Nevin Manimala

Neurol India. 2025 Jan 1;73(1):49-54. doi: 10.4103/ni.ni_1155_22. Epub 2025 Feb 7.

ABSTRACT

BACKGROUND: Traumatic brain injuries (TBI) pose a major public health challenge to the Indian health system. The trajectory of patients from the site of injury to definitive management needs to be understood to improve prehospital management.

OBJECTIVE: We conducted a prospective survey to review the epidemiological and pre-hospital characteristics of TBI patients requiring emergency surgical intervention at a level I neuro-trauma care center.

METHODS AND MATERIALS: Patients who underwent emergency neurosurgical management for TBI at the National Institute of Mental Health and Neurosciences (NIMHANS, Bangalore) between June 2021 and December 2021 were included in the study.

RESULTS: A total of 214 patients were included in the study (86% males). The most common cause of TBI was road traffic accidents (70%) which involved a motorized two-wheeler in 87% of the cases. No safety gear was used in 87% of the road traffic accidents. The median delay in first contact with any medical facility was 60 min. The median time of seeking care at NIMHANS was 6 h and 50 min after the injury. More than one-third of the patients had visited two or more health facilities before reaching NIMHANS for treatment.

CONCLUSION: Road traffic accidents without safety gear constitute the major cause of TBIs requiring emergency surgery. A major challenge exists in prehospital care and organized hospital transfer of acute TBI patients requiring emergency surgery.

PMID:40652468 | DOI:10.4103/ni.ni_1155_22

Neurol India. 2025 Jan 1;73(1):17-28. doi: 10.4103/neurol-india.Neurol-India-D-24-00263. Epub 2025 Feb 7.

ABSTRACT

Chronic subdural hematoma (cSDH) is a prevalent neurosurgical disorder with increasing incidence, especially among the geriatric population. Although surgical management has been the conventional approach, the optimal strategy remains debated. Tranexamic acid (TXA), an antifibrinolytic agent, has emerged as a potential alternative, but its efficacy and safety require thorough investigation. This systematic review and meta-analysis aimed to evaluate the role of TXA in the management of cSDH, focusing on its impact on recurrence rates, clinical outcomes, and adverse events. Randomized controlled trials (RCTs) reporting on the safety and efficacy of TXA in adult patients with cSDH were systematically searched in multiple databases. Primary outcomes included clinical and radiological recurrence requiring re-surgery, while secondary outcomes encompassed adverse events and mortality associated with TXA treatment. A comprehensive search yielded 35 articles, with four RCTs meeting the inclusion criteria. The meta-analysis, involving 148 patients, demonstrated no significant reduction in mean postoperative volume at follow-up or recurrence rates with TXA use. Heterogeneity was low to moderate, and no significant adverse events were observed. Although there is a trend toward early and more complete resolution of cSDH with TXA acid after burr hole drainage, the results lack statistical significance to advocate its routine use in post-surgical management. TXA appears safe in cSDH, emphasizing the need for further research to establish its definitive role in reducing recurrence rates.

PMID:40652463 | DOI:10.4103/neurol-india.Neurol-India-D-24-00263

Tech Coloproctol. 2025 Jul 13;29(1):139. doi: 10.1007/s10151-025-03167-7.

ABSTRACT

BACKGROUND: Patients with lateral lymph node metastasis (LLNM) present particular challenges for both diagnosis and treatment. This study aimed to assess whether indocyanine green (ICG)-assisted lymph node mapping with near-infrared imaging (NIRI) enhances the effectiveness of lateral lymph node dissection (LLND) by further categorizing the lateral lymph nodes in patients with mid-low rectal cancer.

METHODS: Submucosal indocyanine green injection was performed on the distal margin of the rectal cancer. In the ICG-LLND group, the lymphatic drainage pathway and distribution of lateral lymph nodes (LLNs) were explored using a laparoscopic NIRI system. Pathological evaluations were conducted for both the ICG-LLND group and the control group.

RESULTS: The ICG-LLND group demonstrated a significantly shorter postoperative hospital stay compared to the control group, both before (P < 0.001) and after (P = 0.001) matching. While blood loss and operating time were similar between groups, the ICG-LLND group had fewer cases of anastomotic leakage (P = 0.206). Postoperative lymph node harvesting was significantly higher in the ICG-LLND group, with more total lymph nodes (P = 0.001) and lateral lymph nodes (P = 0.002) harvested. The number of harvested lymph nodes in the obturator and internal iliac regions was also higher in the ICG-LLND group (P = 0.001), and the number of positive lymph nodes in these regions was significantly greater before (P = 0.027) and after (P = 0.013) matching. Univariate and multivariate analyses showed that ICG-LLND, nCRT, and positive pN stage were associated with increased lymph node harvest.

CONCLUSIONS: ICG-LLND improved lateral lymph node harvest, particularly obturator lymph nodes, and shortened postoperative hospital stay without increasing complications. This technique may enhance surgical outcomes in patients requiring lymph node dissection.

PMID:40652430 | DOI:10.1007/s10151-025-03167-7

J Comput Aided Mol Des. 2025 Jul 13;39(1):48. doi: 10.1007/s10822-025-00629-w.

ABSTRACT

Identifying orthosteric binding sites and predicting small molecule affinities remains a key challenge in virtual screening. While blind docking explores the entire protein surface, its precision is hindered by the vast search space. Cavity detection-guided docking improves accuracy by narrowing focus to predicted pockets, but its effectiveness depends heavily on the quality of cavity detection tools. To overcome these limitations, we developed Consensus Blind Dock (CoBDock), a machine learning-based blind docking method that integrates molecular docking and cavity detection results to enhance binding site and pose prediction. Building on this, CoBDock-2 replaces traditional docking tools by extracting 1D numerical representations from protein, ligand, and interaction structural features, and applying advanced ensemble feature selection techniques. By evaluating 21 feature selection methods across 9,598 features, CoBDock-2 identifies key molecular characteristics of orthosteric binding sites. CoBDock-2 demonstrates consistent improvements over the original CoBDock across benchmark datasets (PDBBind v2020-general, MTi, ADS, DUD-E, CASF-2016), achieving 77% binding site identification accuracy (within 8 Å), 55% ligand pose prediction accuracy (RMSD $\le$ 2 Å), a 19% reduction in the mean distance to ground truth ligands within the binding site, and an 18.5% decrease in the mean pose RMSD. Statistical analysis across the combined benchmark set confirms the significance of these improvements ( $\text{p}<0.05$ ). Notably, the Weighted Hybrid Feature Selection variant in CoBDock-2 further increases binding site accuracy to 79.8%, demonstrating the benefit of combining multimodel and ensemble feature selection strategies. Variability in predictions also decreased significantly, highlighting enhanced reliability and generalizability. Also, a low-bias hypothetical comparison with a state-of-the-art DiffDock + NMDN method was conducted to position CoBDock-2 relative to modern deep learning-based docking strategies.

PMID:40652425 | DOI:10.1007/s10822-025-00629-w

Pediatr Surg Int. 2025 Jul 13;41(1):208. doi: 10.1007/s00383-025-06123-6.

ABSTRACT

PURPOSE: Ureteropelvic junction obstruction (UPJO) in duplex systems is rare, with laparoscopic pyeloplasty (LP) and laparoscopic pyelo-ureterostomy (LPU) being the main surgical options. However, guidelines for selecting the appropriate procedure based on anatomical variations are lacking. This study evaluates the outcomes of laparoscopic management of duplex UPJO in children, comparing LP and LPU.

METHODS: A retrospective review was conducted on children who underwent surgery for UPJO in duplex systems at two pediatric urology centers over 10 years. Preoperative imaging included ultrasound, diuretic renogram, voiding cystourethrography, and magnetic resonance urography when needed. Retrograde pyelography confirmed anatomy. LP was preferred for lower moiety (LM) UPJO, while LPU was performed for short-segment or hypoplastic incomplete duplex. All children had double J stents for 4-6 weeks. Statistical analysis used t tests and Chi-square tests.

RESULTS: Among 25 children (complete: 11, incomplete: 14), LP was performed in 9/11 complete and 3/14 incomplete cases (p = 0.01). LPU was performed in 11 incomplete cases. The mean operative time was 113 min for LP and 137 min for LPU (p = 0.01). The median hospital stay was 2 days. Two children had postoperative UTIs, and one had early stent expulsion. Outcomes were favorable in all cases.

CONCLUSION: Duplex UPJO consisted of only 3.2% of a large cohort of UPJO from two busy pediatric urology centers. LP was possible in most UPJO in complete duplex, while most UPJO in incomplete duplex had to be managed with LPU. Although LPU was more challenging with longer operative time than LP, both LP and LPU had comparably good results. We strongly recommend intraoperative RGP in all cases of suspected duplex to decide the best surgical option in each case.

PMID:40652413 | DOI:10.1007/s00383-025-06123-6

Eur J Orthop Surg Traumatol. 2025 Jul 13;35(1):302. doi: 10.1007/s00590-025-04433-y.

ABSTRACT

PURPOSE: To investigate the relationship between urinary toxicology screen and traumatic femoral shaft fractures treated with intramedullary fixation, as well as assessing their impacts on morphine milligram equivalents (MME) and hospital length of stay (LOS).

METHODS: Design: Retrospective Chart Review; Setting: Single center, non-academic community level II trauma center; Patient Selection Criteria: All patients who were 16 years or older, and admitted to the hospital following a trauma activation for a femoral shaft fracture were included in the study. Exclusion criteria included patients without a urine toxicology screen, with low energy mechanisms or pathologic fractures, or those with miscoded charts. Outcome Measures and Comparisons: The primary outcomes of this study were MME and hospital LOS. Patients were grouped based on whether or not they had a positive or negative urinary drug screen.

RESULTS: A total of 144 patients met inclusion criteria having sustained femoral shaft fractures treated with intramedullary fixation. 34 patients were excluded from the study for not meeting one or more inclusion criteria. A total of 110 patients met the criteria for analysis. No positive UDS was found to correlate significantly with hospital LOS, and amongst all drugs screened for, only opiates were found to have a statistically significant increase in morphine milligram equivalents per day. Additionally, a negative UDS for opiates showed statistically significant correlation with ICU admission (p value 0.0273).

CONCLUSIONS: Trauma patients with a positive UDS for opioid use, and a femoral shaft fracture treated with intramedullary nail, are at an increased risk for higher MME requirements during their hospitalization, independent of ISS.

PMID:40652410 | DOI:10.1007/s00590-025-04433-y

Ann Med. 2025 Dec;57(1):2529578. doi: 10.1080/07853890.2025.2529578. Epub 2025 Jul 13.

ABSTRACT

OBJECTIVES: This study was to compare the worldwide burden of musculoskeletal (MSK) disorders with the age and gender-specific trends of MSK disorders in China and globally between 1990 and 2021.

METHODS: Using publicly available data from the Global Burden of Disease (GBD) database from 1990 to 2021. Examined the features of the burden of MSK disorders in China and globally, including age and gender-specific trends in incidence, prevalence, mortality, disability-adjusted life years (DALYs), and related age-standardized measures of MSK disorders. To represent the trends in the burden of MSK disorders, the average annual percentage change (AAPC) was computed using Joinpoint. Age, gender were important parameters that were used a comparative study of the disparities in the burden of MSK disorders between China and the global.

RESULTS: The worldwide ASIR of MSK disorders rose from 4641.50 to 4358.54 between 1990 and 2021, and China fell from 4039.13 to 3634.09 per 100,000. The worldwide ASPR rose from 19178.47 to 19836.76, China, went from 16966.24 to 17358.70 per 100,000. The ASMR in China declined from 1.22 to 1.10, while the worldwide decreased from 1.55 to 1.47 per 100,000. The ASDR in China declined from 1615.73 to 1578.71, while the worldwide ASDR decreased from 1886.22 to 1916.21 per 100,000. The worldwide AAPC of ASIR, ASPR, ASMR, and ASDR was -0.21%, 0.11%, -0.25%, and 0.04%, respectively. China was -0.34%, 0.09%, -0.41%, and -0.07%, respectively. The burden of MSK disorders was influenced similarly by age and gender.

CONCLUSION: The burden of MSK disorders rose in China and globally between 1990 and 2021, and it varies with age. Women are more prone than men to acquire MSK disorders. Because of its vast and aging population, MSK disorders continue to be a major public health concern in China and globally.

PMID:40652401 | DOI:10.1080/07853890.2025.2529578

Ann Med. 2025 Dec;57(1):2527357. doi: 10.1080/07853890.2025.2527357. Epub 2025 Jul 13.

ABSTRACT

BACKGROUND: The benefits of robotic pancreaticoduodenectomy (RPD) over laparoscopic pancreaticoduodenectomy (LPD) remain less reported, this study aimed to evaluate the superiority of RPD over LPD.

METHODS: A retrospective 1:1 propensity score-matched (PSM) analysis of the characteristics and perioperative variables of patients who underwent RPD and LPD between January 2021 and June 2023 in a high-volume centre was performed.

RESULTS: The analysis included 193 patients who underwent RPD and 355 who underwent LPD. After PSM, 173 patients who underwent RPD were matched with 173 who underwent LPD cases. RPD was associated with a shorter operative time [341 (302-363) vs. 447 (380-510) min; p = 0.001], lower blood loss [105 (50-110) vs. 200 (105-200) ml; p < 0.001], and a shorter postoperative hospital stay [12 (10-23) vs. 15 (12-24) days; p = 0.031]. No significant differences were observed between the two groups in terms of complication grade (p = 0.227), number of lymph nodes harvested (19.01 ± 8.32 vs. 19.95 ± 9.42; p = 0.099). In patients with main pancreatic duct of small diameter (≤3 mm), RPD was associated with fewer grade B pancreatic fistula (16.3% vs. 32.0%; p = 0.045).

CONCLUSION: RPD is as safe and feasible a minimally invasive approach as LPD is. The robotic approach in pancreatoduodenectomy could decrease grade B pancreatic fistula rate in patients with a main pancreatic duct of small diameter and reduce the operative time, blood loss and postoperative hospital stays.

PMID:40652399 | DOI:10.1080/07853890.2025.2527357

Med J Aust. 2025 Jul 13. doi: 10.5694/mja2.52703. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the incidence, risk factors, and length of stay for hospitalisations, with and without amputations, of people with diabetes-related foot ulcers (DFU).

STUDY DESIGN: Prospective observational cohort study; secondary analysis of linked Diabetic Foot Services and Queensland Hospital Admitted Patient Data Collection data.

SETTINGS, PARTICIPANTS: All people with DFU who visited any of 65 outpatient Diabetic Foot Service clinics in Queensland for the first time during 1 July 2011 – 31 December 2017, followed until first DFU-related hospitalisation, ulcer healing, or death, censored at 24 months.

MAIN OUTCOME MEASURES: First overnight hospitalisations for which the principal diagnosis was DFU-related (International Statistical Classification of Diseases, tenth revision, Australian modification; Australian Classification of Health Interventions codes), by amputation procedure type (none, minor [distal to ankle], major [proximal to ankle]).

RESULTS: Among 4709 people with DFU (median age, 63 years (interquartile range [IQR], 54-72 years); 3275 men [69.5%]; type 2 diabetes, 4284 [91.0%]), DFU-related hospitalisations were recorded for 977 people (20.7%): 669 without amputations (68.5%), 258 with minor amputations (26.4%), and 50 with major amputations (5.1%). The incidence of first DFU-related hospitalisations was 50.8 (95% confidence interval [CI], 47.7-54.1) per 100 person-years lived with DFU before healing, death, or loss to follow-up. The incidence of first DFU-related hospitalisation with no amputation was 39.0 (95% CI, 36.2-42.1), with minor amputation 18.0 (95% CI, 17.0-20.0), and with major amputation 5.3 (95% CI, 4.4-6.3) per 100 person-years with DFU. The median length of stay for DFU-related hospitalisations was six (IQR, 3-12) days with no amputations, ten (IQR, 5-19) days with minor amputations, and 19 (IQR, 11-38) days with major amputations. The risks of all DFU-related hospitalisation outcomes were higher for people with deep ulcers or severe peripheral artery disease. The risks of DFU-related hospitalisation with no amputations were also greater for people aged 37-59 years than for those aged 60 years, and for people with cardiovascular disease, infections, or previous amputations; with minor amputations for people who smoked, had end-stage renal disease, previous amputations, moderate to severe infections, or peripheral artery disease, or who were not receiving knee-high offloading or DFU debridement treatments; and with major amputations for people with end-stage renal disease, peripheral artery disease, or larger ulcers.

CONCLUSIONS: The incidence of DFU-related hospitalisations among people with DFU was high, and most did not involve amputations. Risk factor profiles differed between hospitalisations with or without amputation procedures. Our findings could assist services determine which people with DFU would benefit most from intensive interventions, potentially averting large numbers of diabetes-related hospitalisations.

PMID:40652397 | DOI:10.5694/mja2.52703

Public Underst Sci. 2025 Jul 13:9636625251351575. doi: 10.1177/09636625251351575. Online ahead of print.

ABSTRACT

Large language models (LLMs) have emerged as a novel form of media, capable of generating human-like text and facilitating interactive communications. However, these systems are subject to concerns regarding inherent biases, as their training on vast text corpora may encode and amplify societal biases. This study investigates overestimation bias in LLM-generated climate assessments, wherein the impacts of climate change are exaggerated relative to expert consensus. Through non-parametric statistical methods, the study compares expert ratings from the Intergovernmental Panel on Climate Change 2023 Synthesis Report with responses from GPT-family LLMs. Results indicate that LLMs systematically overestimate climate change impacts, and that this bias is more pronounced when the models are prompted in the role of a climate scientist. These findings underscore the critical need to align LLM-generated climate assessments with expert consensus to prevent misperception and foster informed public discourse.

PMID:40652388 | DOI:10.1177/09636625251351575