary intakes for 2 weekdays and 1 weekend at baseline, 3 months, and 6 months after salt and sugar reduction.

RESULTS: The study protocols were approved by the institutional review board of Sunway University (SUREC 2024/029 and SUREC 2024/040). Recruitment for the cross-sectional studies began in May 2024, while that for the longitudinal intervention study began in June 2024. The 6-month intervention began in September 2024 immediately after the official launch of the campus-wide executive order to reduce salt and sugar. We targeted recruitment of 1000, 50, and 300 participants for parts 1, 2, and 3, respectively. We anticipate reduced dietary salt and sugar intakes by 30% and 50%, respectively (World Health Organization targets), and beneficial health effects on the participants.

CONCLUSIONS: The insights gained from this study will help to create a healthier food environment, benefitting individuals who regularly eat out, especially at the workplace.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06473038; https://clinicaltrials.gov/study/NCT06473038.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/69610.

PMID:40690753 | DOI:10.2196/69610

JMIR Res Protoc. 2025 Jul 21;14:e63716. doi: 10.2196/63716.

ABSTRACT

BACKGROUND: Falls are a critical source of injury and hospitalization and leave many older adults unable to return home, especially in rural communities with limited access to health care and support services. Studying falls prevention among rural older adults is essential because they may face an increased risk of falls due to unique environmental factors, geography, and outdoor activities. Moreover, rural older adults may have limited awareness regarding fall-related risks and preventive activities.

OBJECTIVE: The objective of this scoping review is to explore the literature about falls prevention from the perspectives of older adults living within a rural context. This review protocol aims to identify the search parameters and methodology that will be used in the scoping review.

METHODS: This scoping review will be guided by Arksey and O’Malley’s 5-step methodological framework. We will search for relevant peer-reviewed English language literature from 5 databases: CINAHL, PubMed, Academic Search Complete, PsycINFO, and Scopus. The reference lists of relevant studies will be hand-searched to identify papers. Inclusion criteria (English language, peer-reviewed journal papers, original research, focusing on rural perspectives to support falls prevention, and published from January 2013 to December 31, 2023) will be used to determine the eligibility of the journal papers. The data from the included papers will be extracted using a standardized table and analyzed using thematic analysis.

RESULTS: This protocol was registered with the Open Science Framework on June 26, 2024. The scoping review’s data collection and analysis were conducted from September to December 2024. Results from the review will be distributed through publication in a peer-reviewed journal paper, conference presentation, webinar, and a rural community workshop.

CONCLUSIONS: Understanding rural older adults’ perspectives of falls prevention is critical to supporting independence and healthy aging in rural communities. This review’s findings about falls prevention may have important implications for rural community leaders, policy makers, and health practitioners working to support falls prevention in rural communities.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/63716.

PMID:40690750 | DOI:10.2196/63716